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VOL XIV. BATAVIA, JANUARY 20th, 1908. NO. 1 

By A. J. Ochsner, B. S., P. R. M. S., M. I)., 

Surgeon-in-Chief of Augustana Hospital and St. Mary's Hospital; Pro- 
fessor of Clinical Surgery in the Medical Department 
of the University of Illinois, Chicago. 

During the past few years this country has become so 
thoroughly interested in the Tropics that not a few of our 
students go into practice in these countries especially as 
hospital or military surgeons and in the employment of rail- 
road or mining companies. .« 

Some years ago during a visit to the Tropics I became 
intensely interested especially in tropical malaria and in 
diseases transmitted by flies. 

To my surprise I found that few of the local physicians 
had made extensive studies in these directions but that they 
had accepted the treatment taught in their various schools 
during their student years together with what little they had 
learned from personal experience. 

As a result of these conditions it is but natural that 
tropical diseases were looked upon with much horror and 
superstition because they had not been carefully investi- 
gated. Of late there has however, been great activity in this 
direction by many of the ablest scientists of the world, and 
many conditions have been cleared up in a very perfect 

During the past five years the most important observa- 

2 The Plexus. 

tions have been made, , in Italy, India, Africa and South 
America. The'medical Officers of the United States Army and 
Navy have also made most valuable observations in Cuba, the 
Phillipine Islands, and in the Southern portion of the United 
States especially iu Louisana and on the Isthmus of Panama. 

The epidemic of Yellow Fever at New Orleans has given 
a tremendous impetus to scientific observations both among 
those officially connected with this work and those who have 
studied insect infection independently. 

The practical application of all that has been learned in 
the care of those employed in constructing the Panama 
Canal under the splendid direction of Dr. Gorgas has brought 
the most wonderful results the world has ever seen. 

Having spent a portion of each year in the tropics, my 
interest has been directed toward this subject in a practical 
way and I have taken the opportunity of collecting observa- 
tions from all of the above sources. 

I found that the reports of the United States Govern- 
ment which can be obtained by any one interested, by appli- 
cation to the Surgeon General in Washington are especially 
valuable and suggestive. 

In order to make a practical application of the study of 
the reports and observations made in the tropics, I have re- 
duced these observations to a number of rules which are so 
simple that many of those living in the tropics have compre- 
hended them fully and have applied then in their own fami- 
lies and among their employes. The results have been most 
gratifying in several tropical communities in which these 
rules have been followed. 

There are three principle soursces of disease in the tropics 

1st — Contaminated drinking water. 

2nd — Contaminated food. 

3rd — Disease carrying insects. 

1st — Infected water. The difficulties which come from 
drinking contaminated water have been eliminated in China 
and Japan and India for centuries by drinking tea only which 
is always made of boiling water and having the natives educat- 
ed to know that great danger lurks in uncooked water. 

Practical Notes on Tropical Malaria. 3 

Uncooked water in the tropics is most likely to cause 
typhoid fever, typhus fever, cholera, amoebic dysentary 
and dysentary due to other forms of infection. 

In case of plantations in which good water is obtainable 
it has been found that it pays to pipe good water to the 
houses of the natives or to supply a general well which is so 
placed that it cannot be contaminated and this' should be so 
arranged that there will be no pools formed in which mosqui- 
toes might breed. 

2nd — Infected food. Fruits and meats are very likely to 
be infected unless they are protected against the contact of 

All fruits, especially bananas and similar fruits should! 
be kept in carefully screened rooms because the infectious 
material which the flies have deposited upon the surface of 
these fruits is likely to adhere to the hands of the person 
who eats the fruit and later this substance is carried to the 
mouth and eaten with the food. 

Malaria — This is the dreaded disease of the tropics but 
since it has been shown absolutely that it is carried from 
person to person by the mosquito and possibly by the flea 
and the bed bug it is likely that the disease will in a few 
years be as thoroughly under control as small pox is to day. 

By using small mesh wire screening, 18 wires to the 
inch or 7 wires to the c. m., for doors and windows and fine 
meshed netting for beds, one can remain fairly free from be- 
ing bitten because the mosquitoes carrying infection bite 
only after sun down. 

In case however, any person is bitten by infected mosr- 
quitoes notwithstanding these precautions, the following 
very simple rules have been found to be Of great practical 
importance and if they were thoroughly appreciated every- 
where, in the tropics the amount of malaria could be enor- 
mously reduced. 


1st — Determine the hour when chill is expected. 
2nd — 8 hours before take 5 grs. quinine with half a pint 
of hot water. 

5" 5-5^5 

4 The Plexus. 

3rd— 4 hours before take 5 grs. quinine with half a pint 
of hot water. 

4th — 2 hours before take 5 grs. quinine with half a pint 
of hot water. 

5th — Then take 2 grs. every 2 hours for 48 hours with 
hot water. Be sure to take this night and day for this period 
without interruption. 

6th— Take no quinine for 5 days. 

7th — It is well to take a pill 5V to 6 \ of a grain of arsen- 
eous acid with half a pint of hot water before each meal and 
at bedtime during this interval. 

8th— Then take 2 grs. of quinine every two hours for 
three days and two nights, beginning at 4 A. M. a week 
after the day you first began taking quinine. 

Always take quinine with hot water. Always keep the 
bowels very free. For this purpose 5 to 10 grains of calu- 
met taken in the evening followed the next morning by a 
tablespoonful of sulphate of magnesia in half a pint of hot 
water gives excellent results. 


In case of malaria without definite chill take 2 grains of 
quinine every two hours with hot water for three days and 
two nights, and repeat this on the same days of each week 
for four weeks, 

In a case not relieved after four weeks take opposite 
days for four weeks. This is almost never necessary. 

Quinine should never be taken in pills because they 
may not dissolve. Always take the cap off the capsule and 
swallow cap and capsule separately if quinine is taken in 
this form. 

It is very important not to interrupt taking quinine at 
night because otherwise the paracite will have an opportu- 
nity to recuperate from the effects of the drug. An alarm 
clock set so it will ring every two hours at night is very 
useful in treating these cases. 

Take some simple laxative or five grains of calomel with 
a large cup of hot water at bedtime, and from a teaspoonful 
to a tablespoonful of sulphate of magnesia the following 

Practical Notes on Tropical Malaria. 5 

morning also in half a pint of hot water while taking the 
quinine, or take two ounces of castor oH in the morning. 


During the portion of the year when malaria is common 
it is well to impress the following rules upon every one liv- 
ing in the tropics. 

1st — All fruits and meats must be kept away from the 

2nd — One should drink milk hot and take a good deal of 
hot soup. 

3rd — One should take but a light supper composed 
largely of soup or hot milk. 

4th — One should be careful about screening beds. 

5th — One should remain within the house after dusk. 

6th — One should not keep lights in the sleeping rooms 
before going to bed because these lights attract mosquitoes. 

7th — One should wear a woolen abdominal bandage at 
night or a woolen nightdress. 

8th — On every fifth day one should take two grains of 
quinine with half a pint of hot water before each meal and 
at bedtime. 

9th — One should see to it that all the water tanks are 
covered and that there are no stagnant pools about. 

10th — One should keep the premises scrupulously clean 
and the rooms free from vermin. 

It must be remembered that the natives in tropical coun 
tries are almost all infected with malaria, hence it is well to 
put all house servants through a course of treatment before 
admitting them to the house and to caution them against in- 
fection which they will, however, acquire from time to time 
by being bitten by mosquitoes while visiting their infected 
friends. This will result in an acute malaria which can be 
recognized at once and relieved by the above plan of treat- 

In this short communication it would not be possible to 
go into detail, but it may be interesting to give the following 
short explanation of the results obtained by following the 
above rules by those living in the tropics. 

6 The Plexus. 

1. If quinine is actually absorbed even in small quanti- 
ties continuously the adult malarial parasites are invariably 

2. While the absorption of quinine is going on in this 
way the spores do not develop into adult forms, neither are 
they injured. 

3. It requires seven days for the spores after all the 
adult forms have been destroyed by quinine to again develop 
to the adult forms provided no quinine is given during this 

4. Hence if no quinine is given for five days these 
spores will have advanced to a condition' in which they may 
be killed by the above course of treatment with quinine. 

5. Observations seem to show that if absorption takes 
place rapidly all of the quinine will be eliminated in five 
hours, hence the failures which are so common when no 
quinine is given at night. 

6. Patients suffering from tropical malaria often have 
so much mucous in the stomach that little or no absorption 
of quinine takes place hence the benefit from calomel and 
salts or castor oil and from giving hot water with quinine. 

John L. Porter, M. D., Chicago. 

I have chosen the general title of ' 'Painful Feet'' for my 
subject because it is a convenient descriptive term for a 
group of affections of the foot, which vary very much as to 
their etiology and pathology, but have all the common 
symptom of pain. In fact the pain is the one important 
thing about them all from the patient's point of view and for 
which he seeks relief in nearly every case; it is the recogni- 
tion of the various diseases and conditions which produce 
pain in the feet that I wish particularly to call your atten- 
tion to. 

To begin with, it is because the feet have to bear the 
weight of the body, and the arches and levers composing 
the foot are subjected to such a strain in supporting and 

Painful Feet. 7 

propelling the body that the pain is located in the feet. In 
many conditions underlying painful feet the hands would be 
the seat of the pain if we were obliged to walk upon them. 
And our very dependance upon our feet in getting about our 
daily occupation lends added importance to the affections of 
those extremities. We can suffer considerable pain and dis- 
ability in the hands or other portions of the body and still 
keep busy, but when one's feet go back on him he is "down 
and out" in every sense of the term. And right here at the 
outset I want to impress upon you 'the necessity of careful 
examination in every case, not only of the feet but of the 
patient. To listen to a patient's history of chronic pain in 
his feet steadily increasing with more or less disability and 
tell him he has rheumatism and fill him up with salicylates 
and send him on his way, without even examining him or 
his feet is surely a travesty on the practice of medicine, but 
a common one. Surely rheumatism, like charity, covereth 
a multitude of sins, but chifly in medicine, sins of omission. 
Probably seventy-five per cent, of the cases of painful feet 
that come to our attention give history of having been 
treated for weeks or months for rheumatism, and when the 
matter is sifted to the bottom and a correct diagnosis is made 
not one per cent, is due to that disease. 

Pain has been so synonymous with rheumatism, in the 
past at least, where joints were concerned and our medical 
conception of rheumatism has been so hazy that the term 
has been a very convenient one to use when we didn't know 
what the matter was, but with our better knowledge of joint 
diseases and of the pathology of true rheumatism it is time 
to realize that, so far as fainful feet are concerned the 
chances are seventy-five to one against that being the actu- 
al trouble. 

A careful examination of the human foot shows us that 
the weight of the body, borne upon the superior surface of 
the astragalus, falls 2.4 cm. (f inch) inside of the line of 
support, that is inside of a line drawn from the inferior sur- 
face of the os calcis to the space between the second and 
third toes. To realize the importance of this it is necessary 

8 The Plexus. 

to calculate the strain thus brought upon the fibrous tissues 
supporting the arch, say by a person of 150 pounds weight 
at each step. And then when we think of the number of 
steps taken by an average person in a day the wonder is 
that the foot does not give out more often than it does. 

Without doubt the most frequent of the painful foot af- 
fections is flat-foot of some degree. The term flat-foot is 
generally used to designate a breaking down of the longi- 
tudal arch, but clinically there should be recognized three 
different degrees of flat-foot, and for the sake of clearness I 
would call them, first weak-feet, second flat-feet, and third 
rigid flat-feet. 

Weak-feet are those in which the arch becomes oblite- 
rated when the patient stands, due to relaxation of the tar- 
sal ligaments, but in which some active pronation and supi- 
nation is still possible. Such cases are apt to complain of 
pain in the latter part of the day and of extreme fatigue 
upon long standing or walking, and the pain is as frequently 
referred to the dorsal and outer surface of the foot as to the 
inner plantar region although tenderness about the scaphoid 
is usually present. Such feet are seen more in children and 
young adults. Support of the arch by strapping in the 
supinated position and the wearing of a, proper shoe with a 
triangular heel usually results in a cure if the patient will 
exercise the foot daily in a way to strengthen the tibial 

Group two, genuine flat-foot is a condition in which the 
arch is flat when the patient is not standing, active pronation 
and supination is lost and passive attempts to supinate the 
foot cause pain. Tenderness, often exquisite, is found 
about the scaphoid and os calcis and the patient walks with 
a halted gait. These cases often complain of severe pain on 
first arising which wears off later after they have been about 
with shoes on, but later in the day they may have pain up 
the leg to the knee or even to the hips and occassionally 
severe backache, especially in the lumbar region. 

Such feet require as a preliminary treatment, prolonged 
rest and immobilization in a supinated position, followed by a 

Painful Feet, 9 

rigid support to be worn in a properly made shoe. My 
custom is to place a triangular felt pad under the scaphoid 
and then put the feet up in plaster-of-Paris in as extreme 
supination as the patient can stand. This is kept on for 
from two to four weeks according to the severity of the case 
and it is really astonishing to see how much improvement is 
secured. The patient is made perfectly comfortable at once 
and usually when the cast is removed the foot is quite freely 
mobile, pronation and supination have returned, the tender- 
ness is gone and the patient considers himself able to begin 
walking at once, but he isn't, unless a proper support is at 
once given the foot the trouble soon recurs. And right here 
is the proper place to describe what is a proper support and 
to correct some popular ideas about foot-plates. 

I find that the average practitioner has the idea that all 
cases of flat feet require foot plates, that it makes little dif- 
ference what kind of plate is used and that if he sends the 
patient to a shoe store to buy an arch support, as they call 
them, or tells him to go to some instrument maker and have 
some plates made, his patient will be relieved. All three of 
those ideas are erroneous. Some cases are best treated by 
foot plates at once and many cases are benefited by the use 
of foot plates during some part of the treatment, but all the 
foot plates that have been forged since the time of Tubal 
Cain would be of no value in many cases, but positively harm- 
ful. When the patient applies to the shoe maker for a 
support he picks out one of the various styles of arch sup- 
ports that he considers the proper size, puts it into the shoe 
and collects twenty five cents to a dollar and sends the 
patient on his way blissfully ignorant that he has not done 
all that needs doing. The plate may give relief for a time 
or may become so painful in a few hours that the purchaser 
cannot wear it. In ninty per cent of the cases they have to 
be discarded eventually and the patient seeks more expert 
advice. When a patient is sent to an instrument maker his 
u sual method is to make an outline drawing on a piece of 
paper of the patient's foot, over this he traces an outline of 
the shoe, and with these he traces an outline of a piece of 

10 The Plexus. 

metal called a "blank" which he puts into a vise with a 
wooden block shaped like the arch of a foot and over this he 
hammers out the particular style of foot plate which he is 
accustomed to make, puts it under the patient's foot, asks 
him to stand upon it, and if it does not hurt he puts it into 
the shoe and tells him to wear it. If it hurts he raises or 
lowers the arch, or bends the edge until it is comfortable. 
Occasionally he makes a plate which gives support in the 
right place and the patient by wearing it constantly and 
occasionally having it elevated gets along very comfortably. 
But as a matter of scientific accuracy and anatomic good 
sense he might j ust as well put a china plate into the vise 
and try to hammer out a set of false teeth. For there are 
no two feet alike and a plate to be curative must be made 
with an accurate knowledge as to where the trouble lies 
anatomically and for the particular case in hand. 


And now we come to the third and most severe form of 
flat foot, the rigid flat foot. In these cases the foot is pro- 
nated and cannot be either actively or passively supinated. 
The tarsus, especially the scaphoid and astragalus are rotat- 
ed inward and downward, often to such degree that the 
scaphoid comes in contact with the floor, the astragalus is 
seen projecting beneath the skin, the arch is entirely oblited- 
ated and the patient walks with a halting shuffling gait and 
with the feet turned out. Pain is often less severe in these 
cases than in either of the first two classes, because the stage 
of severe painfulness is past, as the ligaments are relaxed 
and stretched to their utmost and the foot has a bony support, 
but the ' patient is extremely disabled, can only walk short 
distances without fatigue and cannot run at all. All motions 
at the ankle are slight and in fact the foot is little else than 
a stiff unyielding stump for the leg. Such cases can only be 
improved, the foot can never be restored to its normal flexi- 
able, elastic condition. Such feet are usually seen in adults 
past thirty five though occasionally they are found in young 
adults and I have seen two or three in children at about 
adolescence. The only treatment that avails anything is 

Painful Feet. 11 

surgical. The patient must be given an anesthetic. When 
complete muscular relaxation is secured, we often find that, 
with a McCurdy or Thomas wrench, the adhesions between 
the bones can be broken up, the shortened ligaments torn 
and stretched and a fairly good restoration of the tarsus se- 
cured by sheer muscular force. In many of these cases the 
peronei muscles and tendons have become so contracted that 
they offer a great obstacle to reduction. In those cases, ex- 
cision of one-half to one inch of both the peroneus longus 
and brevis, just behind and above the external malleolus, 
facilitates the reduction very much. Where these measures 
are insufficient a cuneiform osteotomy, removing a bony 
wedge from the internal border of the tarsus, or an astraga- 
lectomy is the only resort. Whatever procedure is under- 
taken it must be thorough enough to permit the foot to be 
put up in plaster of Paris in a supinated position. This is 
maintained for from four to eight weeks, depending upon 
the amount of traumatism that has been inflicted, and it is 
often surprising to find how much the foot has improved in 
comfort, usefulness and motion following such severe 
measures. After the tissues have entirely recovered from 
the operation some form of a rigid support is devised for 
permanent use and the patient is encouraged to begin put- 
ting a little weight upon the feet, and massage hydrothera- 
peutic and passive motion is begun. Some of these feet are 
thus made much more comfortable, elastic and useful, but 
it requires from two to six months to secure results that will 
permit the patient to walk about with his shoes on again. 

Gonorrheal Arthritis involving the tarsal articulations 
and especially the articulations of the os calcis are much 
more frequent than we used to suspect, in fact that peculiar 
condition known as painful heel is so often the result of 
gonorrheal infection that we suspect it in every instance. 
Baer, of Johns Hopkins, had demonstrated the gonoccocci 
in scrapings from the periosteum iu quite a number of these 
cases. Besides the os calcis any of the other tarsal joints 
may be involved and as the gonorrheal inflammation affects 
the peri-articular more seriously than the articular tissues 

12 The Plexus. 

we find the structures about the foot that have been involved 
softened, boggy and relaxed during the acute stage of the 
trouble, and consequently a degree of flat foot or weak foot 
usually accompanies a gonorrheal arthritis. Another pecu- 
liarity of these cases is that the arthritis usually developes 
after the subsidence of the acute urethritis, often during the 
gleety stage. The history of the case is usually a sudden 
development of pain about the arch of the foot, especially on 
walking, which grows steadily worse until the patient is in- 
capacitated. With this is often a slight swelling and redness 
and if a recent urethritis is confessed a diagnosis of gonorr- 
heal rheumatism is promptly made. But in many instances 
the arthritis occurs so long after the urethritis that both 
patient and physician fail to attach any causal relation to the 
latter, and especially in those cases which develop slowly 
and without acute inflammatory symptoms, as many do. Lat- 
er the foot resumes a practically normal appearance except 
with some pronation and flattening of t!;e arch, but the 
patient still complains of great tenderness under the heel, 
corresponding to the tubercle of the os calcis. This pain is 
only felt when he walks, but examination reveals greater or 
less tenderness all about the os calcis and even of the scaphoid. 
An x-ray of the foot later in the disease, say several months 
after the onset often reveals bony exostoses at the seat of 
tenderness, usually under the os calcis and sometimes at the 
point of attachment of the tendo-Achillis. 

Morton's Me ta tarsalgia.. Is a cramp-like exceedingly 
painful affection of one or more of the Metatarso-phalangeal 
joints. It occurs more frequently in adults and in women 
more often than men. The pain comes on suddenly and 
almost invariably when the patient has his shoe on, and is 
described as cramp-like and excrutiating, often radiating 
along the foot and up the leg. The patient has to sit down 
at once and remove the shoe and rub and squeeze the front 
of the foot and work the toes. This usually gives relief. 
The attacks may occur only at long intervals or may be so 
frequent as to disable the patient. The trouble is caused by 
the flattening of the anterior or transverse arch of the foot 

The Tuberculosis Crusade. 13 

when compressed by the shoe so the ball of the foot has not 
room to spread. (Analogous to the pain produced in the 
hand by squeezing the Metacarpophalangeal joints when 
relaxed.) The third and fourth joints are most often the seat 
of the pain. The wearing of narrow, high heeled shoes pre- 
disposes to the trouble as the weight falls largely on the 
heads of the metatarsal while they are held in a position to 
work at great disadvantage. 

The treatment consists in wearing a stout shoe with a 
low heel and with room enough across the ball to allow of 
inserting a metal or felt insole with a lift corresponding to 
normal arch that will prevent the dropping of the metatarsal 
heads and hold the foot in normal shape. Some cases are 
immediately relieved by strapping the ball of the foot snugly 
with a thin felt wedge under the heads of the metatarsals. 

In a number of cases the pain and disability has been so 
great that resection of the head of the offending metatarsus 
has been resorted to. The operation is successful, but it 
destroys the symmetry of the foot as it makes the toe shorter 
than the others, and I have never seen a case so severe that 
it could not be relieved by mechanical treatment. 

72 Madison, St. 

By Fredrick Tice. 

Professor — Diseases of the Chest. 

Since the beginning of time no other single disease, or 
combination of diseases, has caused more suffering, a greater 
financial loss, a higher mortality or a greater interest and de- 
termination to arrest its ravages or effect its complete ex 
termination than pulmonary tuberculosis. 

Medical history contains accounts of certain epidemics of 
various kinds, that have existed, often with appalling results. 

Small pox endemically or epidemically has existed since 
long before Christ and has claimed a large proportion of the 
population. The plague during the sixth to the seventh 
century caused a high death rate. In the fourteenth century 
this disease in epidemic form swept over Europe and killed 

14 The Plexus. 

one fourth of the population; while in the seventeenth century, 
1665, occured the London plague (black death) in which no 
less than 70,000 died. Cholera Asiatica, while it has existed 
endemically in India for a long time, became epidemic only 
during the past century. 

Although the suffering and loss of life has from these 
various epidemics been enormous, when compared with 
tuberculosis they fade into insignificance. Even the destruc- 
tive devastating, wars do not compare with this disease. 
The death roll of the wars in the ninteenth century has been 
estimated at 14,000,000 while during the same time and in 
the same countries that of consumption was 30,000,000. 
From the statement of Hippocrates: "The most dangerous 
disease, and the one that proved fatal to the greatest number, 
was consumption," we are to conclude that throughout the 
ages this disease has ranked as the greatest enemy of man- 
kind. Its ravages have not been so spasmodic, the results 
so apparent and its presence so feared, chiefly on account of 
its insidious nature. The occurence in our city of one case 
of bubonic plague, Asiatic cholera, yellow fever or even 
small-pox causes a panic,complete demoralization of business 
and traffic, the equal of which a thousand cases of tubercu- 
losis cannot produoe, but the results, however, are not to be 

"Tuberculosis causes annually more than 150,000 deaths 
in the United States at the average age of 35 years. At 
this age the normal after lifetime is about 32 years, so that 
the real loss of life covered, measured in time, is represent- 
ed by 4,800,000 years per annum. If we assume that the 
net value of a year of human life after the age of 35 is at 
least $50, the real loss to the nation resulting from the dis- 
ease (a large proportion of which is known to be needless) 
may be estimated at $240,000,000 per annum." Hoffman. 

According to Osier there are at least a million and a 
quarter cases of tuberculosis constantly in the United States, 
the majority of which are invalids. Assume, however, that 
only one fourth cannot work; they must then be cared for 
by some means and in many instances also a wife and fami- 

The Tuberculosis Crusade. 15 

ly. The loss in wages of this one-fourth, or 312,500, at $1.50 
a clay would amount to $150,000,000 a year. 
* It has been computed that tuberculosis costs'the state of 

Illinois yearly $36,550,000. / 

When we consider the prevelance of tuberculosis and its 
fearful results it is not surprising that determined efforts 
are being made to bring it under control as has been done 
in all other diseases, the wonder is that more has not been 
done before. 

It is not to be inferred that these efforts are of recent 
origin for the present crusade is the result of- many slowly 
developing conditions and ideas. 

From the belief that it was an incurable and fatal dis- 
ease the pendulum has, during the past few years, swung 
to the opposite extreme and for fear that unfounded criti- 
cism and disappointment may occur, the distant rumbling 
of which is already audible, it is advisable to indicate some 
of the conditions, efforts and tendencies in the present tu- 
berculosis crusade. 

Although Hippocrates wrote that tuberculosis was cur- 
able, it was almost generally accepted by physician and pa- 
tient that it was incurable, that one suffering with tubercu- 
losis was doomed. 

In 1747 a Scotch physician from clinical experience ex- 
pressed the opinion that the disease was curable and the 
most important factors were hygiene and that climate and 
medicine must be considered only as "more or less precious 

Sir T. Young (1815) said: "Even with the utmost 
powers of art, perhaps not more than one in a hundred will 
be found curable." 

The genius of Lsennec and Koch, has so materially in- 
creased our knowledge of this disease that the curability is 
beyond question and the means of treatment much modified. 

Carswell (1836) wrote: "Pathological anatomy has 
never afforded stronger evidence of the curability of a dis- 
ease than in the case of phthisis." 

In 1840 George Bodington wrote an essay "On the Cure 

1G The Plexus. 

of Pulmonary Consumption on Principles Natural, Rational 
and Successful," based on personal experience in his sani- 
tarium, the first of its kind, established several years before 
for the treatment of this disease. He emphasizes the im- 
portance of fresh air, sunshine and constant supervision of 
the patient by the attending physician. "Cold is never too 
extreme for a consumptive patient; the apartment should be 
kept aired so that it should resemble the pure air of the out- 
side, pure air being used in the treatment as much as possi- 
ble." (Bodington). Much criticism, censure and opposition 
was encountered; his patients were driven from him; Bod- 
ington was consideted demented and his institution was con- 
verted into a private insane asylum. 

From this humble unsuccessful beginning we trace the 
origin of the countless numbers of public and private hos- 
pitals, institutions and camps scattered the world over. 

The possibility of a cure; the education of the profes- 
sion and the public; the importance of fresh air and sun- 
shine; abundance of food; avoidance of dust and the care of 
the sputum; reporting of all cases to the Health Depart- 
ment, in many cities now compulsory; the establishment of 
State Sanatoria which has been done in many instances; the 
founding of private Sanatoria and camps are all stages of 
evolution in the present treatment and crusade. It is an 
easy matter, comparatively, for the wealthy patient to seek 
advice and treatment; one who can be free from business 
worries and can remain in a private sanitarium as long as 
his condition may demand; but what is to become of the less 
fortunate victim? Owing to the present governor's veto, he 
is deprived of the advantages of a State Sanitarium, and if 
such treatment is desired it must be obtained at a consider- 
able expense in a private institution. Too frequently his 
financial means are exhausted before his disease is arrested, 
he must discontinue treatment, and soon he grows worse, 
and not only patient but many physicians are led to believe 
1 1 j « - claims set up for the treatment are not well founded. 

With the poor laboring man or woman who must depend 
on daily manual labor; who is perhaps the support of a 

The Tuberculosis Crusade. 17 

family; whose home is in one of the thickly settled portions 
of the city where hygienic conditions are at their worst; 
whose food and clothing is poor and insufficient and who 
consults the physician when work is no longer possible, 
presents a most difficut problem. 

It is well enough to advise such patients; to instruct 
them how to live and sleep in the open air and as to the 
kind of food necessary, but unfortunately in most of the 
cases it is not a question as to what is best and proper. 

Even if finances permit the patient may follow instruc- 
tions for a time but will soon become discouraged, skeptical 
and finally disregard all instruction and discontinue treat- 
ment. The public prejudice against free ventilation and the 
fear of exposure is difficult to overcome. Some idea of the 
difficulty may be formed by attempting to induce the healthy 
person or the physician himself to abandon his warm com- 
fortable bed for one in the open air. To ask the sick to do 
so, to suddenly change completely his mode of life is even 
more difficult. 

The latest step forward in the treatment and crusade 
against tuberculosis consists in the establishment of free 
dispensaries under the auspices of the Chicago Tuberculosis 
Institute which has been in existence for some three years. 
During this time much has been accomplished along educa- 
tionol lines, and now, chiefly through its new superintend- 
ent, Alexander M. Wilson, the dispensaries are. ppened, 
modeled after those operated in the eastern cities. One of 
the chief features consists in the services of a trained nurse 
not only at the dispensary but who will visit the home of the 
patient, superintend the treatment and instruct the patient 
how to live. Under her instructions a suitable yard, flat 
roof porch or room will be fitted up for the living and sleep- 
ing quarters according to the modern open air treatment. 

All necessary changes are made without expense to the 
patient as well as furnishing the necessary bedding, food, 
and medicine when the patient is without support. The 
abuse of medical charity is efficiently prevented, by means 
of the nurse investigating the home and determining the 

18 The Plexus. 

earning capacity of the patient and family. If the patient 
is in need of hospital treatment he will be given accommo- 
dations at the Edward Sanitarium near Naperville. 

In case any other number of the family is sick, such 
person will be brought to the dispensary for examination. 

With the services of a nurse it is possible to carry out 
the instructions most efficiently, to keep the patient under 
observation, and render him much medical and material as- 

All cases of tuberculosis coming to the dispensaries are 
reported to the Health Department, and if the patient moves 
or dies the rooms, house or premises are thoroughly disin- 

To the present time six dispensaries have been opened, 
others will be added soon. Location and hours are as fol- 

North Side — Chicago Policlinic Hospital , Dispensary, 
174 East Chicago Avenue, Tuesdays and Fridoys, 2 
P.M. to 3 P.M. 
West Side — Central Free Dispensary (Rush Medical Col- 
lege) 757 West Harrison Street, Wednesdays and 
Saturdays, 11 A. M. to 12 M. 

West Side Dispensary (College of Physicians and 
Surgeons), corner of Congress and Honore Streets, 
Tuesdays and Fridays, 11 A. M. to 12 M. 
West Side Dispensary of the Jewish Aid Society, 
corner Morgan and Maxwell Streets, Mondays and 
Thursdays, 3 P. M. to 5 P. M. 
South Side — SQuth Side Free Dispensary (Northwestern 
University Medical School), 2431 Dearborn Street, 
Mondays and Thursdays, 10 A. M. to 12 M. 
Hahnemann Hospital Free Dispensary, 2881 Cottage 
Grove Avenue, Mondays and Thursdays, 2:30 P. M. 
to 4 P. M. 
A circular is furnished by the Institute which is being 
widely distributed. On the front page appears this quota- 
tion, "It is in the power of man to cause all germ diseases 
to disappear from the world". — Pasteur. Its contents aside 
from other information: 

The Tuberculosis Crusade. 19 


Don't spit on floors or sidewalks. Set the consumptive 
a good example. When you spit, spit into the gutters or 
into a spittoon. 

No spitting, no consumption. 

Live in the open air as much as possible. 

Keep the windows open summer and winter, at home 
and at work. 

Sleep with the windows open; but be sure that the en- 
tire body is warmly clad. 

Fresh air, whether moist or dry, warm or cold, is good 
for you. 

Breathe through the nose, breathe deeply. 

Avoid dust; avoid dusty occupations; never stir up dust 
by dry sweeping; sprinkle water or moist sawdust, or moist 
bits of paper over the floor before sweeping; dusting should 
be done with a moist cloth. 

Never neglect a cold or a cough. 

If you have consumption go to a doctor or to a dispen- 
sary. If you go in time you can be cured. If you wait un- 
til you are so sick that you can not wcrk any longer, or un- 
til you are very weak, it may be too late. 

Don't drink whisky, beer nor other intoxicating drinks. 
They will do no good because they give you false strength 
and in the end ruin the stomach and the appetite for food, 
and make it harder for you to get well. 

Don't waste your money on patent medicines or adver- 
tised cures; aviod doctors who advertise. 

Good food and rest in the open air are the best cures. 
Protect your family and others from the disease by distroy- 
ing everything you cough up; you will at the same time 
protect yourself from breathing the same consumption germs 

Spit into pieces of paper or paper handkerchiefs and 
burn them in the stove. 

Don't cough without holding a paper handkerchief over 
your mounth. 

20 The Plexus. 

Don't cough, sneeze, laugh or talk loudly close to an- 
other's face because small droplets of spit carry germs. 

Don't sleep in the same bed with anyone else, and if 
possible not in the same room. 

The careful and clean consumptive is not dangerous to 
those with whom he lives or works. 

The establishing of these free tuberculosis dispensaries 
is in no way to lessen the responsibility of the state or to 
weaken the efforts being made to obtain state assistance. 
Their field of usefulness is separate and distinctive and 
credit is due to the Chicago Tuberculosis Institute, especi- 
ally Mr. Wilson, for this great undertaking, the financial 
engineering of which is no small matter, as the expenses 
are considerable and all is accomplished by voluntary con- 

The example set by the Institute should be a stimulus, 
and it is hoped that Illinois will soon be in the front rank 
with reference to the war on tuberculosis. 

The support of every physician, student and individual 
is earnestly desired, that this great work may go on and be 
carried to a successful finish, that we may soon say "tuber- 
culosis ivas, not is the greatest plague of the human race". 


By Dr. A. M. Corwin, 34 Washington St., Chicago. 

The age in which we live, reaching back scarce a half 
century, has been so fruitful in discovery and invention that 
the mere mention of byproducts alone would tire the tongue 
of the teller and stagger the belief of that worthy and cred- 
ulous quartet, our forefathers, could they but step forward, 
please and listen. 

Modesty, more becoming than really become, in our 
medical friends, suggests silence, but love of truth bids 
them remark at this juncture that the science and art of 
medicine — the science, I say, and the art thereof — though 
the one is far from exact and the other too exacting to suit 
some of us, with its proscriptions and ; prescriptions, have 

Sporting News. 21 

scarcely lagged behind in the march of progress. But to 
review even in epitome the achievements of this younger 
Esculapius is not our function nor our wish, for it would re- 
quire an entire special edition of the Plexus- 

A wire from our special correspondent to the sporting 
editor (of the Plexus) records the rounds fought between 
various pugnacious bacteria and those white corpuscles of 
the blood, commonly known at the ring-side as leucocytes. 
And here is one round revealed to him by the microscope. 
That instrument, be it said, has uncovered'in our time a vast 
floral world of germs, founded the whole new science of 
bacteriology, indirectly robbed many infectious diseases of 
their terror and added mighty libraries to the literature of 
preventive medicine. 

Metschnikoff years ago found that the white corpuscles 
acted as the scavengers of the blood and as active defenders 
against all manner of microbes, seeking to destroy the ani- 
mal. Given an infected wound or area there rush to it at 
once vast hordes of these cellular soldiers who proceed in 
barbaric, blood-thirsty fashion to overcome and destroy the 
enemy by absorbing and digesting him — fairly eating him 
alive. If the infecting bacteria are not too virulent or too 
many, this protection is accomplished in a short time and 
the disease is at an end. If the strength of the toxins or 
poisons manufactured by the germs is too great, the disease 
gains headway in spite of the valiant leucocytes, p'erhaps to 
the ultimate destruction of the patient. This function of 
the leucocyte in eating up the microbe has given him the 
name of phagocyte, from the Greek phagein, to eat. and 
kutos, a cell, and the process is phagocytosis. As a result 
of tl is discovery has arisen in the past couple of years the 
philosophy of the opsonins and the opsonic index, still in 
the stage of hypothesis and experiment but highly interest- 
ing and giving hope for the conquest, some day, of all in- 
fectious diseases by vaccination, as in the case of small-pox 
and diphtheria. 

The opsonic theory and method rest upon the phago- 
cytic power of the leucocyte and the fact that this power 

22 The Plexus. 

depends largely upon the action or influence of the serum of 
the blood upon bacteria, making them in some way more 
edible, more palatable, and therefore more absorbable. In 
other words, the phagocytes are aided in their inclination 
to destroy germs by supposed qualities or substances of the 
blood serum. These substances or qualities apparently at- 
tack the bacteria without killing or harming them, but in 
some occult fashion fitting them for more prompt absorption 
by their enemies, the white blood cells. 

These substances or qualities, unseen and unknown, ex- 
cept as manifested by their effects, were named by Prof. A. 
E. Wright, of England, who developed this working hypo- 
thesis, opsonins from the Greek opsono; "I prepare a meal 
for." And the opsonic index of any patient toward a par- 
ticular microbe is simply the expressed measure of his 
power of resistance against the microbe, the power of his 
opsonins or serum substances to influence the taking up of 
those microbes by his leucocytes, compared to the power of 
a normal person's blood. 

The method in brief, shorn of its technicalities, is as 

First — Two specimens of blood are obtained by pricking 
the finger and allowing the blood to flow into a glass tube. 
One specimen is from the patient in question, the other from 
a normal person. These tubes are sealed in the flame of a 
spirit lamp and the blood in them permitted to clot, leaving 
a clear layer of serum ready to be drawn off for use. 

Second — A small amount of blood from a healthy person 
is now drawn into a tube and prevented from clotting by 
adding a solution of sodium citrate. This specimen is 
whirled in a centrifuge at a high rate of speed which sepa- 
rates the serum from the corpuscles. These sink to the bot- 
tom of the tube and the serum is drawn off and thrown 
away. The mass of corpuscles which is left is made up of 
all the cells of the blood both red and white; these are 
washed repeatedly in normal salt solution, centrifuged again, 
and the top layer, made up of the white cells which we de- 
sire, is removed and held ready for use, the rest are de- 

Sporting News. 23 

Third — An emulsion of the bacteria in question is made 
by growing these in an incubator for twenty-four hours or 
so and suspending them in salt solution which does not kill 
or harm them. 

We have now: 

1. Washed normal corpuscles or phagocytes, living, 
hungry, ready for a square meol. 

2. An emulsion of living, virulent bacteria, waiting 
like lambs to be slaughtered by the phagocytes. 

3. Two specimens of serum, one from the patient, one 
from the normal person. The effect of these two serums we 
wish to observe, so we proceed with the experiment. 

Two capillary pipettes are sterilized. In one are drawn 
up equal parts of corpuscles, normal serum and bacterial 
emulsion. In the other are drawn equal parts of corpuscles, 
the patient's serum, and bacterial emulsion. The contents 
of each tube are separately mixed to allow the elements 
mentioned to get into action. The pipettes containing them 
are sealed and placed in an incubator at blood heat for fif- 
teen minutes to allow the corpuscles time to eat. (Fifteen 
minutes for lunch is not long). From these two mixtures 
films are prepared on glass slides, properly stained, and 
then examined under the microscope, magnifying a thousand 

In each specimen the number of bacteria contained in 
each of a given number — say fifty — of the phagocytes, is 
counted and the average taken. And since the average 
number of germs occupying a corpuscle in the specimen con- 
taining normal serum is taken as a standard, the number of 
bacteria contained in a cell of the patient's specimen divided 
by the number in a cell of the normal specimen is the opson- 
ic index of that patient, at that time, for that microbe. 

Now the crux of the matter is this. Can we by vaccina- 
tion arbitrarily raise the patient's opsonic index, his resist- 
ance, or can we in the same fashion produce immunity in a 
healthy person against any sort of disease germs as we now 
are doing in the case of small-pox and diphtheria? 

The injection of sterilized cultures of bacteria in the 

24 The Plexns. 

treatment of diseases produced by those germs rests upon the 
assumption that by this means we can increase the germicida 1 
substances or properties of the blood serum, adding to its 
opsonic power, thus bringing about more or less immunity. 

Many germs produce during their growth substances 
hostile to their own life; and so accomplish their own de- 
struction, a sort of microscopic suicide. The yeast plant, 
for example, when grown upon grape sugar produces alco- 
hol, which finally stops the growth of the yeast. ("The 
United Societies" of brewers have taken advantage of this 
depravity of the yeast plant and are encouraging their sui- 
cide in large numbers). 

Bacteria of disease likewise manufacture their own so- 
called anti-bodies, substances inimical to their activity. 
Hence the term, self-limited diseases. In pneumonia, scar- 
let fever, typhoid fever — barring accident — the patient is 
sure to get well if he lives long enough. Tuberculin made 
from sterile solutions of dead bacilli contain such anti-bodies 
and this substance has been found helpful in the cure of tu- 
berculosis in some cases. 

Experiment gives large promise in this field of research, 
but the processes necessary are as yet too complicated, too 
much involved in uncertainties, too expensive, too much a 
laboratory proposition, too much at the mercy of errors in 
technique, etc., to be reliable- 

In conclusion, man has had in his long experience three 
great enemies. In the infancy of his race, with crude meth- 
ods of defense, he waged unequal battle against the giant 
carnivora that hunted him. In our day the call of the wild 
animal no longer sends a thrill of fear down his spine, but 
bear and lion alike are his legitimate prey, and the joy of 
the kill is the sport and the recreation of man's chief execu- 
tive. But though the rifle has made man supreme in the 
animal kingdom, for centuries the unseen vegetable world 
has laid him low by thousands, from infancy to old age, 
waging unceasing warfare upon his happiness, his health 
and his life. 

In the near future the microscope bids fair to do in the 

Hematothorax. 25 

conquest of the vegetable what the gun has done to the 
animal. Happy that day, for then will Homo be free to con- 
centrate all his forces in overcoming the greatest foe of them 
all — himself. 


By W. W. Mercer, Senior Class College of Physicians and 


Hematothorax is the accumulation of blood in the 
pleural cavity. Subpleural ecchymosis may occur in 
asphyxia or during some infectious diseases and intoxica- 
tions. More extensive extravisations of blood may result 
from (1) malignant disease, (2) injuries to the thoracic wall, 
as contused and penetrating wounds, fractures of the ribs 
or sternum, or to severe trauma to the soft parts. 

The course of hematothorax is variable. If not infected 
and the external wound is properly attended to and kept 
hermetically sealed, in the majority of cases absorption and 
resolution occur in a short time, but if infection occurs, we 
have a condition known as pyothorax in which more marked 
constitutional symptoms develop and more energetic 
measures are necessary. If there is entrance of air into the 
pleural cavity, we then have a condition known as pneumc-, 
hemsto-thorax. This may give rise to an infiltration of air 
from the lung into the connective tissue, or cutaneous emph- 

The variation in the nature and extentof the spscifis 
injuries makes possible a great variety of symptoms in these 
thoracic traumatisms. Slight rupture of the parenchyma of 
the lung or a mild hemorrhage into the pleural cavity may 
cause very insignificant clinical symptoms. Some pain over 
the affected area and expectoration of a little bloody mucus. 
Severe rupture and excessive hemorrhage into the pleural 
cavity will cause marked symptoms of dypnea and some 
times extreme anemia from loss of blood. Injury of a large 
bronchus may cause pneumohemato-thorax. 

Wounds of the thorax may be either nonpenetrating or 

26 The Plexus. 

penetrating". The former are of special importance only in 
case of irijury to a large artery in the chest wall such as the 
internal mammary or one of the intercostals. In order to 
arrest the resulting hemorrhage it will be necessary to re- 
sect a portion of one or more ribs and their cartilages. In 
place of ligation of the artery, packing of the wound with 
gauze may be substituted. Penetrating wounds of the 
thorax may cause injury of the pleura, lung, pericardium, 
heart or one of the large vessels inside of the chest. Injury 
to the pleura alone or combined with injury of other organs 
is of very serious moment, both on account of the primary 
hematothorax and of the possible secondary infection of the 
pleural cavity. 

Extreme degrees of hemato-pneumo-thorax may be fatal 
from pressure, but fortunately this is not often the case as 
the air and blood in the pleural cavity is gradually absorbed. 
In case of infection causing pyo-pneumothorax there will be 
extreme dyspnea and cardiac weakness. There will also be 
the general manifestations of sepsis. 

Cutaneous emphysema, starting in the vicinity of the 
external wound, is present in some cases. It is usually 
confined to the region of the wound, but may in rare cases 
extend over the greater part of the chest wall. This usually 
disappears of itself under occlusive dressing. If it shows a 
tendeney to spread, ic may be treated by multiple incisions 
into the subcutaneous tissue. 

The symptoms are primarily those of shock from which 
the patient gradually recovers unless some large vessel has 
been wounded. Dyspnea is very marked. Hemoptysis is a 
characteristic symptom and varies in amount from a little 
bloody and frothy mucus to abundant hemorrhage. Cardiac 
displacement and weakness will be noticed. The face is 
drawn and pale. On percussion dullness will be found over 
the affected areas. It varies with the amount of the hem- 
orrhage. Immobility of the affected side. Vocal fremitus 
is diminished or absent. Breath sounds are inaudible over 
the area. 

On account of the injury oi important organs, the prog- 

Hematothorax. 27 

nosis is serious. Should, however, the patient withstand 
the primary shock and the immediate affects of injury of in- 
ternal organs, other secondary consequences such as infec- 
tion are not of frequent occurrance. 

The diagnosis can usually be made from the history of 
the injury, the position of the wound, hemoptyses, emphy- 
sema and the physical findings. 

The treatment is largely expectant and symptomatic. 
The use of the probe for determining the depth of the wound 
should be discarded. The danger of infection is materially 
increased thereby. The wound and its vicinity should be 
thoroughly disinfected and a sterile dressing applied with- 
out suture of the wound. In case of active hemmorrhage 
from a vessel in the thyracic wall, resection of a rib followed 
by ligation or packing may be necessary. Bleeding from a 
large vessel in the lungs is beyond the surgeon's control. 
Absolute rest and the application of an ice bag to the chest 
wall will be efficient to stop mild hemorrhage in the lung. 
Hypodermic injections of morphia are of value for the pain 
and restlessness. Aspiration is seldom necessary and should 
be performed only when the symptoms of pressure are 
very urgent. The same is true of pneumothorax. In 
haemato-thorax with secondary pyo-thorax, resection of a 
rib and drainage is always indicated. In making an incision 
for the purpose of drainage the original wound may be, if 
practical, made use of; otherwise the rib chosen for resec- 
tion may be either the 8th, 9th, or 10th posteriorly, to the 
outer side of the long dorsal muscles or the 5th or 6th in the 
axillary line. The advantage of the first location is that 
the cavity is opened at its lowest point and in the usual re- 
cumbent position, the drainage is the best possible. In the 
axillary line the ribs are more accessible, thus making the 
operation easier, but the drainage is inferier and hence the 
healing process will be slower. After resection of the rib 
the pus is evacuated followed by irrigation of the cavity 
with a 1-1000 bichloride solution. One or two thick-walled 
drainage tubes are inserted and a voluminous gauze and 
cotton dressing is applied. In order to accelerate expansion 

28 The Plexus. 

of the lungs, expiratory exercises may be employed Heal- 
ing of the thoracic opening may be very slow but ordinary 
cases heal even after the lapse of months. 

The following cases serve to illustrate the above : 

CaseI. Man aged 76. dyspnoea, on exertion, gradually 
increasing for 10 days. Evidences of right pleural effusion, 
dullness to the level of the nipple. Next day dyspnoea in- 
creased, dullness all over the right chest. Respiratory 
murmurs absent, tubal breathing. On the third day the 
right pleura was full of fluid. Aspiration by means of a 
bottle aspirator was done and two gallons of bloody fluid 
was removed. The heart regained its normal position. In 
a few days the remaining fluid was absorbed. Advanced 
age is an indication for early aspiration owing to the slow- 
ness of absorption and the loss of elasticity of the costel and 
pulmonary structures. 

Case 2. Joseph B, age 19, laborer. Slight stab wound 
of the right thorax, one fourth inch in length at right angles 
to and over upper border of the fourth rib at its junction 
with its costal cartilage The wound was dressed and the 
patient dismissed. He spent a sleepless night of great, dis- 
comfort and came back the next morning. Face drawn and 
pale, pronounced dyspnoea and blood was oozing from the 
wound. On percussion whole of right thorax below fourth 
rib gave dullness. Breath sounds were inaudible. No 
cough or expectoration of blood. Fresh dressing was ap- 
plied and patieni put to bed. Temperature of 102.0 ihat 
evening. Next day absolute dullness on right side, ribs 
immobile, intercostal spaces full but not bulging, absence of 
of vocal fremitus, dull heavy pain^ over right side. Aspira- 
tion was done and about one gallon of bloody fluid was with- 
drawn. Patient made complete recovery. 

Case 3. H. L. age 22, clerk. Traumatic hemato-thorax 
from an incised wound of the right thorax involving only 
the costal layer of the pleura. Marked dyspnoea and cardiac 
weakness. Expectant treatment after thorough cleansing 
and dressing of the wound. Complete absorption and rapid 

Treatment of Convergent Squint. 29 

Case 4. Chas. M. a^e 32, laborer. Penetrating wound 
of the right thorax. Extensive hemato-thorax and cutane- 
ous emphysema. Dyspnoea, hemoptysis and large area of 
dullness. Aspiration of about one and one half gallons of 
bloody fluid withdrawn. Occlusive dressing for the emphy- 
sema. Good recovery in a short time. 

Case 5. F. A. L. age 24 Stab wound of the right 
thorax causing division of Internal Mammary artery and 
extensive hematothorax. Ligation of the artery was done. 
Pyothorax developed and resection of the sixth rib in the 
right axillary line was done and pus evacuated followed by 
irrigations. Death occurred in feur days from general 

Case 6. Stab wound of right thorax followed by sub- 
costal abscess and hematothorax. Resection of the sixth rib 
in the axillary line was done and abscess curretted and 
closed and blood removed from pleural cavity. Complete 

By William E- Gamble, B. S-, M. D. 

I am convinced that there should be greater publicity, 
not only among physicians, but among the laity regarding 
the nature of this deformity of childhood 

The notion that convergent concommitant squint is a 
muscle trouble per se, still exists among some physicians, 
and therefore that the treatment lies in operative procedure. 
While it is true that tenotomoy of the contracted tendon, 
with or without advancement of external rectus muscle is 
sometimes necessary, these procedures are a last resort and 
can only be of value to improve the patient's appearance, i. 
e. for cosmetic purposes. 

The most important problem in these cases is to prevent 
monocular blindness, or rather great reduction in sight of 
the squinting eye — the solution of this commonly straightens 
the eyes. 

Usually squint manifests itself periodically at first, at 

30 The Plexus. 

about two years of age; later the squint is constant. The 
reason for this change from periodicity to constancy is found 
in the fact that the child by a trick of the mind suppresses 
the image of the objects seen by the squinting eye, at first 
only part of the time, later on it acquires the ability to ignore 
the images in the eye at all times. The microscopist ex- 
cludes the image in the eye he is not using while at work 
with his instrument. He however, never becomes "cross- 
eyed" from this cause. The old man who has cataract for a 
quarter of a century in one eye, has it removed, his sight is 
recovered and his eyes are straight. Not so with the sup- 
pression of the image in a child during the time of the de- 
velopment of the eye, (up to seven years of age) of the cere- 
bral visual apparatus, — optic radiations, etc. Permanently 
defective vision in the squinting eye is the result, as surely 
as cataract during this period will produce a defective eye, 
if not early removed. 

The law that an organ must be used during the period of 
its growth in order to develop properly, is violated just as 
effectually in one case as the other. 

These children do not complain of double vision, which 
they would do if they were seeing with both eyes. 

While squint, in many cases, is a complicated problem 
requiring much careful study on the part of the physician, 
yet in the final analysis — it is fundamentally a question of 
getting the little one to see with its squinting eye as early 
as possible and keeping it at it until it is seven years of age. 
The eyes and brain by that time have become developed, 
and the sight in the eye would have saved and the deformity, 
in most cases, remedied. 

About 40 years ago the great physiologist, Donders, 
discovered that most of these squinters were hypermetropic, 
— short eye-balled, and that by wearing the proper convex 
lenses the deformity dissappeared. His explanation of this 
effect of lenses, was that there was over innervation of the 
internal rectus muscles, as there was of necessity of the 
ciliary muscles, in order to have clear vision, both being 
ed by the 3rd nerve. The lenses did away with the 
over innervation, therefore the eye did not turn in. 

Treatment of Convergent Squint. 31 

While this is true, it is not the whole truth or else all hy- 
permetropics would squint. In the many cases that are cured 
by glasses, it is probable the result is mainly due to the 
lenses making the image so clear in the offending eye that the 
patient does not suppress it. Unfortunately not all the cases 
are cured with glasses — that is, refractive error is not the 
only etiological factor. In these cases of failure, commonly 
the vision in the squinting eye cannot be brought up to the 
normal with lenses, and yet the fundus looks normal, as seen 
with the ophthalmoscope. The fault lies in improper de- 
velopment of the visual tracts, or in the visual cortex — the 
brain part of the eye. Effort must be made as soon as the 
deformity is discovered to compel the child to use the eye by 
bandaging the good eye for a part of each day or all day for 
ten days or longer, with a period of equal rest from bandages. 

In some cases the child can see equally well with both 
eyes but cannot see with both eyes at the same time, has not 
binocular single vision. It is said that his "fusion centers" 
are at fault. In such cases a modified stereoscope "Ambly- 
scope of Worth" should be used. It is a source of much 
surprise to me what can be done for these children with the 
occlusive bandage and the amblyscope. The earlier the 
treatment is instituted, the greater the prospect of cure. 
Children successfully wear glasses at one and one-half years 
of age and even younger. It is a safe rule to begin treat- 
ment as soon as deformity appears. The advice that is too 
often given, that the child "will out-grow it" is responsible 
for, I fear, almost as many cases of monocular blindness as 
ophthalmia neonatorium. 


Never before was there so great a demand for residence 
telephones. Factories are working overtime to fill orders. 
We have a few instruments on hand that can be installed at 
once for patrons who want service before the snow flies. 





Channing W. Barrett, M D., Chairman. 

T. A. Davis, M. D. W. E. Gamble, M. D. 

A. R. Johnstone, M. D., Editor. 


L. H. Nowak, 08. Ray Esslck, '08- Gustav Eck, 09. 

William G. Epstein, '10. 
Atheletlc Editor. C. H. Tillotson, '06. 

Alumni Editor, John Wehtherson, '00. 

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NICHOLAS SENN, 1844-1908. 
A Memoir by Bayard Holmes. 
The College of Physicians and Surgeons, of Chicago, 
has the distinction of being the first educational institution 
to honor Dr. Senn with a professorship. He was made pro- 
fessor of surgery in the fall of 1884, and began his course of 
lectures in September of that year. From the first they at- 
tracted the attention of the student body in the neighber- 
hood of the County Hospital. They were given in the am- 
phitheatre of the college every Friday night at 8 o'clock and 

Nicholas Sena. 33 

every Saturday morning. Dr. Senn was living at that time 
in Milwaukee. He generally spent the afternoon on the 
train with his notes before him. On arriving* in the city he 
had his outline placed on the blackboard, and his lecture 
began and continued until the small hours of the morning. 

Dr. Christian Fenger frequently sat in the area of the 
amphitheatre, and other distinguished surgeons listened to 
his oratorical and exhaustive presentation of the principles 
of surgery. 

These lectures were afterwards embodied into a book 
which was published by F. A. Davis & Co., and which has 
had a very powerful influence upon the professional mind. 

It was my privilege to be a member of the class which 
heard these first lectures, and I can speak for then; influence 
upon me and my associates in the class. They gave the 
young medical men of Chicago their first glimpse of the lit- 
erature of surgery in the three great languages of the scien- 
tific world. They presented to us the ideas of the workers 
in the pathological and bacteriological laboratories of 
Europe. For the first time we heard Von Esmarch, Bilroth, 
Ogston, Rosenbach, Koch, Lister, Horsley, Kocher, Klebs, 
Grawitz, Friedlander, Fraenkel, Pasteur, Neisser, Marchi- 
afava, Lancereciux, Laveran — each and every one of these 
men — spoken of as individuals and familiar acquaintances. 
Frequently their epoch-making monographs were passed 
around the amphitheatre, and the significance of their con- 
tributions were forced upon our attention. Every subject 
was approached with an exhaustive synopsis, which included 
its historical and evolutionary development, and concluded 
with present indications for treatment and the possibilities 
of the future. I was serving an interneship in the County 
Hospital, and I had unusual facilities for study and the ap- 
plication of his teaching. In one of his lectures he had re- 
ferred to the characteristic of the staphylococcus aureus, 
and the streptococcus pyogenes. The next morning I 
brought him some test-tubes of agar-agar, and others of 
gelatine, showing these characteristics. He was immensely 
delighted, having never seen any of these micro-organisms 

34 The Plexus. 

before. He looked over my rudimentary laboratory at the 
hospital and made me valuable suggestions, and honored me 
with an invitation to spend a few days at his home. Here I 
found an immense library, the overflow of which has been 
placed in the Crerer Library as a most suitable memorial to 
the man and his work. This library was wholly unclassified 
and occupied the main part of two floors in a large, old- 
fashioned mansion. Its weight had broken down the foun- 
dation of the house. In a physical way I saw before me the 
literature of the world of medicine, and immediately set 
about obtaining a reading knowledge of the modern lan- 
guages. In spite of my work at the County Hospital, my 
position in his class was so conspicuous that he awarded me 
a prize at the end of the course. The college, however, did 
not see fit to graduate me, and for many years the prize was 
locked up in the vaults of the college. 

Dr, Senn's contributions to medicine began early in his 
career. He was practicing in a small town not far from 
Milwaukee, and there undertook the study of the intercapus- 
lar fracture of the femur. The results of this work he 
presented to the American Surgical Association. Shortly 
afterwerd he removed to Milwaukee where he studied the 
ligation and repair of blood vessels, and afterwards, at the 
Milwaukee Hospital, in connection with Dr.Connell, he made 
the series of experiments upon intestinal anastomosis and the 
treatment of gunshot wounds of the abdomen, which proba- 
bly gave him the greatest reputation and secured him the 
greatest number of imitators. Every surgeon from St. Peters- 
burg to San Francisco immediately began working upon 
mechanical means of joining injured intestines, with the re- 
sult that the literature on this subject is one of the most 
cumbersome and amusing in the field of surgery. Hardly a 
subject in all the gamut of surgery is left unadorned by Dr. 
Senn's contributions. His monographs are numberless and 
his textbooks make an imposing pile. He was indefatigable 
in research in the practice of his profession, and in record- 
ing his experience and his scientific conclusions. The ' day 
was not long enough. He never employed stenographers. 

Nicholas Senn. 35 

amanuenses or typewriters, but wrote everything out in 
longhand. The evening and the night were his times to 
study and for writing, and he generally went to bed toward 
morning. He was a very moderate eater, and when I knew 
him hardly ever took stimulants, and smoked as a social 
function rather than as a habit. 

He devoted little time to any society excepting medical 
societies, and perhaps his influence was less felt on that ac- 
count. When he was with his friends, as I frequently saw 
him at the house of Dr. Penger, he was convivial and enter- 
taining to a remarkable degree. One could hardly rise to 
so great eminence as he attained without arousing jealousies 
and opposition. This opposition was not so much toward 
him personally as toward the ideas which he fought for and 
so successfully taught. The pre-antiseptic surgeons were 
united in opposing him. He met them at every medical so- 
ciety, at every consultation, and even in the wards of the 
hospital, and we must admit it, in the newspapers. The 
fact that his ideas prevailed was due less to his personality 
than to their inherent truth. He was not a diplomat, and 
rarely resorted to the means which were termed diplomatic. 

Few men spent more time in medical societies than Dr. 
Senn. He was occasionally honored with an office or a 
presidency, but these positions were rarely sought by him, 
and they were more honored in his acceptance than he was 
in the positions conferred upon him. 

When Dr. Charles T. Parkes died, Dr. Senn was called 
to the professorship of surgery in Rush Medical College and 
moved to Chicago. In the amphitheatre at Rush Medical 
College he attained the acme of his clinical teaching. The 
Presbyterian Hospital and the great increment of patients 
which came to him furnished unlimited field for his activity 
and daring. Unlike many of the younger men he never be- 
came a slave to the ceremonial of antisepsis. Unlike many 
of the younger men he failed to abandon the autopsy in vivo 
when it became necessary. It was for him to bring the rank 
and file of the medical profession to a recognition of the 
powers and possibilities of modern surgery. lb remains for 

36 The Plexus, 

his pupils to sh6w that, by timely consideration and early 
diagnosis, the tragical surgery of the great teacher will 
rarely be necessary. 

No city in America has ever presented two such charac- 
ters as Senn and Fenger in the same arena. They were not 
competitors, but supplemented each other's attitude, view- 
points, powers and attainments. 

To the present student body Senn will never be a per- 
sonality, but a revered memory. His words will carry au- 
thority and his example will be emulated. For a generation 
be will be familiarly spoken of, and then his work will re- 
main upon the pages of medical literature by the side of 
Paget, Von Esmarch, Von Longenbeck, Vidal, Courvoissier 
and Fenger. ■ He was happy in the strength which he in- 
herited from his Swiss ancestors, for the inspiration which 
he received from his education in the best days of the Chi- 
cago Medical College and the Cook County Hospital, and in 
his timely entrance upon his work, just at the beginning of 
the antiseptic period of surgery and pathology. The stu- 
dent body to-day is fortunate in following this period and 
beginning their professional activity when benign medicine, 
hygiene and immunity promise so much for human life and 
happiness. His was the warfare of the pioneor. Ours is 
the sturdy pursuit of better methods of life and surer means 
of fighting sickness and death. 


Chaplain Dorenfloser has satisfied us that Shakespeare 
was centuries too early in the choosing of his Anthony. 

We greatly appreciate Dr. Bacon's interest taken in us 
this year. Numerous interesting and practically important 
cases have been brought before us by his endeavors. 

• In regard to the above clinics, we as a body, have been 
placed face to face with a question now weighing heavily on 
the mind of each senior. Is it within the power of the pro- 
fession to estimate the potential nerve energy of "the Soph- 
omore," who at one of these occasions held down a front 

Notes. 37 

seat until, the operative work finished, when quizzing began 
he slipped up a row. Perhaps he does not realize the short 
space of time it would require for a single Senior to distri- 
bute such an illtraders wearing apparel to his classmates. 
Be careful "Sonny Boy"- 

'Tis now a settled fact that our worthy president will be 
here on time henceforth and will to the fullest extent dis- 
charge the duties connected with his office. Why?? Well! 
"The worthy grandmaster" has recently been "stung" in 
the region of his right auricular appendage by one of cupid's 
"curare-dipped" arrows. Those "Stogis" sure were dream- 
producers, Spence. All kinds of congratulations. 

Meade has by some means, just or unjust, we know not 
which, earned the title of "Sparrow." Durkee seems to 
know something about it. Ask him. 

All have seemingly been benefitted by the X-mas vaca 
tion; each seems to feel refreshed, and though Lalor and 
others, through family rights, have lost their upper lip 
adornments, Henning's seems to have taken on Oshkosh in- 
spiration. Even Charley Skwor kept the whole quizz class 
waiting for his return, all because of an important engage- 
ment — durable or "un"durable?? — we give up attempts at 
differential diagnosis in diseases, especially "cardiac," in 
which Charley is involved. 

Dolan gracefully??? tips over Dr. Quine's table. Yes, 
he's from Kankakee, Dolan is. 

Seniors feel the absence of Come and Otrich, who now 
are on the sick list, and we join in wishing you a speedy 
and complete recovery. 

We understand that our class was well represented at 
the democratic ball. Even Golobith is still wearing an 
"ecchymose'd eye. " The "high-rollers" are not all asleep 
or extinguished yet; you'll notice. 

"Great minds run in like channels." Goldberger, while 
on maternity service, innocently endeavors to duplicate 
Dolan's trick of last summer, but alas, Dolan's ability is to 

38 The Plexus. 

be won only by persistent effort and practice backed up by 
experience, and in his endeavor to be a Dolan, Solomon G. 
is overcome by the law of opposites, and in trying to pre- 
pare the "Dolan Uterine Stimulant" from "Lysol," prepares 
an antiseptic solution from Ergot. 

Say! But didn't Miss Dart "hand" it to our pit assist- 
ants in regard to preparation of supplies, eh? 
Get off from the cot and get busy, fellows. 


Ballard sleeps well, in all classes now. 

Rumor has it, that in Missouri, the people are accus- 
tomed, to blindfold their cattle, with green cloth, to induce 
them to eat the grass: For reliable information, the reader 
is referred to Miss Dale, who is ever delighted to give a 
vivid account of Missouri people and their habits. 

Quiz Master — "What is the cause of tumors?" 

Student — Arousing himself from his peaceful repose 
and pleasant dreams, — "The Mosquito-" 

Quiz master— "What nerve. supplies the muscle of the 

Crouch— "The sciatic." 


Foronda. (to Benzene) — Dear Docther, pies give bearer 
five sense worth of Anndie Toxyn, for gargle baby's throat 
and obleage. 


Past, Present and Future, 

Present themselves to our view. 
The first and last are for God, sir, 

And the present is up to you. 
Strike, each morn, a richer mental tone, 

And carry your efforts through. 
Both Past and future, let well alone, 

For the Present is up to you. 


A few days ago, a certain Miss— who had been studying 
Chemistry and Biology for some time, received a visitor, a 

Notes. 39 

former seminary chum. After canvassing the fun and gum 
drops, that made up their early education, the visitor began 
to inquire the nature of her friend's studies. 

"And so you are studying Chemistry. How do like it?" 

"Oh, its perfectly lovely! Its about science you know 
and we just dote on science." 

"Oh, it must be nice. What is it about?" 

"Its about Molecules, as much as anything else and 
Molecules are too nice for anything. If there's anything 
I really enjoy its Molecules." 

"Tell me dear, what are Molecules?" 

Molecules, well Molecules are wee things and it takes 
ever so many of them. Do you know there ain't anything, 

but what's got Molecules in it. And Mr. ,is just as sweet 

as he can be and Mr. too. They explain everything so 


"How I'd like to study Molecules." 

"They teach Protoplasm too. And if there's anything 
perfectly heavenly, its Protoplasm. I really don't know, 
what I like best, Molecules or Protoplasm." 

"Tell me about Protoplasm." 

It's just too sweet to live. You know, its about how 
things get started. The time Mr.— explained about Pro- 
toplasm, there was'nt a dry eye in the house. We named 

our hats after Mr. . This is a hat. You see the 

ribbon is drawn over the crown and caught with a buckle 
and a bunch of forget-me-nots. — Ain't it too sweet." 

"Gracious, how exquisitely lovely." 

"Odear, I almost forgot about differentiation and Mr. 
. This is a scarf. We named it after him just be- 
cause he is so bound up in differentiation." 

"What is differentiation anyhow," said the enraptured 

"Oh, it's got something to do with species. Its the 
way you can tell one hat from another, so you'll know 
which is becoming and it's about Amoeba's too. They are 
the sweetest things. If I only had an Amoeba of my own 
I would ask for nothing else in the world." 

"Do you learn anything else besides?" 

"Oh yes, we learn about anatomy and hydrotherapy, but 
we girls don't care anything about that." 

At this moment the door bell rang and the topic was 




W. M. Goodman, Ph. G., C. S. N. Hallberg, Ph. G., W. A. Puckner, Ph.G 

H.H.Rogers, M. D., Ph. B., E. N. Gathercoal, Ph. G., 

A. H. Clark, Ph. G., C. M. Sdow, Ph. G. 

^WlLLIAltfBTDAY7 Editor. 


By Lewellys F. Barker. 

Professor of Medicine Johns Hopkins University. 

This meeting, as I understand it, is intended for the dis- 
cussion of the relations of medicine to pharmacy and of the 
physician to the pharmacist, with especial reference to the 
United States Pharmacopoeia and the National formulary. 
There has been and is still more or less misunderstanding of 
physicians by pharmacists and of pharmacists by physicians, 
and where misunderstandings exiot there is no better way of 
clearing things up than for people to get together and talk 
the whole thing out. Meetings of this sort are, therefore, 
of great value for the promotion of the interests of both 
physicians and pharmacists and for the promulgation of that 
good feeling among the members of two professions whose 
aim should be cooperation and not antagonism. 

Though a medical man myself, I have more than ordinary 
reasons for a kindly feeling, toward pharmacy. In 1884 I 
apprenticed myself to a Canadian pharmacist, signing an 
agreement to spend three years in Mr. GibbarcVs Pharmacy 
in Whitby. Though the term was not completed, I spent 
two full years at this work, at the end of which time my in- 
structor advised me to go into medicine and released me 
from the third year of my apprenticeship. Those two years 

Pharmacy 41 

in the drug store of a country town I consider two of the 
most profitable years I ever spent, not only as preparation 
for medicine but as preparation for life. I learned at first 
hand what goes on in pharmacies and I know much about 
the ideals and a great deal about the difficulties of the phar- 
macist. I know the mysteries of the back-shop as well as 
the brilliancy of the store in front. The apprentice in those 
days began by washing bottles and cleaning show cases and 
I remember that I regarded the permission to make Seidlitz 
Powders and Blaud's Pills later on as great privileges. 

In that pharmacy I became familiar with the great variety 
of prescriptions which doctors send to be filled and with the 
host of proprietary remedies and nostrums with which 
patients dose themselves. I learned to know the subterfuges 
to which the morphinist and the cocaine fiend will resort in 
order to obtain their drugs and I became, I am sorry to say, 
acquainted with the physician who will sell prescriptions for 
spiritus frumenti in quart bottles on days when saloons are 
closed. I know, too, the pressure which' is brought to bear 
upon the salesman in an apothecary shop to do counter- 
prescribing and I remember, how easy it was for a young 
man learning pharmacy and seeing many prescriptions to 
get the idea that he really was competent to treat many of 
the patients who apply to him. An inside knowledge of 
aims, purposes and difficulties in pharmacy thus gained 
makes me feel very close indeed to members of the phar- 
maceutical profession. In my days of apprenticeship I 
gained a high regard for the pharmacist of the better sort, 
and this regard has grown with the years. It is, therefore, 
an especial pleasure for me to say a few words here tonight 
concerning some of the relations which we have met to 


In the treatment of disease, we, as medical men, use. 
many measures; physical, chemical and psychic in order to 
get our patients well. Therapeutics is by no means limited 
to the administration of drugs, indeed pharmaco-therapy in- 
cludes only a relatively small portion of our methods of 

42 The Plexus. 

treatment. Formerly it occupied a relatively more promi- 
nent place perhaps, than it does now. Indeed, the reaction 
against drug- giving has been so great that some medical 
men have gone to an extreme and assumed that the use of 
drugs in the treatment of disease will gradually disappear. 
It must be confessed that no one familiar with the history of 
drug therapy can fail to marvel at the death of enthusiasm 
after enthusiasm with regard to the virtue of various sub- 
stances which from time to time have been used in the treat- 
ment of disease. We realize now how useless in themselves- 
many of them were and how much of the effect following 
the administration of the drugs was due to the faith that the 
doctor and the patient had in them rather than to the chemi- 
cal changes and physiological effect swhich they produced in 
the body. But having discovered this truth we should not 
fall into the error of denouncing the use of all drugs or de- 
preciating the value of pharmaco-therapy. Treatment by 
drugs has its place along with treatment by baths, good 
nursing, massage, exercise, diet, climate, electricity and 
mental influences. All doctors, I feel sure, prescribe a 
certain number of drugs, and I believe very often with great 
benefit to the patients. The number of substances available 
has enormously increased and there is every prospect that 
the future will provide us with substances now entirely un- 
known to us which will prove of the greatest value in in- 
fluencing the tissues of the body. It has been a great ad- 
vance to get away from the crude poly-pharmacy and the 
grotesque empiricism in the use of drugs so characteristic of 
the past. The simplification of prescriptions, the attempt to 
treat our patients rationally rather than empirically, and the 
movement toward clinical experimentation with drugs by 
careful pharmacological studies on animals are signs of our 
times which we most heartily approve. It must not be for- 
gotten, however, that the physician standing before the sick 
man has to act. If he can act rationally all the better, but 
the domain of rational action is as yet very limited and we y 
as medical men, are compelled in the vast majority of our 
cases still to resort to empirical practice. It would be wrong 

Pharmacy. 43 

if we did not so act. Our aim is, however, to change em- 
pirical, as speedily as possible, into rational therapy. 


Medical men have gone through a century when they 
were more interested in studies of diagnosis perhaps than in 
studies on treatment, but one sees marked signs of returning 
enthusiasm for therapeutics. There is a much more opti- 
mistic spirit abroad now than formerly existed. The nihilism 
which followed upon the studies of pathological anatomy is 
giving place to an opposite attitude as a result of researches 
in pathological physiology and pharmacology. 

I do not think even physicians as a whole realize what 
great progress has been made during the last few decades 
both in pharmacy and pharmacology. Pharmacy especially 
has made great strides, thanks to the laborious investigations 
of high-minded and well-trained pharmaceutical chemists. 
The extension of the methods of identification of pharmaceuti- 
cal substances, the purification of drugs, the introduction of 
methods of accurate standardization, the devising of modes 
of preservation of pharmaceutical preparations, and the dis- 
covery of additions which will make medicines which are 
otherwise nauseous, palatable, and the working out of modes, 
of combinations and varieties of form of administration all 
testify to the successful activity of the pharmaceutical 

At the same time the pharmacologists have been busy 
testing the physiological effects of drugs and active principles 
upon man and animals, controlling their work by the ac- 
curate methods of physiological laboratories and subjecting 
the results to rigid criticism. The studies upon the action 
of digitalis and its principles, of atropine and the various 
alkaloidal substances, of anesthetics, antipyretics and hyp- 
notics come at once into mind. We have now a vast maga- 
zine of information regarding the physiological effects of the 
substances in ordinary use and the contents of this store- 
house are being increased by rich harvests every year. 

As a result of these researches in pharmaceutical chem- 
istry on the one hand and in pharmacology on the other 

44 The Plexus. 

medical men are now supplied with a materia medica incom- 
parably superior to anything the world has known before, 
and in the eigth decennial revision of the Pharmacopoeia of 
the United States of America we have an epitome of the 
most important results of these studies, at least on the phar- 
maceutical side. In that volume we have brought together 
a list of substances and preparations which in the opinion of 
experts are most suitable at the present time for use by 
physicians in the drug treatment of disease, and if we add to 
that list the unofficial preparations of the third edition of the 
National Formulary, a volume published by the authority of 
the American Pharmaceutical Association, the resources of 
the prescriber are sufficiently extended, certainly to meet all 
ordinary purposes of pharmaco-therapy. These two volumes 
embody the earnest conscientious work of the leading bota- 
nists, pharmacologists, chemists, pharmacists and thera- 
peutists in this country. These men have given their best 
energies to the work, practically without remuneration, with 
results which are an honor to themselves and to the profes- 
sions of pharmacy and medicine. This country ought, in- 
deed, to be proud of the result which, in the opinion of good 
judges, excels anything which has been done in Europe. 


The United States Pharmacopoeia and the National 
Formulary mention all the remedies which in the opinion of 
the Committee are sufficiently valuable and have been well 
enough tried to merit general recognition. Moreover, so 
many kinds of preparations containing the substances have 
been given that the most diverse requirements of the physi- 
cian would seem to be met. There is great advantage in 
uniformity, not only scientific but economic advantage and 
our physicians, it seems to me, would do well to avoid the 
use, as far as possible of preparations other than those 
mentioned in these two books. Unfortunately medical men 
at present use an enormous number of preparations not con- 
tained either the Pharmacopoeia or the National Formulary. 
The promoters of secret and proprietary medicines, knowing 
the enormous fortunes to be made by the exploitation of 

Pharmacy. 45 

their wares have often led reputable pharmacists and physi- 
cians to aid them in the accomplishment of their selfish ends. 
I do not need to refer to the multitude of secret formulae 
and proprietary products daily offered to the public and to 
the profession. These preparations as a rule contain nothing 
which is valuable which is not already at the disposal of the 
prescriber In the Pharmacopoeia and the Formulary, though 
if one reads the persuasive circulars sent out by the proprie- 
tary firms he will see that great discoveries profess to be 
made in domains in which science is as yet almost entirely 
ignorant. The claims of these people are notoriously often 
false. They take old remedies and give them new names; 
they re-christen old combinations or make slight modifica- 
tions in their form, and pretend to virtues accessible only 
through them. These secret and proprietary products are' 
but little removed from the patent medicines of the laity; 
indeed, by ordinary lay individuals they are regarded as 
patent medicines and especially since patent medicine man- 
ufacturers have begun to put their formulas upon the bot- 
tles, the distinction between proprietary products and patent 
medicines has been almost wiped out. Though the propri- 
etors pretend to physicians that their preparations reach 
the profession only by way of the physician's prescription, 
it is well known that they exploit the physician in order 
sooner or later to advertise and sell directly to the laity. 
The more iniquitous promoters do not hesitate to' change 
the formula of the preparation when it suits their conveni- 
ence or when such change, after establishment, will add to 
their profits. Physicians often prescribe such remedies in 
entire ignorance of their actual contents, an exhibition of 
irresponsibility scarcely conceivable in the enlightenment 
which is the boast of present day medicine. The pharma- 
cist becomes commercialized, for the pharmacist's activity 
consists in the transfer of proprietary remedies from the 
original bottle to a bottle carrying the label of a physician's 
prescription, without need of pharmaceutical training or at- 
tainment. And can we blame the pharmacist who would be 
reputable if he, seeing the success that nostrums win and 

46 The Plexus. 

the ready way in which well-meaning but careless physici- 
ans prescribe them, is tempted to go into the manufacture 
of nostrums for himself? Worst of all is the demoralization 
of patients by the growth of this evil for the patient is en- 
couraged to treat himself and to induce his friends to try 
the remedy which promises to do so much. Starting, per- 
haps, with a proprietary remedy of the better sort it is easy 
for him to pass step by step to the use of the more injurious 
and baser patent medicines. 


And now a word as to what the attitude of the physici- 
an and of the pharmacist should be as to this matter- It 
seems to me very clear that we, as members of the medical 
profession should show a greater appreciation of practical 
pharmacy and of the opinions of those who have devoted 
their lives to the Pharmacopoeia and the Formulary. We 
should accept the Pharmacopoeia and the Formulary as our 
guides as far as remedies in the shape of drugs are con- 
cerned, and we should be so convinced of the adequacy of 
these resources that we shall be able to resist — indeed I may 
say, resent — the overtures of the pretending nostrum mon- 
gers. We should take care never to prescribe remedies the 
action of which we have learned only from the circulars of 
the proprietors of the remedy. I think that one of the most 
beneficent pieces of work of the many important things now 
being carried on by the Americal Medical Association is that 
of the Council on Pharmacy and Chemistry. We must, of 
course, be ever on the search for new remedies and for im- 
provements in old remedies. There is such a thing as legit- 
imate clinical experimentation with drugs. We should not 
so soon have had quinine for the treatment of malaria or 
mercury for the treatment of syphilis had it not been for 
bold clinical experimenters in the use of the new remedies. 
But we have come to recognize the great importance of car- 
rying on such experimentation only under rigidly controlled 
conditions. Observation in a few cases and without control 
by modern physiological methods is of scarcely any value, 
and those of us who have not the opportunity of experiment- 

Pharmacy. 47 

ing in the right way will do better not to experiment at all, 
but to seek the aid and advice of those who devote a large 
part of their time and energies under the most suitable con- 
ditions to such experimentation. Above all we should nev- 
er be led into giving a testimonial to a nostrum seller. The 
promoters of secret formulas and proprietary remedies are 
versed in the subtleties of temptation and you have only to 
consult medical journals and proprietary-house publications 
in order to see how frequently they deceive even those whom 
we often regard as the very elect of our profession. 

I think the reasons why physicians use proprietary med- 
icines are manifold. In the first place it is sometimes due 
to laziness. It is so much easier to write the name of some 
much-vaunted compound than to write a decent prescription. 
Moreover, physicians unless they have had some experience 
in a drug store, are rarely well trained in the knowledge of 
prescription writing, but even this lack of knowledge no 
longer excuses the use of proprietary remedies since the 
Pharmacopoeia and the National Formulary supply us with 
an abundant list of compatible and palatable preparations. 
Another reason why physicians use proprietaries lies in their 
suggestibility. Physicians are only human beings and 
human beings are all more or less suggestible; that is to say 
their minds are accessible to influences strongly pressed 
upon them from the outside. Even well-trained physicians 
if they will allow themselves to read the skillfully worded 
advertisements of the promoters, may be led astray. There 
is only one safety for the physician; as soon as you recog- 
nize the contents of an envelope to be a proprietary medi- 
cine advertisement, put it in the waste basket without read- 
ing it. Finally medical men are, I believe, sometimes led 
to use proprietary remedies because they are new and no 
physician likes to be behind the times. Occasionally a new 
proprietary remedy is of great value, and if one can be sure 
of it there is no reason why he should not use it, but it is 
the safest plan to be sure, and as a rule, not much is lost by 
waiting until those who have the skill and the opportunities 
for careful testing — men — I mean too who have no financial 

48 The Plexus. 

interest in the sale of the remedy, have given a favorable 
report upon it. It may- seem a little paradoxical, but now- 
adays if a physician wished to impress his patient by pre- 
scribing something novel (why he should is hard to under- 
stand), he might succeed better by using a preparation from 
the Pharmacopoeia or the National Formulary than by re- 
sorting to a proprietary, for many a patient has run a gamut 
of proprietary remedies who has not heard of the corres- 
ponding simple and well-tried preparations in our national 

I have spoken strongly of my feeling as to what the 
physician should do in this matter, and you will permit me 
perhaps also to say a word as to what I think the attitude of 
the pharmacist should be. I believe that the pharmacist 
should join hands with the physician in stamping out this 
nostrum business. We should co-operate with the medical 
profession in protecting the laity from prescriptions given 
by people incompetent to prescribe, be it the patient him- 
self, his neighbor, a proprietary medicine manufacturer, a 
pharmacist or a quack doctor. The pharmacist should see 
to it that he and his assistants are able at all times to fur- 
nish preparations of the pharmacopoeia and formulary of 
standard strength and in accord with modern pharmaceuti- 
cal art. For I believe there is going to be an ever-increas- 
ing demand for these preparations now that physicians are 
learning the importance of limiting their prescriptions there- 
to, and especially since any physician can for a merely nom- 
inal sum buy from the American Medical Association a handy 
pocket volume containing all these formulas: If, in addition 
to this, you who are pharmacists, will realize, as I am glad 
to say the best of you do, that you belong to an honorable 
and most useful profession, and that it is therefore incum- 
bent upon you to conform always to professional usages and 
to avoid the unprofessional, you will as a 'class, preserve a 
dignity, and your places of business will have a style that 
will be consistent with the high and useful calling ■which is 

Read at a mpeting of the Baltimore Branch of the American Phar- 
maceutical Association. 

Matthew W. Borland. 49 


ByF.'M. Goodman. 

For the third time within a year the necrologist is called 
upon to inscribe on the roll of the- departed the name of an- 
other colleague who in years agone was a most active and 
devoted worker in the interests of pharmacy and the rising 
generation of pharmacists, Matthew W. Borland. 

Soon after the great fire of 1871 Mr. Borland became an 
interested member of the old Chicago College of Pharmacy, 
serving as a trustee, and when in 1876 the college took up 
more commodious quarters on the corner of Wabash Avenue 
and Jackson Street, he was elected president, and while still 
conducting a thriving business at the corner of Van Buren 
Street and Center Avenue, served in 1879 as a member of 
the publishing committee, assuming charge of the advertis- 
ing and subscription departments of "The Pharmacist." 

Soon after this he indulged his innate love for art by 
taking a trip abroad, spending time among several of the 
great European galleries in study and observation. After 
his return he entered upon the study of medicine, and this 
proving more to his taste than the practice of pharmacy, he 
disposed of his store and spent his time as a disciple of 
Cheiron rather than of Galen. 

As the events of the past force themselves upon the 
mind, be, it 

He solved,. That as the ranks of the old officers and mem- 
bers of the school, like the ranks of the Grand Army of the 
Republic, of which he was a member, are fast thinning out 
and in a few years more the writing of our school history 
must pass to younger hands, the remaining members of the 
old guard will still revere the names of our former associ- 
ates, and while bowing in humble submission to the un- 
changing and inevitable laws of nature, mourn and extend 
sympathy to the loved ones of the departed. 
But yesterday the mighty oak 

Was covered o'er with leaves, 
Now, white and frosty is the coat 
That to their dead form cleaves. 

50 The Plexus 

What is it to be a man 

Then fall away to dust? 
The briefest race, to one who can 

And lives a life so just. 

Hence 'tis sweet on looking down 

To days that are no more, 
To see the smile and not a frown 

For this, he never wore. 

A pleasant word to all he gave, 

And cheered the one in pain; 
And when the poor appealed to him 

They never sought in vain. 

What is it then to be a man 

The highest place to fill? 
He lives, and throws aside the ban 

That does most mortals kill. 

He lives again in thought and deed, 

As we absorb his worth. 
And unto others we give heed 

And cheer their path from birth. 


Edward D. Stefano, '06, and Martin Schupmann, '06, 
were among the successful candidates for the registered 
pharmacist's certificate at the recent examination in Chica- 
go. Only a third of those who took the examination were 

Karl E. Anderson, '07, has engaged in the drug business 
at Roberts, Wis. He calls his pharmacy the Central Drug 
Store, and reports a prosperous trade in spite of the money 

J. H. Wehrley, '05, has bought a drug store at Beecher, 
111. Mr. Wehrley was employed in the chemical laboratory 
of Armour & Co., Chicago, for two years, but has now re- 
turned to his first love — pharmacy. 

H. P. Sandkoetter, '95, is the energetic and efficient 
chairman of the committee on U. S. P. and N. P. Propa- 
ganda of both the city and state pharmaceutical associa- 
tions. He is also a candidate for the Board of Pharmacy. 
We bespeak for him the active support of the alumni. 








By Channing W. Barrett, M. D., of Chicago. 

As the larger questions of appendicitis have been 

settled we are now as perhaps never before turning our 

attention to the technique. Numerous papers have been 

devoted to the management of the stump. Many cases are 

Ligature Being Applied to Mesoappendix. 


The Plexus. 

operated upon to relieve minor but persistent or oft re- 
curring symptoms. The disability is not great, but this may 
lead to a severe attack. To encourage the acceptance of 
surgical relief before the severe attack occurs, the operation 
should have the following advantages: — 1. It must be safe. 
2. It must reach the appendix through as small an opening 

Appendix Severed and Clamp Removed. 

as is consistent with good work, in order that the abdominal 
wall shall not be unnecessarily weakened. 3. No considerable 
stump of appendix should be left outside or inside the bowel 
4. The stump should be dealt with in such a way as to leave 
no opportunity for leakage of feces or septic material from 

Dealing With the Appendix Stump. 53 

the bowel, and should allow no possibility of hemorrhage in- 
to the bowel or peritoneal cavity or cellular tissue. 5. No 
unnecessary opportunities for adhesions should be created. 
6. The above advantages in dealing with the stump should be 
attained without tedious sewing, undue manipulations, or 
unnecessary opening of the bowel. 

The method of tying the stump and leaving it uncovered, 
formerly practiced and again being revived, is easy of appli- 
cation and allows of no immediate escape of bowel contents, 

Tucker in Place for Inserting Slump. 

but often leaves an undue portion of the appendix, necessi- 
tates a non-absorbent ligature, leaves opportunities for ad- 
hesions, and, above all, connects the bowel cavity with the 
peritoneal cavity by means of a tied fistula lined by mucous 
membrane, which is difficult to obliterate. This may not 
have the same objection in cases in which draining is neces- 
sary, but in clean cases, where ideal surgery may be done, 
this is unsurgical. 


The Plexus. 

The method of dissecting the appendix out of the caecum 
and, closing with interrupted suture has the advantage of get- 
ting rid of all the appendix but the great disadvantage of an 

Ligature Inserted at Base of Appendix and Clamps in Place for 
Severing Appendix. 

open bowel while manipulations are going on. with the pos- 
sibility of leakage of feces. It introduces into the clean 
appendicitis case the dangers incident to intestinal surgery 

Dealing Wij^li the Appendix Stump, 


with their added mortality. • The cuff method has the dis- 
advantage of mucous membrane to mucous membrane, is 
tedious and has nothing to commend it if the tying off of the 
whole stump is safe and furnishes a pocket for infection if 
the stump is infectious. The same may be said of sinking 
the tied stump by means of a purse string. The purse string 

Slump Inserted Ready for Tying the Ligature as Seen Through 
a Window iD the Bowel. 

method may be made to prevent leakage of feces, is quickly 
done, and leaves little opportunity for adhesions but is now 
being condemned because it does not sufficiently provide 
against hemorrhage. The technique of Harris making the 
ligature include the artery obviates this to some extent, but 
it is not entirely reliable. The method proposed of tying 
the appendix in the caecum is impractical and dangerous. 
A method which I now present depends for its success upon 

56 The Plexus. 

the following fact's i that 'portion of J tbe stump which lies out- 
side the ligature before the stump is inverted is the only 
portion tied, the rest lies in direct communication with the 
bowel untied. Unlike the ordinary purse string suture, then, 
the suture is so placed that all the vascular portion of the 
appendix lies outside the suture as shown in the cut. The 
technique is as follows: — With as small an incision as possible 
the appendix is secured and freed from adhesions, the meso- 
appendix is clamped, tied and cut so that the appendix 

Cross Section at Base of Appendix Showing Course of Ligature 
which is to Tie Appendix Slump when Inverted. 

stands up directly from the bowel. A number two catgut of 
good tensile is threaded into two straight needles. A third 
needle is now made to enter the appendix (strength is used 
on a straight or curved needle). The needle enters the tissue 
at the junction of the bowel and appendix one-fouth the cir- 
cumference from the mesoappendix. It is made to enter the 
deep structures and yet avoid the lumen and come out on the 
opposite side of the appendix. It is then made to enter very 
close to its exit sweep around the opposite side of the lumen 
in the deep structure and emerge close to its former entrance. 

Bealing With the Appendix Stump. 57 

A loop of the catgut is retained opposite the two ends. We 
now have nearly all the appendix lying outside the suture. 
The appendix is clamped a little distance above the suture. 
Another clamp is placed immediately above this and the 
appendix cut between the forceps. The ligature is now 
made to hold the caecum by traction upon its two ends and 
the opposite loop. The forceps are now removed and my 
forked appendix tucker is made to carry the crushed stump 
into the bowel. At the same time the ligature is drawn 
down and encircles the tucker but may be drawn as tight as 

Tucker Used to Invert the Slump. 

desired, as the tucker cannot hold on to the stump. All 
forceps used to invert the stump have a tendency to hold to 
it and return it. The one point tucker is worse than useless 
in dealing with the untied stump, leaving the forceps to be 

The operation is completed by overstitching the stump 
with a continous Lembert suture, carrying it along the free 
edge of the mesentery running to the mesoappendix stump 
and this suture is tied to one end of the ligation on the meso- 

This operation then ties all the vascular portion of the 
appendix, turns the raw edges in, brings peritoneum to per- 
itoneum, does not pucker the bowel, and these advantages 
are gained through the use of a suture which is easily placed 
making the operation safe and easy of performance. 

58 The Plexus. 

SENN, M. D., Ph. D., LL. 1). 

Under the auspices of Rush Medical College, North- 
western University Medical School, College of Physicians 
and Surgeons, Chicago Medical Society, Chicago Surgical 
Society, and the Nicholas Senn Club, memorial services to 
the late Dr. Nicholas Senn were held at the Music Hall, 
Fine Arts Building, Sunday, February 2, 1908, at 2:45 p. m. 

Rev. Frank W. Gunsaulus, D. D., delivered the Invoca- 

Prof. Albion W. Small, of the University of Chicago, 
acted as chairman, and in opening the services said that by 
circumstances beyond control, the official heads of three 
universities, who would naturally have taken part in the 
memorial services, were prevented from being present. Dr. 
Judson is in New York, President James is confined to his 
home by illness, President Harris is detained at his home 
by serious illness in his family. This absence of the proper 
official representation is therefore no index of the part which 
the sympathies of these universities take in the tribute of 
respect and admiration for Dr. Senn. Not merely the pro- 
fessional faculties, but the academic faculties regard his 
death as a loss to the educational insterests of Chicago, of 
Illinois, of the country, and all the world. The representa- 
tives of these institutions bow their heads in sorrow and 
join with the medical profession in celebrating the worth 
and notable professional achievements which are attached 
to the name of Dr. Senn. 


Dr. Frank Billings, Speaking for Rush Medical College, 
said that a majority of those present have had the pleasure 
of listening to Dr. Senn and of witnessing his magnificent 
manner of teaching. Dr. Senn was a teacher long before 
he began medical college work. In his early days hi Wis- 
consin he was a teacher. He taught those who came in 
contact with him as individuals, and in Milwaukee he or- 
ganized a medical society which was the center of medical 
thought in that city. Many of his pupils are now living 

Nicholas Senn. 59 

examples of the best medical and surgical practice as taught 
by Senn. Dr. Senn's first experience as a medical teacher in 
a college was in 1884, when he was called to the College of 
Physicians and Surgeons, Chicago, to occupy the chair of 
the Principles and Practice of Surgery. Those who lived 
in the city at the time he began his medical teaching and 
listened to him were astounded that a man who had lived in 
the counbry part of his life and but a short time in a large 
city, could express as he did then the advanced thought of 
medicine and surgery at that time. He continued his serv- 
ices in that institution for four years, after which he accept- 
ed the chair of the Principles of Surgery and of Surgical 
Pathology in Rush Medical College, where he taught from 
1888 to 1891. There his teaching was phenomenal. He 
drew members of the medical profession from every part of 
the city; and students from all medical schools, who eagerly 
listened to him. The speaker was very forcibly impressed 
with his manner of teaching. Upon a blackboard Dr. Senn 
would put down a synopsis of the subject of his lecture, and 
would then follow it very closely. He knew medical litera- 
ture, and hence his lectures not only contained his own 
opinions concerning the principles of surgery, but the opin- 
ions of others. He had a prodigious memory, and without 
recourse to notes gave notations from this book and that 
book on the subject of which he was speaking. , He re- 
mained in that position but a short time. He was then called 
to occupy the chair of Professor of the Principles and 
Practice of Surgery and of Clinical Surgery in Rush Medi- 
cal College through the death of Prof. Charles T. Parkes. 
Senn was the fourth man to occupy the chair made eminent 
by Daniel Brainerd, Moses Gunn, and by Charles T. Parkes, 
each a leader in medicine and surgery of his day, and great 
as were those men, he was the peer of them all as a teacher 
and as a surgeon. He was an organizer of his own teaching 
course and his organization in arena teaching was wonder- 
ful. He had a method and carried it out systematically. 
His clinics were fashioned after German surgical clinics, but 
modified by Senn and made better therefore. He showed at 

60 The Plexus. 

these clinics pathologic specimens which were obtained from 
former operations. These he described as a pathologist. 
He followed this with the demonstration of microscopic 
preparations made from some gross specimens which he had 
previously shown. These were passed about and explained. 
He exhibited and demonstrated patients who had been be- 
fore the class previously, explaining what operations had 
been done on them, the processes of healing of wounds, etc. 
Immediately after this he would show new patients, operate, 
and then was at his best. He was a wonderful diagnostician 
in surgery. He remembered everything. Those who were 
in contact with him for many years say that in some cases 
he could tell the character of the disease from which the 
patient suffered simply by looking at him; while other phy- 
sicians were at a loss to know what the disease was. Senn 
knew, because ten or twenty years before he had seen a like 
case. He knew the methods of examination and demon- 
strated his reasons for diagnosis before his class. As to 
treatment he differed from most surgeons in that if the case 
was not an operative one, he could explain as fully and 
clearly what the medical treatment should be as if he were 
an internal medical man instead of a surgeon. He was a 
dextrous operator and did not quail before the most formid- 
able operations. He had a facility of expression in describ- 
ing disease that few men possess. He was didactic — per- 
haps Socrotic. He had a good voice, and was never at a 
loss for words. He impressed upon his students, whether 
they were practitioners or undergraduates, the fact that he 
understood his subject; that he knew what should be done 
for every disease that came under his notice. He was emi- 
nently a teacher of the arena, and was never so happy as 
when standing in a large arena full of students to whom he 
could expound the principles of surgery- He was a writer, 
and in everything he wrote he was a teacher, and certainly 
no one man in the medical profession has ever written as 
much. Many of his books are still used as text books. They 
have been translated into other tongues than English. In 
Japan they are used as textbooks in medicjil schools and in 

Nicholas Serin. 61 

the army. In Russia they have been translated and are 
used in the army. These books are authoritative on the 
subjects of which he wrote. This is particularly true of 
hi; Principles of Surgery. He thinks that no other man in 
America has done as much as Senn did in that book for 
American surgery. No other man probably will ever occu- 
py his place, nor will any other man unite in one individual 
his facility of expression in the teaching of a large number 
of students and at the same time wielding a pen with such 
clearness of expression in writing books that are now con- 
sidered as authoritative and used the world over. 


Dr. William E. Quine, representing the College of Phy- 
sicians and Surgeons, said that in Senn a great body gave 
loyal backing to a great mind. His powers of endurance of 
both body and mind have rarely been equaled by any of 
God's creatures; and he needed them all, for his hunger for 
the honors of achievement was so insatiable that it would 
scarce brook needed rest. He worked more hours per day, 
per year, per decade, than any man he has known; and the 
mountainous fruitage of his toil has been the wonder of his 
friends. For him recreation was merely another kind of 
work and serious work at that. Senn told him thirty years 
ago in words of fiery earnestness that he would rather die at 
forty with every year of life accounted for, than to have a 
century of existence barren of results. Of all the attributes 
of his busy powerful mind, memory and orderliness were 
perhaps the most effective. He forgot nothing; and every- 
thing he had ever known seemed ready for his instant use. 
Without a minute for reflection he could bring to bear upon 
any question within the domain of his serious study all the 
batteries of literature from the very inception of investiga- 
tion of the subject through each successive stage of devel- 
opment down to that very day; quoting names and dates 
with unvarying accuracy, and keenly analyzing the validity 
of every claim ; and to do it as readily and confidently as he 
could repeat the Lord's prayer. Such powers, supported by 
his own exhaustive investigation of the same subject, made 

62 The Plexru, 

him matchless in conversation and unconquerable in debate. 

His passion for authorship dominated every other inte- 
rest he had in life. He stands sponsor for twenty-three 
published books, and at least two that are still in manuscript, 
every word of which was written by his own hand and with 
his own pen — to say nothing of unnumbered lectures, essays 
and addresses that have appeared in print under his name. 

Nicholas Senn was a man of heroic mould. His courage 
was equal to any danger. Whether assailed by the shocks 
of surprise incident to grave and complicated surgical opera- 
tions, when hundreds of critical eyes were watching every 
movement and when death lurked within a hair's breath of 
the edge of his scalpel, and hesitation meant tragedy; or 
hunted and beset by murderous Arab robbers on the desert 
of Syria and without the possibility of aid; or encloudecl in 
"the pestilence that walketh in darkness and spareth not;" 
Senn was always Senn — undaunted, quick, sagacious and 
unerring and ready to give a good account of himself every 
minute of the time. He could out-Luther Martin Luther. 
He could counterpart the sacrifice of his countrymen, Arnold 
Winkelreid; he could denounce corruption and dishonor at 
the peril of his life, equal to Savonarola, and walk to the 
stake as sturdily as John Huss; and he could stand shoulder 
to shoulder with "Horatio on the Bridge," to do battle to 
the death and with challenge and defiance in his heart to 
the last throb. 

On ordinary occasions he was rather indifferent as to 
personal appearance and in daily habits distinctly careless 
in respect to the smaller matters of dress. Evening attire 
was an abomination, and it was an extraordinary concession 
to the occasion which induced him to wear it. And yet the 
pomp and formalism of military parade fascinated him and 
the insignia of military rank allured and charmed and en- 
thralled him. Senn was human. He loved honors and 
compliments and public edulation, and accepted all that 
were offered as complacently as a child accepted its food; 
but in his personal relations he could diagnose the sycophant 
and self-seeking with the keen unsparing analysis of a Rich- 

Nicholas Serm. 63 

elieu, and the greatest deluge of honeyed words from such 
an one could never win a point. He read men like an open 

Senn had a world of admirers, but few intimate friends. 
True, there were countless thousands who were friendly and 
deserving of his friendship; but few of these were admitted 
to his confidence. He was courteous and affable to every- 
body, but reserved, except to the favored few. These had 
been weighed and measured and tested and approved; and 
there was not an immoral, vulgar, profane or deceitful one 
among them all. For them -Senn's loyalty and confidence 
knew no limit. He knew men. He was in no wise a society 
man. He could enjoy a joke on the other fellow, but was 
himself a bad man to practice on. He was a man of refined 
and exalted sentiment, and his heart and mind and mouth 
were as clean as a little girls- 
He was delightfully free-handed with his friends, but 
frugal in the small affairs of life; fragul, not because he 
cared for money, but because wastefulness was a crime. 
From the beginning he aimed at finantial independence — at 
independence, not at pride of wealth or of display, and when 
he had achieved it he bore himself grandly. 

Dr. Quine referred to the Senn collection of books in 
the Newberry Library, representing an outlay of $50,000, 
and placed at the service of the medical profession for all 
time, as a donation; also the Senn Memorial Building erected 
at the cost of $50,000, for the uses of science; the Senn pro- 
fessorship endowed in the sum of $25,000, and the Senn 
fellowship endowed in the sum of $16,000, and the Senn 
rooms in the St. Joseph's Hospital endowed in the sum of 
$35,000, for the perpetual care of stricken members of the 
medical profession; and added, there is nothing to be said 
but this: That Nicholas Senn, as a man, has done more for 
the medical profession than all other physicians combined 
who have ever lived in this great city. 

Finally, Dr. Quine said: 'T can imagine him now with- 
in three degrees of the north pole with Peary. I can imagine 
him left there — alone. No living thing within sight, within 

64 The Plexua. 

reach — alone. Without the possibility of shelter or of help 
and with desolation around him and death in the air — alone 
with God. 'And God saw everything that he had made, and 
behold it was very good.' A man. In God's own image and 
a glory to His power — Senn. 

"We symbolize a life arrested in the midst of great pro- 
ductiveness and power by a broken column. But a broken 
column would not typify Senn; rather mark the spot where 
rests his honored clay by a granite shaft, broad-based and 
deep-set in Mother Earth, and hewn four squares to every 
wind that blows — and finished at the top." 


Dr. Henry B. Favill, representing the Chicago Medical 
Society as it President, said that the career of Nicholas 
Senn illustrates that a man is not made by circumstances. 
Perhaps the most noteworthy fact in the professional de- 
velopement of Dr. Senn is that his greatest and most en- 
thusiastic scientific achievements were during a period when 
his daily toil in medical practice was the most burdensome. 
After completing his medical schooling and serving in the 
Cook County Hospital, he plunged into t'.ie thick of country 
practice. Promptly he was recognized as a man of strength 
and progress and very early in his career attracted the at- 
tention and commanded the respect of the profession of 
Wisconsin. Steadily he forged ahead, not only in his private 
practice, but in public recognition. 

Interested, indefatigable and effective, it was but a 
question of a few years when he naturally and inevitably 
sought in Milwaukee a broader field for his activities. There 
he continued aggressive, original and inspiring. He has 
never known a man whose capacity for sustained labor, not 
for a few days, but month after month, was as great as that of 
Dr. Senn. In this fact coupled with his indomitable persever- 
ance, lies the explanation of his remarkable productions 
during the period from 1880 to 1895. His professional suc- 
cess, his leadership, his triumphant demonstration of his 
ability during this period might easily have satisfied any am- 
bition. To him these were minor considerations. To be a 

Nicholas Senn. 65 

physician was his fashion, and he brought into his labors 
every contributary resource that was at that time available. 
The effect of his commanding supremacy upon the profes- 
sion of Wisconsin was pronounced. He never held the place 
of rival or competitor; he was the acknowledged leader, and 
young men drew from him inspiration and encouragement. 
In those days and in the later days of his brilliant medical 
teaching, his precept focused not upon final surgical achiev- 
ment, but upon the broad principles underlying morbid con- 
ditions. Generalization and the whole morbid picture were 
far more satisfying than his surgical technic. Not at all 
early in his career did he become specifically a surgeon. 
As he reached his full maturity, the dawn of scientific 
medicine occurred. He was among the first to grasp the 
enormous significance and possibilities of the new life. Day 
and night he labored with the scientific problems of medicine, 
always with the broad relationships of the living organism 
as the background to his conception. At this period he 
acquired the deep friendship and respect of Dr. Christian 
Fenger, and the picture of those two masters, shoulder to 
shoulder, during those days of medical conflict, demonstra- 
tion and revolution, is never to be forgotten. This friend- 
ship furnished him untold comforts and inspiration in his 
scientific pursuit, and as a result of it the medical profession 
in the Western States has profited inexpressibly. 

In his early life he had an enormous experience in gen- 
eral practice. In his later life he unfailingly interpreted 
his surgical problems in the light of his broad medical ex- 
perience. Those who have encountered him realize that 
there was no territory of general medical thought in which 
he had not an expert judgement. Voluntarily putting aside 
all that was not specialized work, he nevertheless was 
competent to assume any medical responsibility, and to this 
fact was due largely the notable conservatism which char- 
acterized his surgical views. No man knew better than he 
the triumphs and possibilities of operative management. No 
man less than he was carried away by enticing possibilities 
from the sound footing of medical judgement. To his breadth 

6 6 The Plexus. 

of view as to the human body and to his all-around de- 
velopment as a physician are due this recognized soundness. 
In other directions not technical, in the broad human re- 
lationships between the doctor and patient, he maintained an 
equal poise. Occupying a position where he could have arbi- 
trarily commanded extreme material rewards, he habitually 
maintained a conservative attitude. His patient's real in- 
terest was his interest, and he rarely was beguiled into the 
sophistries of modern professional relations. To the mind 
unaccustomed to consider medical specialization in its effect 
on individuals, these reflections may not seem so important, 
but to the medical mind fully appreciating the dangers and 
the disadvantages of too narrow lines of thought and act- 
ivity, the characteristics of Dr. Senn stand out, not only as 
noteworthy, but as offering a demonstration that breadth 
and depth are not incompatible. Surgery owes him an in- 
expressible debt, but those who knew him best, and par- 
ticularly during the great part of his life when he was an 
active factor in general medical affairs, know that his great- 
est contribution to the interest, intensity, ideas and scienti- 
fic conception of medicine, was as a physician. 


Dr. D. R. Brower, representing the Nicholas Senn Club 
as its president, said that Dr. Senn was probably the most 
traveled medical man in this or any other country. His 
journeyings included trips through every State and Territory 
in the Union; the Dominion of Canada, from Labrador to 
British Columbia; he went as far north as Etah in Green- 
land, the most northern point inhabited by human beings in 
the world, and as far south as Punta Arenas, the most 
southern town in the world, and visited all the countries in 
between. He made two trips around the world, one by way 
of Siberia, the other by way of India. He visited every 
country in Europe; he explored Africa and all the important 
islands of the Pacific and the Atlantic Oceans. With the 
exception of two or three insignificant countries in Asia, he 
had indeed seen the whole world. 

Dr. Brower made seven'somewhat extensive trips with 

Nicholas Senn. 67 

Senn, averaging- at least three months each, so that he had 
at least twenty-one months of the closest possible contact 
with him, and as a result he classified Dr. Senn as the most 
remarkable personality it has ever been his privilege to 
know. Such was his exceeding modesty that few came to 
know of his greatness. He was a pleasant traveling com- 
panion. He knew how to travel. He never fussed about 
things that are often sources of discomfort to many travelers; 
he was so intent on studying nature and humanity that the 
trifles of life never long engaged his attention. He was as 
much at home with the humblest peasant as with the most 
exalted personages. His linguistic power made him a valu- 
able companion; his full vocabulary of the Continental 
languages made it always possible for him to find some one 
from whom information could be obtained, when necessary. 
His encyclopedic knowledge gained by diligent study of all 
places to be visited made him a useful companion. His great 
brain so classified and retained this fund of knowledge that 
it was available at a moment's notice. At the International 
Medical Congress at Moscow, held in 1897, he received many 
honors. He delivered one of the three general addresses of 
that Congress, selecting English as the language, thus show- 
ing his loyalty to his adopted country, and it was received 
with great enthusiasm. The Czar had invited him to be his 
guest at the Kremlin, but this great honor he declined, giv- 
ing as a reason that he preferred to remain withjiis Ameri- 
can companions. The night of the great banquet in the 
Arcade, the Russian medical men bore him on their shoulders 
and in triumphal procession marched up and down the cor- 
ridors, singing the praises of the great American surgeon. 

In their trip around the world they had no sooner reached 
Tokio than Dr. Senn received a card from the Surgeon- 
General of the Imperial Navy of Japan, introducing a Com- 
mander of the Japanese Navy, and detailing him for daily 
attendance. This beautiful compliment opened wide to them 
everything in that city. On the last night of 'their sojourn 
the Army and Navy gave an elaborate banquet, attended by 
the leading physicians and surgeons of Tokio, and the 

68 The Plexus. 

English and American naval surgeons stationed at Yokohama. 
Baron Hashimoto, Japan's most famous surgeon, presided. 
In the reception room there was a table, and placed on this 
table were all the books that Dr. Senn had written — the most 
delicate compliment the speaker ever saw paid to anyone, 
telling them that here is the man and there are his works 
which have encircled the world. 

Reference was made to Dr. Senn's great physical endur- 
ance. He was ready for any exertion, and Dr. Brower 
thinks he knew nothing personally about ordinary fatigue. 

He had no discomforts from ocean travel. He loved the 
ocean always, but loved it least when it was at rest. 

Dr. Senn's six books of travels contain an immense fund 
of information gathered from many sources. They are ex- 
cellent guide- books, descriptive of peoples, countries, fauna, 
flora, climate conditions and the relation of health and 
disease. His style was entertaining, his language choice, 
often dramatic, often poetic. His trained perception and his 
mature judgment made his conclusion always valuable. 

Dr. Brower knows nothing in the language more dramatic 
than the chapter entitled, "A Thunderstorm before Santiago 
de Cuba," and no more beautiful word painting than his, "An 
Evening in Tahiti,'" and he was sure every physician would 
be benefited by reading "Travel as a Means of Post-Graduate 
Medical Education," the opening chapter of "Around the 
World via India." These books will long remain monuments 
of his deep learning and indefatigable industry. 

"The master surgeon's journeys in this world have 
ended. A noble, generous, self-sacrificing life has begun its 
journey in the great beyond, and when he has reached the 
presence of the Great Physician, whom he loved so well, 
then may it be said to him: Well done, thou good and faith- 
ful servant. Thou hast been faithful over a few things; I 
will make thee ruler over many things. Enter thou into the 
joy of thy Lord." 


Dr. A. J. Ochsner said that Nicholas Senn possessed 
the intuition of the true prophet in surgery. Thus he re- 

Nicholas Sonn. @9 

cognized almost at the beginning of his professional career 
three aids in the development of surgery which enabled him 
to rise from the obscure practitioner of medicine to the 
world-famed surgeon. He appreciated the importance of 
clinical microscopy, animal experimentation and antiseptic 
surgical technic. The microscope laid bare the pathologic 
changes in the tissues of the human body, placing before us 
clearly defined scientific facts where before we were com- 
pelled to grope in the darkness of the theoretic suppositions. 
With the introduction of animal experimentation it was pos- 
sible to find safe methods for the relief of these conditions 
of disease. At the same time the introduction of antiseptic 
surgery eliminated the danger of wound infection and in- 
sured favorable results for the surgical treatment which had 
been introduced. These three conditions he utilized to the 
utmost. His great logical mind enabled him to grasp their 
importance as well as their scope. His phenominal enthusi- 
asm carried him over every obstacle; his almost superhuman 
physical and intellectual strength enabled him to accomp- 
lish in a few years that for which in others a lifetime would 
have been too short, and his unchanging devotion and cease- 
less industry enabled him to continue these labors through 
a period of nearly forty years. No wonder, then, -that the 
attention of the entire medical and surgical world was drawn 
to this western pioneer in the field of surgery. But his 
great scientific attainments did not in any way obstruct his 
practical usefulness. His early training on the Wisconsin 
farm had not only given him a most vigorous development 
of body and mind, but also a very high degree of practical 
skill and dexterity. In this way he became the most exalt- 
ed exponent of surgical science and at the same time quite 
as distinguished a leader of successful surgical technic. 
With all of these qualities and with the power of conveying 
his knowledge to others as a writer and orator, he naturally 
became in the eyes of the world as well as in fact the master 
surgeon of the western continent. 

Looking back to the days when Prof. Senn delivered 
his first course of lectures in this city in the old amphitheatre 

70 The Plexus. 

of the College of Physicians and Surgeons, fills one today, 
alter the lapse of a quarter of a century, with an enthusiasm 
and a devotion as distinct as though it were but yesterday. 
There never were such lectures on this subject before and 
it is safe to predict that their equals will never again be 
produced. They were inspired; they were the words of a 
prophet; they made young men enthusiastic workers in this 
great field for the remaining years of their lives. 

Had Senn possessed the power of organization, which 
is after all not to be compared with the wonderful powers 
he did possess in so phenomenal a measure, the Senn school 
of surgery would have rivaled or excelled the famous 
schools of Billroth or Volkmann. There is no one among 
us who does not owe a debt of gratitude to this great man. 
His genius; his enthusiasm, and his devotion have inspired 
us; his learning has elevated us; his industry and persever- 
ance have served a notable example, and his skill has re- 
lieved our suffering. There will for all time to come be in- 
scribed upon the pages of surgical history high on the roll 
of honor the name of Nicholas Senn. 

Chairman Small, in bringing the service to a- close, said: 
There is a meaning to this memorial service, and while it is 
not exhausted by speaking and the hearing of praise, the 
real meaning of it is in the mind and renewal of allegience 
to ideals. A man who has done something worthy of praise 
is a social asset, not merely as a memory, but as a mark to 
be reached. We have heard the character and worth of Dr. 
Senn praised because of his honesty as a scientist; his in- 
genuity as a teacher; his resourcefulness as a physician; his 
courage as a surgeon; his loyalty as a friend, a citizen and a 
man. The dignity and the worth of our tribute is in the de- 
gree in which we are saying these things of him for his own 
place and for his own part in life. These things we will 
value; these things we will emulate; these things, as we 
have the ability, will we promote. 

Portrait Bust of Dr. Quiae. 7 L 


W. A. Pusey, M. D. 

One of the b33t things in this wjrld is a strong and fine 
personality. And it is at the same time one of the most 
elusive and difficult to analyze. It is not intelligence, or 
intellectuality, or great industry, or capacity for work, or zeal; 
it is not even honesty, or bravery, or fidelity, or kindliness; 
it is certainly not aggressiveness or an ability to get on. 
One may have any of these qualities, developed to the point 
of genius, and yet lack lamentably in personality. A strong 
and fine personality is rather a combination of many of these 
qualities into that homogeneous entity that we recognize as 
character, in the large sense of the word. And, in spite of 
its intangibility, it is one of the best and most potent of 
human influences. It excites admiration and emulation 
without jealousy. It developes ambition and it is an inspira- 
tion. In those subjected to its influences it establishes 
standards of conduct towards which they strive and it 
awakens an affectionate regard that is one of the abiding 
satisfactions of life. 

The influence of a fine personality is intimate and re- 
quires for its full play close contact with individuals. And 
so, we see its powers exercised most frequently by parents 
and other teachers. Fortunate is the family which has this 
guiding force, and more fortunate the school. In the family, 
where incentives are the highest to the development of 
pirental character, its manifestations are not infrequent 
and the memory of such a personality is enshrined in the 
love and devotion of many a family. In the school its pre- 
sence is more uncommon, but occasionally some lucky body 
of students comes under its sway. 

The greatest illustration of such a personality is Socrates. 
That ungainly curious lovable old man, without leaving 
a line of his own writing, exerted through his disciples an in- 
fluence upon civilization that will last as long as culture. 
Samuel Johnson and Dr. Thomas Arnold of Rugby, are 
other notable illustrations. Dr. N. S. Davis of Chicago was 

72 The Plexus. 

such a personality, who, I happen to know, had a strong in- 
fluence upon Dr. Quine. At all times fortunately we can 
find some examples; Harvard has one in President Eliot; 
Johns Hopkins one in Dr. Welch. And one such man in his 
effect on character building is a whole university. 

During almost forty years now Dr. Quine as a teacher 
has been exerting the influence of such a personality as I have 
attempted to indicate. When a very young man he began 
to teach medicine, and now year in and year out for thirty- 
eight years he has, with almost unexampled industry and 
enthusiasm, kept up the work. His formal work has been 
to teach students how to recognize disease and how to care 
for the sick. How well he has succeeded in this is attested 
by his long established reputation of greatness as a teacher 
of what we technically know as materia medica and thera- 
peutics and the practice of medicine — the broad subjects that 
cover the practical work of the physician. His unconscious 
and even larger work has been furnished as an example. 
Successive classes of doctors have gone out, not only in- 
debted to him for knowledge, but better men for his influence. 

For twenty -five years Dr. Quine has done his work as a 
teacher in the College of Physicians and Surgeons. During 
fifteen years of this time he has been its dean and its central 
figure. His influence has shown itself upon faculty as well 
as upon students. With us of the faculty he has acted as a 
centripetal and stimulating force. He has held us to our 
work and unconsciously made us strive to live up to our high 
obligations. And he has furnished us a standard of ability 
and scholarship and fidelity to duty none too easy to live up 
to, but good for us all. 

A large number of us, therefore, who have had the bene- 
fit of Dr. Quine's influence during these parsing years have 
honored ourselves with the privelege of presenting to the 
College of Physicians and Surgeons this token of our esteem 
for him. We, his colleagues and his students, want to set 
up this likeness of him here at the center of his labors. It 
presents, in a somewhat accentuated form, the rugged and 
forceful qualities of his personality. What no portrait can 

Acceptation of Quine Bust. 73 

show is the accuracy and fullness of mind, the faithfulness 
to responsibility, the kindness to those needing help, the 
almost pathetic affection for those near to him, which have 
made him so fine to us who have had the benefit of his inti- 
mate association. 

While he lives and while we live these things will need 
no memorial, but, after we are all gone and tradition alone 
remains, we would have this portrait stand here, with the 
hope that it may still exert some part of the old influence, 
and as a tribute from those who knew him. 


By D. A. K. Steele, M. D., LLD., Chicago. 

Mr. Chairman and Friends: — On behalf of the College of 
Physicians and Surgeons of Chicago, I accept this bust of 
Dean Quine, and promise you that in the years to come it 
shall occupy a place of honor in this college where, for 
a quarter of a century, Dr. Quine has spent the best years of 
his life, as "friend, teacher and schoolar" eloquently, with 
consumate force, dignity and enthusiasm inculcating the 
truths of modern medicine to hosts of medical students, many 
of whom, by emulating his example and teaching, have 
reached the highest ranks in the medical profession, and 
join with us tonight to do him honor. 

In accepting thee Oh though bust, to serve the College 
of Medicine of our magnificent State University as a per- 
petual reminder of the greatest medical orator and most 
forceful and eloquent teacher of medicine yet developed in 
this great medical center of America; we must remember 
that the ideal beauty has not yet come, in music, painting 
or statuary, and thou mayest have some imperfections. To 
those of us who have known and loved Dr. Quine for a third 
of a century as friend, teacher and colleague; as a virile ag- 
gressive leader of our choosen profession thou wilt never 
seem like the real Quine. Thou art too cold, hard and un- 
sympathetic. When we look at thee we miss the genial 
smile, the warm handclasp, the generous aid, the cheery 
well! well! well! of the real Quine. We will remember him 

74 The Plexus. 

as he is not as the sculptor depicts him. But thou must 
speak for him to future generations of medical students, and 
typify him as our greatest medical teacher. Though must 
serve as an inspiration and incentive to high ideas, clean 
speech, pure morality, and eloquent teaching of scientific 
medicine, if thou wouldst fulfill thy mission and represent 
the man who has made himself so beloved by his students, 
faculty and profession as to have made thy presence pos- 
sible. His name and fame as a medical orator will endure 
long after thou hast crumbled into fragments. 

Dean Quine, I have known you since boyhood, I speak 
of you as friend and neighbor with no phrases of fulsome 
flattery, but in the words of homely truths twixt man and 
man I express my estimate of you. I knew you as the ideal 
young doctor and beloved professor, blending in your make- 
up the elements of a true man (from the Isle of Man). 
With perfect health, mental vigor, manliness, honor, honesty, 
courage, truth, and a devotion to high ideals and an un- 
wavering self-confidence. You were born too far from 
Ireland to be a real wit, and yet far enough away from 
England to possess a thorough sense of humor. A sort of 
betwixt and between the two, as it were, and as you came to 
this country in your sixth year, you have been gaining in 
wit and wisdom ever since. You stepped directly from the 
student's seat to a Professor's chair and with . another leap 
to the staff of the Cook County Hospital. While you were 
yet a very young man you performed the first ovariotomy 
ever done in the County Hospital. I was your interne and 
your assistant and the patient recovered. I knew you as a 
therapeutist, obstetrician and gynecologist long before you 
became famous as an internist, expert diagnostician, clinic- 
ian and consultant. In 1870 I knew you as Secretary of the 
Chicago Medical Society and three years later as its presi- 
dent and later on, I knew you as President of the Illinois 
State Board of Health and President of our State Medical 
Society, and for long years as the loved leader in this College. 
All these anS many other honors came to you because you 
earned them by hard work and devotion to duty, by doing 

Liquid Carbon Dioxide. 75 

all things well that come to your hand, because of your pre- 
paredness for them. For nearly 40 years you have poured 
out your generous, sympathetic soul into the life of this city 
and left your impress upon it. In the development of its 
institutions of learning, of science and of research. You 
have taken a large part in its social, religious and profes- 
sional advancement, and now tonight, while we are strewing 
roses in your pathway, do not think you are to be Oslerized, 
for I pray God grant you many, many years more of mental 
vigor and professional activities. 

Long live Quine. 



For several years the intense cold of liquid air has been 
utilized by a few experimenters in the treatment of naevi 
and other lesions in the skin which it is desirable to destroy 
with the production of the least possible amount of scarring. 
The treatment, however, has not passed beyond a few hands 
on account of the difficulties surrounding liquid air. Liquid 
air is not commercially obtainable and even when it can be 
gotten it is very expensive and rapidly dissipates, it can be 
kept in a closed container, but must be allowed to evaporate 
slowly. A supply therefore when obtained disappears 
quickly regardless of whether it is used or not. On account 
of these practical objections to the use of liquid air it oc- 
curred to me over two years ago, while witnessing a demon- 
stration of the therapeutic use of liquid air, that liquid carbon 
dioxide might be substituted for it. Liquid carbon dioxide 
is obtainable in commerce and can be gotten wherever soda 
fountain supplies are sold. For over two years now I have 
used carbon dioxide in this way. 

Underlying the use of both liquid air and frozen carbon 
dioxide is of course the production of an inflammatory reac- 
tion or the destruction of tissue by rapid and deep freezing. 
The difference from freezing by the application of a rapidly 
evaporating spray, like ethyl chloride for example, lies part- 
ly in the much more intense cold and partly in the fact that 

76 The Plexn.s. 

with CO 2 the cold is applied under pressure so that deeper 
freezing takes place. The temperature of freezing of CO 2 
is about 90° C, that of liquification of air about 180° C. The 
effect of the two upon the skin is practically the same, 
both producing instantaneous freezing. 

Carbon dioxide is furnished for commercial purposes in 
iron drums in which the gas is maintained in the liquid state 
under a pressure of eight-hundred to one-thousand pounds 
to the square inch. If the liquid carbon dioxide is allowed 
to escape from the nozzle of such drum and caught in a cloth 
it evaporates so rapidly that it freezes itself and is deposited 
upon the cloth in the form of snow, looking exactly like 
ordinary snow. This can be handled in a thick cloth or 
piece of chamois skin very much like ordinary snow is 
handled. It can be pressed into balls or sticks and can be 
whittled by a knife into any desired shape; it can even be 
handled in the hands if no pressure is exerted upon it. When 
applied with light pressure to the skin it freezes instantly; 
the depth of freezing can be varied by the amount of pressure 
exerted. If the snow is firmly pressed against the skin, 
freezing in a few seconds takes place to the depth of one to 
three-sixteenths of an inch. Freezing of course causes in- 
jury to the tissues and the amount of reaction or destruction 
which is caused by it is directly in proportion to the duration 
of the freezing. The freezing of normal skin for one or two 
seconds will produce a very slight dermatitis which quickly 
passes away; freezing for ten seconds will produce an acute 
dermatitis with some vesiculation; freezing for twenty to 
thirty seconds will produce a tense bulla and slight des- 
truction of the skin; freezing for a minute will produce a 
tense bulla which is followed by a dry slough which sepa- 
rates in the course of two or three weeks. Even after de- 
structive freezing the amount of scarring which is left is very 
slight. The application of the snow is comparatively pain- 
less; there is a feeling of intense cold upon its application 
and after the parts thaw out there is a burning which is 
rather uncomfortable— about like that of a bee sting. 

It will be readily seen that the process offers a very 

Liquid Carbon Doxide. 77 

efficient method of producing destruction of lesions in the 
skin. It furnishes a very easy way of destroying moies, 
warts or other similar lesions. I believe experience will 
show that it has a far more valuable use in the treatment of 
both pigmented and vascular naevi; lesions which are with- 
out other satisfactory method of treatment in the majority 
of cases. I have used the method now in probably a hundred 
and fifty cases of numerous sorts, including at least a score 
of naevi. Both vascular and pigmented naevi can be re- 
placed by skin showing very slight scarring and practically 
no trace of the previous naevi. 

The method of application in naevi is simple; pieces of 
snow are molded into the proper shape and a certain part of 
the naevus is destroyed at each application. At the be- 
ginning it is well not to undertake to treat more than half a 
square inch at the first application; this is in order to dis- 
cover the amount of reaction which is produced in a par- 
ticular individual by freezing for a definite length of time. 
My rule is to apply the snow at the first application for ten 
seconds, then wait until the effect of this has been determined ; 
that usually requires a couple of weeks. After the first ap- 
plication longer applications can be made if they are found 
to be necessary. It is a good plan in treating a large lesion 
to freeze at each application of the snow not more than 
half a square inch, but several areas of this size can'be treat- 
ed by successive applications at one sitting, so that large 
areas can, if necessary, be treated at one time. Experience 
has shown that very moderate applications are sufficient to 
destroy the color in vascular naevi. It is usually not neces- 
sary to make the applications of more than ten second's 
duration; such applications will usually take out the color 
from a perfectly red birth mark, but the applications can be 
repeated later if desirable. Pigmented naevi are more re- 
sistant to freezing and require longer applications, and 
usually from thirty seconds to a minute is required to pro- 
duce the requisit amount of destruction of tissues in these 
lesions. In pigmented, as in vascular naevi,. one should be- 
gin with shorter applications, say from twenty to thirty 

78 The Plexus. 

seconds; then after experience has been obtained in the 
particular case the applications can be made as long as 
necessary to produce the requisite amount of destruction of 
tissue. Large naevi can be removed in this way. They 
will be replaced by smooth, flexible scar tissue which causes 
no deformity by contraction of the scar. The result in pig- 
mented and in vascular naevi have been equally good. 


By Aimi Paul Keineck, Chicago. 

Adjunct Professor of Surgery, University of Illinois; Surgeon to the- 
Cook County Hospital. 

Though it has not been demonstrated beyoud scientific 
contradiction, that in the thyroid gland is to be found the 
sole primary cause of the disease, we are believers in the 
thyroid theory, because: 

1. There is present some structural alteration of the 
thyroid body in all cases of exophthalmic goitre. This ap- 
plies to the secondary as well as to the primary forms of 
this disease. Most of the recent observers have come to 
the conclusion that the histology of the typhoid gland in 
primary Grave's disease is in many respects specific. "We 
must not conduce that because we cannot detect any en- 
largement of the thyroid body that, therefore, the gland is 
not diseased; it always is." 

2. Because exophthalmic goitre is the direct opposite 
of myxedema in symptomatology, in pathology and in thera- 
peutical indications. 

3. Because the symptom-complex of this affection can 
to certain degree be determined by the ingestion of large 
doses of thyroid gland substance, or of its various prepara- 

4. Because all medical or surgical measures which tend 
to decrease the functional activity, or to lessen the volumn 
of the gland, also tend to lessen the severity of the symptoms, 
or to arrest them. Schultze 8 says: "Clinically it makes no 
difference whether the secretion of the gland is increased, 

Exapkthalmic Goitre, 79 

or altered, or is altered chemically as the result of changes 
in the blood, in the alimentary canal, or in the central 
nervous system, the fact remains that the removal of the 
growing gland does away with the symptoms, and upon 
failure to remove the diseased gland depends the failure of 
the cure." Incidentally, we may say that the surest and 
most efficacious way of reducing the volumn of the thyroid 
body is by removing a portion of it. 

5. Because in the cases which we have collected and 
which we report, recovery from the disease, in rapidity and 
in completeness, has been in proportion to the extent of 
gland tissue removed, short of its entirety. 

6. In those cases where the symptoms recurred, re- 
currence was associated with, and seemed to be dependent 
upon, hypertrophic changes in the remaining portion of the 
thyroid gland. Recovery could be secured by a secondary 

7. Because the symptom-complex of this affection finds 
its most satisfactory and most consistent explanation by 
considering the condition a general toxemia, the result of 
quantitative or of qualitative changes, or of both, in the sec- 
retion of the typhoid gland. The tachycardia, the mental 
changes, the sweating, the prostration, the increase of body 
temperature, the diarrhoea, are all symptoms that we find 
in other intoxications. It is perfectly possible for a gland 
to show a great hyper-activity without actual enlargement, 
as for example, the salivary gland in the state of salivation. 

The anatomical changes noted in the primary and 
secondary forms of this disease are unlike; so unlike that 
they, of themselves, make imperative and classification of 
the disease into primary and secondary forms. In the sec- 
ondary cases, we agree with Dean Lewis 4 when he says that 
the goitre in the secondary forms does not differ in structure 
from the simple or parenchymatous, or other goitre, upon 
which the Basedow's symptom-complex has not been 
grafted. Exophthalmic goitre has been observed in simple 
goitre, in fetal adenomata, in cysts, and in carcinoma of the 
thyroid gland. (Bloodgoo'd, Ehrhardt.) It has been thought 

80 The Plexus. 

that small tumors of the thyroid gland, the seat of secondary 
Grave's disease, act as irritants causing an overactivity of 
the gland, much as a foreign body in the eye will produce 
an excessive secretion of tears, and the removal of this 
sorce of irritation by operation has been followed by a com- 
plete relief of the symptoms. 

In the primary form of Grave's disease, definite patho- 
logical changes are constantly present in the thyroid gland. 
Kocher and Reinbach, Brissaud and Langhans have denied 
the above statement, but the existence of the changes have 
• been comfirmed by so many competent observers that their 
occurrence can no longer be contested. (Greenfiield 5 , Ask- 
anazy, Soupault 6 , Haemig, Aubarsch, MacCallum 1 and Ehr- 
hardt.) In 28 primary cases of exophthalmic goitre, MacCal- 
lum fonnd changes present in the thyroid gland in' each in- 
stance, although all the glands and all the parts of the same 
gland were not equally involved in all the cases. It is well 
to bear in mind that changes may occur in one portion of the 
gland and not in another. Dean Lewis examined the thy- 
roid gland in four cases of primary exophthalmic goitre, and 
his findings agree with those of Greenfield, Edmunds, Mac- 
Cullum, etc. What are these changes, considered as con- 
stant and as almost as characteristic? 

1. Changes in the follicles which are increased in num- 
ber and which are also changed in size and form. Instead 
of appearing round or square, when examined microscop- 
ically, they appear branched and stellate. Dr. Radocanachy 8 
noted an increase in the number of the alveoli, proliferation 
of the epithelium and changes in its character. There is 
presented the appearance of a gland which is working at 
high pressure. We find an increase in the secretory tissue, 
for the number of the alveoli is increased and the epithelial 
cells themselves, instead of being cuboidal, are columnar. 
Dean Lewis says: "It seems as if the proliferating epith- 
elium following the lines of least resistence, had grown into 
the follicle. The connective tissue of the follicle is also in- 
vaginated so that in many sections the invaginated epithelium 
with its connective tissue stalk resembles an intestinal villus."' 

Exaphthalmic Goitre. 81 

In other parts of the gland, the follicles are usually small. 
Many of the follicles contain desquamated epithelial cells. 
The secreting area of the vesicles is increased by the in- 
growths from their walls. 

2. Changes in the character of the epithelial cells. The 
cells are changed from the cuboidal to the cylindrical, 
columnar type. The epithelial proliferation may be so great 
that alteration of the shape of the cells results from mechan- 
ical pressure. (Edmunds.) Many of the cells are in the 
state of fatty degeneration. (Virchow.) 

3. Qualitative and quantitative changes in the colloid. 
The colloid is greatly diminished in amount; it may be 
absent. This change, however, has also been noticed in the 
thyroid gland of patients dying from other diseases. Some 
of the vesicles instead of containing colloid are filled with 
cells. Is this disappearance of colloid due to lessened se- 
cretion, or does it result from more active removal by the 
lymphatics? That is still an unsettled question. 

4. Increase in vascularity. The blood vessels are dis- 
tended and are increased in size; the friability of their walls 
has been noted and commented upon by many operators. 
(Kummel, Kocher, Mayo.) This friability increases the 
liability to primary and secondary hemorrhages. In this, 
as in all other active hyperplasias, the enlargement of the 
nutrient arteries is very evident. No adequate idea of the 
vascularity of the gland is gained from inspection of the 
specimen after death, but at operation it is found to be ex- 
traordinarily rich in widely distended vessels. This is es- 
pecially noticeable in the veins. 

5.' Changes in the connective tissues. There is an in- 
crease in the amount of connective tissue. In some cases 
this increase 'in connective tissues causes a lobulated ap- 
pearance in the tumor. The fibrous septa of the gland may 
show some thickening at a comparatively early date. All the 
above mentioned ' histo- anatomical changes may exist in 
small foci and not through the entire gland. Probably this 
explains why, in some instances, they have escaped the 
observation of investigators. 

82 The Plexus. 


The thyroid gland is an organ essential to the integrity 
of the human organism. In the absence of necessary thyroid 
gland or glands, the spontaneous or gradual arrest of funct- 
ion of this body, or its total destruction by disease, or its 
ablation, by the surgeon, will almost, if not invariably, be 
followed by myxoedema, either acute or chronic in type. 
Post-operative tetany and myxedema are indentical; as far 
as their etiology is concerned; one condition often develops 
into the other. (Von Eiselsberg 9 .) Tetany, it would seem, 
according to the latest researches, is a condition of parathy- 
roid insufficiency of the thyroid glands (Mayo 1 °, Rochester, 
Minn.) To avoid removing all the glandulae parathyroidea, 
save the posterior capsule of the thyroid gland. The saving 
of this posterior fibrous capsule also lessens the liability of 
injury to the recurrent laryngeal nerves. 

The development of impending myxoedema can be pre- 
vented; its manifestations controlled either by the successful 
transplantation of thyroid tissue in another part of the 
body, or by continual injections of thyroid (Vassale,) or by 
prolonged feeding of thyroid gland tissue. (Lanz, Canter. ' [ .) 

The above facts are accepted as proofs that myxoedema 
is a disease due to insufficiency, or to absence, of normally 
functionating thyroid tissue in the system; as ample grounds 
for consideration of myxoedema among the diseases of the 
the thyroid gland. 

The demonstration of the fact that in exophthalmic 
goitre we have a disease which is the diametrical opposite 
of myxoedema in symptomatology, pathology and thera- 
peutical indications, will aid to give credence to the thyroid 
theory. Let us consider the evidence that contrasts the 
two diseases. 


1. Enlargement of the thyroid gland (almost always 

2. Exophthalmos (a cardinal symptom.) 

3. Frequent presence of other ocular symptoms, as 

Exaphthalmic Goitre. 83 

Von Graefe's, Dalrymple's, Stellwag's, Jullinek and Rosin's, 
Gifford's 12 , etc. Eye symptoms are of great diagnostic 
value, chiefly by way of confirmation. Gifford's sign is an 
involuntary resistance to eversion of the upper lid. 

4. Excitable and mobile pulse, palpitation, tachycardia. 
Permanent tachycardia is more commonly met in exoph- 
thalmic goitre than in any other affection. 

5. Exophthalmic goitre tremor (cardinal symptom.) 
Murray noticed tremor in three cases out of 120. The tremor 
in this condition is raped and vibratory, there being as many 
as 8 or 10 vibrations per second. 

6. Agitation, insomnia, irritability, excitability. A 
peculiar mental condition of nervousness is a common 
symptom in exophthalmic goitre. 

7. More or less profuse perspiration. Skin fine, soft, 
moist and warm Feel better in cold weather. Diarrhoea 

8. Typical myxoedema may supervene on the subsidence 
of an equally typical exophthalmic goitre. 


1. Atrophy or absence of the tyroid gland (is mentioned 
in all the reported cases.) 

2. Recession of the eye-ball not uncommon. In cases 
not consecutive to exophthalmic goitre, exophthalmos is 
never present. * 

3. Absence of ocular symptoms. 

4. Sluggish heart action. Bradycardia, a -common 
common symptom. 

5. Myxoedema— absent, except in its rare occurrence in 

6. Apathy, somnolence, dullness of apprehension and 
of perception. 

7. Absence of perspiration even in the warmest weath- 
er. Myxoedematous skin. Patients always feel cold. Con- 
stipation common. 

8. Myxoedema never precedes exophthalmic goitre. 


Glandular hyperplasia, increase in number of follicles. 

4 The Plexus. 


Follicles are markedly diminished in number; may be 
absent. In cases where gland is not absent there is noticed 
a progressive glandular atrophy l7 . 



The ingestion of thyroid preparations is always harm- 
ful. It aggravates the symptoms. 

All measures which tend to lessen or diminish the 
amount of thyroid secretion are followed by improvement. 


The continual ingestion of thyroid preparations is posi- 
tively curative. 

Inplantation of gland tissue, if the latter maintains its 
integrity, is curative. 

The symptom-complex of this affection can to a certain 
degree be determined by the ingestion of large doses of thy- 
roid gland substance, or of its various preparations. Our 
knowledge of the phsiological action of thyroid gland sub- 
stance, or of its preparations, is still limited. Tachycardia 
and increased metabolism constantly results from their in- 
gestion. Toxic doses will cause such symptoms as rise of 
temperature, insomnia, agitation, polyuria, albuminuria, 
complete paraplegia, etc. These symptoms we also fre- 
quently meet in cases of exophthalmic goitre. The fact that 
the symptom-complex of this affection can be experimentally 
determined, produced by the ingestion of thyroid prepara- 
tions, is no longer contested. In our opinion it forms an- 
other important link in the chain of evidence supporting the 
thyroid theory. 

Cunningham administrated daily by mouth to a rabbit one 
gramme of thyroid extract; it caused exophthalmos. Law- 
ford has reported one case of exophthalmos due to thyroid 
feeding. Edmunds 14 found that feeding dogs and monkeys 
large amounts of thyroid substance could bring on exoph- 
thalmos, tachycardia, loss of weight and wasting. Murray 
obtained similar results. Nothaft 1 6 reports a case of a pa- 
tient who took 1000-5 grain tablets of thyroid extract in five 

Exapbthalmic Goitre. 85 

weeks. He developed all the symptoms of exophthalmic 
goitre; upon cessation of the drug all the symptoms prompt- 
ly disappeared, with the exception of the struma and exoph- 
thalmos, which persisted for six months and then gradually 
disappeared. Doyen performed a partial thyroidectomy in 
a case of exophthalmic goitre; cure resulted. For some 
reason or other the patient took some tablets of thyroid ex- 
tract, the symptoms of exophthalmic goitre recurred. With 
suppression of the drug the symptoms subsided. Beclare 
observed the development of the symptom-complex of this 
affection in a myxedema woman, who had taken at the be- 
ginning of the treatment 92 grammes of thyroid extract in 
eleven days. The drug was discontinued, the symptoms 

A critical analysis of the voluminous literature of the 
subject has convinced me that the following conclusions are 

1. Thyroid gland substance, or any of its preparations, 
should never be administered in the treatment of exophthal- 
mic goitre. Their use in that disease is irrational, and it is 
invariably attended by an aggravation of symptoms. Their 
use invariably increases the dangers of operative interfer- 

2. As a therapeutic agent in the treatment of exoph- 
thalmic goitre, thymus gland substance and its various 
preparations are useless. Their use is at times attended by 
an aggravation of symptoms. They cannot be considered 
curative agents. 

3. Parathyroid extract as a curative agent of exoph- 
thalmic goitre has no efficacy. MacCallum says that the al- 
ternations noticed in the glandulse parathyroids do not 
seem to be constant or sufficiently extensive to support the 
idea that the parathyroids have anything to do with the de- 
velopment of the disease known as exophthalmic goitre. 

4. The medicinal treatment of the disease which we 
are considering is, the use of belladonna being excepted, in 
reality largely symptomatic. For the anaemia arsenic has 
been given; for the nervousness and restlessness the bro- 

86 The Plexus. 

mides; for the tachycardia, digitalis, sthrophanthus, etc. All 
these agents are palliative, not one has ever proven to be 

5. All symptoms of medical treatment of this affection, 
be they hygenic, dietetic, medicinal, organotherapic or elec- 
trical in nature, are unsatisfactory, are disappointing. Their 
comparative powerlessness has induced surgical endeavors 
to cure the disease. There is not any form of medicinal 
treatment which has been successful with sufficient frequen- 
cy to carry conviction of its worth. 

6. Serum therapy* of exophthalmic goitre is as yet in 

*By serum therapy is meant the employment of either (a )the serum 
of thyroidectomized animals, or (b) the serum of animals treated with 
increasing doses of thyroid extract, or(c) milk in the dried or liquid 
form' of thyroidectomized goats. With the use of th^ese different sera, 
authors report failures and successes. 

an experimental state. The results attending the use of 
"thyroidectin" are not invariably satisfactory. Miller, 
Quine, Billings and others have had failures attending its 
employment. Their use is not devoid of dangers. 

7. It is now a demonstrated fact that all* operative 
measures which tend to lessen the secretory activity of the 
thyroid gland, or to diminish. the amount of thyroid gland 
tissue present in the organism, are of value in the treatment 
of exophthalmic goitre. That method must be chosen which 
at the time seems to be the least dangerous without sacri- 
ficing chances of success. 

a. Intra- glandular injections are unsafe in exophthal- 
mic goitre. There is the danger of sepsis, of injecting the 
irritant agent into the blood vessels, of provoking alarming 
hemorrhage (alarming through the compression that it may 
exert upon the respiratory passages). 

b. The ligation of the thyroidal arteries in this disease' 
was first recommended in 1886 by Woffler. It has been prac- 
ticed by operators of such eminence as Roux, Rydigier, 
Kocher, etc. It is now used only as a preliminary, or as an 
accessory step to partial thyroidectomy. The ligation of 
the four thyroid arteries is liable to determine gangrene of 

Exaphtbalmic Goitre. 8» 

the thyroid gland, is liable to induce thyroid insufficiency. 
The objections to ligation of two or three of the thyroid ar- 
teries as a routine treatment of exophthalmic goitre are the 

1. It is a procedure often difficult of execution, the hy- 
perthophied thyroid gland having altered the anatomical re- 
lations of the part; the infiltration of the tissues also adds to 
the technical difficulties. The ligation of the vessels is 
especially difficult in the retro-clavicular and retro-sternal 
varieties of goitre. 

2. Owing to the greatly increased vascularity of the 
organ, branches of the thyroid arteries are liable to be mis- 
taken for the trunks of the vessels. 

3. It does not secure as complete nor as permanent mit- 
igation of the symptoms as partial thyroidectomy, and it is, 
we believe, equally difficult to perform. Ligation of the in- 
ferior thyroids is just about as serious a matter as thyroid- 
ectomy. Bressman states that improvement is slower after 
ligature of the vessels than after operative treatment on the 

c. Exothyropexy for exophthalmic goiter has been 
performed with varying results. This operation has been 
termed "an unfinished partial thyroidectomy. " 

d. In the absence of accessory or aberrant thyroid bo- 
dies, total thyroidectomy is very liable to be followed by 
cachexia strumapriva. This explains why the operation is 
no longer performed by those who know. Kocher reports 
70 per cent, of cachexia strumapriva in thirty-four cases of 
total excision of the thyroid gland. Post-operative myxo- 
edema can always be controlled by the administration of 
thyroid extracts. 

e. Partial thyroidectomy is as yet the most satisfactory 
operation for performance in all cases of exophthalmic goitre 
be they primary or secondary in type. Kocher, as a result 
of his enormous experience believes that we can say that 
partial thyroidectomy can be performed without danger 
provided the heart is sound, careful haemostasis is obtained 
and the wound drained. In cases that survive the operation 

88 The Plexus, 

it is invariably attended by marked alleviation of symptoms, 
in many instances by complete and permanent cure. Kocher 
is of the opinion that partial resection and ligature of the 
vessels is the most rational procedure. He first ligates the 
two superior thyroid artiries. This, in his opinion, is easy 
of execution and makes the subsequent work easier. He 
then ligates one inferior thyroid artery before extirpating 
;the gland. No more thyroid tissue need be left in site than 
is present in the normal organism, that is from 30 to 60 
grammes. The surgeons that have, for the cure of this dis- 
ease, removed the largest quantity of thyroid tissue short of 
its entirety, are those that have obtained the very best re- 
sults, both from the standpoint of the number of recoveries 
as well as from the standpoint of completeness of recoveries. 
If not enough gland tissue is removed, the maximal benefits 
are not derived from the operation. If too much is removed 
thyroid insufficiency may develop. A small amount of glan- 
dular tissue is all that is required to maintain the ordinary 
nutrition of the body. When the thyroid gland is not total- 
ly removed, the possibility of post- operative myxoedema can 
be said not to exist. Kocher met it only once in 1,000 ope- 
rations for goitre. In this case he removed half the gland, 
the remaining half atrophied. The symptoms disappeared 
following the administration of thyroid extract. 

8. The secondary forms of exophthalmic goitre, when 
subjected to partial thyroidectomy, almost invariably recov- 
er from the operation and from the disease- 

9. Operators disagree as to the most suitable anesthe- 
sia for these cases. All the anesthetic agents have their 
partisans. Fatalities have occurred with all of them. Local 
anesthetics have the disadvantage of not completely abolish- 
ing the perception of pain. General anesthetics have the 
disadvantage of increasing the cardiac insufficiency, and of 
frequently being followed by cough which may induce sec- 
ondary hemorrhage, by vomiting that may soil and infect 
the dressings on the wound. Kocher recommends local an- 
esthesia, he never operates on singers for goitre under gen- 
eral anesthesia. The Mayos, (Rochester, Minn.) employ gen- 

Exaplithalmic Goitre. 89 

eral ether anesthesia in almost all their cases. Kummell 
uses oxygen chloroform. Kurt, Schulze and Riedel have 
seen an acute bronchitis follow operations for exophthalmic 
goitre in which only local anesthesia had been employed. 
Ries (Chicago) employs scopalamine morphine anesthesia. 
According to Prof. Fenger, the degeneration of the heart 
muscle will account for some of the sudden deaths, while 
the absorption of thyroid, shock, anemia and general nerve 
exhaustion will account for most of the other deaths that 
are not due to the anesthetic. 

10. The dangers of partial thyroidectomy in exoph- 
thalmic goitre are either avoidable, such as infection and 
hemorrhage, or unavoidable, such as "acute thyroidism.'' 
This latter, also called "Thyroid fever," is liable to occur 
after the observance of all precautions now known to us. 
We do not yet know how to prevent nor how to cure "acute 
thyroidism." It is not always fatal. Free drainage of the 
operative wound is our most serviceable weapon for com- 
batting the complication. The nature of the anesthetic, and 
that of the operation, seems to have little influence in its 
production. All Basedow patients seem very sensitive to 
surgical operations. 

11. There is no doubt that the mortality is greater in 
bad cases than when symptoms are slighter and the patient 
in better condition. Early operations give the best results. 
They give a lower percentage of deaths and a very much 
higher percentage of cures. Exophthalmic goitre tends to 
diminish vital resistance and to exhaust the nerve centres , 
hence operate before the patient's vitality has been lowered 
by chronic thyroid intoxication. Kocher lays great stress 
on the avoidance of the development in all cases of goitre 
of what he calls the "thyroid heart." This, he asserts, can 
be acquired either by waiting too long for surgical inter- 
vention, or by an excessive iodine or thyroid extract therapy. 
He assures us that the prognosis in Basdow's diseases will 
be much better in the future, if the operation is done early. 

12. Operative points: 

a. It is well to prepare patients for some time, to ob- 

90 The Plexus. 

serve them and to better estimate their ability to withstand 

b. Place the patient in the inverted (reversed Trendel- 
enburg) position. Put a round pillow beneath neck so as to 
give better access to goitre. Maintain neck in that position 
which interferes least with respiration. The most rigid 
aseptic precautions should be observed to avoid infections, 
mediastinitis, deep phlegnon of neck, thrombo phlebitis, 
septicemia, etc. ■ 

c. Kocher's transverse convex incision allows of a 
complete exposure of both lobes. Prom a cosmetic stand- 
point it is the best as the usual neckwear will hide the scar. 
If it is necessary to make a section of the sterno-hyoids and 
sterno thyroid, the Mayos advise that this be high, so as to 
preserve the nerve supply to these structures. After re- 
moval of the tumor, divided muscular structures must be 
sutured. After completion of operation cutaneous wound 
must be sutured accurately. Drain through an opening 
made below this wound. 

d. Homostasis must be perfect. Do not depend on 
temporary compression to arrest the bleeding. It is decep- 
ti /e. When possible tie the bleeding vessels — it is prefer- 
able to leaving clamps in position. Clamps interfere with 
the healing of the wound. Nurses should be instructed to 
watch for first symptoms of secondary hemorrhage. 

e. Tissue should be left at the poles of the gland, pre- 
ferably about the inferior thyroid arteries, so as to reduce 
the risk of injuring the recurrent laryngeal nerves. 

f. Drainage is of the utmost importance. 

1. To remove what primary wound secretion is pre- 
sent. Although at the time of operation the bleeding may 
be stopped absolutely there is always considerable oozing 
afterwards into the large cavity of the neck which it is im- 
possible to obliterate by spong pressure. This clot may 
cause interference with union, may cause pressure upon the 

2. To remove what contents of the gland have been ex- 
pressed into the wound during the operation. A certain 

Exaphthalmie Coitre. 91 

amount of the toxic secretion of the gland being allowed to 
accumulate slowly in a wound that is closed will often cause 
such symptoms as may prove fatal in an otherwise successful 

g. Swab mucus away from throat. There is always a 
hypersecretion of mucus giving rise to troublesome cough- 
ing. This is one of the reasons why the bleeding points 
should be well secured for avoidance of secondary hem- 

h. Keep patient physically, mentally and emotionally 

13. Recovery from all symptoms is neither immediate 
nor simultaneous. The first symptom to subside is the tach- 
ycardia. The tremor or the nervous and psychical symptoms 
also disappear quickly. The total disappearance of men- 
strual disturbances is of good prognostic omen, it takes 
months for the entire beneficence of the operation to become 
manifest. The exopthalmia is the last symptom to disappear. 
Albert Kocher says that a total disappearance of exopthal- 
mos can only be expected in those cases in which the opera- 
tion is performed early. Eye symptoms disappear in the 
majority of cases quickly and completely, irrespective of 
persistence or disappearance of exopthalmos. The longer 
the period of observation after the operation, the better ap- 
parent the results. 

14. When, after a partial thyroidectomy, the symptoms 
recur, the recurrence is most frequently associated with a 
hypertrophy of the remaining portion of the gland. Removal 
of a portion of this will bring about a cure. 

15. Partial thyroidectomy is indicated: — 

1. In all cases of secondary Exopthalmic Goitre. 

2. In all cases of Primary Exopthalmic Goitre. 

a. When, after three months of well conducted ap- 
propriate medical treatment, the patient's condition is not 
markedly improved. 

b. When the goitre compresses or distorts the trachea, 
or the oesophagus, or both. Long continued dysponea is 
very liable to beget pulmonary emphysema. 

92 The Plexus. 

c. When tachycardia is marked- Long continued and 
excessive tachycardia is very liable to beget organic heart 

d. When exopthalmos is so marked as to prevent com- 
plete closure of the lids during sleep. Kocher and others 
report cases where patients lost their eyesight through 
ulceration of the cornea secondary to marked exopthalmos. 

e. If the patient is loosing strength. 

f . If all acute cases that seem like a sudden intoxication 
of the body by thyroid, even when no marked enlargement 
of the thyroid body can be demonstrated. 

16. Surgical treatment of Exopthalmic Goitre is justi- 
fied by theory and by facts. 


1. Campbell, Harry, F. R. C. P. British Medical Journal 1902. Vol. 
II, p. 1420. 

2. Schultze, Kurt, Mitteilung, a. d., Grenzgebiete der Med. und der 
Chir. . Jena, 1906; Sechszehnter bd. p. 161. 

3. Heioeck, Aime Paul, Surgery, Gynecology and Obstetrics, 1907, 
Vol. V., p. 623. 

4. Lewis, Dean, Surgery, Gynecology and Obstetrics, Chicago, 1906, 
Vol. IV, p. 476. 

5. Greenfield British Medical Journal, 1893, Vol. IT, p. 1261. 

6. Soupault Gaz.Hebdom de Med et de, Chir., Paris, 1897, Vol. 
H, p. 664. 

7. MacCallum, W. C. Trans. Am. Phys., Phil., 1905. Vol XX, p. 

8. Rodocanachy. Lancet, London, 1897. Vol. II, p. 911. 

9. Von Eiselsberg, in Von Bergman System of Practical Surgery. 
Phil., 1904. Vol. II, p. 357. 

10. Mayo, C. H. Sur. Gyn. and Obst., Chicago, July, 1907, p. 30. 

11. Canter. Dr. Charles, Annales de la Soc. Med. Chir. de Liege, 
1894. Vol. XXXII, p. 12. 

12. Gifford. Ophthalmic Record, Chicago, 1906, June. Vol. XV, 
p. 249. 

13. Starr, M. Allen, Loomis and Thompson, System of Practical 
Med. Vol. Ill, p. 693. 

14. Edmunds, Walter. Brit. Med Jour., Oct., 1905. 

15. Nothaft. Centralbl far innere Med, Leipz., 1898. Vol. XIX, 
p. 353. 





Charming W. Barrett, AY1 D., Chairman. 

T. A. Davis, M. D. W. E. Gamble, M. D 

A. R. Johnstone, AY1. D., Editor. 


L. H. Nowak, '03. Ray Esslck, '08- Gustav Eck, '09. 

William G. Epstein, '10. 
Atheletic Editor. C. H. Tillotson, '06. 

Alumni Editor, John Wehtherson, '00. 

Library Dept., Metta M. Loomis. 

Publisher - - - - J. E. Forrest. 

Subscription St. OO per Annam in advance. Single copies. 15 cents. Issued 
Monthl ' . S—ri«i *!> communion tlmix md remittances 'or subscription* and adver- 
tising to J E. FORM'e^T, .ittavi^i, lifi Ois. 

Entered at Batavia Post Office as Second-Class Matter. 

Any subscriber desiring tlie Journal discontinued at the expiration of his sub- 
script^' should so notify the Publishers; otherwise it will he assumed that the 
subscription is to tw on tinned and the Journal'sent accordingly. 

Contributions of matter suitable for publication are invited, and should be sent 
sn not ^iter than the 25th of the month previous to that of publication. The pub- 
lishers will not no; 1 - iri-nsei ves responsible for the safe returu of MSS. unless 
lufflcie-t stamps are forwarded. 

riend contribution- to A. R. Johnstone, M. D., Editor,"4147 Lake Ave., Chicago. 


The American Medical Association will hold its annual 
meeting in Chicago June 2nd to 6th, and Tuesday evening, 
June 2nd, is set aside for Alumni night. On this evening 
Alumni Associations of various Medical Colleges will have 
special entertainments arranged. 

The faculty of the College of Physicians and Surgeons 
will give an evening of fun to its Alumni, which will con- 
sist of a lunch and part vaudeville entertainment. Wit and 
wisdom will be dispensed before, during and after the lunch. 
The entertainment will be complimentary. All that the 

94 The Plexus. 

faculty demands is that you will come and bring your best 
smile and your good cheer with you. 

The Alumnus who fails to attend the A. M. A. meeting 
and the Alumni night will have to prove an alabi if he ex- 
pects to retain his good name. 

Begin now to make plans for the meeting on June 


On Saturday evening February first the ceremonies as 
sociated with the unveiling of the Professors Ray and Quine 
busts were held in the audience room in the college. 

Professor Ray occupied the chair of surgery in the col- 
lege until the close of the school year of 1883,. and was 
succeeded by Profs. Senn and Fenger. Prof. Ray was a 
man of the old school and embodied in his character the 
best qualities of the heroic surgeon of preantiseptic days. 
He was an anatomist of unusual ability and a fine operator. 
He had the instinct of the teacher and the generous physi- 
cal, mental and moral qualities of the leader among men. 

It is eminently fitting that the lives and work of men 
who have left their stamp upon the profession of their time 
and who are remembered by those with whom and for whom 
they labored, should be kept fresh in the minds of all men. 

Dr. Frank Billings made the presentation speech and 
recalled the many great characteristics of Prof. Ray, under 
whom Dr. Billings was a student. He referred at length to 
the untiring energy exhibited by Prof. Ray in his work as a 
surgeon and as a teacher, and paid loving tribute to the 
sterling honesty and tender sympathy and unfailing courte- 
sy of the man. 

The presentation of the Quine bust was made by Dr. 
William A. Pusey, and it was accepted by Dr. D. A. K. 
Steele. Dr. John B. Murphy spoke of the great work Prof. 
Quine had accomplished as a teacher and in the upbuilding 
of the College of Physicians and Surgeons, the advance- 
ment of which has been a task of tremendous magnitude 
successfully performed. 

The addresses of Dr. Pusey and Dr. Steele appear in 
full elsewhere in this issue. 

'I lie Quine Library Book Plate. 









A very general, and oft expressed sentiment of appre- 
ciation for the benefits derived from the Quine Library, pre- 
vails among all the students. 

From the desire to give this sentiment some tangible 
form of expression, it has become the custom of the gradu- 
ating class to leave some memorial in the Quine Library. 
The gift of the class of 1907 was a book plate, the picture of 
which accompanies this brief sketch/ 

The drawing for the book plate was made by Mr. F- W 

96 The Plexus. 

Goudy of New York whose work speaks for itself in the 
decorative border which surrounds the portrait. Mr. Goudy 
is the owner of the Villiage Press" of New York, and as a 
manufacturer of "The Book Beautiful", he probably has no 
superior in America. 

The engraving was done by Mr. Richards, who as art 
editor of "The World To-Day", has made for himself an en- 
viable reputation among Chicago artists. 

The original drawing of the book plate is framed and 
hangs in the reading room. 

Any member of the class '07 who wishes a copy of the 
book plate may have one by sending address, and stamp for 
mailing to the librarian. 

To the class of '07 most sincere thanks are hereby ex- 
tended for this valued addition to the Quine Library. 


Seniors, especially those of the quiz class, can rightly 
feel proud of our worthy class mate, Doane, who carried off 
the honors in the Englewood Hospital examination, making 
first place. 

Quiz Master — How long does this disease last? 
Gordon — Six years — 2 months — 8 weeks — 4 or 5 days — 
and may be — not at all. 

Murphy gives "Kargon Compound" to his father for 
Nephritis. You're acting strongly against the law of the- 
oretical incompatibilities, Murphy. Prom a practical stand 
point though perhaps "both" mix well. 

According to latest reports Schroeder will have a 
"double celebration" at about the time of graduation. # 

You have the good wishes of the class, Schroeder. 

Dr. King — What is crossed paralysis? 

Clifton — Hemiplegia on one side — paralysis on the other. 

Poor eye-sight is not always detrime tal. Late and ab- 
sent seniors were saved once more by the absence of Dr. 
King's glasses. 

Class-mate gets another title — Mikkelson "Idealist," — 
according to Dr. Barrett. 

Skwor differentiates Herpes Iris from Herpes Zoster, 
as follows: Herpes Iris is same as Herpez Zoster, differ- 
ing from the latter only in its location, Herpes Iris occur- 
ring upon the iris. 




P. M. Goodman, Ph. G., C. S. N. Hallberg, Ph. G., W. A. Puckner, Ph.G 

H.H.Rogers, M. D., Ph. B., E. N. Gathercoal, Ph G., 

A. H. Clark, Ph. G., C. M. Snow, Ph. G. 

CLASS EDITOR: W. D.Mottar, '08. 


At a recent meeting of the Ad Interim Committee of the 
New York State Board of Pharmacy with representatives 
of the education department of the State of New York, the 
matter of registration of schools was taken up and the fol- 
lowing action was taken upon the application of this school. 

"That the University of Illinois School of Pharmacy, 
Chicago, Illinois, be notified that recognition of the institu- 
tion will be accorded in full and that it will be placed among 
the list of pharmacy schools in Group 1, Class 1, on the is- 
suance of the next pharmacy handbook," 

Only the graduates of recognized schools of pharmacy 
are permitted to appear for the licensing examination of the 
New York Board of Pharmacy, and of the 90 schools of 
pharmacy in the United States only 32 have full recognition 
by the New York Board of Pharmacy and Educational De- 


F. P. Boyden, '86, is prescription clerk with A. Acker- 
mann, 63rd and Lexington Ave. 

S. V. Justus, ; 02, has taken a position in Miles City, 

K. E. Anderson, '07, expects to dispose of his pharmacy 
at Roberts, Wis., and intends to enter upon the study of 

98 The Plexus. 

Paul Seyfarth, '07, passed the examination of the Wis- 
consin Board of Pharmacy recently and is now a registered 
pharmacist in that state. 

Ebner McGinley, '05, passed the recent Illinois exami- 
nation as registered pharmacist. Leo A. Ginnsy, a senior 
of this year, and J. C. Kehoe, a junior student, were also 
successful. Among the assistants registered were F. E. 
Schinz, '07, R. R. Gasen, ex-'08, and W. S. Spencer, '09. 
The next examination will be held in Chicago beginning 
Tuesday, March 10th. 

Chas. M. Ford, '74, is president of the Colorado Phar- 
maceutical Association, 

F. H. Spiller, '94, visited the school recently. He con- 
ducts a prosperous pharmacy in Gardner, 111. 


By M. I. Wilbert. 

Apothecary at the German Hospital, Philadelphia. 

"Facts Worth Knowiug," is the title of a pamphlet 
"about the war on 'patent' medicines and the mercenary 
motives back of it" that, in reality, constitutes the most 
scurrilous attack on the medical profession, particularly 
medical associations, that has as yet been published by the 
Proprietary Association of America. 

It comprises 93 closely printed pages, including the title 
page, and it should be carefully studied, if not completely 
read, by every intelligent physician and pharmacist in the 
country. Personally I believe that this pamphlet, if given 
the widespread circulation that is promised it in a circular 
letter that is now being distributed, will be a factor for good 
and it can undoubtedly be made much if the men who are 
attacked will but heed the isolated truths and correct the 
existing abuses that are enumerated in connection with the 
great mass of misrepresentation and untruthful assertions 
that are contained in its pages. 

I do not intend, at this time, to even attempt to discuss 
the contents of this pamphlet further than venture the gen : 
eral assertion that it is an interesting illustration of the ex- 

Pharmacy. 99 

tremes that otherwise intelligent men will descend to, to se- 
cure for themselves a continuation of their present, self as- 
sumed, privilege to rob and at the same time injure the 
helpless and unsuspecting sick and afflicted. I also desire 
to point out to you some more or less interesting facts and 
their 'relations to this publication and its object. 

By way of introduction let me say just a few words on 
the personnel of the Proprietary Association of America and 
the interests that it represents. 

Some two years ago (Nov. 18, 1905, page 1589), the 
Journal of the American Medical Association published the 
complete list of the then members of the Proprietary Asso- 
ciation of America. Since that time quite a number of firms 
who were engaged in the manufacture of what is known as 
"ethical" proprietaries have withdrawn from active mem- 
bership, so that the membership today is somewhat different 
from what it was then. 

In other respects, however, the Association has under- 
gone no material change, the membership of the Proprieta- 
ry Association of America, now. as then, includes wealthy, 
well established and influential firms whose membership, in 
turn, includes graduates of medical schools, graduates of 
schools of pharmacy, graduates of collegiate institutions 
and even university men; Bachelors or Doctors of Art, of 
Science, of Philosophy, of Law and even of Divinity. Many 
of these men have had the advantage of intellectual training 
in some of our most representative educational institutions, 
put they have signally failed to absorb the fundamental 
principles of moral responsibility embodied in the golden 
rule of Humanity's great teacher. 

While it is quite true that the greater number of nos- 
trums are originated by illiterate and ignorant persons, this 
truism does not hold good for the manufacturers and ex- 
ploiters of the more widely used, because the most widely 
advertised, nostrums of today. 

To appreciate this statement more fully we need but 
remember that the successful conduct of a business amount- 
ing to hundreds of thousands of dollars annually requires a 

100 The Plexus. 

knowledge of men and affairs that is not readily acquired by 
an ignorant or illiterate person- It must unfortunately be 
admitted, therefore, that the men who are directly or indi- 
rectly responsible for this malicious attempt to mislead the 
public, by untruths and deliberate misstatements are finan- 
cially well-to-do, and, in some instances at lest, well edu 
cated persons whose love for gain has developed in them a 
moral twist that sanctions "trickery, treachery, humbug, 
fraud and lies"' as being permissible in "legitimate" busi- 

The motives that prompted the publication of this par- 
ticular pamphlet are perhaps best illustrated by a review of 
the number and value of the interests that are involved. 

A recent number of the Pharmaceutical Era (Oct. 24, 1907, page 20 ) 
contains the following- tabulated estimate of the growth in number, val- 
ue and output of establishments devoted to the manufacture of proprie- 
tary remedies, of which upwards of 25,000 are enumerated in the last 
edition of the Era Price List. 
Year. Establishments. Capital. Materials. Products. 

1880 563 10,620,880 6,704,729 14,682,494 

1890 1,127 18,596,823 11,930,916 32,620,182 

1900 1,719 36,977,833 18,000,441 58,988.181 

1905 2,245 45,611,640 21,293,051 74,520,765 

This table represents a number of very interesting facts. To begin 
with it should be remembered that the values here given are the values 
as computed by the manufacturer, and the figures, therefore, do not in- 
clude the profit to middlemen and retail dealers, which will readily 
amount to 35 or 40 per cent, of the value of the finished product as given 
above. This would make the cost of proprietary medicines, to the con- 
sumer, foot up a total of upwards of $100,000,000 in 1905. 

Apart from showing the rapid increase in the number of establish 
ments devoted to the manufacture of proprietaries, this table is also in- 
teresting in that it illustrates the very rapid, though constant increase 
in the difference between cost of materials and value of the finished pro- 

In round numbers, this difference amounting to 130 per cent, of the 
cost of materials, in 1870, had increased to 250 per cent, in 1905. Much, 
if not all, of this difference was no doubt necessitated by the increased 
cost of advertising that is required to sell goods of this class. It has 
been conservatively estimated that no less than one-half of the cost of 
nostrums to the public, is spent for advertising, and that of this sum no 
less than 90 per cent. is paid for advertising in the several periodical 
publications that are, largely at least, distributed through the United 

Pharmacy. 101 

States mail. Many of you will no doubt wonder what connection there 
can bi between this discussion of the Proprietary Association of Amer- 
ic i and a discussion of "the ways and means for promoting the greater, 
the most desirable and helpful use of official and semi-official piepara- 
tions." When you remember, however, that even a reasonable degree 
of success for this propaganda must involve a well established and gen- 
erally recognized feeling of respect and a desire for co-operation between 
physicians and pharmacists, and when voj r. j alizi that these requh-e- 
ments, fundamental as they are, do not exist, largely because of the ma- 
chinations and the intrigues of m -rubers of this very same Proprietary 
Association you will begin to appreciate how far-reaching and how po- 
tent have been thj influences of this particular Association. 

I may perhaps be permitted to go back and rehearse a . 
few fragments of history in regard to the present propaganda 
against '"Patent" medicines. You well know that the 
present day warfare is nothing new, that intelligent leaders 
of men have warned against nostrums from time immemorial 
and that, in this country, the history of medical organizations, 
and, I am glad to add, of pharmaceutical organizations, re- 
flects one continuous struggle against the deception and fraud 
so manifest to the leaders of medicine and of pharmacy, in 
the exploitation and the sale of nostrums. 

One fundamentally important and unexpectedly far- 
reaching influence of the introduction of so-called "Ethical" 
proprietaries has been the levelling influence that they exerted 
on the several classes of men engaged in the sale of drugs 
and medicines. 

Those of you who can remember the conditions existing 
in the early seventies, before the advent of the factory made 
prescription, will no doubt recall the difference in appearance 
of the apothecary shop, or pharmacy, to which you were 
directed by the physician, to take or send his prescriptions, 
and the neighboring drugstore where paints, oils, varnishes, 
'groceries, glass, "Patent" medicines and a thousand and one 
other articles were sold, in addition to the heavy drugs, spices 
and herbs that were used in the household at that time. The 
pharmacist of that day was a highly respected citizen, who, 
because of his varied attainments, was looked up to«and 
respected by the physician as well as the laity. His shop 
was frequented by the medical men of that period and he 

lOi The Plexus. 

was frequently consulted on wiys and means for accomplish- 
ing certain objects, the making of new preparations or the 
combining of certain ingredients in a new form or remedy. 

Many, if not all of the distinctive features between the 
pharmacist and the drug seller disappeared with the intro- 
duction and the gradual popularization of the ready to take 
remedies introduced in large number some thirty years ago. 

The levelling influence of these ready made preparations 
was, subsequently, still further augmented by the more than 
mediocre requirements of our pharmacy laws which per- 
mitted the registration of all men, learned or ignorant, who 
had ever pretended to sell drugs and medicines in any way 
or form. 

.It will not be necessary for me to go into an extended 
discussion of this particular phase of our development. 
Many of you have lived through it and know as well as I do 
the demoralizing influences ' wieided by this particular com- 
bination of nostrum and law. 

To those of you who are of a younger generation, it will 
suffice to point out that this levelling influence practically 
compelled the sale of all kinds of nostrums in the better 
class of pharmacists and that this in turn led to the introduc- 
tion of active competition with cut-rate advertising, which, 
ultimately, led to substitution and, in a few isolated cases, 
even deliberate counterfeiting, and this, in turn, brought 
about a bitter and altogether indiscriminate attack, by man- 
ufacturers, which brought the whole fraternity into disrepute. 

Neither can it be said that the part that the retail drug- 
gist has taken, in the evolution of nostrums, during the past 
ten or fifteen years has been particularly creditable. Not 
being satisfied with the profits that were to be secured on 
the sale of widely advertised nostrums, at cost or below, he 
was led into making compromising alliances with members 
of the Prcprietary Association of America, who, a decade 
before, had maligned and discredited him. Worse than this, 
perhaps, he has numerously entered upon the co-operative 
exploitation of a line of preparations that bid fait- to outrival 
the rankest products of the old time nostrum maker. 

Pharmacy. 108 

In this connection it will not be necessary to discuss the 
relative merits or demerits of such institutions as "The 
United Drug Stores Company" and "The American Drug- 
gists" Syndicate." Even the most cursory survey of their 
literature will convince the majority of you that their very 
existence it a sad reflection on the present day attainment of 
the average retail druggist; particularly when we learn that 
upwards of one thousand retail druggists are said to be 
financially interested in the several companies. There are, 
it is true, mitigating circumstances. In many cases the 
retail druggist has had a hard; bitter struggle for existence 
and he no doubt felt that he Was compelled to put in a line 
of cure-all preparations to meet the unjust competition of 
the self- dispensing doctor and the cut rate prices on adver- 
tised nostrums offered by department stores. 

The rank and file of retail druggists are honest, well 
meaning and law abiding citizens. Many of the sins of 
omission and commission that they have been found guilty 
of are clearly due to lack of knowledge on the one hand or 
to stress or dire necessity on the other. Individuality he has 
never been taught, and his neighboring physicians have 
never taken the time or the trouble to impress on him the 
need for recognizing his limitations. He in common with 
the great mass of humanity, including a very fair number of 
medical practitioners, has been misled and misdirected 
hrough the wiles of the makers of proprietaries. 

To digress for a moment, the retail drug-gist should know that there 
.are certain fundamental principles controlling the action of drugs in 
health and disease; many <>f these are understood, ofotliers little, as yet, 
is known. These fundamental principles suggest limitations and they 
also suggest that the real danger from the use, or the abuse, of any 
remedy, unless it is a dangerously potent one. is not in the direct injury 
of a sledge hammer variety, but in the insidious undermining of tha 
health and strength of the individual, coupled with procrastination and 
delay resulting- in the loss of all chances of ultimate recovery. 

So-called ''Patent" medicines are either inert and, therefore, fraud- 
ulent, or they are medicinally active and, therefore, fraught, with harm, 
when taken without a proper knowledge of th^ir uses and limitations. 
Appreciating these facts the retail druggist must also realize that the 
claims that are made in connection with all classes of nostrums are false 
and misleading, and that in selling- preparations of whose composition 
know little, and of whose action he knows less, he discredits himself and 
lowers the standing of the calling he has chospn to follow. 

This brings us then to a very brief consideration of the 
remedy for the present day condition. 

I believe, and I sincerely hope, that we have once more 

104 The Plexus. 

reached the parting of the ways, between the pharmacist, 
the man who is honestly and earnestly desirous of practicing 
the art and science of pharmacy, and the drug seller, the 
man who is willing to sell anything and everything that 
offers, for the profit that may accrue to him. 

There are in this country hundreds of well qualified 
pharmacists who would gladly divorce themselves from their 
more undesirable side lines if they were but offered the op- 
portunity to do so. This opportunity is now at hand, and 
is being offered them in the form of the pure food and drug 
laws that have been, or will be, enacted in the several states. 
If these laws are rigidly enforced, and I believe that the 
rapidly awakening public will demand that they are enforced 
they will make the retail druggist responsible for all sub- 
stances sold in other than the original container furnished 
by the manufacturer. 

With the complicated nature of substances used in the 
filling of physicians' prescriptions the retail druggist, with 
his numerous side lines, will find it impracticable to comply 
with the need for repeatedly testing the articles he carries 
in stock and this, in itself, will bring about a segregation of 
the two lines. 

In this connection it should be remembered that the 
preservation of medical substances is far from being negli- 
gible, but is, in reality a matter of considerable moment. 

To prevent the rapid deterioration of vaccine virus, se- 
rums and other biologic products requires a knowledge of 
their mode of manufacture, their composition and their uses 
that is not usually possessed by the man who is unwilling or 
unable to follow the current literature of the day. 

The same is true of drugs and galenical preparations, 
quite irrespective of whether they have been made by the 
pharmacist himself or by self-styled experts, in manufactur- 
ing establishments. When this well-known fact is once 
more duly appreciated by the majority of physicians they 
will be willing to ignore the label on the bottle, as being a 
guarantee of excellence, and will demand, as they should, 
that the dispenser assume and be willing and able to demon- 
strate his responsibility for the article he dispenses. 

When this time comes, and let us hope that it is near at 
hand, we will have a generation of the profession of phar- 
macy, the patient will be assured of obtaining uniformly re- 
riable compounds, and the physician will be reasonably sure 
of secvring concordant results, with given substances under 
similar conditions. — From the Bulletin of the American 
Pharmaceutical Association. 






VOL XIV. BATAVIA, MARCH 20th, 1908. NO. 3 


By Edward Mikkelson, 

College of Physicians and Surgeons, Class '09. 

Acute obstruction of the intestines of the non-infectious 
type is usually caused by strangulation, intussusception, 
volvulus, stricture, intestinal paralysis of foreign bodies. 

The cardinal symptoms of acute obstruction are abdom- 
inal pain, vomiting and obstinate constipation. 

The pain, which may be in any part of the abdomen, 
generally comes on during movement or exertion. It is at 
first collicky and intermittent in character, but when steno- 
sis is complete becomes continuous and intense. Abdomi- 
nal tenderness, absent at first, may become excessive. Con- 
stant and distressing vomiting soon ensues; gastric at first, 
then biliary, then becoming fecal. 

Constipation may be present from the onset,, but often 
the contents of the intestine below the point of obstruction 
are evacuated, after which no fecal stools are voided. Tym- 
panites makes its appearance from the second to the sixth 
day. It is most marked when the obstruction is in the colon, 
and slight when the obstruction is high up in small intes- 
tine. Tumor is rare except in intussusception, Tenesmus 
is frequent if the obstruction is in the colon, especially if 
there is intussusception, less often in volvulus and stricture. 
Excessive peristalsis may be seen accompanied by audible 
rumbling, gurgling and splashing sounds. 

The general symptoms are well marked and grave from 

106 * The Plexus. 

the beginning of the obstruction. They are prostration,, 
palor, an anxious expression, cold sweating skin and a nor- 
mal or sub-normal temperature; rarely a slight fever may 
exist, but usually late in the disease. Thirst is extreme, 
the tongue is dry, the respiration is accelerated and the 
pulse feeble and rapid. The urine is scanty and high col- 
ored and may be suppressed. 

The duration of acute obstruction is usually from two to 
six days, the patient becoming comatose or dying from ex- 
haustion, or in very acute cases from collapse. 

The complications from acute obstruction may be catar- 
rhal, diphtheretic or suppurative inflammation of the mu- 
cous membrane, with localized peritonitis in the immediate 
vicinity of the obstruction. The condition continuing, gan- 
grene or ulceration with perforation and resulting diffuse 
peritonitis; or pyemia may further complicate the condition. 

The existance of obstruction having been determined 
by the cardinal symptoms, it becomes desirable to ascertain, 
if possible, the sight and cause of the obstruction. Is it in 
the small or large intestine? 

In general, if in the small intestine, vomiting, soon be- 
coming fecal, is an early symptom and the tympanitic dis 
tention is not prominent or may be slight. If the obstruction 
is high up in the duodenum or jejunum, the meteorism is 
slight, fecal vomiting may not be marked, indicanurea is 
common? collapse and suppression of urine occur early and 
rapidly. If in the ilium the distension is greater, is mani- 
fest mainly in the mid-abdomen and fecal vomiting is an 
early symptom. 

If the obstruction is in the colon abdominal distension 
is marked, fecal vomiting is much less frequent and in- 
dicanurea is seldom found. If the obstruction is in the 
lower end of the ilium or in the caecum, inspection may 
show the ladder pattern of tumidity in the lower mid-abdo- 
men; if in the rectum or sigmoid flexure of the colon the lat- 
ter may stand out prominently in. a horseshoe shape around 
the upper and lateral oortion of the abdomen, and tenesmus 
with the passage of ulood and mucous may be present. 

Acute Intestinal Obstructions. 107 

Abdominal examination may reveal a tumor or swelling, 
but this is rare except in intussusception or fecal accumula- 
tion. Digital examination of the rectum may disclose the 
existance of a tumor or stricture and will show whether the 
lower bowel be full or empty. Information may be gained 
by noting the amount of water that may be injected into the 
bowel under anesthesia with the patient lying on the back 
and the hips elevated. Normally in an adult, six quarts, 
while in an infant one and one-half pints will be retained 
under a pressure of three feet. Unless more than three 
pints will enter in an adult, obstruction at the sigmoid 
flexure cannot be excluded. Auscultation over the caecum 
may be employed to determine the arrival of fluid at this 

The causes of acute obstruction are found to obtain in 
about the following propertions: Intussusception 35 per 
cent., strangulatian 35 per cent., volvulus 15 per cent., gall- 
stone 8 per cent., stricture 6 per cent. 

Most cases of acute obstruction are due to strangulation 
or intussusception, less commonly to volvulvs. 

The following points may be of some assistance in de- 
termining the cause of the obstruction. Strangulation is 
commonly due to adhesions from previous peritonitis or 
laparotomy; next most commonly to Meckel's diverticulum, 
the free end of which may become adherent to the abdomi- 
nal wall and the intestine riding on or becoming wrapped in 
it. The appendix or fallopian tube may act in the same 
manner in producing strangulation. Looping of intestine 
through omental or peritoneal slits, or the forumen of Win- 
slow, or the occurrence of diaphragmatic hernia or the me- 
chanical action of pedunculated tumors may all lead to 

Strangulations usually occur in males between the ages 
of fifteen and thirty years. 

Intussusception is usually due to irregular peristalsis, 
the upper gut invaginating into a lower portion. In 75 per 
cent, of cases the ilium enters the caecum. This usually oc- 
curs in children, 56 per cent, of cases occurring before the 

103 The Plexus. 

tenth year. The onset is acute, there is tenesmus with mu- 
cous and bloody stools, and a sausage-shaped tumor can 
generally be palpated at the location of the obstruction. 

Volvulus, a twist, usually axial and in 87 per cent, of 
the cases involving the large intestine, and caused by vio- 
lence or trauma. Sixty per cent of the cases occur at the 
sigmoid flexure and 33 per cent, about the caecum. Volvu- 
lus may occur in persons having messenteries of exceptio- 
nal length. 

A large gallstone may ulcerate into the intestine and 
cause intermittent acute obstruction as it passes down. 

Strictures may occur from dysenteric, tubercular and 
syphilitic ulcers and then cause acute obstruction. 

Paresis, as a result of sepsis, peritonitis, or trauma, or 
following a surgical operation or from pressure due to vol- 
vulus, strangulation or intussusception may cause acute ob- 

Finally there are miscellaneous and rare causes of ob- 
struction such as foreign bodies, glass, hair stones, false 
teeth, enteroliths, fruit stones, thread and other substances, 
any of which may be the acting cause of obstruction. 


By Mark T. Goldstine, M. D., L. M. (Rotunda). 

The cause of placenta prsevia is not definitely known, 
but it is most probably due to a low inplantation of the 
ovum and to the involvement of the decidua vera. That 
these conditions result from endometritis is almost certain 
since they seldom occur in primapara, but happen most fre- 
quently in women who have borne many children in rapid 
succession or in those who have had abortions and in those 
who are suffering from chronic metritis. When the ovum 
enters the uterus it usually adheres to the part of the mu- 
cous membrane prepared for its reception, or lodges in a 
cleft in the membrane. But if this membrane is diseased 
and so rendered unsuitable, instead of being detained in the 
neighborhood of the Fallopian tube, the ovum drops down 

Placenta Praevia. 1(3 

and becomes implanted in the lower uterine segment. With 
the development of the ovum and placenta in the lower 
uterine segment, this portion of the uterus becomes very 
vascular and contains many large blood vessels, notably the 
vessels at the placental site. 

If these vessels are torn through, the result is a violent 
hemorrhage. These hemorrhages usually start about the 
seventh or eighth month of pregnancy, at first slight, but 
always recurring with increasing severity. 

Hemorrhage is the only symptom and the chief danger 
in placenta praevia, and hence to arrest or control this 
hemorrhage is the chief duty of the medical attendant. In 
order to do so successfully, he must carefully consider the 
conditions which are present. In cases of placenta praevia 
the os on examination is apparently very dilatable and con- 
sequently gives the idea that the foetus could easily be ex- 
tracted per os, but when the procedure is attempted it is 
found that extraction of the foetus is accomplished only 
through a thin and easily ruptured portion of the uterus. 

Hence, instead of dilation of the cervix, there results 
lacerations and hemorrh&ge from this highly vascular por- 
tion of the uterus, impossible or very diffiult to control. 
The high mortality of placenta praevia is due more to a dis- 
regard of the above facts and consequent improper treat- 
ment than to the inherent dangers of the plancent praevia 

The chief causes of death are hemorrhage, septic infec- 
tion, air embolism, lacerations 'of the cervix and lower uterine 
segment in attempts to deliver the child through an undilat- 
ed os or from the use of the vaginal plug, which very im- 
perfectly controls hemorrhages and hence materially in- 
creases the loss of blood and life. 

The method introduced by Dr. Robert Barnes is more 
scientific and more successful than version, but it entails un- 
necessary fingering of the placental site and so is not in ac- 
cordance with modern views of aseptic midwifery. 

The modern treatment of placenta praevia is simple and 
effective, and the treatment recommended by Dr. W. J. 

110 The Plexus. 

Smyly in a recent communication. 1. It is the method used 
in ten cases which came under my care, three of which are 
reported in this paper, all the mothers lived and eight 
children lost. The method consists in rupturing the mem- 
branes and bringing down a foot at the earliest possible 

By this method the back and buttocks of the child by 
pressure upon the placenta, act as an efficient and antiseptic 
plug, and since the membranes are ruptured no further 
separation of the placenta takes place. 

The great advantages of this method are that it com- 
pletely arrests the hemorrhage and that it requires but slight 
manual interference; moreover, all manipulations are within 
the membranes, and the child is not extracted, but its expul- 
sion is left to nature, so that the cervix .is not torn. The 
uterus remains firmly retracted and there are secure and 
firm coagula' formed in the placental vessels. In carrying 
out the. operation, the patient is placed on her back and 
deeply anaesthetized. The vagina should be rendered as 
aseptic as possible by washing out thoroughly with a mild 
solution of creolin. Carbolic and corrosive sublimate should 
not be used as they are dangerous, owing to the close prox- 
imity of the open blood vessels. If the foot does not present, 
the child should be turned by external manipulation, and if 
this fails, then by the Braxton-Hicks method. 

The foot is brought down and secured with a piece of 
gauze. Very little traction is required, only sufficient to 
control hemorrhage. In no case should the child be extracted 
but the expulsion left to nature. The results of this method 
in the Rotunda Hospital of Dublin, for the past ten years, 
show the following results, in an article published by Dr. 
Lyles, in a recent number of the British Medical Journal. 
One of the 76 cases died after practicing version and extrac- 
tion, from hemorrhage. Of the remaining 75 there were 
three deaths, or a mortality of 4 per cent., but not one of 
these was from hemorrhage. Two were septic on admission 
and one died of pulmonary embolism on the tenth day* 

Dr. Strassman, of the Charite Hospital, Berlin, gives 

Placenta Praevia. Ill 

the following statistics of cases of placenta praevia treated 
by abdominal manipulation, bringing down the foot and 
leaving the expulsion of the foetus to nature. This mortali 
ty was only 2.45 per cent. The same method with bipolar 
version, 8.6 per cent. In version, by extraction, 20 per 

There are two exceptions to the above treatment: First, 
when the head has passed the os and can be safely delivered 
with forceps; and second, when the os is not sufficiently di- 
lated to admit two fingers. 

In the latter the vagina should be plugged for two or 
three hours and then removed, when the os will be found 
sufficiently dilated to permit version being done. 

Of the following three cases not one had the advantage 
of being in a hospital. 

Case I. Jane B., age 27. Third pregnancy. Previous 
history negative. Slight hemorrhage two weeks before ex- 
amination. Uterus about the size of a seven months' preg- 
nancy. Child lying in transverse position. No foetel 
heart' beat. Vaginal examination showj cz the size of a 
dollar, membranes entact, hand presenting, margin of pla- 
centa felt just above the internal os. Diagnosis was made 
of placenta praevia. Patient had considerable hemorrhage 
and a few slight pains. External version was performed 
and part brought down and delivery left to nature. Hem- 
orrhage ceased. Child born dead in four hours. . No post- 
partum hemorrhage. Normal puerperium. 

Case II. Kate O'C, age 27. Fourth pregnancy. Pre- 
vious history negative. No history of previous hemorrhage 
during the pregnancy. Patient had a little bleeding on ris- 
ing the day of examination. Saw patient at 11:30 p. m. 
She was bleeding profusely with pulse 130 to 140. Exami- 
nation showed os the size of a dollar, with the head present- 
ing, while on the right side was a large mass of placental 
tissue. Diagnosis of lateral placenta praevia was made. 
Same treatment as case one, with child born in eight hours, 
dead. Slight post-partum hemorrhage. Normal puerpe- 

112 The Plexus. 

Case III. Margaret M., age 35, fifth pregnancy. Pre- 
vious history negative. When seen patient was having only 
a slight hemorrhage, but up to half an hour before had been 
bleeding profusely. She was exsanguinated and very weak, 
pulse 140 to 150. Uterus indicated eighth month of preg- 
nancy. No foetal heart heard. Os admitted three fingers 
easily and was entirely filled with placenta. Head present- 
ing. Diagnosis, central placenta prsevia. Same treatment 
as cases one and two. Hemorrhage ceased as soon as 
foot was brought down, and child was born seven hours 
later, dead. In this case the child came through the pla- 
centa, the membranes being in the form of a perfect sac. 
No post-partum hemorrhage. Normal puerperium. 
IOC State*Street. 


.By Fred C. Zapffe, M. D., Chicago. 

From the service of Dr. Alex. Hugh Ferguson, at the Chicago Hospital. 

Hazel L., aged three years, presented herself with a 
very marked talipes equinovarus (Pig. 1), which an opera- 
tion, done about one year previously, failed to relieve. The 
case was a typical one, and a careful examination showed 
that any attempt at correcting the deformity by means of 
casts or other apparatus would entail the loss of much valu- 
able time without yielding any result. Therefore, an opera- 
tion was advised and consented to. 

The tendo Achilles and plantar fascia were cut in the 
usual manner. Next, a curved incision was made, the con 
vexity pointing down over the dorsum of the foot, extending 
from about one inch above the external malleolus downward 
across the dorsum of the foot as far as the middle of the 
metatarsal, and ending on the inner side of the first meta- 
tarsal, extending through the skin to the deep fascia, expos- 
ing the tendons of the flexors of the ankle joint and the an- 
nular ligament. This incision serves to give easy access to 
all of the tarsals and metatarsals, as well as to the ankle 

The head of tie astragalus was excised with an osteo- 

Talipes Equinovarus. 


tDme through a slit between the tendons so as not to injure 
the tendon sheaths or ligaments, and a V shaped mass was 
removed from the tarsus, irrespective of the joints that 
might be invaded, the bones included in the mass being the 
external and middle cuneiform and portions of the cuboid 
and scaphoid. As the result of this procedure, the foot easi- 
ly was made to assume an everted position, slightly beyond 
the normal. The borders of this incision were brought to- 
gether firmly with several heavy catgut sutures passed 
directly through the bones. 



£'-Y'-;-.v> '.;"":. i : V. 

Fig. 1 

This having been accomplished, the next step in the 
operation was to transplant the tendon of the tibialis anticus 
from its insertion in the head of the first metatarsal to the 
external side of the fifth metatarsal at its proximal end. The 
tendon was severed close to its insertion into the bone and 
was diverted in its course, pulling it out from under the 

The Plexud. 

anterior annular ligament, on the inner side of the foot, 
passing it to the outer side over the tendon of the external 
longus digitorum back under the annular ligament. A groove 
is made for the tendon in the astragalus, the groove being 
lined with fascia taken from the adjoining tissues. A few 
firm catgut stitches securely fastened the tendon to the fifth 
metatarsal, just to the outer side of the attachment of the 
tendon of the peroneus tertius and in front of the point of 
attachment of the peroneus brevis. 

Fig-. 2 

The foot was dressed in an over corrected position and 
a plaster of Paris cast applied over a starch bandage. 

The subsequent course of the case was an uneventful 
one, the patient leaving the hospital in excellent condition 
and with a foot that to all intents and purposes was normal, 
(Fig. 2). 

Heart Complications of Scarlet Fever. 115 


By I. H. Eddy, M. D. 

Associate Prof. Gynecology Illinois Postgraduate Medical School, In- 
structor Gyneeolog-y College Physicians and Surgeons, Med. Dept., 
University 111. Assistant Surgeon Marion Sims Hospital. 

Reprinted from American Journal of Obstetrics- 
Ill reviewing the literature of the Heart Complications 
of Scarlet Fever, I am convinced that the heart has not re- 
ceived the attention which an organ so important, and, in 
my judgment, so frequently involved, should receive. One 
cannot but notice the extensive study that has been devoted 
to the Kidney of Scarlet Fever and the meager attention 
that has been given this important organ of which I speak. 
While there may be those who will not agree with me on 
what I have to say on the subject, I am sure that a careful 
future study will reveal many a hidden fact. 

Wm. Hunter, in a clinical lecture on complications of 
scarlet fever (British Medical Journal, 1906, vol. 421), in his 
group of 150 cases gives 

Adenitis. 19 per cent. 

Actual Nephritis . . ..... 2.8 " " 

Otitis 6.4 " " 

Rheumatism 4.3 " " 

and many other complications in small percentages, but does 
not give any report on the various heart lesions; the im- 
portant emphysis being directed to "Oral Sepsis'', and its 
relation to other complications. 

L. Fischer, in a paper entitled Clinical Observations 
with Special Reference to the Heart and Other Complications 
{New York Medical Journal, Vol. 80, page 1160), says: ''More 
attention should be directed to the heart as manifested by 
the pulse, and less to the temperature as a guide to a prog- 

He reports a very interesting case to bear out his state- 
ment, which I have considered worthy of quotation: 

E. K. — female, age five years; vomiting followed by the 
eruption of scarlet fever, covering the entire body, the rash 

*Read before North Branch Chicago Medical Society. 

116 The Plexns. 

being distinct for three days. The child was up during the 
second week and was given a liberal diet. On the twelfth 
day she had a sinking spell and evidence of heart weakness 
was^noted. She was seen on the twenty-first day of the 
disease by Dr. Fischer, who found a marked decrease in the 
amount of urine, edema, and the characteristic appearance 
of acute nephritis; the temperature was 100°, heart sounds 
muffled, pulse slow and irregular. Myocarditis was deter- 

J. F. Luhan (American MedicalJournal, September, 1906) 
reports 129 cases without a death or severe complication F. 
McEwen {Pediatrics, N. Y., 1905, Vol. XVII, page 343) says: 
"Endocarditis does not seem to be common; however, it is 
insidious in its onset and easily overlooked." 

Anne Sturges Daniel {Jour. Amer. Med. Assn., Vol. 34, 
page 536) reports 450 cases: Three hundred and four mild 
cases all made complete recovery, except three, which were 
left with permanent endocarditis. The heart was carefully 
examined at frequent intervals during the first five days only. 
Sixty-six cases presented an endocardial murmur, disappear- 
ing entirely in sixty-three. Six cases presented persistent 
irregular heart action. A number of cases with dyspne and 
sudden death were attributed to edema of the lungs. Endo- 
carditis without other complications was present in two 
cases. Endocarditis and nephritis in three cases, the endo- 
carditis appearing first. Endocarditis and chorea in one 
case, the former appearing three days before the chorea. 

Hatfield {American Text) says: ''Cardiac dilatation, en- 
docarditis and pericarditis should be guarded against in 
scarlatinal nephritis." Alfred R. Spencer (Lancet, 1905) re- 
ports a case of endocarditis with pericarditis treated with 
antistreptococcic serum, with recovery; also a case of acute 
pericarditis coming on early in the acute stage, being rapidly 
fatal, the blood showing a pure culture of the streptococcus. 

Silbermann quotes the following (Jahrbuch Kinderheil- 
kunde, Vol. XVII, 1881-1882): "Bamberger, in 67 cases of 
acute scarlatinal nephritis found fifteen cases of enlargement 
of the heart and four of dilatation. 

Heart Complications of Scarlet Fever. 117 

Friedlander found by anatomical examination in a great 
many cases of scarlatinal nephritis, that the heart was hyper- 
trophied in nearly all cases and combined with dilatation in 
many, being most marked in the left ventricle. In these 
cases the increased weight of the heart averaged 40 per cent. 
He found the hypertrophy to be due to three causes — 

1st — Changes in the capillaries of the kidneys. 

2nd — Impairment of the function of excretion. 

3rd — Retention of urinary salts. 

Gerhardt and Beneke found that the heart at birth is 
relatively greater and decreases up to the third year, when it 
reaches the minimum. Between the third and seventh years 
it again becomes relatively larger and it is not infrequent to 
find the apex beat outside of the mammary line — a point to 
be remembered in examination. 

Goodhard reports five cases of acute dilatation with four 
deaths, the diagnosis being confirmed by postmortem. 

In two hundred and twenty-five deaths during the recent 
epidemic in this city I found one hundred and thirty various 
complications, forty of which were diphtheria. 

When it came to affections of the heart, simple endocardi- 
tis was reported but three times, ulcerative endocarditis once, 
acute dilatation three times, dilatation and hypertrophy once, 
and under the heading of heart complications, three. 

These facts in themselves are sufficient to convince the 
most skeptical that heart complications are not observed in 
a large percentage of cases. If so, what was the real cause 
of death in these cases? Which vital center gave way to the 
toxemia of this disease? 

We know that myocarditis is especially to be dreaded in 
diphtheria, and I also maintain in scarlet fever (it being 
generally accepted as a streptococcus infection); yet diph- 
theria was given as complicating forty of these cases, and 
myocarditis was not mentioned in any of them. 

What are the productive factors of heart complications? 
The two important factors mentioned by many of our best 
authors are the toxemia of the pyrexial stage and the late 
toxemia of nephritis; to these, however, I wish to add several 

118 The Plexus. 

additional factors which seem worthy of mention: 

1. Exertion, which may be manifested in many ways. 
It is not at all uncommon for light cases to be overlooked, 
and being constantly on one's feet is a strain that many 
hearts cannot withstand. There are other cases of a severe 
nature that remain up and around for a short time only, as 
one I report, i. e. , a young man walked into my office with 
the disease well marked, and when questioned said he had 
noticed the rash for two days, during which time he had 
been working. 

2. Vomiting, when persistent, may be an important 
factor; it was present for six days in one of my cases, and I 
think was productive of dilatation. 

3. Toxemia of Complications. We have but to give scar- 
let fever a thought to appreciate the fact that it is a septic 
disease throughout, and it would seem that the toxins arising 
from the various complications and especially from oral 
sepsis are very important in the production of heart compli- 

4. Rapidhj Developed Anemia which materially interferes 
with the nutrition of the heart muscle. 

5. Actions of Tonins upon the cardiac nerve supply. 
Harley, in his observations was struck by the frequency 

with which he found fibrinous clots in the heart and great 
vessels during the pyrexial stage. This, he states, is the 
most common cause of death during the early part of the 
disease, and is indicated during life by the sudden reduction 
of a full pulse of about 120 to a running pulse of a much 
higher rate, of imperceptible character, and usually attended 
with orthopnea and delirium, due to the obstruction of the 
pulmonary and cerebral circulations. On opening the body 
immediately in these cases, and while the warm blood was 
still fluid, the right heart was found distended with fluid 
blood and a bifid clot extended into the great vessels. 

In thirty-nine cases of endocarditis and pericarditis re- 
ported by West, six were due to scarlatina. 

The profession seems to be of the opinion that nephritis 

Heart Complications of Scarlet Fever. 119 

is the great factor to be dreaded in the production of heart 

Is it not an indisputable fact that the heart is an in> 
portant factor in the production of nephritis? I maintain 
that in heart complications, and especially in myocarditis, 
where the tension is extremely low, we may have a passive 
congestion, with all the symptoms of a nephritis which may, 
with the aid of the toxins of the disease, induce an acute 
nephritis, which in turn aggravates the heart condition. 
This is well illustrated in the case reported by Fischer. 

In what way are the various heart conditions manifested? 

There may be no indication of the impending danger in 
these cases; acute dilatation is no doubt the cause of sudden 
death, and is the true factor, instead of enema of the lungs, 
so frequently mentioned. 

However, in most cases that are carefully and frequent- 
ly examined, some or many of the following symptoms will 
be noted: A weak, irregular pulse, which may be increased 
or exceedingly slow, with very variable tension; extreme 
sudden pallor of the face and extremities and at times cya- 
nosis, especially around the mouth and tips of the fingers. 

There may be precordial pain, although the pain may 
be referred to the ensiform cartilage or upper part of the 

One symptom I consider extremely important, and no 
doubt the one that causes a failure in diagnosis of many 
cases, is the sudden change from a rather strong', full, quite 
regular pulse to one of irregular rhythm and variable or al- 
most imperceptible tension. 

A rise in temperature is an important symptom in endo- 
carditis and pericarditis, but is not usually seen in myocarditis, 
unless the myocarditis be of a septic nature or some other 
complication be present. 

Murmurs are frequently found; are usually systolic in 
time, of a soft, blowing character, and heard most distinctly 
at the apex; however, it is not uncommon to hear them 
over the entire chest, and completely obliterating the first 

Pharmacy. 120 

In myocarditis the first sound may be shortened and the 
second sound weakened. In endocarditis we usually find the 
second sound accentuated unless myocarditis is present as 

True murmurs are due to two causes — either endocarditis 
or dilatation resulting from myocarditis. 

Restlessness and anxiety are often present, especially 
in nervous individuals. 

The apex beat may be displaced, diffuse, indistinct or 
entirely absent. 

There may be an increase in the cardiac dullness, which 
is du& to dilatation, pericarditis with effusion, or hyper- 

One may feel assured that myocarditis is present if the 
pulse is of a weak running character, irregular in rhythm 
and quality; if the heart tones are muffled, the apex beat 
diffuse and indistinct and cyanosis or extreme pallor occur. 

Tachycardia with irregularity, variable tension, slight 
temperature and a soft blowing murmur heard at the apex 
are pathognomonic of simple endocarditis. 

Should temperature be irregular, and a leukocytosis be 
present, unless explained by other conditions, we may be 
sure that the endocarditis is ulcerative. 

A weak running pulse, increased cardiac dullness, diffuse 
indistinct apex beat, and a systolic murmur are indicative of 
myocarditis with dilatation. 

Pericarditis should be suspected when we have an in- 
creased triangular area of cardiac dullness, muffled and 
distant heart tones, an apex beat which is diffuse, indistinct 
or absent, precordial pain, and should we be able to elicit a 
friction fremitus synchonous with the heart tones, the find- 
ings are pathognomonic. 

Acute dilatation is much more frequent in adults than in 
children, and is explained by the fact that in children we 
have a more running pulse with a lower tension, which gives 
the heart a better opportunity for hypertrophy. 

Before entering into the consideration of prevention and 
treatment, I wish to present the following cases: 

Heart Complications of Scarlet Fever. 121 

No. 1. — R. C , male, age 16. Has always been in perfect health. 
Was seen January 19, with severe vomiting. Temperature 104.6 . Pulse 
135. Marked angina. Heavy scarlet rash covering the entire body, 
which remained visible for three weeks. The temperature and pulse 
continued rather high for four days, after which it fell rapidly to normal, 
with no secondary raise. The vomiting was persistent for six doys. Until 
January 25 the pulse had been quite good. January 26 it dropped to 48, 
because irregular, variable tension. Examination showed weak diffuse 
apex beat, increased dullness, systolic murmur at the apex and at times 
cyanosis of the lips and fingers. It is evident that myocarditis with di- 
latation was present. From January 27 to February 3 the pulse rate was 
from 40-60, remaining in the 4os most of the time. February 4, pulse 38; 
patient cyanotic and evidence of collapse. February 5-16, no great 
change was noted, the pulse still remaining exceedingly slow and at 
times very irregular. By February 21 the murmur had disappeared ; nd 
pulse rate was nearly normal. The patient sat up ten minutes on the 21, 
the pulse rising to 84. February 22, sat up fifteen minutes, pulse varying 
from 52 91. On 23d, sat up again fifteen minutes, pulse rising to 93, the 
murmur reappearing. It was evident that the heart was unable to 
withstand the additional strain. The patient was again kept in bed for 
eight days, the murmur rapidly disappeared, and beginning on March 3 
he was allowed to sit up a few minutes at short intervals without any 
material effect upon the pulse rate and nothing further of importance 
was noticed. 

No 2. — L. McD., female age 6. Always well until last June, whtn she 
had a mild attack of mumps. Last October she had diphtheria, at which 
time a myocarditis developed. On February 8 she did not seem well, 
but was playful. February 10 I saw her and found temperature 103°, 
pulse 120, good quality, angina, and the rash of scarlet fever well out, 
which remained distinct for three days. The temperature gradually 
lowered and the angina cleared up radidly. Nothing unusual was noted 
for about a week, when extreme pallar at times was seen. On examin- 
ation the apex beat was indistinct and weak. No temperature. Pulse 
slightly increased and quite irregular. A few days later she began to 
show some temperature and a soft blowing- systolic murmur heard at the 
apex. A diagnos's of myocarditis and endocarditis was made, the 
symptoms gradually incrersing in severity. On the 19th, 20th and 21st 
dav of the disease the pulse became very irregular and ranged from 70 
to 1» On the 22nd, temp3rature 100, pulse 116, very irregular, and 
tension quite variable. The systolic murmur was marked and heard 
over the entire cheat, and a diastolic murmur of extremely high pitcn 
was heard in the aortic region. Blood count showed: Reds, 4,050.000: 
whites, 6,800. Thi9 condition persisted until the 27th day. From 27th 
to 30th day a decided improvement was noted. Again on the 31st day 
the pulse became very irregular and increased, murmurs become more 

122 The Plexus. 

distinct for two days. A few days later another relapse occurred, th& 
patient running some temperature and a variable pulse. The 14th week 
the patient was allowed to get up, the murmur having entirely disap- 

No. 3 — Miss W. O., nurse. Had most of the diseases of childhood. 
Typhoid fever at age of ten and recurrent attacks of appendicitis since 
that time. January 19 she was called to nurse case No. 1. January 23 
she developed scarlet fever and was sent to the Cook County Hospital. 
On arriving, temperature was 104°, pulse 132, reaching 160 during the 
first night and becoming imperceptible several times. During the 
second day there was evidence of collapse. A diagnosis of myocarditis 
was made by Dr. Baum. 

No. 4. — C. G.. male, age 33. At age of 21 had la grippe. One year 
later had an attack of appendicitis, but was not operated. Otherwise 
has always been well. On February 13 he visited my office. On ex- 
amination the symptoms of scarlet fever were well marked, and on 
question. ng found that the rash had been present two day. Tempera- 
ture at the time being 100.2, pulse 108. Third day complained of pain in 
the left side. Sixth day pulse varied from 60-96, irregular; slight 
temperature. Weakness and restlessness present. Cardiac dullness 
greatly increased; apex diffuse and indistinct. Eighth day pulse very 
irregular, hands and feet cold and clammy. Patient much depressed. 
Ninth day apex beat outside nipple line; no murmur present. Increased 
dullness was noted in transverse and vertical diameters. Heart tones 
distant. Tension of right radial artery much lower than left. Myocar- 
ditis and pericarditis with effusion were evident. Eleventh day com- 
plained of precordial pain. Apex beat not obtainable. Thirteenth day 
pulse increased from 60 to 110 in one hour, becoming very irregular 
throughout the day. Fifteenth day at 2:15, pulse 68 and regular: at 2:30, 
pulse 90, very irregular and compressible. Sixteenth day, dullness not 
so marked; pulse slightly irregular. From this time gradual improve- 
ment was noted until 20th day, when patient had sinking spell; pulse 
64-90, becoming very irregular, and evidence of collapse. Since that 
time gradual, improvement has been seen. 


I feel that justice cannot be done this phase of the sub- 
ject without entering to some extent into the treatment and 
general management of the cases as well as some of the 
complications, as it is upon these factors largely that affec- 
tions of the heart depend. I shall limit myself to the most 
important conditions. 

First. As soon as the diagnosis is made these patients 
should be put to bed for at least three weeks, no matter how 
slight the affection may be, as we often have the most severe 

Heart Complications of Scarlet Fever. 123 

complications with the mildest attacks. Late nephritis is 
especially frequent and one of the prime etiological factors 
of heart lesions. 

Second. The diet should be strictly liquid — milk to be 
preferred, although gruels and broths are quite permissible. 
At all events the patient should take freely of water. 

Third. Antipyretics should not be used for two reasons 
— 1st, because they are not needed in the mild cases; 2nd, 
because they are too depressing to be used in the severe 

We should depend upon the cold sponge, the pack or 
the evaporation bath, if necessary, but do not think it wise 
to use the tub bath, because of the fear and strain connected 
with its application. 

Fourth. Special attention should be given to oral sepsis, 
for not only is it a constant generator of toxins, but also the 
important factor in producing adenitis, cellulitis and otitis 
media that we so frequently see, and which still further en- 
danger the heart. 

In addition to the gargles and sprays generally used 
these cases should receive frequent nasal irrigation (best 
with a fountain bag) of normal salt solution, 2 per cent, boric 
acid solution, or bichloride of mercury, 1: 10,000 to 1: 6,000 — 
the child lying on his abdomen, the mouth being kept open 
to prevent swallowing. 

Fifth. The skin should be kept soft and active by the 
frequent use of baths and the application of lard or lanolin 
containing from one to two per cent, carbolic acid, which 
destroys the scales and relieves the itching so frequently 

Sixth. The bowels should be watched closely through- 
out the disease, calomel being administered at the beginning 
and at intervals throughout the attack. Salines are of value 
and one should not forget the importance of daily colonic 
flushings with normal salt solution. 

Seventh. It is my custom to use mild non-irritating 
diuretics throughout the disease, such as spirits of nitrous 
ether, or liquor ammonii acetatis, and in the ten cases I have 

124 The Plexus. 

treated during the recent epidemic I have not even found a 
trace of albumen, with careful watching. 

Eighth. When vomiting is persistent all medication 
should be discontinued for a short period, excepting perhaps 
the addition of lime water to the milk, or some sedative 
powder. ' If the angina is not too severe, lavage may be used 
if necessary. 

Ninth. The treatment of the different heart lesions 
varies so little that I shall take them up collectively: 

(a) Absolute rest upon the back, the pillow being re- 
moved. (&) The patient should be in a large, well- ventilated 
room, care being taken to avoid a draught, (c) A good 
nurse is indispensable, as it is impossible to care for these 
cases in any other way. (d) The ideal diet should be rich in 
albuminous foods, but here we are handicapped by the dan- 
ger of acute nephritis; however, we should feed them as well 
as conditions will permit, (e) The eliminative treatment 
should be the same as given under prevention, unless the 
cases are very severe, when it is wise to dispense even with 
the bath and flushing. (./) In no case should the patient be 
allowed to raise up or turn on the left side, (g) If the pa- 
tient be nervous or restless, this should be controlled by the 
use of morphine in small doses, which is stimulating to the 
heart as well. Should above symptoms be extreme, large 
doses are indicated, (h) The proper use of stimulants re- 
quires frequent visits by the physician and the constant 
watching of a capable, trained nurse, as changes are sudden 
and many times without warning, (i) Strychnia is no doubt 
one of the best stimulants we have for these conditions, and 
should be given in every case, not only for its stimulating 
effect, but for its generative action on the heart muscle and 
nerves as well. (,/) Alcoholic stimulants (especially brandy) 
are valuabe, and should be given in from half -dram to half- 
ounce doses, depending on the age as well as the condition 
of the patient, (k) As conditions are so variable and changes 
so sudden in these cases, we must rely to some extent upon 
the nurse, as it is just as important not to overstimulate the 
heart as it is not to give enough. Camphor is one of the 

Reminescent. 125 

best stimulants we have at our command in these cases, 
which should be given in sterile olive oil. hypodermically, 
in from one-half to one-grain doses. I have seen the heart 
action improve by its use when other stimulants did not 
seem to have any effect whatever. The important features 
about its being given with oil hypodermically, are its slow 
absorption, continued action, at the same time allaying the 
nervous symptoms. The nurse should always have a hypo 
ready for immediate use. (l) Digitalis should not be used, 
especially when we have marked myocarditis, as the con- 
traction of the arterioles increases the tension and favors 
dilatation. However, it may be of value when we have a 
rapid pulse with extremely low tension; the best preparation 
being fat-free tincture or freshly made infusion- (»?) The 
use of the ice bag should not be forgotten where we have a 
rapid, irregular action, (n) Our guide in determining the 
time for the patient to get up should be the pulse and mur- 
mur (if one be present). The murmur should have disap- 
peared and the pulse should not show more than a very 
slight increase from this exertion. Should the pulse show a 
distinct rise it is indicative that the heart is not able as yet 
to withstand the extra strain, (o) The anemia should 
receive its proper treatment with the peptonates or iron and 


A doctor of our acquaintance was once left alone for 
two weeks in a northern mining camp with a large company 
practice on his hands, and not another doctor within twenty 
miles. It was midwinter and very cold. 

The day's work for the doctor did not end before mid- 
night any day of the two weeks, and calls between midnight 
and seven in the morning were not infrequent. After ten 
days of this work the doctor felt . himself to be the most 
tired man in the world. 

The doctor threw himself down on his bed on the night 
of the twelfth day at a little after midnight, feeling that un 

126 The Plexus. 

til he had had several hours of sleep he would be unable to 
answer a call however urgent the case might be. 

Shortly after he had gotten to sleep there came a loud 
knocking at the door, which roused him. He went to the 
window and looking out saw a man on the steps below 
whom, when he looked up, he recognized in the bright 
northern starlight as one of the best Cornish miners in the 

The man said that his wife was about to be confined and 
asked the doctor to come to his house. The doctor- said 
"all right, I'll be up," then turned back into the room and 
closed the window. As he stood listening to the crackle of 
the miner's boots on the frozen walk the doctor shivered 
from cold and tire and was miserable. He got into bed for 
a minute to get warm. At seven o'clock he awakened and 
jumped out of bed with the realization that he had neglecte 
a patient in a trying and dangerous ordeal, and his sense of 
guilt nearly overpowered him. His first impulse was to 
hurry to the home of the patient, but while he dressed he 
argued that if anything alarming had occurred they surely 
would have sent for him again. He knew that there would 
be many patients at the office for dressings and to leave 
messages to call and that he had a hard day's work ahead. 
He decided to keep the office hour unless sent for in the in- 

At the end of the office hour the doctor jumped into his 
cutter and drove to the home of the patient he had neglect- 
ed. In response to his knock the door was opened by the 
woman he had expected to attend. She looked perfectly 
well and had no appearance of one who might need the ser- 
vices of an obstetrician. 

The doctor still wonders if he really dreamed that call. 


The doctor was tired and irritable after many days and 
weeks of strenuous work and many nights of broken rest. 
At 1 a. m. a heavy pounding on the door awakened him and 
on going to the window he saw a night-shift man from the 
mine with an injured hand. He called to the man that he 

Eeminescent. 127 

"would be down in a minute and closing the window proceed- 
ed to put on some clothes. The pounding was renewed with 
increased vigor. Again he called out of the window that he 
would be down in a minute. The window was barely closed 
when the pounding was resumed. This was repeated until 
irritability gave way to madness and the doctor opened the 
window and poured into the startled ear of night a volume 
of invective of such profane wealth as he has never himself 
heard before or since. Then he hurried down and opened 
the door prepared for any emergency. He found the patient 
with an injury to the hand and — stone deaf. 

A. R. J. 

Government Control of Matters Medical. — During the 
past few years, a certain element of the American people 
and even some educated physicians, have been clamering 
with more spread eagleism than sound sense, for federal 
control of matters of public health and medical licensure. 
To those in the least conversant with legal affairs or those 
reasonably informed as to the origin of the national govern- 
ment or the context of the constitution, it is unnecessary to 
say that the changes advocated are absolutely impossible 
without constitutional amendment. True, amendment was 
secured to the constitution at the close of the war of the re- 
bellion, to define the social status of the negro, but that it 
could now be obtained to provide what a few may regard as 
better and more uniform supervision of matters of state 
medicine, is beyond the pale of any conceivable reason. 

But even if such amendment could be had for the ask- 
ing, do we really want it? Morefield Story, former presi- 
dent of the American Bar Association, and Burke Cockran, 
of New York, in noteworthy addresses at the Jamestown 
Exposition, urged above all other things that no change be 
made in the constitution which would in any way abridge 
the rights and powers of the individual states or give more 
power to the national government. Patriotic as we all may 
be, we must appreciate that our federal government has 
been bettered by the fact that the various states stood as 
censors over its actions and clothed with enough power to 
do much toward governing themselves. 






Channlng W. Barrett, M. D., Chairman. 

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A. R. Johnstone, M. D., Editor. 


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Nothing is so necessary to the success of an institution 
as enthusiastic good feeling. For its cultivation our col- 
leges have been willing to sacrifice both scolarship and 
physical culture to competative athletics. The price has 
been high, but the results have often warranted this expen- 
diture. Even a million dollars has been expended by our 
colleges rather than forego the conditional elimination of 
foot ball. 

In our institutions fellowship should be cultivated not 
alone between students and teachers, but more especially 

Editorial. 129 

between the Alumni and the resident students and teachers. 
This right relationship is promoted by the clinics and by 
the annual graduation exercises. The various college fra- 
ternities with their resident and intercollegiate dinners and 
meets also hold the old to the new, and the resident to the 
scattered associates. The rousing enthusiasm of a unified 
faculty, student body and alumni can not be resisted. 

Any need of this college can be supplied by the indi- 
vidual action of this triangular force. 

In our recent extension of the equipment of the school, 
the running expenses have far exceded our earning capacity. 
Honest education is always expensive as well as time-con- 
suming. The immediate equipment and construction must 
be for a future ideal and demand. To keep up this stand- 
ard the assistance of the alumni is necessary. 
* * * 

It seems as if every advance in one direction limited 
advance in another. The development of laboratory in- 
struction has ruined reading and lectures. This is wrong. 
The laboratory must have its library. The rule of thumb 
in the laboratory is just as bad as the "my experience" of 
the operating room. A laboratory of one man is as sterile 
of brain stiring power as an operating room of the man of 
such large experience that he does not read. 

The college is fortunate in having so large a medical 
library of most useful literature, but unfortunately few of 
the graduates have been trained in its use or in literary in- 
vestigation of any kind. . 

Man, journals and monographs of value are absent, but 
they could be secured if the need of them was sharply felt. 
As it is our alumni contribute valuable additions each year 
to the shelves. The catalogue is still very incomplete. 
Bound books only are given cards. In time all the articles 
in the great journals should be catalogued. This is especi- 
ally necessary in a student library. Reading makes a pro- 
found doctor, clinical experience makes a ready doctor, 
while the laboratory makes a cock-sure doctor. 

Bayard Holmes. 

130 The Plexus. 



Dr. Matthew Woods, of Philadelphia, in the Journal of 
the American Medical Association, Vol. L., No. 9, reports 
three cases of epilepsy cured by surgical operations per- 
formed for other purposes. One an amputation at the wrist 
for a burn of the hand, one for the repair of an extensive 
incised wound of the thigh received in a fall, and one for 
the removal of tubercular glands of the neck. 

In his comments Dr. Woods refers to the many reported 
cures of epilepsy by a variety of procedures, all of which 
suggest that the effect is produced by the profound impres- 
sion made on the nervous system of the individual by the 
treatment adopted. He ascribes the cures claimed for the 
Corsican method of cauterization behind the ears by actual 
cautery, for many of the trephining operations, for removal 
of "peripheral irritation" after Brown- Sequard, for the ope- 
rations on the genitalia of males and females, as well as for 
the various non-surgical methods used by healers and fakirs, 
not to the specific thing that is done, nor to the necessity for 
such operation, but rather to the profound impression made 
upon the nervous system by the operation or treatment. 
Dr. Woods seems to believe that if there be found any reas 
onable excuse for the performance of a surgical operation 
of whatever kind it should be done in the hope that it may 
incidentally cure the epilepsy or modify its severity. This 
idea is held by some epileptic patients themselves who have 
experienced the effect of shock on their condition. The 
writer recalls some years ago being importuned by an un- 
fortunate young epileptic to bleed him. The young man 
had met with a railroad accident some years previously and 
had had his left elbow crushed. He remained free from 
epileptic seizures for eight months after the injury, and be- 
lieved that the loss of blood at the time was the reason for 
his improvement. 

Shortly before this occurrence the writer had had occa- 
sion to attend an epileptic woman in confinement. The 
labor was protracted and very painful and was followed by 

Editorial. 131 

a terrific post partum hemorrhage. In this case neither the 
shock of delivery nor the hemorrhage with its resultant 
anemia seemed to have any appreciable effect on the epilep- 
sy. The patient had a severe epileptic seizure within three 
weeks after the delivery. 

The deplorable condition of the epileptic and the hope- 
lessness of cure by ordinary medicinal measures would seem 
to furnish excuse for the adoption of any treatment that 
promises relief however unscientific that treatment might 
seem to be, but surgical measures have proved fruitless in 
such a large majority of cases that one must seriously doubt 
their utility. Add to a very natural skepticism of such 
measures the fear that one may be charged with the exer- 
cise of undue surgical zeal and the conservative surgeon 
will be careful not to overstep the bounds of reasonable 

The New Postal Law.— Under the new law which takes 
effect June 1, 1908, no monthly publication will be allowed 
to go through the mails as second-class matter more than 
four months after the time for which it is paid. On the ad- 
dress label of every wrapper is the date to which the sub- 
scripton is paid, and every subscriber may know from this 
why his journal fails to appear, if he does not receive it. 
The publisher is compelled to cancel all subscriptions four 
months after the date to which they are paid. 


Dr. R. M. Swindle, '06, late interne in Washington Park 
Hospital, has located at 63rd St. and Cottage Grove Ave., 

A letter was received from Dr. Eric Bartholomew, '07; 
who is in Florida. He says he likes the country and pros- 
pects for the future, and is doing well. 

Dr. E. J. Danek, '06, has resigned his position as phar- 
macist at the college to accept the same position at the 
Auditorium and give more time to his practice. 

1132 The Plexus, 

Dr. Wm. B. West, '06, has given up his location in Ke- 
waunee, 111., and is looking for one in Chicago. 

Dr. L. M. Schmidt, '06, late interne at Cook County Hos- 
pital, has recently left for the Carolinas. He is getting 
ready to accept a position in the navy which he secured 
some time ago by examination. 

Dr. Rach, '06, late interne of St. Bernard's Hospital, 
has bought the location of Dr. Froom at 39th St. and Went- 
worth Ave., and will locate there. 

Dr. Ford, '06, late interne in West Side Hospital, is lo- 
cated in North Evanston and doing extremely well for a few 
months' start. So well in iact he has taken an assistant, 
Miss Morehouse, a West Side Hospital nurse, whom he mar- 
ried March 3, at the Church of Epiphany, Chicago. 

Dr. Arnold, '07, has located at Paris, 111. He lately 
finished service at Lakeside Hospital. 

Dr. Gilbert Wynekoop, '06, has left Augustana Hospital 
and located on the North Side. 

Dr. Furstman, '07, has moved his location to Taylor and 
Halsted Sts., Chicago. Dr. Furstman is married. 

It is reported Dr. Chas. Ballance, '06, who was holding 
some position in Washington state, has gone east for a little 
post graduate work. * 

Dr. Chas. Howard, '06, who located at Lewiston, 111., a 
short time ago, is reported to be doing very well. 

Dr. Fred Wagner, : 06, who moved to Missouri just a few 
months ago is reported to be doing very well. 


The "Junior Prom," given for us by 49 of the members 
of the class of '09, on the evening of March 2nd, in every 
way proved a decided success. Each Senior able to attend 
reports having spent a very pleasant and profitable evening, 
and praise and appreciation are abundant for the class of '09. 

As a class we herewith again wish to voice our sincere 

Notes. 133 

thanks for each arrangement made in our behalf, for the 
completeness of which we offer our congratulations. 

You have given much to the Seniors, and we extend our 
sincere best wishes for your welfare. May you be as favor- 
ably entertained by the class of '10. 

Thurber has difficulty in maintaining his equilibrium on 
the polished floors. 

Hayhurst presents a trying proposition to the members 
of the Quiz Class by placing the following notice on the 

Notice — "Return 2000 Appendices to library at once." 
Here's hoping we've got but one apiece, Hayhurst. 

At times Seniors will smile without apparent reason, 
but not so with classmate Ziegler. Since the latter part of 
February he is called "Pa," and shows he is very happy 
over the arrival of an 8i pound heir to his material and im- 
material benefits. Our hearty congratulations. May the 
"Junior" in his good time find among men the enviable place 
his father has won for himself by his strong and helpful 
Now that we near the closing days of our college course, 
examinations in college, hospital, state; preparations for lo- 
cations; visits to and bills from the photographer; the ord- 
ering and payment of invitations; all combine to make the 
life of the Senior a very strenuous one. But thanks to the 
ability and labors of our executive committee and our corps 
of class officers, much of the. cares for worry is being simp- 


The research work of the Sophomores has been preg- 
nant with results. Crouch, who by the way advocates rid- 
ing a broncho as very good exercise, on the plea that it 
favors katobolism, reports also that a lesion in the auditory 
center of the brain causes the loss of sight. 

Bentzien was visited by his father several days ago, 

134 The Plexus. 

and thereupon, replenished, he left for Madison. Heeps of 
joy. Joy's gift of speech may be acquired, but most likely 
is congenital. 

Heim and Jacobs are still picking up lemons in the gar- 
den of love. 

Nervous Anatomy — "We can stand it, but not under- 
stand it." 

(Talking from experience.) Donohue remarks that Beer 
contains 2 per cent, alcohol. Evidently he confines his 
statement to picnic beer. 

Quiz Master — "What is saponification?" 
Machlin — "Making soap." 

Dr. Dreyer — "What are the bile pigments?" 
Borchard — (Sentinizing the bacteria on the ceiling.) — 
"Why, there is Billi Rubin, Billi Verden and Billi — some- 
body else. 

Righeimer is still memorizing the Latin name for Cal- 

Carey, well known as a sociologist, is preparing an ex- 
tensive treatise on the subject "Do Married Men Make the 
Best Husbands?" Puley and Parker are supervising the 
work and supplying all deficiencies. 

Grainor, judging from general symptoms and a decided 
inability to study, insists on the existence of the "Bacillus 
Spring Feveralis." 

Question — Why is a woman like a whale? 




P. M. Goodman, Ph. G., C. S. N. Hallberg, Ph. G., W. A. Puckner, Ph.O 

H. H.Rogers, M. D., Ph. B., E. N. Gatherco-J, Ph G., 

A. H. Clark, Ph. G., C. M. Snow, Ph. G. 

CLASS EDITOR: W. D.Mottar, '08. 



By C. S. N. Hallberg, Ph. G., M. D. 

Professor of Pharmacy, School of Pharmacy, University of Illinois. 

In order the better to understand and appreciate what 
should be the relations of the Pharmacist to the Physician, 
it may be well to briefly review the History of Medicine and 
Pharmacy and the origin of the two professions as separate 

During the Galenic Period (130-1600 A. D.) the art of 
medicine consisted chiefly in the endeavor to discover re- 
medies for the cure of diseases. This naturally required 
that the physician would prepare and compound and often 
collect the medicines he employed, and thus was developed 
the vegetable Materia Medica. This practice was-stimulated 
by the search for the Elixir ad longam vita and the Con- 
fection which reached its climax in the Confections of Damo- 
cratus and Andromacchus — the two illustrious body-physi- 
cians of Nero — yet surviving as Theriac also an ingredient in 
the Elixir still remaining as the Elixir Proprietatis or Tinc- 
tura Aloes et Myrrhae. 

During the latter part of this period the search for the 
"Elixir" was also participated in by the Alchemists, in con- 
nection with the finding of the "Philosopher's Stone," which, 

*Lecture No. 2 of Course on Medical Economics delivered to Rush 
Medical College, 1908. 

136 The Plexus. 

when found was expected not only to tramsmute the baser 
metals into gold, but also to give Everlasting Life. 

While the Alchemists did not realize their ambition their 
labors resulted in a vast amount of experimentation upon 
which the Science of Chemistry subsequently developed. 

The Galenic Period was succeeded by the Paracelsic 
Period (1600-19) which introduced mineral substances as 
medicines, beginning with Mercury and Antimony, and with 
their introduction the Materia Medica was vastly augmented. 
The preparation of chemical substances for medical use 
required more time and labor, also skill and experience than 
could be given by the physician, and thus was developed a 
class of specialists who manufactured these chemical sub- 
stances and who also relieved- the physician of himself .pre- 
paring all other medicines that he used. 

The introduction of chemicals and other potent medi- 
cines as commercial articles soon had the effect of being 
taken advantage of by persons — lay and others — for criminal 
purposes and thus we have, "The Era of the Poisoners," in 
Central Europe— one of the darkest pages of the history of 
the Dark or Middle ages. 

A solution of Arsenic, practically similar to "Fowlers 
Solution" became known as Aqua Tofanse in memory of a 
woman named Tofana in Italy, who, at the time she was ex- 
ecuted, confessed to having murdered several hundred 
persons by poisoning them with arsenic. 

This name is a ghastly reminder of that of the New 
England woman Toppan who only a few years ago confessed 
having murdered some thirty persons by administering to 
them poison. 

Poisoning became so common a practice that it became 
a profession, followed by certain families for generations. 
Poisoning was the common practice invoked to get rid of 
"undesirable citizens" either through hate, jealousy or 
greed, as examplified in the lines of the immortal Bard of 
Avon: — 

"Noting his penury to mjself, I said: 
And if a man did need a Poison now, 

Pharmacy. i!-i7 

Wlm.-e s'lle i- present deaih in Mantua, 

I Iere liv.-.s a Caitiff wretch would sell it him." 

— Romeo and Juliet. 


Beginning with the sixteenth century the authorities in 
all the countries on the European Continent employed rigid 
measures to stop these practices. 

First:— Pharmacies were established, who had the sole 
right to handle poisons, and thus became responsible for 
their use and abuse. 

Second: — Physicians were required to order poisons only 
on prescription when used as medicines for their own and 
their patron's protection. 

Because of the exclusive privileges and the immunity 
from competition through restriction on trade, often by limi- 
tation of the number of establishments, this developed into 
a class of highly-educated and trained apothecaries who, as- 
sured of a life-tenure, were largely independent of com- 
mercial considerations. 

While these conditions still exist, of late due to the com- 
mercial tendencies and the encroachment of the large manu- 
facturing interests the apothecaries, in some European 
countries, do not enjoy these privileges as exclusively as 

This rigid control of the sale of poisons and medicine 
was however, possible only in countries where the code is 
supreme as distinguished from those governed by the com- 
mon law. 

Broadly considered, medicine in all its branches and 
practices has not attained as high a status in English-speak- 
ing countries as in the countries on the continent of Europe. 

In the latter, regulations are secured simply through 
the fiat of the authorities, while here and in the United 
Kingdom, such regulations or restrictions must await the 
slow progress of enlightened public sentiment, and the 
treacherous processes of political compromises before they 
can be enacted into legislation. 

This is the fundamental reason why medicine in the 

138 The Plexus. 

United States is not accorded the same privilege and why- 
its representatives do not enjoy the same prestige as they 
do in European countries. 

To prove this we need only compare the status of the 
profession in North America with that south of the Rio 
Grande where the doctor ranks the soldier and often the 

It is for the reasons cited that the relations of the phar- 
macist and the physician have been rather difficult to define. 

While the medical profession has its code governing re 
lations among the members and the public, there is at least 
generally speaking, no written code concerning the relations 
of the pharmacist. 

In the code-countries the pharmacist is hedged about 
with all kinds of rules and regulations, even the amounts he 
may charge for preparing medicines being limited by " law. 
The ancient apothecary in assuming the privilege of a phar- 
macy had, on bended knees, to take an oath in which his 
duties and relations to the physicians and the public, were 
in detail enumerated and in which he bound himself to ful- 
fill all his functions or suffer all the ills of purgatory. 

The relations of the pharmacist to the physician may 
specifically be stated as follows: 

1. The attitude to the Prescription, 

2. The Recommendation of Medicines. 

3. Adherence to the Standards of the U. S. P. and 
N. F. 

4. Professional Courtesy. 


Since many physicians have quit writing prescriptions 
because they do not feel warranted in writing one prescrip- 
tion which may come into use for a whole neighborhood, or 
from the dangerous effects of potent or habit- forming drugs 
following unwarranted repetition of compounding such med- 
icines as were designed only for a particular ^person for a 
particular period, the following declaration has been formu- 
lated by a joint committee of the Chicago Medical Society 
and the Chicago Branch of the American Pharmaceutical 

Pharmacy. 139 

First. The prescription is an utterance of the prescriber who alone 
should direct and control its employment. It should whenever practi- 
cable carry the name of the patient, the age in years, if a minor, and the 
date wh^n written. 

Second. The pharmacist who prepares the medicine should retain 
the prescription as reference for his services and as record for a certain 
limited period, not less than five years, for the protection of the prescrib- 
er, himself and the patient. 

Third. The medicine prescribed should be supplied not more than 
once on the same prescription: ( 1 ) if ordered by the preccriber "not to 
be repeated" ( N. rep.) (2) if containing medicinal substances commonly 
called narcotic or habit-forming drugs, (3) if called for by some person 
known not to be the original holder. 

Fourth. Copy of the prescription may be furnished and should be 
written on an especial blank, containing a declaration that it is a copy 
of a prescription which has been delivered to the original holder and ia 
not to be refilled except on order of the prescriber. The copy is made 
"without recourse to possible error. 

These requirements are exceedingly reasonable and can 
offer no possible objection. The declaration has already- 
been approved by several branch medical societies. 


Theoretically it might be said that the pharmacist 
should not recommend any medicines, but suggest that his 
patrons seek the advise of a physician. But this is imprac- 
ticable because the average layman thinks he knows as 
much about medicines as does the doctor. 

Incidentally it may be added that this is true to some 
extent due to the senseless activity of many doctors in per- 
mitting themselves to be used for exploiting numberless 
proprietary pharmaceuticals to their patrons who soon be- 
come thoroughly familiar with them through the literature 
with which they are so well supplied. 

Besides in this great country every man, woman and 
child enjoy the privilege of recommending medicine for 
every ailment; and while the laws require a high degree of 
qualification and license for the practice of medicine, any 
old woman can set up as a healer and any adventurer with 
a few dollars can organize a chemical company and dope the 
community by the wholesale under the apparent sanction of 
the government. That is by the guarantee label of the 

140 The Plexus. 

Food and Drug Act and the copyright and trade-mark laws. 

It is therefore exceedingly difficult to draw the line 
where the pharmacist's privilege begins or ends, except for 
at least one well fixed principle, viz.: He has no right to di- 

The pharmacist has the right to supply such articles 
without medical prescription as are not in the Poison and 
Narcotic Drug Schedule when called for by a patron. 

He has the right to supply the articles of the Poison 
and Narcotic Drug Schedule only under such restriction as 
required by law. 

He should never recommend any "patent medicine", 
display them or allow his name to be used in connection 
with them. 

As to what extent he should entirely refuse to handle 
them will be a matter of individual taste or judgment, and 
such attitude will be hastened if the physicians through 
their societies will resolve to give preference in their patro- 
nage to such pharmacies as do not keep patent medicines at 

To meet the popular demand for domestic medicines it 
has been suggested that a list of official articles from the U. 
S. P. and N. P. should be selected by the joint medical and 
pharmaceutical societies which may be supplied under suit- 
able labels. 

The wisdom of this plan may be questioned but it is 
worth considering. 

THE U. S. P. AND N. F. 

That uniformity may be secured in strength and dosage 
of medicines every civilized community has established a 
standard through the pharmacopoeia, a work compiled by 
joint medical and pharmacal authorities. 

The U. S. P. is revised by a national committee on re 
vision composed of pharmacognosists, botanists, chemists, 
therapeutists and pharmacists elected by delegates from 
medical and pharmaceutical organizations and the medical 
departments of the different branches of the federal govern- 

Pharmacy 141 

The present official pharmacopoeia — the eighth decen- 
nial revision — fixes the standards for the identity, purity, 
strength and quality and gives directions for the prepara- 
tion, valuation, preservation and compounding of medicinal 

While the pharmacopoeia has always been regarded as 
the standard by the common law, has been the basis of the 
adulterations section of all state laws and recognized by the 
departments of the federal government, it has not been le- 
gally recognized by the federal government for interstate 
purposes until the enactment of the Food and Drugs Act by 
congress of July 1906. 

The National Formulary is a work issued by the Ameri- 
can Pharmaceutical Association compiled by a committee on 
revision of this association. 

It is a compilation of some 500 formulas for such more 
ephemeral preparations as may not have earned a place in 
the pharmacopoeia or for some other reason not deemed 
worthy a place in the more elaborate work. 

This formulary is now in its twentieth year and has 
been twice revised, that now official being designated as 
N. F. III. 

The National Formulary is recognized in the Federal 
Food and Drug Act on the same basis as the Pharmacopoeia 
and in some respects it is of equal importance to the physi- 
cian since it comprises most of the more modern and elegant 
preparations which many physicians findat of advantage to 

It is the consensus of opinion that the U. S. P., VIII, is 
the most complete and up to date of any of the World's 
pharmacopoeias . 

No less an authority than Dr. L. F. Barker, professor 
of medicine in Johns Hopkins University, formerly of the 
University of Chicago, recently in an address to the Balti- 
more branch of the American Pharmaceutical Association, 
expressed himself to that effect. 

But it is only recently that physicians generally have 
begun to realize the advantages of employing the articles 

142 The Plexus. 

and the preparations of these works. While manufacturing- 
chemists and pharmacists are a necessity and both physi- 
cians and pharmacists are indebted for the improvement 
that they have helped to make and put into practical use, 
there are hords of concerns who belong to neither profes- 
sion who appropriate some physician's prescriptions, put 
them out with some more or less fictitious formula under 
some catchy suggestive trade name ladened with the most 
extravagant therapeutic claims — most often only for the 
purpose to get the physician to prescribe them andT then to 
advertise them as cure-alls to the public. 

The history of all the older medicines of this class will 
support this statement. 

As soon as they have secured all the free advertising 
from the doctors they call for, these usually get-rich-quick 
concerns, throw the doctors overboard and then begin to 
work the public on the strength of the doctor's testimonials. 

But with the establishment of the Council of Pharmacy 
and Chemistry, three years ago through the activity of the 
section on pharmacology of the American Medical Associa- 
tion, the attention of the medical profession has been 
aroused to this state of affairs and after exposure of many 
of the most important of these preparations as being veri- 
table fakes, every right thinking physician has begun to re- 
alize that he has been making a great mistake and that he 
would no longer remain the unpaid peddler of these patent 

The U- S. P. and the N. F. containing about 1,500 arti 
cles comprices nearly every medicinal article that a physi- 
cian may need, but in order that he may avail himself of all 
the latest additions to the Materia Medica and results of 
modern progress in science, the Council of Pharmacy and 
Chemistry examines all the more important remedies as 
they appear, and such as conform to its rules are admitted 
to the New and Non-Official Remedies, a book published by 
the American Medical Association. 

The work of the American Medical Association in the 
examination and exposure of these frauds is constantly be- 

Pharmacy. 143 

ing chronicled in the Journal and has already begun to bear 

Many medical societies have become interested in the 
work and the state medical journals, with some exceptions, 
due to their love for tainted money being greater than their 
love for the profession, are aiding the movement for reform 
in the Materia Medica. 

The American Medical Association furnishes reprints of 
reports on the different phases of the work, and publishes 
also a booklet, "The Physician's Manual of the U. S. P. and 
the N. P.," suitable as a convenient reference for the phy- 

It should be remembered that the principal aid to the 
introduction of a medicine to the public for self medication 
is a short euphonious name and for that reason alone no 
physician should ever patronize a preparation unless it has 
a scientific preferably latin title. 

While the practice of pharmacy is now regulated by law 
in every state and territory of the Union, and there are 
nearly eighty institutions teaching pharmacy, probably one 
half of those licensed to practice pharmacy are non- gradu- 
ates. With the exception of the states of New York and 
Pennsylvania graduation from a college or school of phar- 
macy is not required, but any one having the necessary 
amount of drug store experience is eligible for examination 
and registration. 


No preliminary education has been required until re- 
cently when some 28 of the leading colleges of Pharmacy 
and University Schools known as the Conference of Pharma- 
ceutical Faculties have adopted a requirement which is to 
be gradually increased until graduation from high school 
will be necessary for admission. For 25 years the Pharmacy 
Laws have practically been at a .stand-still, but little advance 
made in the requirements to practice since the first enact- 
ment in 1880. The laws are also defective in that any one 
can own and operate a drug store provided that the dispens- 
ing be done by a registered pharmacist. This has 

144 The Plexna, 

caused the establishment of drug departments in all the big 
stores and Show-bill printers and Milliners to engage in 
what to them appeared a profitable business since registered 
clerks could easily be secured. The result is that nearly 
every drug store on State Street in Chicago within the loop, 
is owned by laymen whose only interest in pharmacy is how 
much money they can make out of the business. 

Some of these stores carry $1,000 a year saloon licences 
and are depots for all kinds of rank nostrums and operate 
lunch counters. 

One of these most centrally located operated by the Mil- 
linery Rexal syndicate, still trading under the name of one 
of the best known old-time apothecaries displays the symbol 
of the firm name as "B a R." 

Advertisements appear in the daily newspapers con- 
cerning proprietary articles which they manufacture or 
stand sponsor for as agents which are the rankest frauds 
and impositions on the public. Their windows are filled 
with the most motley collections of toilet articles, rubber 
goods and suggestive devices of which the nervous debility 
and female weakness remedies are always most prominent. 

Your indulgence is craved for describing this situation 
but it was deemed necessary in order that you may realize 
the difficulties in the way of securing the co-operation of 
druggists generally. 

While it is not contended that graduation from a College 
makes always a qualified pharmacist, still you, as medical 
students and practioners, know well enough that no one 
could attempt to qualify in these times as a physician with- 
out the many years of study and training required by the 
modern Medical College, and the same is true in Pharmacy 
though of course, to less extent. 

The average druggist who has never attended a College 
of Pharmacy, may, through experience and contact with 
educated pharmacists and physicians, acquire some know- 
ledge of what should be his relations to the physician and 
the public but if so, it is due to favorable circumstances. 
The majority have no conception of their occupation in its 
professional relations. 

Pharmacy. 145 

It is believed that until requirement for practice com- 
prises graduation from a college of Pharmacy, physicians 
should discriminate in favor of graduates just as they should 
warn their patrons against patronizing the bargain and cut- 
rate drug stores. 

It is believed that there should be a Medico-Pharmacal 
Code describing the respective functions and responsibilities 
between Pharmacists and Physicians and that the declara- 
tion on the prescription already mentioned may form the 
basis for such work. 

The American Pharmaceutical Association organized 
over a half a century ago for the advancement of Pharma- 
ceutical Science, fostering education in the theory and prac- 
tice, "for the perfection and protection of Standards for medi- 
cines, for the suppression of quackery and empiricism has 
taken up this work of reformation. 

It has established branches in the principal cities and 
desires the co-operation of physicians in the discussion of 
these questions of mutual interest in the hope that in the 
near future the educated and reputable pharmacist may 
work hand in hand in the great work of relieving human 
suffering and cure of disease. 

It is our hope that the practice of pharmacy and its 
votaries may resume the traditional relation to medicine as 
symbolized by the virile figure of Esculapius, ever ready to 
fight disease, with the aid of the poison pressed from the 
serpent's fangs by the trusty hand-maiden Hygeia — the 
Goddess of Health and the Symbol of Pharmacy. 


The forty-eight Commencement of the University of 
Illinois School of Pharmacy wil be held in the Auditorium 
of the Young Men's Christian Association Building, 151 
La Salle St., on Thursday afternoon, April 23rd at two 
o'clock. Dr. Wm. A. Evans, City Health Commisioner will 
make the prinicpal address. President Edmund J. James 
will confer the degrees. 

In the evening a banquet will be tendered the graduat- 
ing class by the Alumni Association. 

UQ The Plexus. 


The Junior Class has organized and elected Officers as 
follows : 

President — W. J. Johnson. 

Vice-President — J. F. Wendt. 

Secretary — Leo Elliott. 

Treasurer — Rob't E. Ford. 

It was voted that the class be represented in the Illio 
and an assesment to cover the necessary expense was an- 

Beta Chapter of the Phi Gamma Sigma Fraternity has 
elected officers for the coming year and completed arrange- 
ments for the annual banquet which will be held at the 
Sherman House, Monday evening, April 6th. The officers 
elect are: 

D. T. Gunning, Grand Master. 

Clemence Zimmerman, Scribe. 

G. A- Anderson, Worthy Master. 

J. F.' Wendt, Treasurer- 

Not less than fifty of the students took the recent exam- 
ination of the State Board of Pharmacy and are now anxi- 
ously awaiting the results. 


J. K. Rigg, '03, has purchased Enlow's Drug Store at 
Melrose Park. 

F. E. Bucklin, '07, succeeds Bellack Bros, at Melrose 
and Robey Sts. He had been in charge of this pharmacy 
since it was established several months ago. 

Chas. Herbold, '99, passed the Indiana State examina- 
tion recently. He expects to engage in the drug business at 
Gary, Indiana. 

P. O. Martin, '07, is a member of the firm of Martin 
& Fithian and conducts a prosperous pharmacy at Newton, 

Dr. G. Machenheimer, '06, has recently established him- 
self in business at Shawnee, Okla. 

Geo. R. Baker, '84, died suddenly March 6th, aged 53 
years. He had recently moved his drug store from Wabash 
Ave. and 18th street to Englewood. Mr. Baker was at one 
time among the most prominent druggists of Chicago, being 
proprietor of a well-known pharmacy in the Ashland Block. 
He was for several years a trustee of the Chicago College of 






VOL XIV. BATAVIA, APRIL 20th, 1908. NO. 4 


Daniel N. Eisendrath, A. B., M. D., Chicago. 


The first accurate description of a subphrenic abscess 
was published by Bouchard 1 in 1862. In 1882, Ley den 8 re* 
ported several cases in which the diagnosis was made clini- 
cally. Maydl, 3 in 1894, collected 179 cases, which he divid- 
ed into twelve groups, according to their cause. Among 
these were 23 following appendicitis. Since this time Weber, 4 
Sachs 5 , and Elsberg 6 have reported a number of cases. Els- 
berg was able to collect 73 cases of subphrenic abscess fol- 
lowing appendicitis, which had been published up to 1901. 
I have been able to add 33 cases, including 5 of my own. 


Few statistics are available from which to draw deduc- 
tions as to the relative frequency of this complication. 
Weber found it nine times in 350 cases, and Moschowitz 1 
found 8 cases of sulphrenic abscess among 2,000 cases of ap- 
pendicitis occurring in Mt. Sinai Hospital. 

"Read before the Chicago Medical Society, Oct. 9, 1907. 

1. Bull, de la Soc. Anatomique, 1862. 

2. Ztschr. f. klin, Med., 1882. 

3. Subphrenische Abscesse, Josef Safar, Wien, 1894. 

4. Deutsche Ztschr. f. Chir.,liv. 

5. Arch. f. klin. Chir., 1. 

6. Ann. of Surgery, xxxiv. 

7. Arch. f. klin. Chir , Ixxxii. 


The Plexus. 


The subphrenic region is divided into a right and left 
space by the falciform ligament of the liver. An abscess 
situated in the right space does not communicate with the 
left, unless the septum between the two is broken down. 
Each subphrenic space is again divided, incompletely, into 
an anterior and posterior space by the coronary ligament. 
A portion of the right lobe of the liver is not covered by 
peritoneum, owing to the separation of the two layers of the 
coronary ligament. This area is about the size of the width 
of the palm of the adult hand, but it plays no role in the 

Fig- 1— Modes of transmission of infection to right and left subphrenic spaces from 
appendix region- 1- Along outer side of colon. 2. Along inner side of colon. 3. Across 
transverse colon and stomach. The double arrow 3 shows that infection can either 
travel in front of the stomach and cause an abscess in the general peritoneal cavity be- 
tween the spleen an liver, or the infection can pass through the foramen of Winslow into 
the lesser peritoneal cavity. R. U. L., right upper lobe of lungs. R. L. L-. right lower 
lobe- R. S, S., right subphrenic space. D., diaphragm. R. C. S., right costophrenic 
sinus. L. U. L-, left upper lobe of lungs. L. L. L., left lower lobe- L. S. S., left sub 
phrenic space. L. C. S., left costophrenic sinus. 

Subphrenic Abscess. 


pathology of the subphrenic abscess. The right lobe of the 
liver lies in almost direct contact with the lower portion of 
the bony thorax, being separated from it by the diaphragm 
and the costophrenic sinus of the pleura. 

Subphrenic abscesses may be located within the peri- 
toneal cavity or in the retroperitoneal tissues. If intraperi- 
toneal, the abscess may only accupy a small portion of either 
subphrenic space, either laterally or in front or behind. 
The abscess may be located high up under the dome of the 
diaphragm. It rarely fills the entire right subphrenic space 

Fig. 2. — Side view of thorax ond abdomen to show relation of pleural reflection to 
ribs and costal cartilages (see description in text). S. L., scapular line. P. A- L-, posterior 
axillary line. M. A. L., midaxillary line. A. A. L., anterior axillary line. The heavy 
black line represents the level of the reflection of the costal pleura on the diaphragm. 

150 The Plexus. 

being usually limited by adhesions between the liver and the 
inferior space of the diaphragm. 

The intraperitoneal variety is far more common after 
appendicitis than the extraperitoneal. In the latter the in- 
fection travels upward behind the ascending colon in the 
retroperitoneal tissues. It can not extend very high upward, 
owing to the close attachment of the peritoneum to the in- 
ferior surface of the diaphragm. In the intraperitoneal 
variety (Fig. 1) infection either travels along the inner or 
outer side of the colon, or between its anterior aspect and 
the abdominal wall. In the 106 cases which I have been 
able to collect, the abscess was intraperitoneal in 50 per 
cent., and extraperitoneal in 25 per cent. In the remaining 
reports the location was not given or was doubtful. 

A subphrenic abscess may follow an attack of appendici- 
tis in which there has been no suppuration in or around the 
appendix. Such cases have been described by Weber, 
Krohne and Fink. Subphrenic abscess after appendicitis is 
usually situated in the right side, but 6 left-sided cases have 
been reported (Schlesinger, Reizenstein, Korte, Darling and 
one of my own). Subphrenic abscess seldom occurs as the 
result of a general suppurative peritonitis. There are only 
seven such cases on record. It is often impossible to trace 
any purulent tract from the appendix to the subphrenic 
region. The position of the appendix bears a direct relation 
to the formation of the subphrenic abscess. In the majority 
of cases the appendix was retrocecal (Fig. 3). This is the 
second most frequent normal position of the appendix, ac- 
cording to Monks. 

A persistence of the embryonal position of the appendix, 
due to non-rotation of the cecum, also favors the formation 
of a subphrenic abscess. The appendix is thus brought in 
close contact with the right lobe of the liver (Fig. 4.). The 
proximity of the subphrenic spaces to the pleural cavities 
explains the frequency of plural effusion as a complication. 
The pleuritic fluid is usually seropurulent, and may be en- 
capsulated or not. Pericardial involvement is rare, although 
several cases have been reported in which death followed 

Subphrenic Abscess. 151 

rupture of the abscess into the pericardium. Munro has 
called attention to the fact that subphrenic abscess may be 
the result of a liver abscess after appendicitis. Rupture of 
the subphrenic abscess into the lung has been reported in 
19 cases. In the majority of cases subphrenic abscesses, 
after appendicitis, contain only pus. They thus differ from 
those following perforation of a gastric ulcer, in which the 
abscess cavity frequently contains both pus and gas. 

The anatomic relations of the left subphrenic space are 
far more complicated than those of the right. The abscess 
either lies between the left lobe of the liver, stomach and 
spleen, or between the stomach and abdominal parietes, or 
in the lesser omental cavity (Fig. 5). 

Before reviewing the symptoms and treatment of this 
complication of appendicitis, I desire to report the following 

Case 1. — Gangrenous appendicitis, with abscess formation; left- 
sided subphrenic abscess, diagnosed two weeks after operation: death 
from septicemia. 

F. M. aged 11, was admitted to the Michael Eeese Hospital with 
well-marked symptoms of appandicitis. A well walled off intraperitoeal 
abscess cavity was opened, but no effort was made to remove the ap- 
pendix. Condition quite critical. At the end of the first week the 
temperature was 106 F., pulse 130. The wound was reopened, but no 
cause for the septic condition was found. Examination of the thorax oh 
the right side was negative. At the end of twenty-one days an area of 
dulness was found over the base of the left lower lobe posteriorly. An 
exploring needle was inserted and fetid pus obtained. The pleural 
cavity was opened under the impression that the complication was one 
of abscess of the lung. The left lower lobe was found adherent to the 
diaphragm. On being separated from the latter a needle was inserted 
through the diaphragm and very fetid pus was obtained. An abscess 
located between the left lobe of the liver and the spleen was drained, 
by the transpleural route. The septic symptoms improved for a short 
time, but recurred, and death took place about five weeks after the 
original operation. 

The peculiarity of this case is the left-sided situation of 
the abscess. The only signs which caused a search for such 
a complication to be made were the persistence of high fever ? 


The Plexus, 

rapid pulse and other signs of deep-seated infection, in spite 
of thorough drainage of the primary appendiceal abscess. 
The subphrenic infection was not the result of a generalized 
suppurative peritonitis, since such a condition never existed 
in this case. The infection probably followed between the 
adherent coils of intestine along the inner side of the colon 
to the left subphrenic space (Fig. 1). This case shows the 
necessity of a thorough physical examination in every case 
of suspected subphrenic abscess. 

pig_ 3,— Route of infection from a retrocecal oppendix to the right subphrenic space 
(sagittal section). 

Case 2. — Right-sided subphrenic abscess; acute retrocexal appendi- 
citis ; death from subphrenic infection, five days after onset of illness. 

H. G., aged 6; seen August 16, 1905 history of acute inflammatory 
affection of right side of abdomen for previous three days. Temperature, 
103 F. ; pulse. 152. Immediate operation. Appendix retrocecal, with 
tip extending almost to liver, Marked inflammatory changes, and 
covered with plastic exudate. The appendix was intraperitoneal. 
There was no perforation, nor evidence of abscess formation. Gauze 
drainage. Twenty-four honrs after operation, pulse rose to 162, and 
respirations to 60. Twenty-four hours later, examination of wound 
negative; no tenderness on palpation over liver, and no area of duluess 
in lower part of chest. The temperature rose to 104 F. , the pulse re- 
maining about 160. Death occurred sixty hours after operation for re- 
moval of appendix, and five days after onset of attaok. The autopsy, 

Subphrenic Abscess, 


held three hour§ after death, showed that there was no free fluid in the 
peritoneal cavity, and no evidences of any peritonitis. On separating 
the right lobe of the liver from the abdominal wall a well-encapsulated 
abscess, containing eight ounces of pus, was found. 

The abscess was relatively small and could not be recog- 
nized by the ordinary physical signs. The persistence of 
the fever and rapid pulse should have served as an indica- 
tion for a systematic exploration of the subphrenic region. 
with the needle had the course been less rapid. The intra- 
peritoneal position of the appendix behind the cecum, with 
its tip close to the liver, favored the localization of infection 
in the right subphrenic region. It would be better in such 
retrocecal appendiceal cases to have the patient placed in 
the Fowler position after operation, and some method of 

Fig. 4. — Mode of transmission of infection to the right subphrenic space from an ap 
pendix which is congenitully displaced either in front of or just below the right lobe of the 

drainage should be provided for the retrocecal region, mak- 
ing a counter-opening in the loin. There was no abscess 
formation in the primary appendiceal lesion. The course 
was a very rapid one. 

Case 3. — Eight-sided subphrenic abscess, complicated by encapsu- 
lated disphragmatio empyema, Recovery. 

S. F., aged 30, male, was admitted to my service in Cook Connty 
Hospital, Sept. 29, 1905, with a diagnosis of empyema. The only 
history obtainable was that he had been operated on, one year previous- 
ly, for appenditis. A large scar in the right iliac region and the presence 
of a hernia rendered it possible to infer that an appendiceal abscess had 


The Plexus. 

Tseen drained. Two weeks before admission to my service he was seized 
•with a sharp epigastric pain; temperature on admission, 103 F. There 
was an area of dulness extending from the eighth rib downward on the 
right side of the chest in the scapular line, and from the fourth rib in 
the mammary line. Greatly diminished respiratory and voice sounds 
were heard over this area. 

Exploratory puncture showed thick fetid pus. The seventh rib was 
resected in the posterior axillary line ; no pus found in the pleural cavity. 
The right lower lobe was adherent to the diaphragm, and. on being 
separated a considerable quantity of fetid pus escaped. What was 
supposed to be an ' encapulated diaphragmatic empyema was drained, 

Fig. 5. — Various forms of subphrenic abscesses complicating appendictitis. S., in all 
of the figures, represents the abscess- E., in 3, represents "empyema. D. E., in 6, diffuse 
empyema. *. Abscess beneath dome of diaphiagm. 2, Abscess low down in subphrenic 
space. 3- Combination of encapsulated diaphragmatic empyema and subphrenic abscess. 
4. Left-sided subphrenic abscess. Large abscess occuping entire right subphenic space. 
6. Combination of right subphrenic abscesses and non-encapsulated empyema. 

the patient showing considerable improvement for a few days, but the 
septic symptoms recurred, and on October 14, two weeks after admission, 
the thoracic wound was inspected and a bulging upward of the diaph- 
ragm noted Exploratory punoture showed the presence of a subphrenic 
abscess, which was drained at its lowest point by resecting the tenth rib 
in the anterior axillary line. Uneventful recovery. 

Case 4.— Retrocecal appendiceal abscess; subphrenic abscess under 
right dome of diaphragm; transpleural drainage; post-operative empye- 
ma; death from septicemia. 

Subphrenic Abscess. 


H. A., aged 18 ; entered my service at the Michael Reese Hospital 
on Feb. 11, 1906. He had been treated for the previous two weeks for 
appendicitis. The condition had improved after the first week, but re- 
currence of fever led his physician to send him to the hospital. On 
admission, there was rigidity in the right hypochondriac and lumbar 
regions, and some dulness over the same area. At operation, the 
ascending colon was found adherent to the obdominol wall along its 
entire length; a large abscess containing very fetid pus was discovered 
just in front of the right kidney; appendix was retrocecal but intraperi- 

Fig 6. — Area of combined liver and subphrenic abscess, dullness in a case of right- 
sided abscess. 

toneal; it was perforated at its middle; after being separated from the 
posterior aspect of the cecum it was removed. Temperature fell grad- 
ually to normal, but rose again five days after opening the appendiceal 
abscess. The wound was reopened, but no retention found. A counter 
opening was made in the ileocostal space, without any improvement. 
Examination of the thorax showed an area of dullness at the convex 
upper border from the seventh rib downwards, between the anterior 
axillary and scapular lines. 

Exploratory puncture of this area showed the presence of fetid pus. 
The seventh rib was resected in the posterior axillary line, the needle 
liaving been left in place after the exploratory puncture. The needle 

156 The Plexns. 

was found to have entered an abscess containing about six ounces of pus,, 
lying between the upper surface of the liver and the right dome of the 
diaphragm. It was impossible to suture the diaphragm to the chest 
wall. The pleural cavity was walled off with gauze, and a drain insert- 
ed into the subphrenic abscess across the costophrenic sinus. A very 
septic empyema developed, and the patient died sixty days later. 

This case illustrates the difficulty of draining those 
abscesses which are located high up under the dome of the 
diaphragm. Several of K6rte's patients died of a similar 
postoperative empyema. 

Case 5. — Development of subphrenic abscess during non-operative 
treatment of appendicitis. Drainage of abscess while patient extreme- 
ly septic. Death two weeks after operation. 

C. F. , aged 38, was seen one month after onset of appendicitis, 
which had been treated conservatively without operation. On admission 
the patient was very septic and emaciated with septic nephritis. Rigid- 
ity and tenderness over right hypochondriac and epigastric regions.. 
Both right and left lobes of the liver were" displaced downward, so that 
the lower border of the right lobe was below the level of the umbilicus. 
There was dulness from the sixth rib downward in the mammary line; 
from the seventh in the midaxillary line. Some edema over seventh and 
eighth ribs in the midaxillary line. Absence of respiratory sounds over 
area of dulness in the axilla. Exploratory puncture through the right 
seventh interspace in the midaxillary line showed chocolate-colored 

Under local anesthesia incision wat made along jjthe line of the 
needle left in place. The seventh rib was resected, a distance of about 
two inches, in the midaxillary line, and immense quantities of pus were 
evacuated from an abscess lying between the posterior surface of the 
right lobe of the liver, the diaphragm and the upper pole of the kidney. 
A counter opening was made in the ileocostal space. The initial sepsis- 
continued, and the patient died two weeks after operation. 

» The five cases just reported illustrate the varied clinical 
pictures which a subphrenic abscess produces. There are 
usually three modes of onset: (a) An acute form, in which 
the symptoms appear with the attack of appendicitis or a 
few days afterward, (b) A subacute form, in which signs of 
infection occur a few weeks after the beginning of the ap- 
pendiceal attack, (c) A chronic form, in which the symp- 

Snbphrenic Abscess. 


i;oms appear months after the appendiceal disease has been 
recognized or operated on. In Case 3 of my own series the 
subphrenic symptoms appeared one year after the removal 
of the appendix. 

(a) Acute Form. — This variety may accompany or im- 
mediately follow an attack of appendicitis which occurs in 
an appendix arising from a normally placed cecum, or it 
may be the mode of periappendicular infection, which an ab- 
normally placed appendix takes, as referred to previously. 
In this latter form the non-rotation of the cecum causes the 
appendix to lie close to the subphrenic region. Previous 
articles speak of this mode of onset being accompanied by 

Fig. 7.— Relations of pleurel reflection to diaphragm on right side of th»rax after re 
section'of tenth rib, between posterior axiliary line P. A. L. and anterior auxiliary line A* 
A. L- P., parietal pleurn showing at its lower border the level of its reflection on the 
diaphragm D. M. A. L. midaxilliary line. 

severe pain in the hypochondrium, by nausea, vomiting and 
the signs of a severe infection. That pain and the other 
symptoms just described are not always very marked, is 
shown in Case 2 of my series. 

The persistence of high temperature, with or without 
accompanying signs of severe septic infection, is the most 

158 The Plexus. 

characteristic symptom of the acute form. 

Pain and tenderness in the right hypochondrium may or 
may not be present. 

In some cases physical examination of the chest will be 
of the greatest aid. If the abscess contains pus only, an 
area of dulness, with a convex upper border, is found in or 
near the axillary line (Fig. 6). If the abscess contains gas, 
there will be an area of tympany above the dulness. It is 
impossible to differentiate areas of dulness due to pleuritic 
fluid from those due to a subphrenic abscess, if both are 
present. If the collection of pus beneath the diaphragm is 
small, and lies under the dome (Fig. 5), as in Case 3 of my 
series, or causes but little displacement of the liver, as in 
Case 2, physical examination is of but little value, and syste- 
matic exploratory puncture of the entire hepatic region 
would be the only means of making a diagnosis. Localized 
edema and tenderness of the skin of the lower thorax, or 
close to the costal arch, points to the presence of a subph- 
renic abscess usually of extraperitoneal location. 

In some cases the displacement of the liver downward 
is very marked. Bulging along the costal margin or in the 
epigastrium is quite rare. In left-sided abscesses there is 
dulness at the lower portion of the chest, either in front or 
behind, or on the side. This dulnes, if in front, often extends 
into the epigastrium, or into the left hypochondriac region. ■ 

Exploratory puncture is one of the most valuable means 
of diagnosis. If the pus is fetid, it is strongly indicative of 
the presence of a subphrenic abscess. If the needle pene- 
trates quite deeply before pus is obtained, this should also 
lead to the suspicion of a subphrenic abscess. 

If there are marked symptoms of sepsis following an 
attack of appendicitis, and the exploring needle reveals only 
a small amount of serous exudate, such a finding should lead 
one to consider the possible presence of an encapsulated 
pleuritic exudate over a subphrenic collection of pus. If a 
non-encapsulated empyema accompanies a subphrenic ab- 
scess, it is impossible to differentiate by exploratory puncture 
unless one first obtains ordinary non-fetid pus, and later, on 

Subphrenic Abscess. 159 

deeper introduction of the needle, a fetid pus. One can dis- 
tinguish the pus obtained from an abscess of the liver by 
the fact that it has no odor and is chocolate-colored. 

(b) Subacute Form. — In this form the symptoms appear 
from eight to twenty-one days after the onset of an attack 
of appendicitis, or after the removal of the diseased appen- 
dix. A week or more after the attack or operation, the 
temperature rises again, accompanied by the gradually in- 
creasing symptoms of septic intoxication. The fever is us- 
ually of the remittent type, and is accompanied by a corres- 
ponding rise in the pulse rate. The patient begins to lose 
in strength, and becomes greatly emaciated. 

The local signs in this form do not differ from those de- 
scribed under the acute mode of onset. In a few cases this 
recurrence of fever and of septic symptoms is accompanied 
by pain over the corresponding side of the chest, cough and 
dyspnoea, but these latter symptoms are not at all constant. 
In the absence of any retention of pus in or around the seat 
of operation, this reappearance of fever, etc., should always 
lead one to search for the physical signs of a subphrenic ab- 

Rupture into the lung has probably taken place if large 
quantities of pus have been expectorated suddenly in these 

(c) Chronic Form, — Case three of my own series best il- 
lustrates this mode of onset. For weeks to months after an 
attack of or operation for appendicitis there are indefinite 
symptoms. In some cases there is an occasional rise of 
of temperature, accompanied by sweats and slight loss of 
weight and strength. In others there are no symptoms un- 
til the patient is suffering from the symptoms of acute sep- 
sis, due to an obscure deep-seated focus. In these cases the 
diagnosis can only be made from the local physical signs of 
dulness, etc- , in the lower part of the chest, aided by ex- 
ploratory puncture, taken in conjunction with the history of 
an attack of appendicitis, or of an operation for removal of 
a diseased appendix, or drainage of an appendical abscess. 


The Plexus. 


If a patient who gives the history of some inflammatory 
condition in the right lower quadrant of the abdomen, or 
who has been operated on for appendicitis, has a continued 
rise of temperature, accompanied by other symptoms of sep- 
tic intoxication, one should always make a diligent search 
forja subphrenic abscess. The downward displacement of 
the liver, the presence of an area of dulness with a convex 
upper border, continuous with the dulness of the liver (Fig. 
6), and the finding of fetid pus on exploratory puncture are 
very characteristic. If there is localized bulging or edema, 
the diagnosis is rendered quite easy, The principle condi- 


Fig. 8. — Same as^ Figure 7 'but pleural reflection has been retracted upwards and 
diaphragm incised, thus, opening the abscess cavity- The line aa indicates the line of 

tion to be differentiated is empyema. This is, at times, 
practically impossible. The history of a preceding pneu- 
monia, followed by continued fever, and the local physical 
signs, is often of great aid in making a diagnosis of empye- 
ma. The upper level of the area of dulness is more apt to 
be horizontal in empiema instead of convex, as in a sub 
phrenic abscess. 

Subphrenic Abscess. 161 

In many cases a differentiation is impossible, except 
from the history and the character of the pus. If the sub- 
phrenic abscess contains gas, and the three characteristic 
zones described under symptoms are present, the diagnosis 
is not difficult. If an empyema and subphrenic abscess co- 
exists, differentiation is impossible. This is especially true 
of an encapsulated empyema, as in case three. This case 
also shows that persistence of fever after drainage of an 
empyema should lead to the suspicion of a subphrenic ab- 
scess. The X-ray is not sufficiently reliable to be useful as 
a means of diagnosis. 


In general the chances for a spontaneous evacuation of 
the abscess through the lung or externally are so slight that 
the prognosis is bad in non-operated cases. Even in those 
cases of subphenic abscess in which an operation was done, 
the mortality has been much greater than it should be. This 
is due to the fact that the diagnosis has not been made in 
many cases until the patient is so septic that operation is of 
little avail. 

Elsburg, in his article published in 1901, found that in 
73 cases of subphrenic abscess after appendicitis, 11 of 51 
patients operated on died, a mortality of 22 per cent. Of 22 
patients not operated on, 18, or 82 per cent., died. The 107 
cases which I have been able to collect since the publication 
of Elsberg's article include his 73 cases. In these 107 cases 
(all following appendicitis) the results were as follows: 

Patients. Per cent. 

Died with operation 23 21.5 

Died without operation 19 17. 7 

Totals 42 39.2 

Patients. Per cent. 

Cured with operation . . . . * . . , 61 57 

Cured without operation 4 3.8 

Totals 65 60.8 

These latter figures show that with the additional 34 
cases which I have been able to collect (including my 5) since 


The Plexus. 

Elsberg's article, the mortality in 84 cases in which an ope- 
ration was done was 25 per cent. It is impossible to state 
what the mortality is in non-operated cases, since the majo- 
rity of these are either not recognized or are not published. 
That it is fully 80 to 85 per cent, must be concluded from 
the 19 cases which I have been able to collect. When we 
consider the almost moribund condition in which many of 
the patients are brought to the surgeon, 75 per cent, of re 
coveries in 84 operated cases is decidedly encouraging. 

Fig. 9.— Method of operation in low transpleural drainage of subphrenic abscesses. 
After subperiosteal resection of that portion of the rib which lies over the abscess, the 
parietal and diaphragmatic layers of the pleura are sutured together. 

If the diagnosis is made at an earlier period of the dis- 
ease the percentage of recoveries will be far greater than 
even 75 per cent. Such an early diagnosis can only be made 
if the physician or surgeon will bear in mind the relative 
frequency with which subphrenic abscess occurs as a com- 
plication of appendicitis. 


There are five methods of draining a subphrenic abscess: 
(a) By an incision in the epigastrium; (b)by an incision along 
the costal arch; (c) by an incision in the lumbar region; (d) 

Subphrenic Abscess. I63 

by the transpleural route, (e) by pushing the pleural reflec- 
tion upward and opening the abscess cavity through an in- 
cision in the diaphragm without opening the pleural cavity. 
The first three methods are indicated when there is bulging 
in the epigastrium along the costal arch or in the lumbar 
region. A simple incision will suffice to evacuate the ab- 
scess. If, however, suppuration continues and septic symp- 
toms reappear, it indicates either an accompanying empy- 
ema or insufficient drainage, or, finally, a persistence, as 
Bevan has shown, of the original focus. Such conditions 
require more extensive operations. 

The ideal method of opening a subphrenic abscess, no 
matter what its origin may be, is by one of the last methods, 
viz., resection of ribs over the area of suppuration with or 
without opening of the pleural cavity. 

Before taking up the relative merits and indications of 
the transpleural and transthoracic but extrapleural routes, 
I desire to review briefly the anatomy of the pleura in so 
far as it is of interest in connection with subphrenic abscess. 
I have found by the dissection of a large number of formali- 
nized cadavers that the majority of text-books on anatomy 
give the line of reflection of the diaphragmatic pleura at a 
higher level than is actually the case. Gray gives the lower 
limits of the pleura, i. e., the line of pleural reflection, as 
follows: On both sides the line of reflection meets the an- 
terior axillary line at the junction of the eighth ri,b with its 
costal cartilage. It continues to descend until it reaches its 
lowest point at the tenth rib in the midaxillary line. 

Cunningham was the first anatomist to call attention to 
the fact that the line of pleural reflection is lower than was 
formerly supposed. His observations were confirmed inde- 
pendently by Elsberg and by me. The diaphragmatic pleu- 
ral reflection as now generally accepted is as follows: 

In the mammary line,, at the junction of the cartilaginous 
and bony portions of the eighth rib. Then passing down- 
ward (Fig. 2), it follows the lower boarder of the ninth rib 
from the anterior to the midaxillary lines, crossing the lower 
border of the tenth rib at the posterior axillary line, then 

164 The Plexus. 

passing slightly upward again to reach the side of the vert- 
ebral column at the level of the twelfth dorsal spine. 

One can readily see the value of this knowledge when 
we recall that the attachment of the diaphragm to the chest 
wall is lower than the line of the pleural reflection. Els- 
berg, in his article on "Subphrenic Abscess After Appendi- 
citis," published in 1901, described a method of operating 
which avoids opening the pleural cavity. He employed this 
technic in two cases. About two inches of the ninth and 
tenth ribs are resected in the usual manner, somewhere be- 
tween the scapula and anterior axillary lines. The pleural 
reflection is seen in the wound and is pushed upward. An 
exploring needle is then inserted through the diaphragm 
and an incision made alongside of the needle, and drainage 
tubes inserted into the abscess. 

In my own work, both on the human subject and on the 
cadaver, I found that the pleural reflection was so low that 
one could only resect the tenth rib between the anterior and 
posterior axillary lines without opening the costophrenic 
sinus of the pleural cavity. The diaphragm lies in the 
wound and can be incised readily after the pleural reflection 
has been pushed upward (Fig. 7) If the ninth rib is resect- 
ed, the costrophrenic sinus will certainly be opened unless 
the resection of the rib is carried out strictly between the 
anterior and posterior axillary lines and great care is taken 
in pushing back the periosteum of the ninth rib. This will 
be understood by referring to Figures 2, 7, 8 and 9. 

If, as in one of my cases, the abscess cavity is situated 
high up under the diaphragm (Fig. 5), it can only be reached 
by the transpleural route. 

The method described by Elsberg, which I have modi- 
fied, is the ideal one. It avoids a possible pneumothorax 
and empyema. In two of Korte's cases and one case of my 
own the cause of death was postoperative empyema. In 
many cases it is impossible to open the abscesses by any 
other route than the transpleural. 

In some cases the costophrenic sinus will be found en- 
tirely obliterated by adhesions between the costal and dia- 

Ghosts that Stare at Us. 165 

phragmatic pleurae. The pleura can then be incised with- 
out opening the pleural cavity proper. 

If it is necessary to open this pleural cavity several 
methods can be employed. If possible, the diaphragmatic 
pleura should be sutured to the costal pleura. If there is 
much bulging of the diaphragm it is best to aspirate some 
of the pus lying beneath it before suturing. If it is impos- 
sible to bring the diaphragm to the chest wall the general 
pleural cavity can either be walled off with gauze or a larger 
portion of the ninth and tenth ribs can be resected. The 
former (tamponade) is very unsatisfactory on account of 
the danger of leakage. The second method, i. e., more ex- 
tensive resection, has been recommended warmly by McDill 8 , 
who employed it in 100 cases of emebic liver abscess drained 
by the transpleural route. It had been previously employed 
by KOrte, Lejars and others. After a four-inch partial re- 
section of the ninth and tenth ribs in the midaxillary line an 
assistant presses the thoracic wall inward against the dia- 
phragm, to which it is sutured, while an incision is made 
through the diaphram into the subphrenic abscess. 

8. The Journal of A. M. A.. Aug-. 10, 1907. 


By George B. H. Swayze, M. D., Philadelphia, Pa. 

Late Professor of Obstetrics and Dean of the Medico-Chirurgical College 

There^are staring at us as doctors the glassy eyes from 
sunken faces — like so many ghosts — of dying friends and 
patients whom we half-heartedly gave up in the start of 
broken health because we believed that they had "gone into 
the decline" of tuberculosis, and therefore little help remained 
for them. We doubtless prescribed an expectorant for the ear- 
ly cough, we scarcely had courage to suggest the sterio'yped 
formula of daily punishment with dosages, of cod liver oil or 
whisky and raw beef, because of the gloomy prognostication 
of their significance- We played the professional imbecile 
to while away the interval of time betwixt the start and the 
end without throwing across the weary way any real barrier 

166 ThePlexus. 

of defense against the hastening foe to vital energy. We 
smothered from recognition the dismal facts as long as pos- 
sible rather than disclose the gangrenous bite of alarm 
about the then supposed inevitable. 

To an extent we supposed that we were wise — to a 
greater extent we were cowardly and foolish. Fortunately 
for the trustful public, the long day of tucking down the 
fringe of so grave an issue as developing consumption with 
evasive words, meanwhile smudging our subterfuge with 
croton oil and porous plasters, is now more happily drawing 
towards its close. Between talking things and doing things 
timely and worth the while arises an oasis of relief freed 
from the clouds of daily despair and the somber sunsets of 
hastening death. With the isle of rescue in near view, now 
is the time for everybody, including backward and dubious 
doctors, to cultivate alertment of capacity that will actively 
tend to aid in repressing and arresting the ravages of con- 
sumption among us. The awakening spirit is actually now 
here. The nature and effective management of the insidi- 
ous disease is now being practically comprehended. Inte- 
rest in the only available means of prevention and early re- 
lief and cure is being aroused broadcast. Tuberculosis is 
the form of disease afflicting population that exceeds every 
other. Then the restraint of tuberculosis requires and de- 
serves pre-eminent attention by every physician and in eve- 
ry home in America. Every practitioner of medicine should 
become an antituberculosis teacher. Every householder 
should become a guardian against the development and rep- 
etition of the great white plague in the home. For this one 
time again I raise my voice for the rally, and put my should- 
er to the wheel of advance. No more surrenders to super- 
stitious creed of heredity. Everybody forefended by the 
orthodox solace of natural hygiene. The seal of zealous in- 
struction persistently impressed upon public attention. At 
it, and at it perpetually for the ransom of humanity. What 
a stupendous work to be done! Most worthy and ennobling 
the task! Silent but heroic and irrepressible revolution in 
the relief of human suffering, the reduction of grievous in- 

Ghosts that Stare at Us. 167 

validism, the shielding of labor values and family support! 
Less simpering over hair-splitting theories — more quickstep 
in sensible action on lines that timely avert calamity! 

All cannot be accomplished at one bound. But the 
steady pace of time will gradually measure out the oppor- 
tunities to those who will begin now to watch for them and 
who will faithfully utilize every early chance to rescue life. 
Example is the inspiring test of sincerity and effectiveness. 
I therefore revert to the impetus of example to all who only 
need to discern the royal way by which others take hold of 
a practicable reformation in the management of tuberculosis 
among local or nearby population. In three preceding re- 
cent papers I dwelt particularly on the great work of the 
Phipps Institute in Philadelphia for the study of tuberculosis 
through receiving for care and treatment incurable cases of 
consumption, and by analysis of the condition of each patient 
admitted, also further by the physical revelations of autop- 
sies at the finale. A glance Avas also given at the Tubercu- 
losis Exhibition lately held in this city. Reference was also 
made to the general purpose and plans adopted by the Penn- 
sylvania Society for Prevention of tuberculosis by creating 
branch dispensaries, classes among work folks, church folks, 
labor clubs, for the spread of needful instructions, of timely 
personal hygiene, of oversight and regulation of diet calcu- 
lated to check or arrest the disease in its incipiency. 

Since there is no short way of reaching either the be- 
ginning or the end of this most important subject, I shall 
cut right across to its present stage and attiude. It has 
been said of President Roosevelt that he is a man who does 
things. By recent evidence there is another man prone to 
do things rather than merely talk of things. His name is 
Worcester, formerly rector of St. Stephen's Episcopal Church 
in Philadelphia, but later of Emmanuel Church, Boston. 
Fortunately for society, Rector Worcester is a broadminded 
man, who does not limit his brain interest only to pretty 
parables for the souls of mankind, but devotes forceful con- 
sideration also to the physical welfare of the temple of the 
soul while abiding on earth. Rev. Worcester had in his 

168 The Plexus. 

church a mental wide-awake, Dr. J. H. Pratt, who planned 
a tuberculosis clinic as a charity feature of the Emmanuel 
Church home mission work, by which the tuberculous poor 
in Boston community might receive appropriate treatment 
and care in their homes. That humane movement was start- 
ed about three years ago, and it is reported that thousands 
of patients have been helped, and eighty per cent, of them 
cured since the tuberculosis clinic was organized. Rector 
Worcestor was so actively interested in the cause that he 
desired to see this field of usefulness extended. He there- 
fore visited Philadelphia a few weeks ago especially to 
recommend the work of his former congregation in this city, 
and Drged that the members get busy at organizing church 
tuberculosis clinic or classes after the model of the Em- 
manuel plan. Backed therefore by certain influential 
members, the St. Stephan's clinic in Philadelphia was or- 
ganized without delay — the meeting of patients being held 
in the S. S. building adjoining the church. The chosen 
medical director, the chief nurse, and the principal parish 
visitor are in active charge. Two meetings are held weekly. 
The number in attendance increases at each meeting. On 
Mondays the diagnosing medical examinations of patients 
are made. On Thursdays instructions are given to the 
patients as to how they are to help to cure their own disease 
and to 'prevent its spread to others. Reports are also re- 
ceived from patients on that day as to their daily doings in 
conformity with the regulations of the clinic. None who 
fail to follow instructions of the physician in charge, and to 
obey the printed regulations furnished to patients, will be 
allowed to continue in the class. Homes are visited and in- 
spected. Modes of living are examined into, and errors 
corrected. In simple manner the doctor explains the group 
system of treatment, insists that patients remember that 
medicine alone cannot cure tuberculosis, and that patients 
for themselves must largely win their cure by strict observ- 
ance of hygiene and sanitary laws that promote the upbuild- 
ing of health in general. It is particularly noted that all 
sputum must be burned daily as the most sanitary way of 

Ghosts that Stare at Ub. 169 

-disposing of the troublesome waste matter expectorated. 
"When going about the streets or on the cars, each patient 
carries a supply of small paper napkins to receive all ex- 
pectorated matter. The collection of this is temporarily de- 
posited in small paper bags carried in the pocket for the 
purpose, and burned at once on returning home. It is taught 
at this clinic, reinforced by a tract furnished by the Penn- 
sylvania Society for the Prevention of Tuberculosis, that if 
the patient is careful with his sputum he is harmless to 
others, but also that the patient should never swallow any 
of his sputum for fear of transferring the disease from the 
breathing organs to other parts of the body. Furthermore, 
the hands should be washed and the mouth well rinsed be- 
fore partaking of food. Soiled wash clothing and bed linen 
should be first boiled before washing. Avoidance of fatigue, 
plenty of rest, regularity of habits, continuance of fresh 
breathing air and plenty of good wholesome nourishment to 
build up the physical condition are radical essentials for 
prevention, also for arrest of the disease. Patients must 
always have nine hours' sleep, retiring before ten p. m. ; must 
sleep alone and with windows of the sleeping-room kept 
freely open day and night, in spite of ordinary change of 
weather, so that the patient will not inhale the same air 
twice. It is also now taught that tuberculosis is NOT he- 
reditary — and is found in children of consumptives chiefly 
because of the unsanitary enviroment which the children 
shared in common with their parents. It is also in the plan 
to serve the poor patients liberally with good eggs and milk 
as convenient forms of concentrated nourishment to over- 
come tendency to loss of weight. 

This condensed outline of home mission work among 
persons disposed to tuberculosis has been written and is 
here printed in behalf of the unfortunate consumptives 
everywhere who may be reached and helped, and should 
convey sufficient idea of how to start a class clinic to repel 
encroachments of consumption wherever such field of serv- 
ice is needed. Secretary Wallace Hatch, of Pennsylvania 
Society for Prevention of Tuberculosis, will assist to organ- 

170 The Plexus. 

ize group classes and can furnish important printed material 
for use of patients. Besides St. Stephen's, other churches 
have started similar system of ^clinics — Church of Crucifixion, 
Calvary Presbyterian, Centenary Methodist Episcopal. 
Representatives of labor unions are taking up the practical 
work of relief in similar manner. Every considerable town 
in the United States could afford to give decisive aid to pre- 
vent waste of valuable life by tuberculosis because of ignor- 
ance and inaction in regard to available agencies of preven- 
tion and rescue. Every intelligent person can soon learn 
how to avert consumption. Live as much as possible in 
fresh air. If not out of doors, then put the fresh air indoors 
continuously by open windows. Live where the air is not full 
of poison from smoke stacks, locomotive gases and housetop 
chimneys. Avoid shut-up sleeping rooms. Avoid inhaling 
the decay exhaled into crowd air. Abstain from all crowded 
places where the rebreathed air from promiscuous lungs in 
large numbers is the only quality of breath drawn into the 
lungs. Persons threatened with consumption are often com- 
pletely rescued by taking to outdoor life. I have urged 
many to forsake stuffy office nooks, or villainous store air, 
and get outdoors, even to walk the streets as canvasser from 
door to door, or to start truck raising on a patch of open 
country ground. The Evening Telegraph of to-day prints a 
brief of a circus rider who saved his life by selling news- 
papers on the street. The air under^the circus tent is always 
surfeited with impurities from crowded breaths. Suffering 
with consumption, this circus performer in the Barnum show, 
engaged in the sale of newspapers on the streets of Altoona, 
Pa., last Spring. He now has announced that he is entirely 
cured and that the open-air life did it. Shouting "Extra" 
cured him. There we are with the very simple problem! 
The houseling, hemmed in with heater gas, gas stoves, coal 
oil stoves, growing thinner and coughing constantly, drifts 
into tuberculosis and dies prematurely. The huckster on 
the open streets has good lungs and is hearty and well. I 
know an old gentleman who had a large newspaper route in 
this, city on which he delivered his morning papers to patrons 

Ghosts that Stare at Ua. 171 

and made his collections weekly till he was eighty years old 
before he retired. It is not asserted that he had consump- 
tion when he started; it is proven that his health remained 
well preserved amid all variations of weather the year 
round, while many other men and women went under with 

Since it has been my lot personally so long to combat 
quite alone against the medical vogue of believing that the 
bacillus is the original potency in causing prevalent forms 
of disease, it is but just to the interests of square reasoning 
to note here that the germ fallacy, like a straggling sheared 
sheep, is browsing from the top of the prominent hill along 
the down slope of the other side, and disappearing from the 
horizon of its infatuating doctrine. Dr. Walsh, of Phipps 
Institute, specialist in the treatment of consumption, who 
has had over seven thousand cases of tuberculosis to pass 
under his study during the last seven years, when lately ad- 
dressing the meirfbers of the womans' club in this city is re-, 
ported to have declared: "It is not necessary to go out into 
the country to get fresh air. Sunlight is a marvellous 
germicide. While spitting upon the streets should be stopped 
absolutely, there is an exaggerated idea of the danger from 
dust" (dried sputum mingled with outdoor dust). "As a 
matter of fact, the tubercular germs in the street will not 
survive the rays of an August sun more than twenty 
minutes." So we see that the street-spitting fallacy, for 
doctrinal theory, has been over-estimated; it is a bubble of 
unseasoned sense. 

I understand that Dr. Walsh teaches that all consump- 
tive cases are considered curable if caught early and treated 
with clean breathing- air and sanitary environment generally. 
Dr. Pratt, in connection with Rev. Dr. Worcester's church 
classes, Boston, to repeat, affirms that of each one hundred 
patients enrolled, there have been eighty per cent, of cures. 
Fresh pure air beats all the drugs in the world as the normal 
remedy for abnormal state of lung cells and blood corpuscles 
coincident with tuberculosis. The Philadelphia Bureau of 
Health recently reported a very pronounced increase of cases 

172 The Plexus. 

of consumption — 181 new cases in a week! While winter 
house heating, with closed windows, with much re-breathed 
close gassy air indoors naturally causes insufficient oxygena- 
tion of the blood cells, and proportionally aggravates and 
burdens disordered lungs, nevertheless the marked increase 
of cases of consumption reported is largely due to the dis- 
covery of numerous -cases at the tuberculosis classes now 
being organized, and where patients with cough and failing 
health have applied for gratuitous expert medical examina- 
tion. Thus the more cases found and helped, the sooner is 
the spread of the insidious plague reduced. But now I have 
a gentle criticism. Dr. Walsh, as reported, in his address 
made the illogical statement that heat from coal stoves, coal 
grates, does the air no harm, while heat from gas and oil 
stoves does great harm. The doctor evidently has but half 
studied the problem of fuel gases indoors. He seems oblivi- 
ous to the fact that soot-choked stove elbows and down 
draughts by high winds pushing across chimney tops, back 
the poisonous carbonic oxide gases from coal fires into the 
breathing-air of houses with serious harm. An open grate 
will throw out with its heat more fuel gas than does a stove 
well managed. General Washington contracted his fatal 
quinsy by inhaling the gas poisoned air from his open grate 
fire in his bedroom. Of course, he was bled and re-bled in 
the death-trap of that room at Mt. Vernon till death ended 
the tragedy. The relative harmfulness of all coal fires in 
the home and in the business place depends on the chimney 
draughts by which the gases of combustion are either drawn 
clearly up the flues to the outdoors above the house, or 
whether obstruction, heavy air, lack of draught, cause them 
to drift into the house. There remain yet many essential 
facts that tuberculosis specialists need to learn about pro- 
tection of lung integrity. The lecturer further strained his 
deduction if correctly reported: "If smoke were dangerous, 
Pittsburg would not have the lowest mortality from con- 
sumption of any of the cities." Without looking up the 
statistics, we may qualify that assertion with the fact that 
the smoke of Pittsburg is thrown into the outdoor air. 

Ghosts that Stare at Us. 173 

Furthermore, the majority of families residing at Pittsburg 
do not cluster in the smoky district, but locate upon the ex- 
pansive elevations beyond, where the air is relatively clean 
and fresh. But withall Pittsburg has occasion to make con- 
test against the great white plague. The central board of 
education has adopted a program for regular instruction in 
tuberculosis prevention measures through a weekly class 
conducted by sanitary officers. 

Returning now to practical work in Philadelphia, the 
free tuberculosis dispensary of the state department of 
health, recently put in operation here, presents instructive 
demonstration. Since it was opened less than two months 
ago, there have been two hundred and forty-seven appli- 
cants, and over two hundred persons have been under treat- 
ment. The local medical director and a staff of four medi- 
cal assistants conduct the work. There are three visiting 
nurses to call at the homes of patients. Each physician of 
the staff has- his own hours at the dispensary for clinical 
service, and each has his own organized class of patients. 
On Saturdays there are two clinics. To patients who are 
accepted on account of their poverty, two quarts of pure 
milk and six eggs are supplied daily by the dispensary— a 
sufficient appropriation, I understand, having been provided 
by state legislation. Patients are weighed fortnightly to 
test the degree of their physical improvement. 

But we doctors must get at it, and do something for 
these unfortunate tuberculous cases when it is worth while. 
If I had a voice of thunder and if my words could have the 
gleam of lightning, I would appeal to the medical province 
of today. Let us wake up! Wake up to the common debt 
we owe for the rescue of the uninformed and therefore un- 
vigilant people about us who are unconsciously drifting into 
the snares of tuberculosis — and that unnecessarily! Refer- 
ring to state progress, the governor of Pennsylvania takes 
this cheerful view: "A new year is greeting us. A great 
day is at our doors if we have the cleverness to know how 
to turn the knobs and clasp hands with the welcome mes- 
sengers of deliverance of population from the blight of the 

174 The Plexus. 

great white plague, tuberculosis." Until recent years too 
many people have been inhaling stink in shut-up rooms 
without knowing that they were thereby smiting the vitali- 
ty given to sustain life. When a student at Dickenson Sem- 
inary in my youth, I sometimes visited the room of a fellow 
student who could help me in my Latin. The room air there 
smelled actually sour with carbonic acid exhalations in lim- 
ited space with no ventilations. Ten years later I saw a 
brother of this talented student and inquired how he was. 
"Dead — died several years ago of consumption!" was the 
reply. Seminaries and colleges may teach book hygiene to 
classes, but practical hygiene means actual visitations to the 
rooms of students to press into actual grasp the meaning of 
life-saving ventilation. The Fresh Air School, where schol- 
ars study all day with their wraps on, with large windows 
open on all sides, is said to be now in operation at Provi- 
dence, R. I., and has proved the same success herein Amer- 
ica as it has already proved in Germany and England. This 
may be an overstrained adoption of fresh air service. But 
the day may be hastened when every home, as well as office 
building and school house that is built, will be scientiffcally 
provided with ventilators which shall supply plenty of fresh 
air and carry off steadily the used-up, worn-out air. Louise 
Satterthwaite hits the problem of sanitary breathing-air: 
"In our trolley-cars we find a stale and human tang which 
shows that it is quite unfit to breathe and every window is 
steamed with the breath of those therein. In every steam 
car you enter there is a degree of warmth exactly like a hot- 
house—and ventilation quite ignored- In our school-rooms 
the air reeks of the physical personalities as well as clothes 
of the pupils. In the business offices there is also too much 
warmth and quite too little oxygen. In the homes of the 
people an open door or window is regarded as little short of 
suicide by the majority of people- But they fail to catch 
the lesson of the various infirmities which attack us in win- 
ter. Grippe, which lays low its thousands, pneumonia and 
bronchitis and chronic throat affections — ordinarily looked 
upon as unforeseen afflictions; when all the time we could 

Ghosts that Stare at Us. 175 

have breathed better air and found ourselves immune. We 
must have oxygen or fall sick and perhaps die." 

Women and children are special sufferers from close 
disease-breeding house-air. Many women are slow suicides 
— queer with follies. If they take a pew in church and de- 
tect a slight waft of ventilation reaching them, they imme- 
diately twist and flinch because of it, but will nevertheless 
waft with their fans a constant breeze of promiscuous crowd 
breaths into their faces and fancy it is a legitimate refresh- 
ment! Barbarous custodians of lungs and life! And the 
men show no more consistency. They seem equally oblivi- 
ous to the defenses of blood integrity and reliance of health. 
I see them enter churches and immediately remove their 
overcoats before waiting to ascertain anything about what 
is the temperature of the audience room. Then if they feel 
a perceptible movement of ventilation, instead of resuming 
the warmth of overcoats for body heat, they stare right and 
left to discover which window is admitting fresh air, and fly 
to the window cord and close out the refreshing atmospher- 
ic invoice that will help to prolong life and defer a funeral. 
An office lady secretary cries out: "I am acquainted with 
a number of men in a business way, and only one of them 
knows what the term 'fresh air' means. Among the offices 
in our building there is a large room where fifteen or twenty 
men have desks. Go into it when you will, every window 
will be found shut and the atmosphere thick with tobacco 
smoke. Open a window and you will hear remonstrances 
from every worker within twenty feet of it. 'Do you want 
to give a fellow pneumonia?' they demand, and hastily push 
up the sash so that the supply of air is cut off. And every 
man of them is afflicted in season and out with grip and 
colds and other ills which come from living or work in a 
vitiated atmosphere. If no one came in to open the door, 
would a half dozen men put into a small room together sit 
there and talk and smoke until they had consumed all the 
oxygen and died of suffocation?" This is the type of men 
who, ignorant of natural cause, die early of pneumonia, of 
consumption, of heart failure. A few years ago in Phila- 

176 The Plexus. 

delphia, a bridge on a very prominent street had to be 
switched off from trolley use because of serious damage that 
corroded and endangered its iron support because of loco- 
motive gases and smoke from the railroad beneath. Pollu- 
sion of the air laden with sulphurous fumes poured out be- 
neath had done the damage. If polluted air, under the open 
sky, acting upon massive metal work protected with paint, 
destroyed the safety of a powerful bridge, what must be the 
destructive effects of such polluted air upon the lungs of the 
human beings who are compelled to breathe it? In the city 
of London it is estimated by competent authorities that 
nearly half a million tons of sulphuric and sulphurous acids 
are yearly emitted into the air from chimneys, and that 
more than twelve hundred tons of solid matter — soot and 
hydrocarbons — are yearly deposited from the same source 
upon the square mile of the city. What chance have the sen- 
sitive lungs of population in such vitiated environment? 
The pollution of the air in New York and Philadelphia is 
not so great as in London, but the difference is one of degree 
and not one of kind. Our factory mill district of Kensing- 
ton quite equals the pollution of London air. It is there 
that consumption is the most prevalent destructive to life. 
It is hoped that the antituberculosis clinic among the ope- 
ratives in this our Kensington mill district will soon bring 
down its rate of deaths by consumption. 

As physicians we have a great contest before us. But 
our lieutenants must be found in the public. Members of 
the Civic Club here turn to women for assistance in flanking 
the march of consumption. Establishment of special classes 
in public schools for tubercular children, the maintenance 
by the city of a department of books on cure and prevention 
of tuberculosis in public libraries, and the organization of 
employment bureaus to find healthful occupations for pa- 
tients discharged from sanatoria as means of combating the 
white plague is now under discussion. Dr. Wallace Hatch, 
of the Pennsylvania Society, urged the women's co-opera- 
tion, and advocated the awakening of universal interest in 
measures for prevention of the spread of tuberculosis and 

Ghosts that Stare at Us. 177 

the arrest of its development among the young, by conduct- 
ing special classes in schools, where infected children could 
be properly cared for, instructed in hygienic principles and 
taught how to overcome the incipient dangers of the disease. 
The women were advised to spread the idea of the mainten- 
ance of shelves of books especially devoted to consumption 
by the free library to catch the attention of youths of both 
sexes who are warned by weak chests and suggestive cough 
that lung danger is lurking along their way. As result of 
the ghostly contagion propaganda proclaimed by certain 
specialists who were unable to comprehend the spread of 
consumption except by germ infection, opposition has 
frowned on the admission of tubercular pupils in public 
schools. But discretion should not strain itself into hyste- 
ria. In Chester, Pa., a thirteen year old girl was lately ex- 
cluded from school attendance by the Board of Education 
on account of suspicion that she had tuberculosis, and a 
legal row resulted for her restoration of school privileges — ■ 
with what result I have not learned. But the superintend- 
ent of education in Philadelphia affirms that no consumptive 
child has been barred from school by the Board of Educa- 
tion in this city- The physical condition of pupils in Phil- 
adelphia is trusted to the discrimination of the medical in- 
spectors appointed by the director of public health and 
charities. In case of a child suffering from advanced tuber- 
culosis, the parent is advised to take it out of school. Su- 
perintendent Brumbaugh holds the view that outside the 
question of prevention is that of the welfare of the afflicted 
child. That knowledge bought at the cost of health is pur- 
chased too dearly. 

Public meetings to discuss tuberculosis are evidence of 
the earnestness awakened among the people. This spirit 
should be cultivated until vigilance and measures of relief 
become universal. Why should any form of disease be al- 
lowed to reign unopposed by practical means of repression! 
The brain of man is selfish, stubborn or stupid that will not 
exercise thought and action for the repression of the ghostly 
scourge known as consumption. Every time that I see the 

178 The Plexus. 

glassy eyes of a consumptive glaring so pathetically at me r 
I wonder how on earth doctors could so long have fancied 
that medicines put into the stomach could successfully serve 
as substitute for pure and fresh air inhaled into the lungs. 
Recently representatives of workers in almost every industry 
and trade in Philadelphia were present at a conference held 
in the lecture room of the College of Physicians to plan 
methods of combating the white plague in factories and 
workshops. It was decided to distribute instructive litera- 
ture on the subject and to place large cards relating to pre- 
vention in factories. Representatives of forty trades joined 
in this popular demonstration to outline plans for the cam- 
paign to be pushed vigorously in the working places of this 
city. Wide-awake delegates denounced the state bureau of 
factory inspection for the lax way in which the bureau in- 
spects unsanitary mills. Child labor in mills was especially 
condemned as a menace to the health of the young. Dr. 
Hatfield, president of the state society conducted the meet- 
ing. The secretary of the Journeymen Barber's Union made 
a practical hit when he said: "I can give this society work 
for two years to come among the barber shops of Philadel- 
phia. Our trade is a powerful factor in spreading tubercu- 
losis under conditions in certain shops. Many of them have 
not running water. They use the same towel on dozens of 
faces. Floors are not scrubbed often enough." 

Madame Laurence Fiedler, who is considered by many 
the most advanced woman student in France of the social 
problems of her sex, has come to New York on an import- 
ant mission for the French government — to study American 
methods of fighting tuberculosis. She declares herself par- 
ticularly impressed with what she calls our indirect method 
of resisting the disease. She visited Riverside Hospital, 
donned a nurse's outfit and watched every stage of treat- 
ment followed in that institution. She thinks that we are 
not yet doing all possible in a curative way of resisting the 
white plague. The Pennsylvania society for prevention in- 
tends to start an "after case department" by card index of 
consumptives who have left sanatoria convalescent, but- 

Parliamentary Medical Education. 179 

should be provided with suitable employment to prevent re- 
lapse. The patient will be followed and looked over every 
six months and reports made to the sanitarium where treat- 
ed. One object is to see that convalescent patients are not 
overtaxing themselves, or taking up work too arduous for 
their strength, or not sufficiently remunerative to procure 
the special diet needful to sustain normal weight. A circu- 
lar letter to the stores of the city, asking for help in main- 
taining the relief work has been issued under the auspices 
of the finance committee consisting of men of substantial 
means, whose interest and practical activity will add finan- 
cial and moral support to the greatest crusade against a 
subtle persisting disease that haunts our modern life. 

This article has recited enough to show that the most 
important fact for us as doctors to realize is that in the re- 
pression of consumption, much needs to be perseveringly 
done, done, instead of merely and quite uselessly exploited 
as hot air that dies in its birth. Personally I am but one of 
the interesting brethren. But I meet with heart and hand 
every other brother who will dignify our profession by en- 
ergetically joining the present crusade to banish the ghost 
of consumption that haunts our professional pathway. — The 
Medical Times. 


By J. H. Long, M. D. 

In the last few years the Council of Medical Education 
of the American Medical Association has been taking a live- 
ly interest in several questions connected with the character 
of the work in our medical schools. It will be recalled that 
valuable reports have been published on the actual working 
conditions as found by inspection of all the schools of medi- 
cine in the United States. But it is evident that good work 
in college cannot be done with poorly equipped students; 
boys with limited education cannot follow certain lines of 
work now offered in many of our large schools, and which in 
time will have to be offered in all of them, yet such boys are 
admitted and the schools suffer in consequence. 

180 The Plexus. 

It is becoming clearly recognized that the most import- 
ant part of our medical education is the beginning of it, or 
perhaps, better, the preparation for it, and to aid in secur 
ing plans for a course preliminary to the actual medical 
school work the council appointed a special committee, con- 
sisting of Profs. J. H. Long, of Northwestern, C. R. Bar- 
deen of Wisconsin, and G. A. Piersol, of Pennsylvania, to 
work out a schedule of preliminary studies. Such a scheme 
was presented in a report of this committee to the council 
at its annual meeting held last April. Prof. Long's paper 
in Science gives a summery of this report along with various 
comments from educators on the practicability of the plan 
outlined. It is pointed out that there can be no great ad- 
vance in our medical school work until some of the topics 
now followed in the Freshman year are covered before the 
student begins that year. In other words, the student 
should come to the medical school with general chemistry, 
physics, biology and certain languages already well com- 
pleted. While Prof. Long and his colleagues on the com- 
mittee believe that this work can be finished by a good stu- 
dent in one year of college work after leaving the high 
school, it is probable that for many boys two years will have 
to be devoted to it. 

It is suggested, finally, that the fitness to begin the stu- 
dy of medicine, like the question of fitness to practice med- 
icine, should be determined by authority other than that of 
the medical schools themselves. 


The association of gangrene and eclampsia is both rare 
and interesting because of the liability of confusing the ne- 
crotic areas with burns of the unconscious or semi-uncon- 
scious person. The pathological findings do not correspond 
with those of burns, but indicate an internal cause which 
the author suggests to be a chemical irritant in the blood 
itself. This irritant so alters the character of the blood that 
the tissues readily break down in the presence of some de- 

Notes. 18£ 

termining factor. What this irritant consists of is unknown 
but is supposed to be similar in character to the toxins of 
diabetes. The fact that only three cases of this character 
have been reported shows that the lesions have been mis- 
taken in burns, and hence the physician is apt to be held ac- 
countable for the condition despite the best of treatment. 
The author reports two cases of gangrene and eclampsia oc- 
curring after hot bottles and bricks had been applied to the 
patient's limbs. Sloughing took place in each case and final 
healing was delayed for several months. 


Dr. S. G. Higgins, '05, Milwaukee, who is associated 
with Dr. H. V. Wurdemann in the practice of the eye. ear, 
nose and throat, was recently calling on friends in town. 

Dr. Wm. A. Walter, '06, will soon return from Vienna 
where he has spent the past six months studying the path- 
ology of the eye. 

Dr. L. H. Peters, '06, who has been holding a hospital 
position in Silver City, New Mexico, has left the hospital 
and gone into general practice in the far West. Cards an- 
nouncing his marriage were received last month. 

Dr. Chas. C. Clement, '06, has recently been appointed 
assistant surgeon to the Illinois Charitable eye and ear in- 
firmary where he served an internship last year. He is 
located in the Venetian building. 

Dr. J. W. Birk, '01, who is located at Bucyrus, Ohio, 
was in Chicago a few days recently. 




BATAVIA, ILL., APRIL 20th, 1908. 


The 44th annual meeting of the Illinois State Dental 
Society will be held at Springfield, May 12, 13, 14 and 15, 
1908. The sessions and clinics will be held in the State 
Armory Building. Wednesday and Friday mornings will be 
devoted to clinics, other sessions to papers and discussions. 

Every registered dentist in the state should be a mem- 
ber of the state society. Take a few day's vacation and at- 
tend the meeting at the state capitol. . 


The 12th annual meeting of the association will be held 
in Boston on July 28th to 31st, inclusive, and promises to be 
one of the most important in the history of the society. It 
is 28 years since our National Society has held a meeting in 
New England and it is confidently predicted that the at- 
tendance and interest will surpass that of any previous ses- 
sion. Here is an opportunity of seeing the far east and en- 
joying a good program. 


The practicing M. D. charges for every office visit, be 
the time ever so small, while the average dentist really 
makes all the treatments, consultations, etc., free! He often 
performs an operation of an hour that requires as much skill 
as many a surgeon's operation, and probably receives $2, 
while the surgeon receives $200. Some operators may get 
an adequate fee, but the fact remains that dental fees are 
genrally too low. — A Waas, Dental Review. 

Dr. E. A. Royce, of Chicago, writes in the Dominion 
Dental Journal: "Personally I have found the mounting of 
crowns with gutta percha very difficult, and recently have 

Dentistry. 183 

been using a combination of gutta percha and cement for 
many cases. The gutta percha is placed upon, or in, the 
crown, as the case may be, and while soft the crown is 
pressed to place, and after removal of crown and gutta 
percha the root is smeared with the soft cement and the 
crown replaced, allowing the cement to cover the root and 
cement the gutta percha to it." 

Dr. G. W. Cook, in discussing the paper of Dr. J. E. 
Hinkins on "Abnormally Acid Saliva," said: 

In reviewing the literature on oral pathology and the 
pathological changes that take place in tooth substances 
some thinkers have revealed the fact that they were of the 
opinion that certain of these lesions were caused by an acid, 
probably not the bacterial fermentation acid, but an acid 
which was the result of a mucoid degeneration of the mu- 
cous epithelial glands situated in various mucoid epithelial 
structure in a particular locality in the oral cavity, and there 
by its constant contact with tooth substance, produced many 
of the lesions which we attribute to erosion. In purely 
local erosion, I am still of the opinion that the mucoid de- 
generation of the tissue in that locality is the true exciting 
cause of the erosion; but general erosion, I think the authors 
of this work have clearly revealed, is the result of the gen- 
eral aciclidy of the salivary secretions. Investigation may 
possibly show, however, many obstacles to this belief. 

The following news taken from the Chicago Record- 
Herald shows that dentists are recognized in civic affairs: 

"Dr. Bernard J. Cigrand, who was chosen last night as 
president of the library board, is well acquainted with the 
work of the board, having been recently re- appointed to his 
third term as member. He is prominent in school and den 
tal circles, being a graduate of the Valparaiso University 
scientific course and the Northwestern University school of 
dentistry. He held the chair of prosthetic dentistry for 
many years at Northwestern, later becoming dean of the 
University of Illinois dental department, which position he 
held for four years. In 1900 he was the Illinois delegate to 
the International Dental Congress at Paris. Dr. Cigrand is 

184 The Plexus. 

the author of many historical and professional works and 
lectures on themes relating to the history of colonial Amei- 

In one of the New York dailies an article ran as follows: 

"I wish tomorrow were over," said a dentist on Friday 
night, "for Saturday is children's day and by night I haven't 
a nerve in my make-up that isn't on edge. The children in- 
variably cry, but I'm accustomed to that. If that was all 
they did I wouldn't mind, but they bite down on my fingers, 
wriggle all over the chair, and what is worse, they romp 
about the office and make life miserable for the patient in 
the chair. If I were beginning my practice over again I 
wouldn't touch a child. I can't stop now without losing 
some of my best patients." 

This dentist should read what Dr. O. U. King, of Hunt- 
ington, Ind., has to offer on this subject: 

"The dentist who wishes the largest measure of success 
with children must be, 

"First, a lover of children, 

"Second, a student of children, 

"Third, a sympathizer with children, 

"Fourth, one who at a glance may read human nature 
and recognize the individuality of each child, and immedi- 
ately gain their confidence. 

' 'Fifth, he must be active in body and mind. A lazy 
dentist will never succeed with children (and with nobody 

In a recent dental gathering reported by a local paper a 
Dr. Green was reported as saying: 

Pope, in his "Essay on Man," says: 
"Say first of God avove or man below, 
What can we reason but from what we know?" 

So in dentistry, we should always keep in mind one ul- 
timate aim and end, and that is to preserve the natural tooth 
in a way to make it give the best service possible; and we 
can only do this by the practical experiences of the past, 
and also by our own experience. I believe that every den- 

Dentistry. 185 

tist who uses gold as his principal filling material has this 

1. Preserve the natural tooth, 

2. Make it useful. 

3. Aesthetic (last). 

While the porcelain inlay dentists in their articles get 
the horSe before the cart, with this formula — 

1. Aesthetic. 

2. Practical. 

3. Preservation or usefulness. 
A few others have this formula: 

1. Easy way to make money. 

2. At little cost. 

3. Aesthetic. 

By so doing they leave out the essential thing the den- 
tist should try to do; that is to preserve the natural tooth in 
a way to make it the most useful. With these formulas at- 
tached to their moving star, they sail away and never stop 
to consider that each human being that falls a victim to 
•their chair deserves to be remunerated with something use- 
ful in return for the hard-earned cash he has saved by stint, 
care and economy. We alone are accountable for our sins 
of omission and commission. 

In dentistry, when we find we can do a thing, and do it 
well, we should hold to it until we find something better be- 
fore we lay the old aside for the new. A good gold filling 
seems to be almost a lost art. 


1. Invocation. 

2. Address of Welcome. 

3. Response to Address of Welcome. 

4. The Annual Address of the Society by the Presi- 
dent, Dr. W. A. Johnston, Peoria. 

Discussion of President's Address. 

5. Report of Committee on Dental Science and Litera- 
ture. C. E. Bentley, Chicago. 

186 The Plexus. 

6. Report of Committee on Dental Art and Invention. 
R. J- Hood, Sparta. 

7. "The Romance of Dentistry." M. R. Harned, Rock- 

8. "Some Phases of Prosthetic Procedure,"' illustrated 
by stereopticon. Dr. J. H. Prothero, Chicago. 

Discussion opened by Dr. C. N. Thompson, Chicago. 

9. "The Use and Abuse of Filling Materials." A Sym- 



'Cement and Gutta percha," C. B. Rohland, Alton. 

'Amalgams," C. P. Pruyn, Chicago. 

'Porcelain," J. F. F. Waltz, Decatur. 

'Gold Inlays," G. W. Dittmar, Chicago. 

'Non- cohesive Gold," C. E. Bellchamber. Effing - 

"Cohesive Gold," L. S. Tenney, Chicago. 

10. "Putrefaction, with Certain Pathological Changes 
Induced." Geo. W. Cook, Chicago. 

Discussion opened by J. W. Hinkins, Chicago. 

11. "Importance of the Local as a Component of the 
State Society." R. J. Hood, Sparta. 

Discussion opened by H. F. Lotz, Joliet. 

12. "Syphilis and Syphilitic Phenomena in the Mouth." 
W. H. G. Logan, Chicago. 

Discussion opened by C. E. Bentley, Chicago. 

13. "A Presentation of Some Conditions of Caries of 
the Enamel." F. B. Noyes, Chicago. 

14. "Superiority of Natural Teeth over Artificial Sub- 
stitutes." H. W. McMillan, Roseville. 

Discussion opened by F. A. Lane, Macomb. 

The program as presented here is practically correct; 
some slight changes may be made in it, but nothing of any 
moment. The committee has endeavored this year to give 
those a rest who have done so much for the society in the 
past, and, as far as possible, has called upon new talent. A 
brief synopsis of each paper will be printed in the official 
program, which will be mailed to all members before the 
meeting. Therefore only a few words regarding each paper 
will be given here. 

Dentistry. 187 

Dr. M. R. Harned has gone back to the earliest printed 
journals and following them dewn to the present, has un- 
earthed all the different methods of practice which have 
been advocated, and will present them under the title, "The 
Romance of Dentistry," for it is a romance and shows how 
human we are and bears a lesson with it, which will be full 
of interest and show that many new things are really very 


Dr. Geo. W. Cook will present a scientific paper, con- 
taining the results of extensive experimental laboratory 
work in the investigation of pulp tissues, and particularly 
the changes that take place in the putrefactive process. 
There has hardly been a year during the last quarter of a 
century in which a paper of true scientific value has not 
been added to the literature of dentistry of the meeting of 
the Illinois State Dental Society, and Dr. Cook's paper will 
surely be a valuable addition to the long list. 

Dr. Robert J. Hood, fully appreciating the relationship 
between the LoCal and State Societies, will have something 
to say as to their mutual conduct. The subject is of the ut- 
most importance to the growth and strength of our great 
society, and Dr. Hood's experience in society work fully 
qualified him to handle this subject well. 

Dr. W. H. G. Logan will illustrate his paper on Syphilis 
with colored drawings of actual cases, and in addition will 
have preserved specimens for exhibition. What could be 
more important than instant and positive recognition of 
syphilitic lesions in the mouth when they present them- 
selves? This paper will deal particularly with the differen- 
tial diagnosis of syphilis from other lesions of the soft tis- 
sues of the mouth. 

Since our last meeting there has been given to the 
world an entirely new process by which photographs in nat- 
ural colors can be produced, and Dr. F. B. Noyes in his 
paper will give us lantern slide photographs of microscopic 
slides in which the color of the staining is as perfect as we 
could see it in the microscope. To Dr. Noyes is due the 
credit of being the first photomicroscopist to do this work, 
and ours the first society to benefit by it. 

Dr. H. W. McMillan has given the subject of the com- 
parative value and usefulness of natural and artificial teeth 
a great deal of study, and will present indisputable tabulated 
iacts which will occasion some surprise, and will surely be 
of benefit to every dentist. 




F. M. Goodman, Ph. G., C. S. N. Hallberg, Ph. G., W. A. Puckner, Ph.G 

H.H.Rogers, M. D., Ph. B., E. N. Gathercoal, Ph. G., 

A. H. Clark, Ph. G., C. M. Snow, Ph. G. 

CLASS EDITOR: W. D.Mottar, '08. 


By Geo. P. Mills, Ph. G., Evanston, 111. 

The lack of that respect to the physician and pharma 
cist which is due because of their higher education, and the 
deplorable condition existing today in the practice of medi- 
cine and pharmacy are agitating some members of each pro- 
fession throughout the country. The compensation they 
should receive, and the opportunity to live, to say nothing 
of existing, are agitating every member of both professions. 
Individual commercialism is blameable to some degree, but 
proprietary commercialism is the octopus which has hypno- 
tized the physician into being its advertising agent, without 
pay, duped the public in that they believe its products to be 
the standards, and squeezed the life out of the pharmacists. 

It will require the combined, earnest efforts of all in- 
terested to dislodge this "dog in the manger." The school- 
ing obtained each day must come from a very much higher 
source, and not from the printed matter distributed so free- 
ly by this octopus, nor from an unsuccessful practitioner, 
the detail man, whose only attainment might well be des- 
cribed as "the parrot to his majesty the proprietor." The 
physician on the firing line, the pharmacist, the chemist and 
the pharmacologist at the magazine, must furnish the data. 
This information, whether relating to new or old remedies, 

*Read before the Evanston Branch of the Chicago Medical Society. 

Pharmacy. 189 

should be compiled and distributed at frequent intervals by 
a competent committee, not salaried by or interested in the 
commercial marketing of drugs. 

The commercialism of this octopus is blameable to a 
great degree for the existence of that awfully funny joke, 
"just as good, "that all too common expression, "up to-date," 
which obliges the pharmacist to load his shelves with dupli- 
cates; that nasty word so often mentioned, "substitution," 
and, finally, that two-edged sword, dispensing by physicians 
versus counter prescribing by pharmacists. 

It is a known fact that there are physicians and so-called 
doctors, as well as pharmacists and so-called druggists. 
What respect from the physician is due to the "druggist" 
who buys from the jobber paregoric, Syrup Hypophosphite 
Co., and a hundred such articles, not even knowing they are 
pharmacopeial or formulary preparations? Still worse, he 
may not possess a copy of either pharmacopeia or formulary. 
What about respect for the higher education of a "doctor" 
whose cases are diagnosed by the patient and whose pres- 
criptions are mostly proprietary mixtures'? Is it to be 
wondered at that the public no longer recognize a difference 
between the actual physician and the man called "doc," or 
the pharmacist and the so-called druggist? 

Closer acquaintance in the medical or pharmaceutical 
body, or between medical or pharmaceutical men, means 
that each individual who considers himself a teacher finds 
he is being taught. The physician whose theory does not 
come in close association with the pharmacist's practical ex- 
perience, or the theoretical pharmacist who does not profit 
by the practical experience of the physician, is necessarily 
biased and short-sighted. Such men retard progress. 

The necessity of making money enough to pay expenses 
and prepare for a rainy day and old age must be conceded. 
Consideration of this side of the subject requires no apology. 
Quite often the physician prescribes "Bank's Mixture," re- 
questing that it be dispensed in the form of a prescription, 
or, better still, for the octopus "one original bottle," so that 
the advertising matter is passed to the purchaser without 

190 The Plexus. 

cost and the pharmacist can not "substitute." While wait- 
ing for this prescription (?) to be compounded (?) the mes- 
senger or patient employs his time reading the label on a 
duplicate bottle. He "draws his own conclusions." He 
doubts the physician's knowledge and the pharmacist's 
ability, and determines that he is quite as competent to pre- 
scribe and compound patent medicines. He decides that in 
the future he will save the physician's fee and buy direct. 
When that future time arrives we find that he has recom- 
mended this "prescription" to all of his acquaintances and 
that they have purchased the articles through some whole- 
sale friend or at a department store. The physician and 
pharmacist not only lose the respect rightfully theirs for 
higher education, but they are obliged to say farewell to 
their living expenses, which they must have, even though 
they make no use of the higher education. Is the 
practice of to day a credit to our teachers or our alma mater? 

Physicians and pharmacists belong to one family and 
they must be made contented members. Undoubtedly the first 
step to take is to get together. The pompous man from the 
firing line fares poorly when he attempts to give orders to 
the man in the magazine who knows it all and vice versa. 
Positively nothing can be done so long as our case is in the 
divorce court. Working solidly together, with a determin- 
ation to win, can not help but bring success. 

A few examples from the pharmacist's standpoint may 
not be considered out of place. 

Three or four years ago Dr. "prescribed" anti- 

kamnia and codein tablets for Mrs. A's neuralgia. Since 
then she has purchased "25c worth of Ak. and C. Tables" 
many times. Has there been proper professional control of 
this patient while using a remedy supposed to contain ace- 
tanilid or phenacetin? Where does the physician's respon- 
sibility begin and end? 

At least ten years ago another physician prescribed tri- 
onal. ' It seems that all of this patient's friend are poor 
sleepers, fortrional has become a household word and "we 
always keep it in the house." Do the physicians realize 

Pharmacy. 19l 

that many times the pharmacist is charged with counter 
prescribing when these friends call for trional? 

Only yesterday a stranger, while selecting cigars, said, 
"By the way, I want you to fill this prescription." The 
"prescription" proved to be "Tono Sumbul Cordial, Warner 
& Co., one bottle," which the customer read and returned to 
his pocket. He then ordered one bottle and, of course, will 
read the label, which states. "Tono Sumbul Cordial is a 
superb tonic and heart stimulant, promotes appetite, rest 
and sleep. Most palatable and contains not more than 20 
per cent of alcohol. Take a tablespoonful undiluted before 
meals or occasionally." It is supposed he will now fully 
understand his case. 

Here is where the physician does the advertising with 
out pay and gets left all around. 

In January of this year, when the National Food and 
Drugs Act went into effect, the formulas of the United 
States Pharmacopeia and National Formulary were made 
legal standards. This act has revived interest in medicine 
and pharmacology and furnished to us more guns and am- 
munition than we ever before possessed. If we fail to use 
these guns to good advantage we may not live to attend the 
funeral of the octopus. 

The United States Pharmacopeia was first compiled by 
physicians about 1820 and is now revised every ten years by 
a committee composed of physicians, pharmacists, , chemists 
and pharmocologists for the purpose of fixing standards for 
strength, quality, etc,, and giving directions for preparing 
medicines. No one doubts the wisdom of such work. 

The National Formulary is intended as a stepping stone 
to the pharmacopeia. The formulas are in very much the 
same position as the Methodist who is taken on probation. 
They may be probationers for some time, finally adopted 
and given their rightful place in the Pharmacopeia, or re- 

The preparations of the Formulary are suggested by 
physicians' prescriptions and are intended to replace many 
of the proprietary preparations. By their use great confu- 

192 The Plexus. 

sion as to strength, dose, etc., is done away with. In com- 
paring these preparations with proprietary articles it may 
be found that they are not flavored or colored so as to be 
exact duplicates. They are intended only as standard, non- 
secret mixtures, and it is to be hoped that they will be spe- 
cified by every physician and manufactured by every phar- 
macist. There is no more necessity for a dozen prepara- 
tions of Syr. Hypophosphite Co. than for a dozen paregorics, 
differing in color, strength and flavor. Most proprietary 
articles are simple mixtures, notwithstanding the gulling 
stories of "great discoveries," "wonderful manipulation," 
and "greater facilities" for manufacturing. 

The council on pharmacy and chemistry, as reported in 
The Journal of the American Medical Association, is doing a 
grand work in exposing the fictitious and deceptive nature 
of these preparations. Proprietary medicines produced by 
original and scientific research are of great benefit, but our 
laws should be revised so that only a deserving reward 
could be obtained for such production. 

Take for example, phenacetin and trional. There is 
surely something wrong when phenacetin, before the pa- 
tent expired, wholesaled at $1.00 an ounce, but after the 
expiration of the patent the price dropped to 33 cents an 
ounce while the official preparation, acetphenetidin (which 
is identical with phenacetin), can be purchased for $1.35 a 
pound. Trional, still benefitting from the patent laws, 
wholesales at $1.50 an ounce, while sulphonethylmethanum, 
the official preparation and identical with trional, wholesales 
at 45 cents an ounce. Then again, the price of sulfonal at 
$1.35 an ounce can be compared with that of the official pre- 
paration, sulphonmethanum, at 38 cents an ounce. 

Looking at another side of the subject we find hosts of 
liquid antiseptics on the market. The physician supposes 
that the one he is perfectly familiar with can be obtained at 
any "up to date" pharmacy. This does not always follow. 
Do the physicians ever stop to consider the delay in delivery 
and the trouble and expense in which it may put the phar- 
macist in supplying this particular make? Has the physi- 

Pharmacy. 193 

cian considered it substituting when any one of the many 
duplicates has been dispensed? It is easy to conclude that 
the interests of the physician, pharmacist and patient will 
be best served if Liquor Antisepticus, U. S. P., is prescribed, 
dispensed and furnished to the man who pays the bill. 

Physicians' charges should be in fact as well as in name 
for professional services. It is difficult for the layman to 
understand how the prescribing of patents, proprietary mix- 
tures or tradename articles can be considered as such. It is 
absolutely impossible for a pharmacist to carry on business 
when he can make only merchandise charges for the servi- 
ces he renders. In explanation of this statement the fol- 
lowing facts are given: 

Many of the proprietary dollar articles are wholesaled 
at from 71 cents to 84 cents a package. The average cost 
of carrying on a drug business is 25 per cent. It will require 
but little figuring to find how these wonderful dollar money 
makers are squeezing the life out of the pharmacist. The 
84-cent preparation actually costs $1.05, and if sold at $1.00 
there is a loss of 5 cents on the transaction. If a necessary 
charge of $1.25. is made, as is often the case, one can feel 
sure that he will be called robber. 

It ill becomes us to find fault with the names hexameth- 
ylenamina, sulphonethylmethanum or sulphonmethanum. 
Why should it be considered more difficult to memorize these 
names than that of the old preparation, Liquor Arsenii et 
Hydrargyri Iodidi? It requires but little application to 
memorize such terms, and there is no excuse for not doing 
so. The words are more than mere names. They really 
mean something to the intelligent man. 

Referring to the use of the pharmacopeal and formulary 
preparations to replace proprietaries, the change must nec- 
essarily be accomplished by degrees. It will require some 
time for the pharmacist to find out which ones will be called 
for and to prepare for dispensing. It will probably require 
just as much time for the physician to become familiar with 
the subject. This matter of using standardized preparations 
has in a way been hurriedly forced upon us, and the plan 

194 The Plexus. 

followed in adopting revisions of the Pharmacopeia can be 
used. Generally there is no definite date when prescribing 
or manufacturing of the preparations of one revision can be 
stopped or the use of the following one commenced. The 
pharmacist may have on hand a quantity of some proprietary 
preparation. He should be expected to furnish the official 
as soon as his present supply is exhausted. 

It is a pleasure at this time to read from an address 
given by George H. Simmons, M. D., General Secretary of 
the American Medical Association and editor of its journal. 

"This is from a book written by Mr. Geo. P. Rowell,. 
entitled 'Forty Years an Advertising Agent'. Mr. Rowell, 
as some of you may know, dabbled somewhat in the 'patent 
medicine' business himself. He is the one who created 
Ripans Tabules. In this book, by the way, he tells bow he 
came to put this preparation on the market. In the chapter 
from which I shall quote he described the 'patent medicine^ 
business in an interesting way, and tells of the fortunes that 
have been made and also lost. He has this to say about an 
'ethical' proprietary that some of you may have heard about: 
''We had a successful advertiser in Halifax, N. S., who 
sold a medicine know as Fellows' Hypophosphites that 
proved so good that some shrewd business men in the medi- 
cine trade who knew about it bought the trademark, incor- 
porated a company with a capital of $100,000, retained the 
original owner as manager, stopped all advertising except 
in medical journals, and thereafter pushed the sale only 
through the medical profession. I had information at one 
time of a young man who was heir to an uncle, recently 
deceased, and had come into possession of a certificate of 
stock of this company, of the face value of $6,000, and made 
up his mind that, shrewd as the old gentleman was, he had, 
without a doubt, acquired trash in this instance, and I heard, 
further, that the young man began to think better of the 
doubtful asset, when one day a dividend check came; and 
when, at the end of a year, he realized that within the 
twelve-month that $6,000 certificate had brought him $9,000 
in dividends, he began to revise his estimate of his deceased 
uncle's prescience in making investments. 

Pharmacy. 195 

" As a 'patent medicine' it was not a success, but as an 
'ethical proprietary' it has been proving a gold mine. So 
since that time this medicine has not been advertised except 
to doctors through medical journals, has it? Look at the 
wrapper around the bottle, read the label on the bottle, 
notice the name blown into the bottle, and then will you 
doubt the statement of the average druggist when he says 
that nine-tenths of Fellows' Hypophosphites is sold over the 
counter direct to the public and that the doctors are 
responsible? What better method of advertising? And 
how easy! Newspaper advertising is expensive! It is 
cheaper to use the doctor." 


The following senior students passed the Illinois Board 
for registration as pharmacists: H. D. Baldwin, A. S. Kis- 
ner, G. F. Knick, Newman Kohn, H. E. Kraft, W. D. Mottar, 
Otto Stoeffhaas, F. B. Stromer, W. R. Tervehn, W. E. Tom- 
linson and W. P. Williamson. Those passing for Assistant 
Pharmacist are F. A. Kufiewski, E. E. Luken, Chas. Propp, 
R. M. Soult and S. F. Voss. 

The Junior students who passed the Board for Assistants 
are Frank Annibale, Howard Arthur, A. F. Cholewinski, 
A. W. Fingl, F. L. Frauenhoff, P. E. Heimsath, W. P. 
Knox, O. W.' Leininger, J. J. Liska, T. J. McNamara, 
Adelaide Marcotte, J. F- Mueller, C. F. Nielsen, O. C. Oberg, 
J. M. Rambo, Edmund Schindel, J. H. Schneider, M. W. 
Thompson, H. A. Underriner, C- E. Walter and J. F. Wendt. 
It is noteworthy that all of the students who went up for 
examination passed successfully. 

The Phi Gamma Sigma fraternity held a very successful 
annual banquet at the Sherman House, Monday evening, 
April 6th. Forty members of the fraternity were present, 
Professor W. B. Day acted as toastmaster and toasts were 
responded to as follows: "The Class of '08", H. D. Baldwin; 
"the Fraternity", H. A. Langenhan; "The Class of '09", W. 
F. Johnson; "Fraternal Incompatibilities", Professor C. S. 
N. Hallberg. 


The Alumni Association held its annual meeting at the 
Illinois Athletic Club Tuesday evening March 24th. About 
forty members were present. Arrangements were made for 


The Plexus. 

the annual banquet to the graduating class on the evening 
of Commencement Day, April 23rd, at the Palmer House, 
A letter from Mr. Henry S. Wellcome was read offering to 
contribute $1000 toward the establishment of a scholarship 
in the School of Pharmrcy as a memorial to the late Albert 
E. Ebert, providing the Alumni of the school would raise 
the sum of $2000. The secretary reported that about $400 
had already been pledged. By unanimous vote Mr. Well- 
come' s generous offer was accepted and the members present 
pledged a further sum of $100 and authorized the officers of 
the association to bring the matter before the Alumni in 
such a manner as might seem best. 

The election of officers resulted as follows: 

President, Dr. A. W. Baer, '85. 

First Vice-President, Frank E. Blake, '07. 

Second Vice-President, Lotis L. Huston, '07. 

Third Vice-President, Miss Francis E. Wells '05. 

Secretary-Treasurer, A. H. Clark, '04. 

Historian, Charlotte E. Stimson, '00. 

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VOL XIV. BATAVIA, MAY 20th, 1908. NO. 5 1 





By Channing W. Barreet, M. D., Chicago. 

Gynecologist to Chicago Policlinic School and Hospital; Adjunct Pro- 
fessor of Gynecology, University of Illinois Medical School; 
Surgeon and Gynecologist Marion-Sims Hospital; 
Obstetrician in Cook County Hospital. 

Although displacements of the uterus and among them 
backward displacements are mentioned frequently in the 
writings of Hippocrates, Galen, Aetius and other ancient 
authors, the true position and normal range of movability of 
this organ is of recent discovery. Even at the present time 
differences of opinion exist as to whether or not backward 
displacement of the fundus is of pathological consequence. 
Theilhauber, E. Schroeder, Pfannenstiel, Salin, Waite and 
others claiming that the symptoms are due to the complica- 

While I cannot go into a discussion of this question. I 
have well-grounded reasons for still holding to opinions 
previously expressed, that retrodisplacements are deserving 
of treatment. To those, however, who consider uncompli- 
cated retrodisplacements of no consequence, Alexander's 
operation is disposed of at once, for it is only in those cases 
that it is permissible. 

Much has been written also upon the supports of the 

198 The Plexus. 

uterus. Many of our text- books abound with phrases refer- 
ring to "intraabdominal pressure" and "atmospheric pres- 
sure" as forces which maintain the normal position of the 
uterus. Repeatedly we read that if the fundus of the uterus 
is posterior to a vertical line drawn from the cervix intra- 
abdominal pressure, exerts itself upon the anterior wall of 
the uterus crowding it backwards. Nothing could be fur- 
ther from the truth. Intra-abdominal pressure in itself 
exerts force equally in all directions. In the upper part of 
the abdomen we have intra-abdominal pressure minus grav- 
ity, and in the lower part of the abdomen we have intra-ab- 
dominal pressure plus gravity, henje the greater tendency 
to hernias through openings in the walls of the lower ab- 
domen. Rectocele, cystocele, uterine prolapse and retro 
displacement are to a greater or less extent hernias through 
the pelvic floor. The uterus like all other intra-abdominal 
organs is held in position by ligaments. These are suited 
to the weight of the uterus. They are not constructed to 
furnish the lower wall of the abdominal cavity and stand in- 
tra-abdominal pressure plus gravity; this force is carried by 
the pelvic floor- If the pelvic floor is rendered useless this 
force falls upon the uterine ligaments and they sooner or 
later prove inadequate to the work thrown upon them. The 
uterus lying in the pelvis with the long axis of the body 
directed antero-posteriorly, parallel to the horizon, with the 
long axis of the cervix continuing backward and downward, 
is held in this position by means of its ligaments, the broad 
ligaments carrying a large portion of its weight, the sacro- 
uterine ligaments holding the cervix upward and backward, 
and the round ligaments running outward, forward and up- 
ward, acting as guy ropes to direct the fundus forward. 
With each respiration, cough or jar the uterus moves accord- 
ing to the force exerted. Prolapse and retroversion are 
closely associated and are caused by anything which increas- 
es the weight of the uterus or anything which decreases the 
carrying power of its supports or anything which exerts 
force or makes traction in the wrong direction. Many cases 
of retro-displacement may be corrected by proper treatment 

Intramural Transplantation. 199 

instituted within a short time after confinement or after a 
traumatism which acted as the etiological factor. But al- 
though the non-operative treatment should receive greater 
attention than the surgical gynecologist has been inclined to 
give it, yet the complications which bear the relation to the 
displacement of cause or effect or are coincident with it, or 
the long continuance of an uncomplicated retro-displacement 
often times makes operative measures necessary. The lite- 
rature abounds with articles' upon this subject and opera- 
tions and technique are described to the confusion of the 
student. To undertake a detailed description of these ope- 
rations is plainly not within the scope of this paper. I wish 
to deal more with the underlying principles of operative 
work. The operations which have been most in the lime 
light have been (1) External shortening of the round liga- 
ments, usually known as Alexander's operation or modifica- 
tions thereof. (2) Ventro-suspensio-fixation with a false 
ligament. (3) Internal round ligament work. ' Other meth- 
ods have had their exploitation, among which may be men- 
tioned vaginal suspension, vaginal fixation, vaginal short 
ening of the round ligaments, but they require no serious 

Operations have had their rise and have maintained 
their foothold as they followed certain essential principles, 
and they have had their decline as they failed to embrace 
other essential principles. An operation to hold its own at 
the present time, 1. Must be safe ; 2. Must be easy of 
execution. 3. Must allow of intra-abdominal verification 
of the diagnosis when this is uncertain. 4. Must allow of 
correction of complications through the best possible open- 
ing when they exist. 5. Must create no false ligaments. 
6. Must use the best part of ligaments and throw out of use 
the poorest part of ligaments. 7. Must stand what Gold- 
spohn has called the double test of pregnancy, that is, the 
operation must not interfere with pregnancy or complicate 
delivery, and the pregnancy must not interfere with the fu- 
ture success of the operation. An operation which meets 
these requirements will live, an operation which fails t 

200 The Plexus. 

meet them will die when pitted against an operation which 
meets them to a greater extent. 

Vaginal operations, other than vaginal shortening of 
the sacro-uterine ligaments, have practically all the above 
points against them, and the latter operation has so many- 
points against it that it has gained little ground. The Alex- 
ander operation was proposed at a time when intra-abdomi- 
nal operating was dangerous, and therefore its strong feat- 
ure, not opening the abdomen, commended it. It used the 
best part of the ligaments. Using the natural ligaments it 
stood the tests of pregnancy. But it was not simple, it was 
technical. Abdominal surgery at this time was in her 
swaddling clothes, fathered by a few men who were giants 
in the profession, they could master the technique by fa- 
miliarity upon the cadaver. The operation was widely test- 
ed and. then a reaction, for it had been used in cases where 
it was contraindicated. It makes no provision for inspection 
of the abdomen in the doubtful cases, or the correction of 
complications when they exist. The greatest friends of the 
operation admit its narrow range of usefulness. Dunning 
shows that only 7.01 «per cent, of cases are uncomplicated. 
Goldspohn, who has been a close student of round ligament 
surgery, insists upon the necessity of intra-abdominal in- 
spection and correction of complications in all cases of re- 
tro-displacement. His bi-inguinal coeliotomy for this pur- 
pose had a place in gynecological surgery when pitted 
against the unsurgical ventro-suspensio-fixation, but it gave 
us at the best only limited opportunities for inspection and 
correction of complications. In the light of the above re- 
quirements the Alexander and the Goldspohn-Alexander 
operations must die or live a very narrow and lonely exist- 
ence. During the last decade of the nineteenth century, 
ventro-suspensio-fixation, championed by such able men as 
Olshausen and Kelly, came into its own, in fact, its popu- 
larity was so great that it became a curse. It had to its 
credit the advantage of being simple and allowing inspec- 
tion of the pelvic organs and correction of complications. 
Abdominal surgery had grown to be a giant octopus with 

Intramural Transplantation. 201 

arms outstretched to woo would-be-surgeons in their swad- 
dling clothes. The simplicity appealed to them. Difficult 
technique could not be learned upon the cadaver, there were 
not cadavers enough. The novice could open the abdomen 
and stitch the uterus to the abdominal wall even though he 
lacked skill at pelvic diagnosis or the ability to insert a pes- 
sary. Surgery that did not open the abdomen was tame 
-and uninteresting. Every maverick of a uterus that could 
not give an account of its slightest wandering was branded 
with the curse of an extra ligament or two. But although 
the incision from this operation gave the best opening for 
doing work, and although it made an easy operation for the 
tired surgeon, it ignored most of the above named essentials 
for a good operation. Theoretically, then, its passing was 
to be expected and, in this instance, the expected happened. 
In the obstetrical and gynecological section of the Boston 
meeting of the American Medical Association, the subject 
came up for discussion and not one voice was raised in favor 
of ventro-suspension or fixation. Among the leaders in this 
line of work then ventro-suspensio-fixation is dead. In ask- 
ing an occasional operator what he does with retro-displace- 
ment, I have received the answer, "I do the thing that I 
know how to do — ventro-suspension," and so the sins of the 
"fathers" in surgery will be visited upon their children unto 
the third and fourth generation. Why should it not be 
used? It creates false ligaments which neither grow during 
pregnancy or involute thereafter. There is no certainty as 
to the size of the resulting ligament, and therefore to relia- 
bility as to results. Transperitoneal ligaments are created, 
which may entangle bowels and omentum. The permanen- 
cy of the operation depends upon the formation of a strong 
ligament that will not stretch extensively, yet these are the 
things which render it dangerous if pregnancy takes place. 
F. Martin collected with Dorland's 179 cases, 425 cases of 
pregnancy following ventral fixations and suspensions. Of 
these 425 cases 96 were complicated during gestation, and 
116 were complicated during labor. Nine versions were 
necessary, fifteen forceps deliveries, three placental reten- 

202 ' The Plexus. 

tions, three post-partem hemorrhages, twenty-four abortions 
(four of which were produced), eight Caesarian sections, one 
ruptured uterus, one inversion of uterus with death of 
mother, nine foetal deaths besides the abortions, seven ma- 
ternal deaths. Ingalls, formerly an advocate of ventro- 
suspension, has changed his views as a result of his obser- 
vations, in three cases of dystocia in which two patients suf- 
fered rupture of the uterus and one case required version in 
which death of the child resulted. Hurdon reports two 
cases in which it became necessary to open the abdomen 
and sever a ventro-fixation ligament because of backward 
and upward displacement of the cervix. Lynch in a careful 
study of Cesarean section, and dystocia following ventro- 
fixation and suspension reports two cases of dystocia and 
collects twenty-one Cassarian sections. He also mentions 
having observed reports of ten cases of rupture of the ute- 
rus. Of the two cases which he reports one liad Caesarian 
section with delivery of twins, the mother dying on the sixth 
day. In the other case version and extraction was practiced 
with difficulty and nine weeks later coelectomy was per- 
formed to obliterate the adhesions which caused persistent 
pain. I have operated upon one case not pregnant for the 
relief of troublesome pulling of the uterus upon the abdomi- 
nal wall. I also lost Mrs. M. at second delivery after a 
ventro-suspension, from a severe post-partem hemorrhage, 
controlled, but returning several hours after confinement. 
A marked post-partem hemorrhage followed the first deliv- 
ery after the ventro-suspension, but from this the patient 
made a good recovery. If further evidence is needed to 
convince the skeptic of the inadvisability of performing 
ventro-fixation operations it is not wanting in literature as 
shown by Noble, Halban, Lynch, Dorland, Goldspohn and 
many others. 

Some of the difficulties encountered are: Retraction of 
scar, severe pain in abdomen, abortion and premature labor, 
posterior ascent of cervix, tumor mass caused by thickening 
of anterior uterine wall, excessive thinning of posterior wall, 
hyperemesis. prolongation of pregnancy, inertia, dystocia, 

Intramural Transplantation. 203 

mal -presentation, rupture of scars, rupture of uterus, re- 
tained placenta, post-partem hemorrhage, etc. In the non- 
pregnant, relapses from inefficient adhesions, pain from too 
firm adhesions, obstruction of bowels, entangling of omen- 
tum, tubes and ovaries around the ligament. Suspension 
has been praised while fixation has been condemned, but 
Kelly, Hurdon, Lynch and many others emphasize the fact 
that intended suspention sometimes results in a fixation. 
The Alexander operation has points of great advantage in 
those cases in which it is indicated, but they are few. The 
ventral suspension allows of correction of complications, but 
causes other complications that are dangerous. To avoid 
these dangers in complicated cases many have devised 
means for using the round ligaments when opening the ab- 
domen. These may properly be divided into two classes, 
those which employ the inner, strong part of the ligament, 
and those which emply the outer, weak part of the liga- 
ment. The latter do not meet the requirements for a relia 
ble operation, and place a confidence in this part of the lig- 
ament not warranted by its size and strength. The former 
operations may again be divided into those which reach the 
ligament through extensive and tedious dissection from the 
abdominal incision and those which reach the ligament in 
the adbomen where it is easily picked up. 

Edebohle, Polk and others have operated through a 
median incision to correct complications and then have made 
the inguinal incisions to shorten the ligaments. This and 
the operations of Noble, Barth, Sandberg and Pinkham il- 
lustrate the length to which operators will go to use the 
round ligament. When one is through with the intra-ab- 
dominal work he is juat beginning a very tedious operation. 
Their technicalities discourage their use. The operations 
which employ the round ligaments and secure them within 
the abdomen, had their beginning with Olshausen sewing 
the round ligament, close to the uterus, to the abdominal 
wall. Others carried the suture in the round ligament a 
little further out. Carl Beck, of New York, freed the round 
ligament from its natural course, and sewed it into the ab- 

204 The Plexus. 

dominal incision making round ligament ventro-suspension. 
Ferguson made a poorer opening for doing work but a bet- 
ter operation for supporting the uterus in his planting the 
cut ends of the round ligament into the abdominal incisions, 
one inch lateral to the median line. Giliam made a de- 
cided improvement upon this when he made a median inci- 
sion and brought loops of the round ligaments through a 
puncture opening to the right and left of the median line. 
This was still ventro-suspension and furnished two trans- 
peritoneal ligaments which might entangle bowel, omentum, 
tubes or ovaries, and three small openings from Jthe abdom- 
inal cavity into the utero-vescical space, through which a 
bowel might become herniated. In view of the many evils 
arising from direct utero- ventral suspension the above ob 
jections were urged strongly against this operation. Fer- 
guson proposed obliterating the two side openings with 
purse string sutures. Simpson proposed to obviate this by 
running the ligament forward over the bladder but under 
the peritoneum to the abdominal wall. We were looking for 
something that, could be done through a median incision and 
yet use the best part of the round ligament so placed as to 
create no complications. It occurred to me that by going 
through the median line to do work in the abdomen and 
pick up the ligaments, I could then carry them through the 
internal ring and fasten them at some point without tedious 
dissection as was done by Edihohl's Alexander operation 
following coelectomy. After considering the many ways in 
which the ligament could be dealt with, such as a puncture 
over the internal ring, tunneling over the aponeurosis, etc., 
the most feasable plan semed to be to pass a curved ligature 
carrier under the aponeurosis to the internal ring and there 
enter the abdomen and secure the silk ligature which had 
been previously placed upon the round ligament two thirds 
of the distance from the uterus to the internal ring. The 
forceps are then withdrawn and along with them the silk 
Mp, and with this, the loop of round ligament, which is 
sewed to the under side of the aponeurosis over the rectus 
muscle, and then if long enough it is sewed to the loop on 

Intramural Transplantation. 205 

the opposite side. We now have the ligament running from 
the uterus to the internal ring then under the aponeurosis 
over the rectus muscle to or near the median- line where it 
is sewed, then back to the internal ring, then through its 
normal course to the labium. It is shortened by the dis- 
tance of its excursion inward and back to the internal ring. 
This operation which I later termed "Intramural Trans- 
plantation of the Round Ligaments," I fir3t performed in 
November, 1903. I taught it in my post-graduate and un- 
dergraduate work, but postponed its publication until I had 
given it a trial on numbers of cases for several months. In 
the spring of 1905, having had it under observation for 
eighteen months, I presented it in April before the Kalama- 
zoo Academy of Medicine, in May before the Detroit Alumni 
Association, in June before the Chicago Medical Society, 
and later before other societies. My first publication, ex- 
cept by reference, was in Surgery, Gynecology and Obstetrics, 
November, 1905. This explanation would not be necessary 
were it not for a much published article by Stuart McGuire, 
in 1905 and 1907 in which he describes an operation of very 
similar technique seen at a clinic and in which he was inno- 
cent of the work done by others, as shown in literature. 
This operation has been combined with most other gyneco- 
logical operations where the uterus is left in. In many 
eases a curettage, amputation of the cervix, perineorrhaphy, 
anterior colphorrhaphy, hemorrhoidectomy, coeliotomy, 
breaking up adhesions, colphorectomy, salpingectomy, resec- 
tion of an ovary, appendectomy and moyomectomy. In one 
■case an extrauterine gestation sac was removed with this op- 
eration following; in another case reported the four months 
-gravid uterus was freed from adhesions, the left tube and 
the ovary were removed and then the intramural transplan- 
tation was done. This patient went to term, had a normal 
-delivery and the uterus was found in good position after- 
ward. Three other cases are known to be pregnant. One 
•produced an abortion the other two went to term. One of 
these became a Christian Scientist and has not since been 
sunder observation. The other had a normal delivery and 

206 . The Plexus. 

the uterus remained in perfect position after child-birth. 
Statistics regarding pregnancy and its effects upon the ope- 
ration are abundant in the Alexander operation, for I hold 
that the placing of the ligament is such that anything that 
may be said of the Alexander operation may be said of this. 
In the four year's experience with the operation I have 
known of only one case in which the uterus was Dot held in 
position. In this case adhesions were extensive before the 
operation. Adhesions between the posterior surface of the 
uterus and the bowel seem to have taken place, pulling the 
uterus slightly backward. One of the sequalce which 
seemed possible was an occasional hernia from disturbances 
at the internal ring and an occasional hematoma from trau- 
ma of blood vessels at the ring. Neither of these accidents 
have been observed. In my early work I think there was a 
tendency to draw the ligaments too tight as an occasional 
case would complain of pulling for some time afterward. 
The operation is not so easily understood as the ventro-sus- 
pension, but it is much less technical than the operations 
which search for ligaments outside the abdomen. 

In some cases I have made a two and one-half inch in- 
cision transversely down to the aponeurosis of the external 
oblique, then a median longitudal .incision to do the work in 
the abdomen, then the ligature carrier was pushed through 
the aponeurosis at the outer ends of this tranverse incision, 
and was carried through the internal ring to pick up the 
control silk on the round ligament. This, while it makes a 
splendid operation* is only advisable when the complications 
are slight. The median incision through all the layers is 
preferable for severe compilations. In addition to the round 
ligament work it has seemed best at times to shorten the 
sacro-uterine ligaments. We should remember that the work 
of ligaments is to carry the uterus, they are not intended to 
do the work of the pelvic floor, and this latter structure 
should be repaired if inefficient. 

This operation makes the most anatomically perfect 
operation which has yet been proposed which does not re 
quire tedious dissection to find the ligament, and has the 

Treatment of Typhoid Ferer. 207 

distinctive feature of having the ligament leave the abdomen 
at the proper place, the internal ring. We cannot hope in 
our operative work to improve upon the normal condition. 
No operation can anchor the ligament farther out or a less 
distance and be quite as right. 
In conclusion I would say: 

1. Alexander's operation fails because most cases -of 
retrodisplacement are complicated. 

2. An operation to be widely useful must open the ab- 
domen for inspection and correction of complications. 

3. It should be capable of being combined with the best 
incision for doing work. 

4. It must not create false ligaments which will not 
evolute during pregnancy and involute thereafter. 

5. There must be no abnormal arrangement of natural 
ligaments which allows them to run transperitoneally. 

6. When the round ligaments are employed the inner, 
stronger portion of the ligament should be chosen. 

7. An operation for retrodisplacement must often be 
performed after much other operating and so should not 
offer any tedious technicalities such as is found in the ex- 
ternal search for the ligaments. 

8. My internal inguinal shortening and transplantation 
of the ligaments through the abdominal wall is again sub- 
mitted for comparison with external shortening of the liga- 
ments, or ventro- suspension operations as one seeming to 
meet the essential requirements of an operation for re- 


By Charles E. Buck, M, D., Boston. 
It is not the purpose of this paper to attempt the in- 
struction of any reader in the correct method of procedure 
in the handling of a case of typhoid fever; nor does the 
writer venture to advance any ideas which are new to every 
body, for in these days of many intelligent readers and 
thinkers and consequent modes of action, it is hardly reason- 
able to expect to do either in a very acceptable manner. 

208 The Plexus. 

In a calling which admits of such a wide range of opin- 
ions, each of which may be correct, all of which are debat- 
able from the fact that there is no fixed standard by which 
to judge one's action, no doctor has a right to say which is 
or is not the correct method to follow, and he has no more 
privilege to criticise his brother physician in his methods, 
provided that they produce results along safe lines, than he 
has to question his religious belief. 

In the treatment of all pathological conditions it does 
not seem to matter from what source we seek information, 
there is invariably a wide difference of opinion in many of 
the details of the procedure advised, and especially is this 
true of the condition which furnishes the subject in this in- 

Very frequently it is that we learn of some doctor away 
off in some remote place, who has been particularly success- 
ful all of his long and useful professional life in the treat 
ment of his cases of typhoid fever. Everybody has him 
who can get him, when such an unfortunate circumstance 
requires his services. Ask him what his treatment is and 
you will'very likely find out that it consists chiefly of good 
nursing by some faithful old experienced nurse, whose only 
claim to the title lies in the possession of a sympathetic 
temperament, a goodly amount of tact, two willing hands and 
a disposition to make them generally useful. 

Another and just as useful and successful member of 
the profession will tell us that every case of this dread dis- 
ease requires two trained nurses, two visits a day from the 
doctor, and the aid of every known method of labaratory 
procedure to keep the patient in the safe path to recovery. 
Between these two extremes there are many methods and 
various details mentioned for our guidance in treating this 
ever present condition. All of these have undoubtedly 
proven more or less successful in the hands of their advo- 
cates. It is a significant fact, however, that nearly all au- 
thorities seem to agree on three essential, fundamental 
points, namely, local antiphlogistic, antiseptic and dietetic 

Treetmcnt of Typhoid Fever. 209 

These seem to be the only practical points on which there 
is perfect accord, and on all others there is a diametrical 
difference. It is also a significant fact, notwithstanding such 
a wide difference in matters of great practical moment, there 
is a curious coincidence in the duration of the disease by all 
these different methods of treatment. It is also a fact, 
equally curious, that if we offset the differences between 
authorities, and treat cases only by means on which all are 
agreed, the average duration of the case is quite as favorable 
as when specific remedial measures are used. 

Through the medium of the following lines the writer 
wishes to simply present, for the perusal of whoever may be 
sufficiently interested to read, a method of procedure in 
cases of typhoid fever which seems to offer very satisfac- 
tory results, without the usual amount of worry and un- 
certainty, which is the ungracious burden imposed by many 
other methods. I used to undertake these cases with fear 
and trembling, but I am not concerned thus now, since I 
have come to follow a regular routine as given below. As 
nearly all the methods mentioned in this article differ some- 
what from the usual routine, and in order that the general 
context may not be broken any more than is necessary, I 
have deemed it advisable to make such explanations as seem 
necessary, regarding these special methods and formulae 
used, in the following procedure, inform of notes, and these 
in the usual alphabetical notation. 

On visiting my case for the first time, I satisfy myself, 
of course, of the presence of the disease. This is not a very 
difficult matter, with the present means of verifying at hand 
for such purposes. This once decided, beyond doubt, and 
the question of where the patient is to be treated finally 
settled, I note as carefully as possible what sort of a person 
I have got to deal with. What is the character of that op- 
sonic index which is to help me in the treatment of this case 
for the nextlthree or four weeks? To what extent can I de- 
pend on Nature as an assistant, and whether I have of neces- 
sity to carry the patient to recovery, or simply to help him 
over the hard places, and trust to his natural resistance for 

210 The PUrne. 

the rest. And right here, it seems to me, we make a great 
mistake, in many instances, in not taking into account this 
natural recuperative force of the patient, and are apt to go 
very wide of the mark in our treatment for the reason that 
the force of Nature gives an impulse to the treatment, which, 
added to our own, may cause "the shot to go wide", so to 

These details established, and the calibre of my patient 
taken, I have the very best nurse that can be procured, and 
start the case off on a basis of twenty-one or twenty-eight 
days, for this is my general average. My first medication 
is half a grain of calomel and soda each, in tablet form. 
This is given in fractional doses, one tablet every half hour 
until three grains have been given. I then follow with one 
tablet containing aloin, cascarin and podophylin. If I see 
good results from this, I do not repeat the dose; if not, I re- 
peat the next day. As a general thing a second dose is not 
necessary. This cleans out the intestinal tract, and it is now 
my duty to clean it up, and this I do with some of the saline 
preparations, usually the saline laxative. ; .| now follow 
with the treatment which is going to keeji this tract clean 
through the entire course of the disease. This may be done 
in several ways, but the one that has served me the best is 
acetozone, varied slightly from the prescribed method. From 
the very moment that I find out definitely that I have a case 
of typhoid, I allow absolutely nothing to pass through the 
intestinal tract which has not been treated with this aceto- 
zone solution (a). 

This may seem a trifle difficult at first, but it is easily 
regulated when one gets in the way of so doing. 

There is a peculiar taste to this solution which has been 
a severe objection to its use, by some, but I have overcome 
this by the use of soda flavors and I have found that the 
sarsaparilla is the best borne, although lemon and ginger 
are good alternates (g). 

The fruit flavors are not as well received. I have, con- 
trary to custom, used seltzer and vichy siphons to liven up 
these beverages when they seem to be getting stale. 

Treatment of Typhoid Fever. 211 

As to nourishment, I have depended on milk and pano- 
peptone entirely, during the febrile period (b). The pano- 
peptone may be taken alone or added to the milk, just as the 
patient wishes; and I usually administer about two ounces 
during the twenty-four hours. I start this routine and then 
await developments, believing that it is better, as a rule, to 
treat the patient rather than the disease, as occasion may 

If there is no deviation from the rule, and nothing but 
acetozone, panopoptone and sterilized milk have passed the 
intestinal tract, there will be but very little balooning of 
intestines, and therefore very little discomfort from this 
source. Then if there is an aseptic condition, from the start, 
and maintained through the case, there will be little to fear 
from mental conditions. To be sure, these conditions may 
appear to a certain extent, but not with the severity that 
usually accompanies some other methods. 

Should tympanites appear to a painful extent, I have 
never had any trouble in relieving the pain by the use of 
the turpentine stupe (d). The mental phase generally yields 
readily to the soothing influence of the ice-bag applied 
always through an intervening towel. 

I keep the bowels moving with the saline laxitive if they 
are restricted; if loose, with sulpho-carbolates, though with 
the above routine interference in either way is seldom called 
for. The bad condition in the mouth can best be cared for 
by the use of lemons, cut, peel and all, into dice' and mixed 
with cracked ice and a little glycerin. Have this mixture 
where the patient can easily reach it with a spoon, and allow 
free use, under ordinary conditions. Now as to temperature. 
This I do not take into account very much unless it goes 
over 102° F., and then I have found that the most pleasing 
method of reducing it is with the hot gauze bath (c). This 
is very easily rccomplished, and is very pleasing to the 
patient, and it jiroduces results. I keep all the depressing 
febrifuges away altogether, as I do not wish to handicap the 
heart in any way. When the heart does show signs of weak- 
ening I have found the combination as exhibited in the 

212 The Plexus. 

cardiac stimulant combination of cactin, quinine and strych - 
nine arseniate, and capsicin (e) to be very satisfactory. At 
the end of the second week, generally, I start the treatment 
which I believe is necessary to reinforce the resistance 
against such toxins as may get by the intestinal glands (f ), 
and I continue this remedy to the end of the ease 

When the temperature drops to normal permanently, I 
commence to withdraw the supports, and devote more atten- 
tion to the diet. The milk is dropped first, and this not very 
reluctantly by the patient. The panopetone follows shortly. 
Broths are given, at first clear, then gradually thickened, 
first with flour, then crackers, then with well-cooked rice. 
Next come oysters, clam-broth and the white meat of a 
chicken. If this procedure causes no relapse, I then allow 
the progress to go through semi-solids, solids and so on to 
complete convalescence. The calcium sulphide is continued 
until the patient is up and about and free from any danger 
of relapse, and the heart stimulant even longer, until con- 
valescence is complete. 

I have tried to be very explicit in this article, for the 
reason that I am aware of the fact that some one is going to 
be sufficiently interested in it to read it, and they may pos- 
sibly wish to try the procedure in some of their cases, and I 
have been so sadly disappointed myself in the articles of 
some writers when it came to the treatments, which I would 
like to have followed, that I have resolved never to be guilty 
of such neglect in the offerings which I might make, should 
any one care to publish them. I submit these few ideas, 
not as conclusive evidence that I am correct in my methods, 
or that I even think that I am, but there is a commercial ex- 
pression, which has been very tersely versed by Nixon 
Waterman, and which I think aptly reveals the status of the 
practice of medicine as we find it to-day, and this will well 
serve my purpose as an apology for presenting this article. 

It delivers the goods, and this is what insures us our 

"The world will buy largely of any one who 
Can deliver the goods. 

Treatment of Typhoid Fever. 213 

It is ready and eager to barter if you 

Can deliver the goods. 
But don't take its orders and make out the bill, 
Unless you are sure you'll be able to fill 
Your contract, because it won't pay you until 

You deliver the goods." 

— Nixon Waterman in "Clinical Medicine." . 

(a) Acetozone solution is prepared by adding 15 gr. of acetozOne to 
a quart of distilled water which has been slightly warmed. There is a 
hydrolytic change necessary in this solution, that it may act at its best, 
and sufficient time should be allowed for this change to take place. 
Two lota should be prepared at first, and then one lot each day will 
keep up the proper succession . The water must be sterile, or the ace- 
tozone will sterilize it at the expense of its own efficiency. Boiled 
water will answer. 

(b) The milk used can be any good clean supply, taken from the 
milkman as it is delivered and administered to the patient as follows : 
One tablespoonful acetozone solution, one dessertspoonful panopeptone, 
added to an ordinary sized glass of milk ; add to this a little piece of ice, 
a squirt of selteer, and let the patient take it through a paper straw, as 
he wishes, in fractional doses, never quickly. Throw away tho straw 
after each glass has been taken. Give from a pint to two pints of milk 
in the twenty-four hours, in this manner. 

(c) Hot gauze bath is prepared by taking 1£ yards of common 
gauze, and wringing it out in very hot water. While it is still rolled up 
pour over it a little pure alcohol, and then quickly remove all the covers 
of the patient above the hips; spread this gauze over him and fan him 
fairly briskly for about one or two minutes. Quickly dry him with a 
towel, and repeat the bath over the lower extremities. The night dresa 
may best be handled, in these cases, by pulling it up around the head 
and not replacing it until both parts of the body have been cooled, then 
it can be placed and there is no danger of its becoming damp. This 
bath may be given every hour if needed to control the temperature. 
Never expose the entire body at the same time. 

(d) Turpentine stupe is the best made by wringing a piece of 
flannel large enough to cover the abdomen, and fold, in very hot water; 
over this sprinkle just ten drops of turpentine; lay this turpentine side 
on flesh, over the abdomen smoothly, and cover with a dry towel, and 
change when it cools; if no more than ten drops of turpentine are used 
there will be no blister; otherwise there may be and this complicates 

214 The Plexus. 

(e) Cardiac ttimulant is No 472 Abbot's List of alkaloidal pellets. 

(f) Calcium sulphide is in a chocolate coated tablet, containing 
half grain eaoh, and is given about 4 to 6 in the twenty-four hours. 

(g) Obtain the soda-flavors of your druggist, and add enough to 
flavor. There is absolutely no harm in them. 

These are more especially for the acetozone solution, as ordinary 
culinary condiments will serve to vary the taste of the milk and pano- 

The acetozone solution should be given in fractional amounts, vary- 
ing from 3 to 5 oz. and at fairly regular intervals, allowing for sleep, to 
use up from 24 to 32 oz. during the twenty-four hours. The judgment 
and tact of the nurse will be needed, but no more so than is required 
with any other method of treating this disease. 


By George Woodhead. 

The healing art, as practiced by native doctors in China 
at the present day, is a strange mixture of superstition, 
charlatanism and quackery. Medical knowledge among the 
Chinese has been at a standstill for many centuries, and 
what the early Jesuit missionaries wrote about it in the 
seventeenth century is true at the opening of the twentieth. 
Le Comte, in his memoirs and observations, published in 
the latter part of the seventeenth century wrote: "There is. 
another disorder in China, a great deal more dangerous than 
that they lay to our charge, and that is that there every- 
body is admitted to practice physic, like other mechanical 
arts, without examinination or taking degrees." 

Voluminous works on medicine, on the pulse, acupunc- 
ture and other medical topics were extant in China centu- 
ries before the Christian era, yet at the present day, Chinese 
doctors are absolutely ignorant of the elements of physiolo- 
gy, anatomy and natural philosophy. They continue to 
ascribe diseases of every kind to pestilential winds, to the 
five colors, blue, yellow, red, black and white, to the five 
elements, gold, wood, water, fire and earth, and to heat and 
cold. Imbued with the belief that all parts of the material 
world are mutually connected, the Chinese physician argues 

Medical Artia China. 215 

that a person of acute discernment can trace the connection 
and overcome its malign influences. 

One of the most curious of the Chinese ideas of anato- 
my is the belief in the connection between certain internal 
organs and the thoughts and passions. Thus the heart and 
pit of the stomach are regarded as the seat of ideas and de- 
lights; the soul resides in the liver, from which emanate all 
good and noble purposes; and in the gall bladder is con- 
tained such courage as the individual may possess. The 
brain is never mentioned in Chinese medical works. The 
lungs are believed to be white, are in the thorax, and con- 
sist of six lobes, four on one side and two on the other. 
"Sounds proceed from holes in them." The liver has six 
lobes and, in Chinese anatomical charts, is placed on the 
right side, while the large intestine, with its sixteen convo- 
lutions is connected with the lungs. ' 

Native doctors pretend that they can determine the na- 
ture of each ailment, its treatment and prognosis by the 
pulse alone. Dr. Halde, a Jesuit writer, includes a transla- 
tion of one of the standard Chinese works on the pulse in 
his books on China. It appears from this that there are 
three pulses in each arm, each of which is again subdivided 
into an inner and an outer pulse, making twelve pulses in 
all. Of each pulse there are nineteen varieties, and every 
pulse is connected with and shows the condition of some in- 
ternal organ. Those on the left arm, for example,, are con- 
nected with the heart, small intestines, liver, gall bladder, 
kidney and bladder, respectively. The six pulses of each 
arm may vary at the same time and are supposed to be af- 
fected by the seasons. 

It is amusing to read the description of the varieties of 
pulses that indicate the approach of death. The disease is 
likely to terminate fatally if any of the following symptoms 
are present: If the pulse frisks like a fish that dives every 
minute and then comes up so slowly that one would think 
she is held by the tail, and yet makes her escape; if it bub- 
bles like water over a great fire in the morning; if it seems 
like a fish whose head is stopped and cannot move, but frisks 

216 The Plexus. 

with its tail; if by the hardest of its beats it resembles a 
bullet or stone or dried earth shot out of a cross-bow, or if 
it resembles the pace of a frog or toad embarrassed in the 
weeds or the hasty peck of a bird. 

Turning now to medicine, we find that the Chinese doc- 
tor is a great believer in the efficacy of the quantity of med- 
icine taken. His doses will vary from thirty to forty pills 
to a pint or even a quart of liquid. Ginseng is the most 
highly esteemed of Chinese medicines, It sometimes fetches 
as much as $250 an ounce and is regarded as a universal 
panacea. "It cures palpitations caused by sudden frights, 
dispels malignant vapors, makes the sight clear, opens and 
delights the heart, strengthens judgment, makes the body 
active and prolongs life." 

What article in the American pharmacopoeia can ac- 
complish all this? Tea is used for external application to 
the eyes. Unfortunately all the remedies used by the na- 
tive practitioner are not of the same harmless description. 
Such substances as tops of stag horns, dried red spotted 
lizard, tiger's bones, scorpions, cicades, centipedes, bear's 
gall, old copper cash and other disgusting ingredients are 
commonly used in native prescriptions. 

Enough has been said to show the backward condition 
of Chinese medical practice today. Before concluding, men- 
tion should be made of the medical mission hospitals that 
are now springing up in every province. The Chinese, after 
they have become accustomed to the presence of the foreign- 
er, willingly patronize his hospital, and already many native 
students have been put through a thorough course of train- 
ing, and sent out to practice on their own account. 

The evils pointed out in this article will only be avoided 
when the advice given by Le Comte over 200 years ago is 
followed and proper qualifications are insisted upon by the 
government before a native doctor is allowed to practice 
upon his fellow countrymen. 

Conjugal Diabetes. 217 


By Alfred C. Croftan, M. D., Chicago, 111. 

During the last three years I have had the opportunity 
of observing six instances of diabetes occuring together in 
man and wife. The first case was discovered by chance, 
because the wife, fearing that the disease might be con* 
tagious, brought her urine for examination. The other five 
cases were all discovered within the short interval of two 
years and three months, presumably because, interested by 
the discovery of the first case, I have since then, whenever 
possible, examined the urine of the consort of a diabetic for 
sugar; if no sugar was discoverable in a random specimen, 
then another test for alimentary glycosuria was made ac- 
cording to the usual method. 

The six cases were found among a total of 241 diabetics, 
i. e.. in 2.49 per cent. Inasmuch as 47 of the patients with 
diabetes were not married or had lost their consort, my six 
instances of "conjugal diabetes" actually constitute approxi- 
mately 3 per cent of the married diabetics studied. 

In looking through the literature on this subject, numer- 
ous instancesof "conjugal" or "domestic" diabetes are found. 
All in all I have been able to collect 162 cases; these are all 
instances in which the coincidence of diabetes in husband 
and wife was so stricking that the possibility of a contagion 
was thought of. 

It is interesting to note the varying percentage of such 
instances that different authors report among the total 
{married, and unmarried and unknown civil state) cases of 
diabetes observed during a given period. The highest per- 
centage as 12 per cent. Fumaro among 127 diabetics found 
15 instances, i. e., 11.8 per cent. Lecorche, among 104 cases, 
six instances, i. e., 5.2 per cent. Leading German authors, 
it is peculiar to relate, find much smaller percentages and 
altogether occupy a rather sceptical attitude toward the 
whole question. Seegen, e. g., found instancesof "conjugal 
diabetes" only three times among 938 diabetics, i. e., in 0.32 
per cent. Senator nine cases in 770 diabetics, i. e., 1.17 per 

218 The Plexn3, 

cent. Then there are very many authors who report one or 
two isolated cases. Consequently it is very difficult to es- 
tablish any reliable data in regard to the general frequency 
of this disorder. An interesting table has been arranged by 
Hanriot who, taking 100 cases reported by different writers, 
found that these 100 cases occurred among 5987 diabetics 
(married and unmarried) and therefore constituted 1.67 per 
cent of the total number observed. 

In view of the scanty material so far observed, in view 
of the fact, moreover, that no attempt has been made to 
classify the various glycosurias that are all grouped under 
the name diabetes, it is altogether premature to venture 
an explanation of the possible causes underlying the pecu- 
liar phenomen of conjugal or domestic diabetes. 

That one is dealing in most of the cases with more than 
a coincidence is clear; such a thing may occur by chance; 
but in my series, for instance, in which glycosuria was regu- 
larly looked for in the consort, the proportion of instances 
discovered is far too great to warrant the inference that this 
is the case. One must think of common errors of alimen- 
tation abtaining in a family or of common errors of living, of 
exposure to common nervous, mental and emotional influ- 
ences. One must think finally of contagion. Syphilis and 
malaria can produce glycosuria as well as certain other dis- 
orders of known type that cause vascular degenerations in 
important organs (liver, pancreas, nervous system) that are 
concerned in sugar metabolism. It is not impossible that 
other infectious agents of unknown character and origin may 
be concerned in the transmission at least of certain types of 
diabetes. This subject is well worthy of further study, it is 
a corollary of the contagious theory of gout that is gaining 
many adherents. To deny the possibility of a ''contagious 
diabetes" is precarious; to affirm its existence altogether 

These facts and considerations at least warrant further 
investigation and the collection of more elaborate and more 
exact statistics. They have induced eminent authorities to 

The Publisher's Lament. 219 

commit themselves strongly in favor of the reality of Con 
jugal Diabetes. 

My object in publishing this note is to stimulate interest 
in this important inquiry. "If you find glycosuria in one of 
your patients, look for it in the mate". 1 

* 1. "Si tu constates de la glycosurie chez un de tes clients, re- 
chereche la chez son conjeint". Martinet Presse, Mais, 1904, No. 12, 


Lives of poor men oft remind us 
Honest men won't stand a chance, 

The more we work there grow behind us, 
Bigger patches on our pants. 

On our pants once new and glossy, 
Now are stripes of different hue, 

All because subscribers linger, 
And won't pay us what is due. 

Then let us all be up and doing, 
Send your mite, however small, 

Or when the snow of winter strikes us, 
We shall have no pants at all. 

The New Postal Law.— Under the new law which takes 
effect June 1, 1908, no monthly publication will be allowed 
to go through the mails as second-class matter more than 
four months after the time for which it is paid. On the ad- 
dress label of every wrapper is the date to which the sub- 
scripton is paid, and every subscriber may know from this 
why his journal fails to appear, if he does not receive it, 
The publisher is compelled to cancel all subscriptions four 
months after the date to which they are paid. 





Channlng W. Barrett, M D.. Chairman. 

T. A. Davis, M. D. W. E. Gamble, M. D 

A. R. Johnstone, M. D., Editor. 


L. H. Nowak, '08. Ray Esslck, '08- Gustav Eck, '09. 

William G. Epstein, 10. 

Atheletlc Editor. C. H. Tlllotson, 06. 

Alumni Editor, John Wehtherson, '00. 

Library Dept., Metta M. Loomls, 

Publisher - - - - - J. E. Forrest. 

Subscription 91.00 per Annum In advance. Single copies, 15 cents. Issued 
Monthly. Send all communication* and remittances for subscriptions and adver- 
tising to J. B. FORREST, Bat* via, IlllBOiS. 

Entered at Batavia Post Office as Second-Class Matter. 

Any subscriber desiring the Journal discontinued at the expiration of his sub- 
scription should so notify the Publishers; otherwise it will be assumed thai the 
subscription is tobf continued and the Journal sent accordingly. 

Contributions of matter suitable for publication are invited, and should be sent 
»n not later than the 25th of the month previous to that of publication. The pub- 
lishers will not hold themselves responsible for the safe return of MSS. unlesi 
lufficie-t stamps are forwarded. 

Send contributions to A. R. Johnstone, M. D., Kdltor,;4l47 Lake Ave., Chicago. 
„ . » 


The Commencement Excercises of the College of Physi- 
cians and Surgeons will be held in Studebaker Hall upon 
June 9th, 1908, at 2 p. m. Dr. Rudolph Matas, of New 
Orleans, will deliver the doctorate address. 


" The faculty are making extensive preparations for the 
entertainment of the Alumni during the week of the meeting 
of the American Medical Association, June 2nd to 5th inclu- 
sive. Arrangements have been made whereby headquarters 
will be established at the Auditorium Annex during that 

Notes. 221 

period where every member of the Alumni body is urged to 
report, register, and meet their former friends and renew 
old associations. It is to be hoped that this will be a time 
when the Faculty and members of the Alumni body can get 
into closer relationship. An informal reception will be given 
at the Great Northern Hotel Tuesday evening, June 2nd, 
from 8 to 11:30 p. m., to which all members of the Alumni 
are most cordially invited as guests of the Faculty. Dr. T. 
A. Davis, chairman of the committee is sparing no pains to 
perfect arrangements and those contemplating attending 
will do well to communicate with him. A good musical 
programme will be rendered at the reception, refreshments 
will be served, and a most enjoyable time is anticipated. 

This meeting will afford an unusual opportunity to renew 
old friendships and incidentally to meet a body of the most 
distinguished men in the medical profession. 

The meeting of the A. M. A., this year will show more 
strongly than ever before a tendency to bring together the 
Alumni Associations of Colleges throughout the country and 
it is essential that our association should take the prominent 
place that belongs to it. 


Dr. A, R. Johnstone of the Lakeside Hospital class '87 
lias recently returned from a trip to Mexico and California. 

The doctor is interested in a large mining, property 
which he went to visit. On his return he visited Los Angeles, 
San Diego, Pasadena and San Francisco. He was forunate 
enough to reach Los Angeles in time to see the final day's 
manouverings of the fleet and its departure for more northern 

Dr. Johnstone reports many openings for young gradu- 
ates who want salaried pgsitions in mining and railroad 
-camps in North- Western Mexico but says that the men who 
take these positions must expect to rough it and to cope with 
conditions that are far Ofrom ideal. The experience he 
obtaines is of the kind to make one ready and self reliant 
and the opportunity to make and save some money is good. 

222 The Plexus. 

There are many P. & S., alumni in Southern California 
and they have organized a P. & S., alumni association with 
Dr. F. C. E. Mattison as its president. Many of the Cali- 
fornia contingent are expected to attend the Alumni entre- 
tainment Tuesday evening, June 2nd. The California con- 
tingent is alive to its own interests and not forgetful of its 
obligations to its Alma Mater. We hope the Alumni mother 
states will catch the infection. 

Dr. L. M. Schmit, who graduated from the College of 
Physicians and Surgeons in 1905, and who took first place in 
the examination for Cook County Internes during that year, 
recently successfully passed a rigid examination before the 
United States Naval Authorities as Assistant Surgeon im 
the United States Navy. He is at present located in Ann- 

Dr. G. G. Dowdall, of the class of 1900, is taking a spe- 
cial course of three months in the University of Vienna. 


Dr. and Mrs. D. A. K. Steele and Dr. and Mrs. Wm. 
M. Harsha have recently returned from the Pacific Coast 
where they spent a month in rest and recreation. 

Much of the time was spent in and about Los Angeles 
and Pasadena where they Were the guests of Dr. P. C. E. 
Mattison of the class of '88. 

They found that the P. & S., has many live representa- 
tives throughout Southern California and they met many of 

While there they attended a meeting of the Clinical and 
Pathological Society of Los Angeles which was held in Pasa- 
dena and report that the activity of that society reflects 
great credit upon the profession of Los Angeles and its 

Dr. Henry P. Newman has recently returned from San 
Diego, California. 

Dr. Newman's family are living in San Diego and the. 
doctor has spent much time there during the past year. * 

Notes. 223 

Dr. Newman has taken the California State Board ex- 
amination and is on the staff of the Agnew Sanitarium in 
San Diego, so that while visiting in that beautiful city he 
will be able to continue his interest in the field of operative 


The following contributions to medical literature have 
been made by various members of the faculty of the College 
of Physicians and Surgeons. The articles having appeared 
in recent issues of medical journals. 

Dr. Channing W. Barrett. The crime of Gynecology 
Chicago Medical Recorder, April, pp. 213-227. 

Dr. Bayard Holmes. A Suggestive Plan for a Modern 
Metropolitan Hospital of Five Hundred Beds. Journal of 
American Medical Association, March 28, pp. 1025-1029. 

Dr. D. N. Eisendrath. Subphrenic Abscess as a Com- 
plication of Appendicitis. Journal of the American Medical 
Association. March 7. pp 751-768. 

Dr. E. G. Beck. A New Method of Diagnosis and Treat- 
ment of Fistulous Tracts, Tuberculous Sinuses and Abscess 
Cavities- Illinois Medical Journal, April pp. 402-411. 

Dr. Channing W. Barrett. Fallacies of Intra-abdominal 
and Atmospheric Pressure as Supports of the Uterus and 
Abdominal- Organs, Surgery, Gynecology and Obstetrics. 

Dr. A. H. Ferguson. Simple Hysterectomy in Simple 
Cases. Surgery, Gynecology and Obstetrics 'May, pp. 

Dr. A. H. Ferguson. Hare- lip and Cleft Palate. Journal 
of American Medical Association. May 9, pp 1517-1522. 

Dr. Wm. A. Harsha. Tuberculosis of the Tongue with 
Report of a Case. Surgery, Gynecology and Obstetrics, 
March, pp. 288-289. 

Dr. D. A. K. Steele. Stab Wound of Fetus in Utero, 
Surgery, Gynecology and Obstetrics, March, pp. 294-296. 


Dr. Wm. L. Ballenger kindly presented to the library 
a copy of his recently published book." Diseases of the 

124 The Plexus. 

Nose, Throat and Ear, Medical and Surgical. This is a vol- 
uminous and beautifully illustrated work of over nine hund- 
red pages. 

Mr. C. E. Colegrove donated a large collection of journals 
and transactions to the library. Among this collection were 
very many volumes of foreign journals that were a valuable 
aid in completing sets. Our sincere thanks are hereby ex- 
tended to Mr. Colegrove for this gift. 

Dr. Byford,who has mcide many donations to the library, 
has recently presented a collection of foreign books and also 
a copy of. his latest publication entitled. To Panama and 

We wish to thank Dr. Lohrin for the gift of a collection 
of journals. 

The following have kindly remembered the library with 
copies of reprints. Dr. Jean M. Cook, Dr. H. L. Mettler, 
Dr. C. W. Barrett, Dr. D. A. K. Steele, Dr. Bayard Holmes. 

Dr. H. Wier Mitchel of Philadelphia has sent us an auto- 
graphed picture of himself Which has been framed and is 
hanging in the faculty reading room. 

In the general readiifg room we have a new picture of 
Dr. Harsha and Dr. Hatfield. 

The growth of the library is evinced by the fact that it 
has been necessary to add another stack for the accomoda- 
tion of the increasing collection of books. 


Meade and Ryan parry Davison's questions having pre- 
viously obtained the history sheet. Billingslea tries the 
same on Tice. — Its nay-nay! for Billy. 

Quizmaster. — What is "Brand Bath." 

Clink. — One composed of equal parts of "bran" and 

As a side issue of the senior course is the interesting de- 
bating contest between Kucera and Fugina. 

Notes. 225 

We wish hereby to call the attention of each senior to 
the fact that our department was not forgotten in arranging 
the coming '08 issue of the "Illio." On a separate page ap- 
pears an engraving of the Senior class officers and the exe- 
cutive Committee. Through this the coming issue of the 
Illio will hold, of things not the common, that which will 
make the book a very proper article on your office table. 

Where the manly senior is now adorned with "van-dyke" 
and "labial brush,*' his womanly classmate wears a "sparkler'"' 
on a suggestive finger. Quite in keeping with June wed- 
dings, but will Miss practice medicine or choose 

household cares as her portion. 

Yes! — it's true, really — 

They're out at last — 
So Sudden too, 

Yet nevermore shall we fellows crane 
our necks for a glimpse of the notice — 

"Senior reports now ready. See Mr. Tomlinson." 

What might have been — ?? 

It may have given transitory pleasure, but perhaps it 
proved a distasteful trick to "Caruso" — the sending to him 
that "phony flunk-slip." The result was rapid in its outset 
producing a primary internal warning, a metastatic noise in 
the college office, and finally endangering Supt. Brown's 

Favorite expressions from faculty man. "Guess who." 
"I see you are looking stupid, let me go over that again." 
[How "he" sees us beats us, as "he" never raises his 
eyes above the railing.] 

"A typical text-book case, one you seldom see." 
"Well yes, what else?" 

Hospital Appointments. Michael Reese, 10 try, 4 suc- 
cessful. Williams, Henning, Reese, Meyer. St. Joseph's 
Hospital. Clark, Nowack. 

We hope in the next issue to report on all other com- 
petitive examination results. 

226 The Plexus. 

With anxious hearts we await the Cook County Hospital 
report, hoping P. and S. will show up in good style. 

Classmate DornblaserMs labeled "the little fat fellow 
mrith the round face" by the inquiring Soph's. 

Watch the "May" Plexus for Senior class items of spe- 
cial interest. 


By P. P. Thometz, Poet-class '08. 
The time has come, alas, my friends, 

To go our several ways, 
To clasp no more the friendly hand 

For" many, many day. 

To years of patient earnest toil, 

At last we say good-bye; 
On years of pleasure and of pain, 

We cast a lingering sigh. 

To varied places we are called 

To practice our art, 
To cities great, or country-side, 

Perhaps some foreign mart. 

For some will go to distant climes, 

Will ease the tortured ill, 
Administer to every want, 

Their duties to fulfill. 

And some will live in pleasant place, 

Will opulence enjoy, 
Luxurious ease at their command 

All means at their employ. 

While some, amid the booming guns, 

Amid the gory fight, 
Will staunch the fallen soldier's wounds, 

Restore his waning might. 

Before we trod our chosen path, 
Let's glance with tearful eye, 

Farewell. 227 

Upon, all that which we may bless, 
And say a last good-bye. 

For passing school days, now we toll 

A sad and dirgeful knell, 
To these, which trained us for the fight 

We bid a sad farewell. 

All those, to whom we owe so much 

Our teachers, dear and kind, 
Reserve for these, some kindly thought, 

Let's leave with grateful mind. 

And from each other let us part. 

With memories sad and sweet, 
Let's hope that in some future day 

Sometime again we'll meet. 

And though this day, our ways must part, 
Let's oft in mind review, 

Our school days gone, those days of joy. 
And friendship strong and true. 

Mutual satisfaction reigns over the "Class Picture" 
which for the past two weeks adorns the college wall just 
opposite the Y. M. C. A. room. 

The grouping is fine, and shows mighty good taste dis- 
played by our Executive Committee, who, in all their work, 
have certainly done much for the Class of '08. We are as 
well satisfied in regard to the invitations the standard of 
which as yet surpasses that of other schools for this year. 

Seniors will be pleased to note that a picture of our 
class officers will appear in the '08 issue of the "Illio." 

We will feel this a special inducement to purchase a copy 
of the University's Year Book, and find pleasure in our be- 
ing represented therein. 

Members of the "Class of '08" have this year vigorously 
claimed hospital interneships both in and out of this locality 
and as they serve they will ever be a credit to their college 
and the profession. 

A complete list of the appointments will appear in the 
June number of the Plexus. 




BATAVIA, ILL., MAY 20th, 1908. 


By William J. Brady, D. D. S. 

During the last ten years the subject of orthodentia has 
undergone the greatest change in practice and in the opin- 
ions thereon of any branch in the whole domain of dentistry, 
and incidentally more real progress has been made in the 
same than in all the centuries preceding. For the first time 
orthodontia has been investigated sufficiently to get at the 
facts concerning the causes of malocclusion and the real 
principles governing the treatment thereof. As might be 
expected when foundation facts are once reached much pre- 
vious theorizing has been undone and many speculative 
structures have been left with nothing on which to stand. 

It has been shown that much of the practice of the past 
has been founded on poor principles, or rather no principles 
at all, and that to secure permanent and satisfactory results 
many things must be done exactly the oposite of what was 
once taught and .what is still widely believed. The practice 
of extraction in orthodontia is one of the things on which 
ideas have been exactly reversed by all those who have 
progressed far enough to understand how the mechanism 
of mastication really operates and how the development of 
the facial structures depends on the normal use of the teeth. 
The stand taken by the believers in modern practice is so 
different from the old and is maintained so vigorously that 
it deserves more than passing notice, especially when there 
is so much proof available on every hand of the correctness 
of the position. 

While the suspision of a fad may always be entertained 
about any radical idea, yet it should not be taken for grant- 

Dentistry. 229 

ed that a new idea is wrong simply because it is radical 
when compared with what is usually believed. The usual 
and the old established are not invariably right, not by any 
means. Some of the most egregious blunders and most ab- 
surd ideas have passed for centuries as the eternal and ever- 
lasting truth. And usually when the truth arrived and was 
announced, and was demonstrated, and was proven again 
and again without doubt, it still was not accepted without 
misgivings and delay, all because "we had bean taught 
otherwise by the fathers." 

The announcement of the incorrectness of extraction in 
orthodontia has been received in much this way. It has 
been pronounced a fad, a one-man idea, a freak notion and a 
wholly wrong proposition, radical and not proven. But just 
the same it has been preached and practiced, and so many 
have not only found the doctrine good, but have proven it 
good, that it will not down nor be hid under a bushel. Ex- 
traction in orthontia is undoubtedly wrong, and has been 
wrong all these years that it has been taught and practiced. 
And these statements are not based on mere opinion, but 
are susceptible of proof that ought to be convincing to any 
reasonable man, so convincing that he should not hesitate 
to accept the new and abandon the old without further ado. 

It may require an absolute backdown to do this, and 
there's the rub with many. After having advocated extrac- 
tion in many instances, mayhap in a dental journal or even 
in a book, it requires quite a stiffly starched spinal column 
to be equal to an absolute reversal of practice and opinion. 
But what is a backdown compared to being right? "The 
wise man changes his opinions, the fool never." The true 
philosopher profits by the truth, wherever it comes from. 

The men who advocate non-extraction in orthodontia 
did not come to that conclusion from traveling along a rose- 
strewn and perfumed path; neither was this wisdom gained 
by any special dispensation of Providence. Not exactly. 
The truth was finally forced upon them through the hardest 
of hard knocks; through dismal failures that made the heart 
sick, that lost business and made enemies, that shook the 

230 The Plexus. 

confidence of friends and colleagues. Dr. Edward H. Angle 
is one of the chief and foremost advocates of non-extraction, 
and no man ever traveled over a rockier road to gain this 
knowledge than did he. Others have experienced a few 
pile-driver jolts also, and the most earnest believers in non- 
extraction are those who have had the most trouble from 
extraction. The difference between them and other men is 
that they have perceived the cause of their trouble and have 
profited by their bumps. 

Extraction for the so-called correction of irregularity is 
a snare and a delusion. It has done far more harm than 
good in the past, and will continue to do so as long as em- 
ployed. We do not include sucn work as extraction of su- 
pernumerary teeth in this category, but we d$ include all 
other kinds, especially extraction to "make room" for teeth. 
Such extraction invariably lessens the room instead of cre- 
ating more, the dental arch collapses still more than its 
original condition and the remaining teeth are worse crowd- 
ed than before. This may not be apparent at first, but may 
be easily proven. Heaven knows there are altogether too 
much proof of it already existing, due to the efforts of^well- 
meaning but much mistaken doctors and dentists. 

Extraction destroys the correct occlusion of the teeth, 
the fact on which permanency of form of the dental arch 
depends. There is no time in life but what the teeth will 
move from their positions and change the form of the den- 
tal arch if said arch is not rigidly maintained intact. The 
dental arch follows the same laws of mechanics as any other 
arch; if one or more of the stones be lost from a vaulted 
doorway or window, that arch will collapse, and there is no 
getting away from the fact. Extraction performs exactly 
the same office for the dental arch, and slowly but surely 
collapse of the dental structure follows. Nature does her 
best to correct the difficulty and patches up the best occlu- 
sion possible from the wreck, but it is never a good one and 
often not even a serviceable one. 

Right here somebody always rises to say; "But what 
if the occlusion is not quite perfect? I have extracted in 

Dentistry. 231 

many cases, and the teeth finally shifted around till my pa- 
tient looked better, and the occlusion was good enough for 
all practical purposes." This statement sounds well enough, 
but, Mr. Man, have you ever really investigated the condi- 
tions in one of these cases? Have you make models of the 
case year after year and noticed the change of form of the 
arch, and watched the gradual drift of teeth about, and 
studied to see how some received practically all the wear 
and others none, and then noted how first one tooth and 
then another was lost years before its time? Have you 
mounted models of the case in an anatomical articulator 
(not an old barn-door hinge) and tested the occlusion — not 
just the open and shut motion, but the incising and lateral 
motions as well — and noted that the shearing action was all 
but lost where your attraction occurred; that often the teeth 
on a whole side were nOt in contact at all upon the slightest 
sidewise motion, and that your seeming good occlution was 
in reality no occlusion at all; all this and plenty more be- 
sides? No, my dear boy, you have not made these tests or 
you would now be against extraction with all your might, 
for you would see its evil effects beyond mistake and you 
would know that extraction was wrong, the same as the 
rest of us have learned from these very same things and 
many more like them. 

No one need doubt in the matter of extraction, nor take 
anyone's work in the case, for anyone who cares may easily 
test it himself, and that too without doing harm. ' Mount a 
' set of good models in any case where extraction has oc- 
curred in an anatomical articulator and begin. Don't use 
the common articulator, for it is absolutely valueless in stu- 
dying occlusion, or for any other purpose for that matter. 
The mere striking together of the upper and lower teeth 
does not constitute occlusion, not by a thousand miles. The 
operation of mastication involves the gliding and sliding of 
all the teeth over each other during all motions of the ja-w, 
and occlusion includes every variety of contact possible be- 
tween the upper and lower teeth, both while in motion and 
while at rest. It takes a real articulator to represent this; 
the fake variety donsn't fill the bill. 

432 The Plexus. 

It will be found that though there may be apparently 
good contact between uppers and lowers when in a state of 
rest, the moment the lower jaw is moved laterally there is 
failure to occlude properly in some particular, and usually 
in many particulars. And it is the proper interlocking and 
shearing during the lateral motion that holds the teeth firm- 
ly to their places, as well as performs the major part of 
mastication, two of the important factors connected with oc- 

The experiment may easily be tried of extracting a tooth 
or two and then rearranging the teeth in a new occlusion. 
Moun^t up a set of models more or less irregularly, but con- 
taining all the teeth, then saw off and lay aside a plaster 
tooth, say a first bicuspid, as is often sacrificed in the vain 
effort to correct through extraction. Then saw off a few of 
the others, as many as thought necessary, and wax them 
fast in new positions, moving them only such amounts and 
giving them such positions as can reasonably be expected 
through regulating. It will be found that it is a hard job to 
make any arrangement whatever whereby even a semblance 
to occlusion is gained, and utterly impossible to make an 
occlusion that performs any service upon the lateral motion. 
Such an occlusion would not hold the teeth in place, and 
such a case would not stay corrected when done. The ex- 
periment may be varied at will, leaving out first one tooth 
and then another, or "extracting" one from both upper and 
lower arches, or any other combination that is usually tried; 
but each and all will fail when the test of lateral motion is 
applied, and each would fail to be permanent if performed 
in actual practice. 

There is neither mystery nor theory in the doctrine 
that extraction in orthdontia is wrong. Anyone may under- 
stand it and demonstrate it for himself. Its bad results 
have been demonstrated practically, alas, time and time 
again, and it must be regretfully stated, it will be practiced 
yet other times by those who ought to know better. In 
years gone by people believed the world was flat — were cer- 
tain of it — till one fine day a man completed a voyage en- 

Dentistry. 433 

tirely around it. All the previous philosophy and teaching 
concerning the world's flatness went out of date in an in- 
stant, yet they could not give up the good old beliefs for a 
long time after. The question of extraction in orthodontia 
is exactly similar; it has been proven wrong. Don't be one 
of those who still believe the earth is flat. — Western Dental 


By George T. Banzet, B, S., D. D. S. 

Although the gold crown is not used to nearly the same 
extent as formerly, yet there are many occasions where it is 
indicated, and to keep pace with the progress in other 
branches of dentistry, it must be perfect; first, in adaptation 
to the root, so as to reduce gum irritation to the minimum; 
and second, the perfection of occlusion must be obtained, 
which perfection can only be obtained by carving the cusps. 

My method includes the fitting of the ferrule to the 
tooth to be crowned, and said tooth should always be devit- 
alized, as only a devitalized tooth can be properly prepared 
to receive a crown, and future trouble be avoided. When 
the ferrule is fitted, leaving just sufficient space for the cusp 
between the top of it and the occluding surface, a combina- 
tion bite and impression is taken with modeling compound, 
and mounted on a crown articulator with plaster of paris. 

After the plaster has set, and the modeling ' compound 
removed, nearly all of the plaster is removed from the inside 
of the ferrule, leaving just sufficient to maintain its attach- 
ment to the model. 

A portion of modeling compound, sufficient to obtain an 
impression of the ocaluding surface is placed in the ferrule, 
the articulator closed and the compound chilled, the articu- 
lator then opened and cusp carved, and the carving finished 
by making a slight depression in the compound at the top of 
the ferrule, slightly exposing its edge. The ferrule and 
cusp is then removed from the model and invested in a 
Brewster cup containing modeling compound very much 

434 The Plexus. 

softened, and then quickly chilled so as to avoid the shape 
of the cusp. 

Pure gold plate, 38 gauge, is placed on the cusp, and 
the cup put into the cylinder and swaged with the water bag, 
in the Brewster press, which will give a perfect reproduc- 
tion of the cusp, with the top of the ferrule clearly defined, 
this indicating where to trim off the surplus. 

The cusp can then be filled with 22k. solder, and united 
to the ferrule, giving a perfectly fitting crown. 

This method is chiefly recommended because of its 
obviating the necessity of securing either die or counter-die, 
thus very much shortening the operation, without in any 
detracting from, but rather increasing its accuracy. 


With a telephone in your home you defy "blue" weath- 
er and enjoy the peace and pleasure of a contented life. 
When tired or discouraged you may sit down and talk to a 
distant friend or relative without effort. Regardless of 
your finances, we have a rate for your purse: — Chicago 
Telephole Company. 




r . M. Goodman, Ph. G., C. S. N. Hallberg, Ph. G., W. A. Puekner, Ph.G 

H.H.Rogera, M. D., Ph. B., E. N. Gathereoal, Ph. G., 

A. H. Clark, Ph. G., C. M. Snow, Ph. G. 

WILLIAM B. DAY, Editor. 
CLASS EDITOR: W. D.Mottak, '08. 


The forty -eighth commencment was held at the auditor- 
ium of the Central Y. M. C. A., Chicago, on Thursday after- 
noon, April 23. There was a large attendance of alumni of 
the school and friends of the graduating class. 

The principal address was made by Dr. Bernard Fantus, 
Professor of Materia Medica and Pharmacy in the University 
of Illinois Medical College. Dr. Fantus took for his subject 
"Medico-Pharmaceutic Relations'" and gave a most interest- 
ing and timely address dealing with the various phases of 
the relationship between the pharmacist and physician. 
He discussed the prevalence of the nostrum evil and the 
prescribing of proprietary medicines by physicians, the 
ownership of the prescription and the dangers of counter- 
prescribing. (The address appears in full in this number of 
the Plexus. 

The class speakers, Rexford De Tompkins, Salutator- 
ian and Raleigh Earel, Valedictorian, acquitted themselves 

President James conferred the degree of Graduate in 
Pharmacy upon thirty-four candidates and gave certificates 
of proficiency to sixteen others. 

Following the conferring of degrees President James 
addressed the class congratulating them upon their accession 
to the ranks of the Alumni of the University of Illinois, a 

236 The Plexus. 

body including dver 5,000 persons, represented in every 
state in the union and in very many foreign countries. 

President James referred to the great progress made by 
the University of Illinois in recent years, it now ranking 
amoung the five or six largest universities of this country as 
regards attendance, while its admission to the conference of 
American Universities including twelve or fourteen of the 
principal universities of this country was adduced as an evi- 
dence of high standing of the institution. Several new build- 
ings have recently been completed or are under construction 
and final arrangements have been made and plans prepared 
for the new veterinary department which will be located in 

The prizes were awarded as follows: 

Alumni Medal for highest general average of ninety- 
five percent or above to Mr. Raleigh Earel, of Quincy, and 
presented by Dr. A. W. Baer, President of the Alumni As- 

The Biroth Prize Microscope awarded for the best work 
in Materia Medica, Pharmacognosy and Histology to Mr 
Harold Dudley Baldwin, of Hampton, Iowa, presented by 
Prof. W. B. Day. 

The Becker prize consisting of a chemical cabinet to 
Rexford De Tompkins, of Mount Sterling, 111., presented by 
Prof. C. S. N. Hallberg. 

Memberships in the American Pharmaceutical Association 
were awarded to Wyley Porter Williamson, of Marietta, 
Ohio and William Emanuel Ruesch, of Joliet, for excellence 
in Pharmacy and Pharmacognosy respectively: 

The list of the class follows: 

Received the degree of graduate in pharmacy. 

Fred Kramer Anderson, White Sulphur Srings, Mont. 

*Harold Dudley Baldwin, Hampton, Iowa. 

Amar Nath Banerjee, Benares City, India. 

Wayne Crawford Denson, Minonk. 

*Raleigh Earel, Quincy. 

Bruce Carr Frantz, Pekin, Indiana. 

Auburn Seth Kisner, Brownsville. 

Pharmacy. 237 

George Ferdinand Knick, Hutchinson, Indiana. 

Newman Kohn, Chicago. 

Herbert Ernst Kraft, Chicago. 

Henry August Langenhan, Ableman, Wis. 

William Darrell Mottar, Chicago. 

Alvrado Benson Owens, Savanna. 

Adolph Vaclav Pavlicek, Chicago. 

James Patrick Renaud, Chicago. 

Charles George Sells, Chicago. 

Frank Edmund Shipman, Paris. 

Roy Mont Soult, Fredonia, Pa. 

Frank Bengal Stromer, Chicago. 

*Rexford De Thompkins, Mount Sterling. 

Steward Franklin Voss, Assumption. 

Stanley Ballenger Webster, Winslow. 

Wyley Porter Williamson, Marietta, Ohio. 

Frank James Zuck, Rockford. 

Frand Alex Crawford, (class of '06,) Oklahoma City. 

Rudolph George Mrazek. (class of '06) Chicago. 

Martin Schupmann, (class of '06) Chicago. 

Claude Enoch Tilton, (class of '06) Fairmount- 

Earl Elliott Anderson, (class of '07) Roberts, Wis- 

Tisdale E. P. Furman, (class of '07) Chicago. 

George Julius Langheim, (class of '07) Charlotte, Iowa. 

Frank John McCabe, (class of '07) Chicago. 

Henry Pfaff, Jr., (class of '07) Chicago. 

Edwin Theo. Schumm, (class of '07) La Porte,' Indiana. 

Received the certificate of having finished the course 
successfully. Will receive the degree when the required 
age and practical experience are attained. 

Joseph Arnold Blatt, Chicago. 

Lesley Ray Crawford, Nachusa. 

Waler William Doerr, Chicago. 

Otto August Fett, Chicago. 

Delmar Nelson Fidler, Watseka. 

Otto John Lorenz, Chicago. 

Edward Emil Luken, Chicago. 

Frederick James Lyons, Grand Junction, Mich. 

238 The Plexus. 

Eugene Lester Miles, Chicago. 

James Strachen Miller, Coal City. 

Herman Lawrence Rauschert, Lake Mills, Wis. 

William Emanuel Ruesch, Joliet. 

*Harry Garrison Skinner, Yates City. 

Carl Frederick Stark, DeKalb. 

John Joseph Staszak, Chicago. 

John Joseph Urban, Chicago. 

*Class honors for excellent scholarship. 

In the evening the Alumni Association gave a banquet 
in honor of the graduating class at the Palmer House. Many 
of the Alumni and their ladies were present, and the Presi- 
dent and several of the trustees of the University were 
guests of honor. 

Prof. C. S. N. Hallberg presided as toastmaster and 
toasts were responded to as follows: 

"The University of Illinois," President Edmund J. James. 

"The Board of Trustees," Mrs. Laura B. Evans. 

"The Alumni Association," Dr. A. W. Baer. 

"The Class of 1908," Mr. Wyley P. Williamson. 

"The Class of 1883," Dr. James A. Lydston. 

State Superintendent of Public Instruction, Francis G. 
Blair, ex-officio a member of the Board of Trustees of the 
University was called upon and responded in a most happy 

Mr. DeWitt, who is well known in drug circles, also re- 
sponded most happily giving the young men some excellent 
practical business advice and suggestions. 

Taken in all the banquet was generally voted the most 
successful that has been held in many years. 


H. P. Sandkoetter, '94, has sold his drug store at 92 
22nd street, Chicago, and will leave May 24th for a trip to 

C. E. Tilton, '06, was appointed yell-master at the Alum- 

Pharmacy. . 239 

ni banquet. The university yell was given with such vigor 
that it woke the echoes in the old Palmer House. 

C. Ed. Hoffman, '06, passed the recent examination of 
the Wisconsin Board of Pharmacy and is now a registered 
pharmacist in his home state. 

W. H. Rudder, '94, was recently elected president of the 
Indiana Board of Pharmacy. Mr. Rudder conducts a pros- 
perous pharmacy at Salem, Ind. 

John E. Kienze, '93, has been elected secretary of the 
Davenport, Iowa, Druggist's Association. 

Charles Howk, '01, has purchased the Baker Pharmacy 
at 61st street and Princetone Ave. , Chicago. 

H. A. Watson, '04, has engaged in business at Grays 

Dr. J. A. Lydston and Mr. W. H. Krouskup of the class 
of 1883 attended the banquet. Dr. Lydston read several in- 
teresting letters from absent classmates. 

Ed. N. Fernholz, '02, died at Harvard, 111., April 26th. 
Mr. Fernholz had taken an active interest in pharmaceuti- 
cal affairs and was secretary of McHenry County Druggist's 
Association at the time of his death. Though but a young 
man he had built up a good business and had made many 


By Bernard Fantus, M, D. 

Professor of Materia Medica and Therapeutic School of Medicine, 
University of Illinois. 

Mr. President, Faculty, Members of the Graduating 
Class, Ladies and Gentlemen: 

It is indeed an honor to have the privilege of addressing 
so splendid an assembly on an occasion like this; an occa 
sion which will remain a life long memory in the minds of 

*Address delivered at Commencement Exercises of the School Tof Pharmacy of the 
University of Illinois, April 23rd, 1908. 

240 The Plexus. 

many present, especially memorable for those who today 
receive the title of Ph G. from this grand university. 

Members of the graduating class: I wish to congrat- 
ulate you upon your achievement. You are to be congrat- 
ulated, particularly on entering the ranks of the great pro- 
fession of pharmacy at this time when it is becoming better 
established than ever before. Therapeutic nihilism, pro- 
prietary and patent medicines, osteopaths, Eddyites and 
other quacks have all been threatening the very existence of 
your profession; but the motto "Pharmacia vera praeva- 
lebit," "True Pharmacy will prevail," is becoming glori- 
ously vindicated. Chemistry, the common meeting ground 
of our profession, is showering ever more bountiful gifts 
upon us. Pharmacodynamics, or the study of the action of 
drugs, is establishing so firmly the therapeutic utility of 
medicines that therapeutic nihilism is now synonymous with 
therapeutic ignorance. Proprietary and patent medicines 
are having the searchlight of scientific and of legal investi- 
gation turned upon them; and ere long they will have be- 
come dissipated by it as the mists of night vanish before the 
morning sun; and medicine is becoming so broad that it in- 
vestigates the practice of quackery in its various forms, 
discovers extracts and appropriates the good and eliminates 
the bad. 

The title of graduate of pharmacy that you have ac- 
quired carries with it honor, distinction and emoluments, 
but also duties and responsibilities. I doubt whether you 
need assistance in bearing the pleasant portion of your lot; 
but it may not be inappropriate at this occasion to remind 
you once more of your duties and responsibilities, most of 
which arise out of the peculiar relations existing between 
the medical and the pharmaceutical professions. 

Most of these relations cluster around that little piece 
of paper, the prescription. How much there is in so small 
a bit of paper, To the physician it represents the last act 
of his medical endeavor at that particular occasion. It is 
the result of all the thought and all the work he has be- 
stowed upon the case at hand. To the patient it is the 

Pharmacy. 241 

anchor of hope, the mysterious talisman of cure, the order 
that will bring health. To the pharmacist it means the 
very reason for his existence as a professional man. All 
the knowledge, all the skill that he has acquired is but to 
fit him for the safe and proper compounding of the medica- 
ment designated. To the law it means the evidence of its 
own nature, a most potent witness capable of fixing guilt or 
blamelessness upon the various parties to the transaction in 
the case of a fatal mistake. 

As is well known there still exists no universal agree- 
ment as to the ownership of the prescription. This is, how- 
ever, for the reason that the nature of the prescription is 
generally misunderstood. Were the piece of paper contain- 
ing the mysterious writing in itself a magic charm that 
works the cure by the very holding of it, the patient would 
be entitled to its ownership. It is, however, nothing more 
or less than a written order from physician to pharmacist; 
it is not the remedy but merely a specification for the reme- 
dy. We may even agree with the jurist who says that the 
prescription belongs to the patient, as he has paid for it; 
but we would have to add, only as long as he does not have 
it filled. The moment he has it filled, it passes from his 
hand into that of the apothecary. Just as a bank check, 
the moment it is cashed it passes from the hand of its form- 
er holder into the hand of the one who cashes it, so tliis 
order, the prescription, passes from the patient into the 
hand of the one who fills it. 

Having once been filled the life of the prescription is 
ended. The only function it now fulfills is to serve as a 
record of the transaction, and as such it should remain un- 
der the guardianship of the pharmacist, accessible at any 
time for a number of years to the proper legal authorities 
for investigation in case of legal proceedings connected with 
•it. It is plain that the druggist has no right, moral or legal, 
to the formula contained in the prescription. The idea em- 
bodied in the prescription belongs to the physician who 
originated it. It does not become common property until 
the owner publishes it. Prescribing is not publishing. The 

242 The Plexus. 

druggist has no right to put up and sell the medicine to his 
patrons without the permission of the prescriber. On this 
principle the propriety of refilling prescriptions without the 
physician's order would have to be settled. If the patient 
in having the prescription filled resigns his right to it, and 
if the pharmacist had no right to make any further use of 
the formula, how can it properly be used again in refilling. 
Undoubtedly if there were no refilling of prescriptions with- 
out the physician's order, many drug habits and other evils 
arising from excessively prolonged or improper use of 
medicines would cease to exist. 

However, while this is the ideal standpoint, we can 
hardly at present assume it, so firmly established is the 
practice of refilling prescriptions. Therefore if we cannot 
abolish the practice we must regulate it. The declaration 
that your worthy Professor Hallberg is so prominent in 
promulgating fills, I believe, the present requirements quite 
well. The prescription should not be refilled (1) If ord- 
ered by the prescriber "not to be repeated" (ne-repetatur); 
(2) If containing medicinal substances commonly called 
narcotic or habit-forming drugs- To this should be added 
drugs capable of producing poisoning on prolonged Use, as 
digitalis, mercury, arsenic or lead. (3) If called for by 
some person known not to be the original holder. 

I do not see that any objection should be made to the 
giving of a copy of the prescription to the patient should he 
demand it, if the filling of copies would fall under the same 
regulations as the refilling of prescriptions. 

I need not tell you that you must put into the prescrip- 
tion all the prescriber orders &nd just what he orders. Nev- 
ertheless I wish to urge you not to deviate from this rule in 
the least. As there are all degrees of lies, there are all de- 
grees of substitution. Even if you are sure that a certain 
brand of chemicals that you have on hand is just as good 
as, for even better than the kind the prescriber has specified, 
do not permit yourself to substitute it. Rather communi- 
cate with the prescriber and tell him frankly that you do 
not have Mallinkrodt's but Merck's on hand, or vice versa, 

Pharmacy. 243 

and ask him what you should do. He will respect you for 
your honesty, and, thereafter, that very doctor will be like- 
ly to specify your drug store whenever he wants to be sure 
that there will be no substitution. You have heard what 
the father said to his son: "My boy, honesty is the best 
policy. I have tried both." 

Remember that the knowledge you acquire regarding 
the nature of his illness, must be kept as your professional 
secret. Make it your rule never to discuss this matter with 
any one, not even your wife or your barber, for these are 
often the most rapid means of communication of news. 

Shield the doctor's reputation for it is "the immediate 
jewel of his soul." Never by word, act or look convey an 
unfavorable impression regarding the nature of the pre- 
scription to your patron. If the doctor has made a mistake 
communicate with him. The physician whom you have 
saved in a tactful manner the consequences of a serious er- 
ror, will ever thereafter be your friend. 

The practice of "counter-prescribing," that is, the giv- 
ing of medicines on a diagnosis made across the drug coun- 
ter, cannot be too strongly condemned. Why, not the most 
learned and most experienced physician could make a safe 
diagnosis and give proper treatment in this manner. The 
drugggist is liable to get the erroneous impression that the 
medicine he puts up is the only means of treatment that the 
doctor uses, when in reality it is often only an unimportant 
adjunct to other means of treatment, such as the regulation 
of the patient's habit of living. Now, when a patron asks 
a druggist to prescribe for a cough or other disturbance, the 
druggist may imagine that he can do this patient just as 
much good as the doctor by giving the same medicine, while 
in doing this he misses the main part of the treatment and 
thereby fails of success. Many a simple or easily cured 
case is made difficult or incurable in this manner. Here is 
another evil that it seems difficult to eradicate at present. 
Hence I am tempted to advocate the following regulations 
for this practice: 1. That the druggist should never pre- 
scribe on his own account a potent or poisonous remedy. 2. 

344 Tbe Plexus. 

That he should never prescribe for a serious disease or one 
liable to become serious. Of course that would mean that 
the pharmacist should be competent to distinguish between 
serious and trifling ailments which is often very difficult. 
In order to be able to do this the pharmacist should have a 
fair knowledge of disease and of its treatment, for it is only- 
little knowledge that is dangerous. I am sure that the bet- 
ter a knowledge the pharmacist has regarding the nature of 
diseases, the less he would want to meddle with them direct- 
ly. I would even advocate that the elementary principles 
of the practice of medicine be taught in schools of pharma- 
cy just as I advocate that more of the true principles of 
pharmacy be taught in schools of medicine. For the more 
pharmacy a physician knows the more respect does he have # 
for the profession of pharmacy, and the more of -medicine 
the pharmacist knows the higher will he rate the practice of 

Finally let me urge you not to become any more than is 
unavoidable an accessory to the "Great American Fraud," 
I mean the patent medicine business, that industry founded 
mainly on lies, liquor, laudanum and other poisons. The 
amount of harm that is done by this trade in human life is 
something appaling. Tbe lives of hundreds of people^are 
sacrificed annually to the heart-depressing headache pow- 
ders. Thousands of babes yearly have their lives nipped in 
the bud by soothing syrups, cough syrups and other system- 
disturbing nostrums. Thousands of adults are made drug 
fiend by the use of mind-enslaving drugs, the habit having 
been started by the patent medicines. Millions of- people 
loose their chance to prompt or complete recovery by tem- 
porizing with self-prescribing. The druggist] must by the 
very nature of his business become an aid to this crime; but 
let him be an unwilling particeps criminis, not an eager 
promotor of it. Let him put the patent medicines on some 
rear shelf of his establishment, and not display ^them promi- 
nently in the best part of his store. Do not let him pollute 
his windows and his store-fixtures with patent medicine ad- 
vertisements which for downright untruths would make 

Pharmacy. 345 

Satan blush. The druggist should not put up and push pat- 
ent medicines of his own, for every dollar gained in that 
business is tainted money. Druggists, you can afford to 
forego this profit. Were the sales of patent medicines for- 
bidden today throughout this land, it would not lessen in 
the least the revenue of the druggist, for instead of selling 
a half dozen of patent medicines with a few pennies profit 
in each, he would compound one prescription with more 
in it than in the half dozen nostrums. 

I am not one of those who look with contempt upou the 
business side of pharmacy, but I have a more exalted opin- 
ion of the pharmacist than I have of the business men. The 
average business man's conscience has not yet awakened to 
distinguish between money gotten by means fair or foul. 
Pharmacists and physicians have for ages refused to in- 
crease their revenues at the expense of human suffering, as 
is for instance evidenced by the French apothecaries' oath, 
which from the eleventh century down to the time of the 
revolution the French pharmacists were obliged to take 
upon graduation: "They swore to honor, respect and be of 
service not only to the doctors of physic who had taught 
them the precepts of pharmacy, but the masters from whom 
they learned their art; to do all that in them lay for the pro- 
motion of the glory and majesty of medicine; to do nothing 
rashly, and in particular to give no purgative medicine to 
sufferers from acute disease without taking counsel of a 
learned physician; not to touch the shameful or forbidden 
parts of a woman without necessity— that is to say, when 
some remedy had to be applied to them; not to reveal sec- 
rets confided to them; never to give any one poison to drink 
nor to advise any one else to do so, 'not even to his greatest 
enemies,' never to administer an abortive poison; never in 
any way to attempt to force the fetus out of its mother's 
womb; to make up the doctor's-prescriptions with strict ac- 
curacy, without addition or diminution, 'as far as they are in 
accordance with the rules of art;' never to dispense any suc- 
cedaneum or substitute without the advice of some more 
learned person; to repudiate and avoid like the plague the 


The Plexus. 

scandalous and utterly pernicious method of practice used 
by quacks, empirics, alchemists, to the great shame of the 
magistrates who tolerate such things, and to keep in stock 
no bad or old drug." The oath ended with the pious formu- 
la: "The Lord bless me as I observe all these things." The 
custom of taking the oath has been abolished, for the good 
man needs no oath, and a bad man will not heed it. 

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VOL XIV. BATAVIA, JUNE 20th, 1908. NO. 6 

CHICAGO, JUNE 2-5, 1908. 

By William Sidney Thayer, M. D., Baltimore. 

The physician has always been and, from the very nature 
of his calling, must be, more or less a public character. In 
the smaller community he is a public character in the sense 
that he is a common source to which the citizens repair for 
advice, not only concerning their physical and mental but 
often also their matrimoninal well-being, In the larger 
centers of population he is a public character in that it is on 
his direction, on the results of his studies and research that 
the community depends for the organization of those more 
general, broader sanitary measures which are demanded to 
meet the exigencies ever arising and multiplying with the 
growth of large urban communities. 

In the early days of this country, when there were no 
large cities, the physician exercised this influence individually 
among his patients, as the family friend and adviser. With 
the growth and development of the nation, the great relative 
increase of the urban population, the multiplying complica- 
tions of our life on the one hand, and on the other, with the 
enormous advances made in the knowledge of the nature and 
sources of disease, of the relations of physiology and path- 
ology to other natural sciences, together with the rapid pro- 
gress in the art of medicine and surgery — with all this 

348 The Plexus. 

growth, the expansion — yes, one may almost say, transfor- 
mation, the functions of the physicians have considerably 

The development of hospitals, of laboratories, of in- 
stitutions for the study of every increasing ramifications of 
anatomy, physiology and pathology — ramifications leading 
directly to botanical, physical, chemical and indeed, even to 
mathematical problems — calls for an increasing body of 
students — physicians who accomplish their function, and a 
most important and radical function it is, in the study of 
special scientific problems — a life widely different from that 
of the country doctor of old. 

Moreover, the advances and extension of the medical 
and surgical art are such that it has long been impossible 
for any one man to develop equal proficiency in all its 
branches. In all large centers of population, therefore, 
certain men have sought to devote themselves to special 
subjects in order that they may, in this manner, acquire a 
greater proficiency, and do more perfect and thorough work. 
This is natural and proper; it is only by the labors of such 
special workers that any art can be perfected. 

In almost all large enterprises today the aid of the phy- 
sician is sought, as for instance, in the organization of the 
relief departments of great railways and corporations and 
in large department stores. The health and comfort of the 
employe and the profit and success of the employer are in- 
dissolubly interwoven. But the distinctly public duties of 
the physician are by no means confined to exigencies arising 
in large centers of population. There are in the history of 
mankind examples of the gradual or sudden desolation of 
extensive districts by the insidious influence of diseases 
which we now know to be in great part preventable. 

Today, with an educated and specially trained body of 
medical men, assisted by an enlightened government, the 
Italians have reduced the mortality in the fever-ridden parts 
of their neighboring peninsula two-thirds in five years; and 
the task is but begun. Already in regions where agricul- 
ture was abandoned, work is being renewed and a fresh life 
is springing up. 

Oration on Medicine. 349 

There is a modern example which touches us closely, of 
a great undertaking— one of the greatest undertakings that 
man has ever essayed— which depends for its success large- 
ly on the labors of physicians. I refer to the digging of the 
Panama canal. The French, with unexcelled mechanical 
skill and energy had failed— failed largely because of the 
dreadful and continued mortality among the workmen. The 
United States took up the work. In the meantime there 
had come the great discoveries of Ross and Grassi and Big- 
nami and Bastonelli, completing those of Laveran, concern- 
ing malaria, and the vital and illuminating contributions of 
our own Reed, Lazear, Carroll and Agramonte, with regard 
to yellow fever. And today the Panama zone compares 
favorably, as to sanitary conditions, with the more healthy 
parts of this country. Yellow fever, though on all sides, is 
here unknown. It is the greatest triumph of preventive 
medicine that the world has ever known. 

And to whom is this due? A few months ago I had the 
good fortune to listen to an account by a distinguished for- 
eign physician, of the work at Panama whence he had just 
returned. After speaking with warmth of the general con- 
ditions, he said impressively, "The successful completion of 
the Panama Canal depends on one mm." If the measures 
admirably planned and carefully carried out by Colonel 
Gorgas fail, if there is a moment's relaxion, if the old epi- 
demics recur, it will be impossible to find laborers, and the 
work will fail again as it did before. And he did not ex- 
agerate- It is on the success of these prophylactic measures 
which can be designed and carried out only by a specially 
trained sanitarium that the completion of this great under- 
taking depends. It is to the lasting credit of our country 
that medical men should have urged and our President re- 
cognized the importance of the appointment of a physician 
on the Panama Commission. 

There is yet another opportunity for public usefulness 
in this country for which the training of the physician is 
peculiarly valuable. I refer to the career of the legistator. 
One has but to consider the few examples already mentioned 

350 The Plexus. 

of the various ways in which medical knowledge and skill 
are of value to the state, to realize how useful the education 
of a physician may be as a preparation for public life. The 
life of a physician, not only prepares a man to treat wisely 
those more specific and practical questions of which we have 
just spoken; more than this no career brings a man in closer 
connection with his fellow; no career gives him a more intij 
mate knowledge of mankind; no career is more fitted to de- 
velop those qualities of charity and tolerance so vital in our 
best public servants. It is true that medicine and public life 
are equally jealous mistresses, and that few men can serve 
both as they would and should be served; but we have in 
this country hardly realized how valuable a preparation for 
public life is the training and career of the physician. One 
has but to look to the prime minister of our sister republic 
in Europe for a most brilliant example of what may be ac- 
complished in modern political life by the man with a medical 

It is doubtless true that the development of the purely 
scientific branches of medicine together with the multiplica- 
tion of specialties which is everywhere observable in our 
large centers of population, have resulted in a relative dim- 
inution of the number of family physicians in the old sense 
of the word, and have, in so far, limited the public influence 
which the old fashioned general practitioner formerly ex- 
erted among his patients. But on the other hand, there have 
developed many wholly new problems which are calling the 
physician more directly into public life. If perhaps, the 
wholesome influence of the family doctor is less felt in the 
community than it once was, yet the opportunities for pub- 
lic service which are to-day before the physician, nay, his 
public duties, have greatly increased. 

The knowledge gained during the last forty years has 
taught us that we can accomplish far greater results by pre- 
venting disease than by attempting to promote recovery 
from that which has already started; it has taught us that a 
large proportion of the gravest maladies from which human- 
ity suffers are acquired through our ignorance and careless- 

Oration on Medicine. 351 

ness and unclean habits; and with regard to many of these 
diseases, it has given us efficacious methods of prevention. 
Prophylaxis is the watchword of the day. We have in our 
hands the means, not only of delivering ourselves from 
dreaded epidemics of exotic pestilence, but of preventing 
largely the terrible yearly sacrifice to the contagious dis- 
eases which have for ages been endemic among us. But 
this deliverance can be brought about only through the 
united and conscientious efforts of the medical profession. 

This is an age of combination and concentration and co- 
operation — of large associations and undertakings. The 
great growth of this association which we have known of 
recent years is but a feature of the times. Despite the in- 
increasing diversification of our interests, we physicians 
have been brought closer together than ever before — and to 
our lasting benefit. For wherever medical men come into 
social contact one with another they cannot fail to feel a 
warm pride in their calling — they cannot fail to be impressed 
with the earnestness, the simplicity, the honesty of the 
character and aims of their fellows — with the realization 
that, despite differences in natural endowment, in advan- 
tages, in surroundings, in temperament;despite the fact that 
we are all human and possess our fair share of human frail- 
ties, we are with singularly few exceptions, all working 
earnestly, as best we can, in the search of truth and for the 
good of humanity. Association and acquaintance deliver us 
from doubt and suspicion and jealousy — those all pervading 
daughters of isolation Our great association has further 
enabled us to distribute to all parts of the country, an ad- 
mirable journal, which is a monument to its honest, faithful, 
fearless editor, so that the practitioner in the distant rural 
community may reap, at the earliest moment, the benefits of 
the discoveries of the student of the urban laboratory. It 
enables us to lay with greater force before local and national 
legislatures necessary measures of sanitary reform. It 
helps us to combat more powerfully the many forces of evil 
which, from time immemorial, have fattened on the credu- 
lousness and superstition of the invalid. It is helping us to 

352 The Plexus. 

teach the public with greater impressiveness the necessity 
of high and uniform standards of education for the phys- 
ician and requirements for the license to practice medicine. 

Here we are then, a great body of medical men, united 
in an Association, not for our personal, financial, political or 
social advancement, but solely in the cause of truth and for 
the benefit of humanity — the deliverance of the public from 
disease. Nevertheless, the work before us is unending, the 
obstacles great. But why should there be obstacles? Why 
have not the recommendations of this Association the force 
of the law? Why is it that, when laws themselves exist, all 
our strength is needed to secure their enforcement? 

The main cause, I take it, of all this is the lack of com- 
prehension on the part of the public of the nature and 
aims of medicine and of physicians. If the public had but a 
small part of the information which is ours, how many 
thousands of lives might be saved every year. The commu- 
nity as a whole has a very vague understanding of the 
nature of the medical sciences and arts. Under these cir- 
cumstances can we expect such a public to sympathize with 
and blindly follow all our recommendations? Surely not. 

In how many ways is this ignorance shown? To take 
but a few examples: 

We know well enough that the one successful way to 
prevent the spread of many contagious diseases in the large 
community is the establishment of well-conducted hospitals 
in which the patients may be isolated as soon as possible 
after the breaking out of the malady. By providing for the 
early segregation of these patients in institutions offering to 
the sufferers the most enlightened care, the community con- 
fers a blessing of incalculable value on the families of rich 
and poor alike. Such hospitals, moreover, afford the only 
opportunity for the proper instruction of students of medi- 
cine in the diagnosis of those contagious diseases, the early 
recognition of which is of such vital importance to the 
public. Furthermore, we know that such institutions are 
absolutely without danger to the neighborhoods in which 
they are situated. The records of the city of Boston, which 

Oration on Medicine. 353 

possesses a model hospital for contagious diseases, shows 
well what a blessing such an institution may be to the com- 

But I know another great eastern city where^ there has 
been, until recently, no provision whatever for the care of 
contagious diseases. More than this, some years ago the 
state legislature passed a law forbidding the erection of a 
hospital for contagious diseases within the city limits with- 
out a two-thirds majority of each branch of the city council, 
which rendered the erection of such a hospital almost impos- 
sible. To us this law seems wicked and brutal in the 
extreme — worthy only of savages. And yet the measure 
was passed by men who were not inhuman; they were 
simply ignorant. And it is difficult to remedy such ignor- 
ance by immediate argument. The vehemence which we 
are too apt to display only excites the sensitiveness of the 
legislator — and where passion enters in reason passes out of 
the door. 

I know again a great city the water supply of which is 
open to serious contamination. At a period during which 
extensive and radical public improvements were under con- 
sideration, a meeting was held of a committee appointed to 
take counsel as to those steps which should be taken to 
improve the water supply. Before this committee there 
appeared a number of medical men and sanitarians, includ- 
ing representatives of the state and city boards of health — 
mer who had made a careful study of such matters. These 
men urged that steps be taken to provide ultimately for a 
proper system of filtration. After they had spoken a gentle- 
man connected with one of the city departments, an engi- 
neer, who had the last word, made a long address in which 
he denied with passion that the water supply was or could 
be contaminated. He ridiculed the statements of the sani 
tarians and physicians, opposing to them the frequently 
repeated and wholly unsounded assertion that they were 
dealing with theories — he with facts. The committee, by an 
overwhelming majority, dismissed, for the time being, the 
question of filtration. The city, fortunately, has not yet 

354 The Plexus. 

suffered from the epidemic which may come at any time. 
The men on that committee were not unintelligent; they 
were simply ignorant of the medical aspect of the question 
at issue, and were utterly deceived by a plausible argument 
filled with pseudo-scientific statements which the orator 
himself appeared not wholly to understand- 

A few years ago I happened to meet on the railway a 
high official of a large manufacturing concern situated in a 
most malarious district. At that time little had been done 
to protect the employes, who were nearly all victims of the 
disease. "This is a healthy enough place," said the official, 
who lived in a well-netted house in a dry part of the town. 
"The trouble with the people here is that they take too 
much quinine. If they would stop taking quinine they would 
stop having malaria." And this was a really intelligent 

How often again do the trustees of large hospitals gen- 
erously seek to "protect" the patient from what they regard 
as inconsiderate and unnecessary scientific zeal, by closing 
the wards to instruction and denying admission to student 
assistants, thereby blindly cutting off from the sufferer the 
greatest boon that they can offer him — the most enlightened 
observation and care. How far are these good men from a 
comprehension of the true significance and value of the 
hospital to the patient and to the public! 

There could be no more striking example of the ignor- 
ance of a well meaning part of the community than the 
agitation of the so-called anti-vivisectionists whose publica- 
tions, shocking and wicked and brutal as they are misleading, 
are yet believed by some misguided people. But those 
dreadful publications, inspired for the most part, by individ- 
uals who probably mean to be honest, are but the offspring 
of fancy and prejudice, born themselves of an utter ignorance 
and misconception of the aims and significance of medical 
science and of the character and ideals of the student. 

These are but a few examples, but they are enough to 
show how little a considerable part of the general public — 
often individuals in whom we might, indeed, expect more 

, Oration on Medicine. 355 

enlightenment — understand the nature of medicine or sym- 
pithize with the generous efforts of the physician and the 
investigator. We can hardly expect people with ideas such 
as these to heed the advice of a body such as ours. These 
considerations should bring home to us the realization that 
the education of the public is a most vital duty, not only of 
medical schools and associations, but of each separate mem- 
ber of the medical profession. On each one of us there rest 
public duties of the gravest import. On the sum of our 
individual efforts depends the success of all the great sanitary 
reforms of the future. 

On a few of the opportunities which come to the physi- 
cian of today, in his intercourse with his patients and his 
friends, to perform some of these public duties I would 
especially speak. 

Many misconceptions concerning the nature of the heal- 
ing arise from the strange atmosphere of mystery which so 
often surrounds medicine. To physicians there is nothing 
mysterious or supernatural about medicine. We recognize 
that medicine is a practical art resting on a basis of scientifi- 
cally proved facts; we realize that our knowledge amounts to 
an infinitely small part of that which we would know and 
hope some day to know. We know that there is an enormous 
field for study. We practice our art simply on the basis of 
what we have learned from the experience and study of those 
who have gone before us, and from what we acquire daily 
from our own study and experience and reason and common 
sense. But from time immemorial the art of medicine has 
been connected in the mind of man with the supernatural and 
the divine. Medicine has been regarded rather as a matter 
of faith than as an art resting on a scientific basis. People 
speak of their "belief" in this, that or the other system of 
medicine, and on the basis of that "belief" recklessly hand 
over their bodies to some individual who asserts that his 
practice is based on a theory or system revealed as by inspir- 
ation to some fortunate mortal, perhaps yesterday, perhaps 
two hundred years ago. 

This blind faith in systems is not so far removed from 

356 The Plexus. 

the faith of the savage in the magic of his medicine man, and 
when we turn to our friends who with such delicious ignor- 
ance and ingenousness have termed their medical faith a 
" science;" when we see them, as we sometimes do, braving 
with fanatical contempt some dreadful infection only to find 
themselves in the end the prey of the fatal poison of reality, 
we seem almost to see the medicine man standing with a 
little group of determined warriors in the midst of the circle 
of fire, bidding defiance even as he falls, his "invulnerable" 
mantle pierced by a score of deadly bullets. 5 

Again, there is a very general idea among people that the 
physician is by practice, if not by nature, disingenous; that 
while he may be trusted to do his duty as he sees it, to his 
patient, truth is not to be expected of him. Scarcely a week 
goes by that I am not asked by the friends of a patient to tell 
a deliberate falsehood. 

From these misconceptions we physicians can not, I fear, 
be regarded as wholly guiltless. We know how few specifics 
there are in medicine. We that by simple physical and mental 
means accomplish our main results. But, alas, how easy 
it is to accomplish these ends by misleading means! How 
easy it is to write the prescription which we know of itself is 
of little value, which we should never dream of taking our- 
selves, and allow the patient to believe that it is this that 
has "cured" him of the transitory, self -limited malady! How 
easy it is by assuming an impressive air — to make the patient 
feel that we possess that mysterious power which has, per- 
haps, come to us from a loug line of medical ancestors, the 
power which enables us at a glance to divine that which 
might never be revealed to our uninspired colleague. 

The same results can be achieved without misleading the 
patient one iota. It is perfectly possible to treat patients as 
we would be treated ourselves. It is scarcely likely that 
they would be treated otherwise. It takes a little longer; it 

5. I have seen in the possession of a friend, the "invulnerable" 
mantle of an Indian medicine man who with a small group of warriors- 
fought until the last man had fallen, although completely surrounded by- 
troops. The garment was pierced by many bullets. 

Oration on Medicine. 357 

involves a little more explanation; but how much safer and 
surer is the result! 

The oracular method is easier, but I fear that some of us 
have forgotten that, by a special decree of the Olympian As- 
sembly, Asklepios was forbidden to trade in oracles. 8 That 
it is necessary for a physician to tell untruths is a myth 
founded on kindness of heart, pure and simple — but an 
unreasonable and a weak, a short sighted and misguided * 
kindness of heart. Truth is as sacred a duty in medicine 
as anywhere else in life. As a matter of policy, as Cabot 
has pointed out, it is almost a necessity, for whatever may be 
true in other spheres of life, the doctor's lie is always detected. 

Few patients ask the physician the direct question, but 
when they do they should be told the truth as we should tell 
the truth in every other sphere of life. 

The physician has no higher public duties than the duty, 
of simplicity, the duty of the avoidance of mystery in medicine 
and the duty of truthfulness. Toward his patient I know of no 
more vital duty than the duty of optimism. 

There is another widespread misconception to combat 
which is an important public duty. I refer to the too com- 
mon feeling of the public that, with many of us, the practice 
of medicine is purely and simply a trade. Viewed in this 
light the practitioner can but be often an object of suspicion. 
His methods and his word are doubted. The best part of his 
influence is gone. There are few, if any, physicians who 
practice medicine as amateurs. The inconveniences which 
every earnest doctor must endure are always considered. 
Most physicians are obliged to depend on their fees, as most 
clergymen are obliged to depend on their salaries, for their 
daily bread. They must provide, not only for themselves, 
but for their families. There are many men to whom, for 
more reasons than one, the material gains from practice are 
an important — a highly important — element in life. There 
are many men, teachers, scientific workers, men who desire 
to limit their practical activities, as well as men who have 

6. Lucian: Lucian 's Dialogue?, translated by Hovrard Williams. 
12 mo. London, 1893. Geo. Bell & Sons. 

3 58 The Plexus. 

achieved such position that they are obliged to restrict or 
select from the overwhelming practice which seeks them, 
who, for these very reasons, rightly demand large fees. If 
the public insists upon having their services rather than 
those of the many other good men in the profession, they 
should and do understand that they must pay a larger honor- 
arium. This is perfectly right and proper. But there are a 
few physicians who enter into the practice of medicine with 
the idea of laying up wealth. There are happily exceedingly 
few to whom medicine is a trade. The man to whom the 
scientific and humitarian aspects of medicine mean nothing; 
the man who practices solely for what he can make; the man 
who finds no interest in medicine outside of that which he 
puts in his pocket; that man is on a level with the con- 
scienceless quack, and the sooner he leaves the profession 
the better for it and for the public. 

There exists, however, a tendency among some of us — 
men who are, for the most part, honest and honorable — which 
is, it seems to me, below the dignity of our calling. I refer 
to the tendency to regulate one's fees according to the means 
of his patient. It is well that a man should have a more or 
less definite estimate of the value of his services, a fixed 
maximal charge for work of a certain character, a charge 
which in justice to himself, he should always make, unless 
he has reason to believe that the patient is not in condition 
to meet it. He will often, with a large proportion of his 
patients, perhaps, be obliged to accept less than the value of 
his services. But that he should speculate on the wealth of 
the rich, that he should demand exceptional recompense 
from the millionaire because of his wealth, is to make medi- 
cine a trade; is to bring distrust and suspicion and discredit 
on his profession; is to put a serious obstacle in the way of 
all the great reforms which we as physicians and sanitarians 
hope to accomplish. 

Another duty, the grave public import of which comes 
to us with much force today, is the instruction of the public 
with regard to the necessary measures of prophylaxis in 
connection with infectious diseases. As has been demon- 

Oration on Medicine. ' 359 

strated again and again, general laws and sweeping public 
measures are of themselves insufficient to prevent the spread 
of such diseases as malaria, yellow fever, plague, cholera 
and typhoid fever. It is only through the cordial and gen- 
eral cooperation of the practicing physician with an enlight- 
ened public that efficient prophylaxis can be established. It 
is impossible here to enter into particulars as one would. 
We can consider but a few examples. The great accomplish- 
ment of the medical department of our army in eradicating 
yellow fever from Havana is fresh in our minds. This work 
was rendered possible by the recognition of the fact that the 
causal element of yellow fever exists only in the body of 
the patient suffering from the disease and in the mosquito 
(Stegomyia fasciata) which* has fed on the blood of the 
sufferer. The mosquito can acquire the infectious agent only 
from an individual affected with the disease, and the human 
being can acquire the disease only through the bite of an 
infected mosquito. Though a great deal can be accomplished 
by general measures directed toward the destruction of 
mosquitos and the removal of breeding places, it is impos- 
sible, by these measures alone, to overcome an epedemic. 
The problem, it was realized, could be met satisfactorily only 
by sterializing, as it were, each individual case of the disease- 
If each case of the yellow fever could be successfully pro- 
tected from mosquitos, one might be sure that, from this case 
at least, there could be no spread of the disease. And so, by 
cooperation of local physicians with the efficient medical 
corps of the army," every suspected case of yellow fever was 
reported. The houses of patients, together with those in the 
immediate neighborhood, were promptly netted and the 
mosquitos already there were killed. In seven months the 
disease was banished from the city. Almost equally brilliant 
was the work in New Orleans, where a dreadful epidemic, 
already well under way, was eradicated by a period at which 
otherwise it would probably have been at the summit of its 
ravages. This problem, it is true, was an essentially simple 
one, once the fundamental knowledge of the manner of 
entrance and spread of the infection has been acquired. In 


360 The Plexus. 

its broader lines, however, the problem is the same in con- 
nection with many of the gravest and commonest affections 
with which humanity suffers. In malaria the task of pro- 
phylaxis is more difficult because the disease is so wide- 
spread, and for the reason that, because of its very mildness, 
many cases pass unnoticed. And yet how much can be done, 
and is being done in some parts of the world, has already 
been mentioned. In typhoid fever the problem is yet more 
difficult; in tubercolosis more so again. 

But in all these diseases, as soon as the physician, the 
public and the government unite and work hand in hand to 
prevent, so far as possible, the spread of infection from the 
individual case, enormous inroads can be made into the mor- 
tality. In all these conditions the infectious agent dies 
sooner or later outside of the animal body and is dissiminated 
primarily by the infected human being and, in the case of 
tubercolosis, to some extent, by cattle. 

To properly combat the spread of preventable infectious 
diseases we need: (1) An enlightened public, (2) a consci- 
entious and united medical profession ready to do its duty 
as individuals and especiclly to work in a spirit of cordial co- 
operation, with (3) central and local boards of health which 
are under the direction of trained sanitarians. 

The organization of all these measures depends, in the 
end, on the result of our individual efforts as physicians. 
The education of the public can be accomplished only by us; 
and it is our duty privately, publicly, day in and day out, to 
explain to the people the rules of self-protection. The 
faithful performance by us as physicians of the necessary 
measures of prophylaxis in every individual case is almost 
the corner stone of the edifice. These duties, it is true, 
greatly complicate the life of the physician. The measures 
which we ought to carry out, and which can perfectly well 
be carried out in every case of typhoid fever, are tedious 
and annoying, but they are no more so than the aseptic and 
antiseptic precautions employed daily by the surgeon. They 
are duties which we must recognize unless we are content 
to lose, as we do every year, thousands of the very flower 

Oration on Medicine. 361 

of our youth through preventable diseases; unless we are 
content to remain as we are now, one of the few nations in 
which the disgraceful prevalence of typhoid fever, a filth 
disease, is a byword throughout the civilized world. Iso- 
lated, individual effort, however, goes but a short way of 
itself. It must co-operate with one another and with our 
boards of health; we must work in unison and see to it that, 
as in the case of scarlet fever and measles and diphtheria, 
so every case of typhoid fever and tuberculosis is reported 
and the proper measures of prophylaxis taken. 

And lastly, the character of our state and local boards 
of health, the most vital point depends largely on the atti- 
tude and efforts of the medical profession. After what has 
been said it is hardly necessary to refer to the increasing 
importance to the community of local and central boards of 
health. It is on these bodies that we depend for the organ- 
ization and direction of the more comprehensive measures 
of prophylaxis, the need of which is increasing daily with 
the greater complications of our life and the advances in 
medical knowledge. Moreover, in recent years, departments 
of health have assumed a wholly new significance with the 
establishment and diagnostic laboratories. Modern methods 
of diagnosis, microscopical examinations of sputa and of the 
blood, bacteriological examinations of smears and cultures 
from the throat, tests for specific agglutinins in the blood in 
fevers are too complicated and time-absorbing for the busy 
practitioner. Much of this work is done in private labora- 
tories by specially trained men. There are, however, many 
who cannot afford the additional expense of such examina- 
tions, people who are not objects of charity and who can 
and do bear the ordinary expenses incident to their medical 
attention, as well as many who must always be cared for by 
the benevelence of the physician or at the public expense 
But it is absolutely necessary, not only for the sake of the 
patient, but also for the protection of the public, that these 
more precise measures of diagnosis be carried out so far as 
possible in all suspicious cases. If they are not carried out, 
a vitally important link is removed from the chain of our 

362 The Plexns. 

public measures of prophylaxis. And so it has come to pass 
that state and county and city boards of health are every- 
where wisely establishing laboratories in which such exam- 
inations are made at the request of the attending physician. 
Now it is clear enough to any mind that the direction of such 
boards should be in the hands of men with a special train- 
ing as public sanitarians, pathologists and bacteriologists. 
That these facts are not wholly appreciated by the general 
public, that the pernicious influence of political favoritism 
now and then plays a part in the selection of such bodies 
need not be mentioned. But I wish to assert and assert em- 
phatically my conviction that, as a people, we are too fond 
of using the word "political" with a smile of contempt; we 
are too fond of speaking lightly of the conscience and hon- 
esty of the politician. Pew politicians would voluntarily 
prostitute a branch of the public service which is so vitally 
concerned with the welfare and safety of the community. I 
have rarely met men in political life who did not pay con- 
siderate attention to the judicious and tactfully offered ad- 
vice of conscientious physicians. It is for us physicians to 
set an example. We know — every one in this hall knows — 
the kind of man who should preside over a department of 
health. And yet what a spectacle do we see with changes 
of administration in almost any of our cities! Applications 
from busy practitioners; from men who, perhaps, from age 
or infirmity, desire to retire from active work; from men who 
have been unsuccessful in practice and are in need of money! 
How is the politician to know what to do if we behave in 
this manner? We physicians do not a] ways realize the re- 
sponsibilities which rest on us in this connection. We ought 
to act and speak fearlessly and frankly, so that men obvi- 
ously unfitted shall be ashamed to offer themselves publicly 
for such positions. We ought to see to it that the repre- 
sentatives of our profession on such bodies are capable and 
well-trained men; men who can give to their work all their 
time, all their thought, all their energy. This again is a 
public responsibility, a public duty which falls upon each 
one of us as a practicing physician. 

Oration on Medicine. 363 

Another opportunity which comes to us as individuals 
Is the opportunity to help forward the movement now hap 
pily started, for better instruction in our schools of medicine 
by increasing the opportunities for practical clinical experi- 
ence. We all know that we improve in the art of medicine 
only by the actual study of disease and the observation of 
the effects of treatment. Rule and precept may help; they 
can not make the physician. Where in our country has this 
practical experience been offered? In but a very few of our 
schools have the students had opportunity to follow at the 
bedside the course of the more serious diseases with which 
they are to meet in after life. I myself was never offered 
the occasion of following a case of pneumonia or diphtheria 
or typhoid fever from beginning to end. Where then were 
the students of my day expected to gain this experience? 
Where? Why on the unfortunate human beings who might 
fall into their hands during their early years of practice. 
And why was this so? Simply because students were not 
allowed in the wards of the hospital except as they followed 
an occasional visit. Now in this country there are hospitals 
enough and more than enough to supply valuable clinical 
experience to all physicians while they are yet in their un- 
dergraduate days. This opportunity is lost because the 
public does not understand. "What," says the hospital 
trustee, "do you fancy that I want students to attend me or 
the sick men and women under my protection?" "Student" 
to them suggests an irresponsible, inquisitive youth who is 
conducting perilous experiments. And the student is ex- 
cluded from the wards. They do not understand that the 
student, as a clinical clerk in the ward, is nothing more than 
a trained assistant. They do not realize that the presence 
of such students is not an experiment; that the system of 
clinical clerks has been in existance for years in England to 
the great advantage of physicians and community. The 
student is excluded from the wards; and what is the result? 
The "protected" patient enters the hospital where he is un- 
der the direct charge of an interne, a recent graduate from 
a school where he has been denied the clinical advantages 

364 The Plexus, 

which he is now for the first time enjoying. He is, however, 
now in a position of considerable responsibility, for his busy 
chief can spare at the most an hour or two for his daily 
visit. He has many patients to care for, and little help in 
emergencies. He does his best, and in the midst of his mul- 
tifarious duties the early symptoms of the typhoid perfora- 
tion are perhaps unobserved, or probably, as he has never 
seen a case before, unrecognized. The dreadful reality 
comes upon him when it is too late. The young physician 
has learned something that he will never forget; but the pa- 
tient? The patient is dead — his one chance, that of an early 
operation, lost; sacrificed to the well-meaning charitable ig- 
norance of the public. Suppose, on the other hand, that - 
the patient enters a ward in which there are a number of 
medical students on duty as clinical clerks and presided 
over by a similar young physician, a recent graduate, but 
one who in his school days has had some months of practical 
experience at the bedside. Under the watchful eye of the 
student who has but a few patients to follow, who is, as has 
been said, but an extra assistant, a trained assistant, the 
first suspicious symptoms are noted. The attention of the 
interne is excited. The blood is carefully examined from 
hour to hour- The surgeon early notified joins in watching 
every change, and by a timely operation the patient is saved. 
What a different picture! "Fancy,"' one may say? No. 
Experience; personal experience. How under these circum- 
stances can the public object to the presence of the student? 
Solely because of a word, because of the word '"student," 
which means to them an irresponsible observer. As a busy, 
active assistant under the direction and orders of a trained 
superior officer, would the public object to his presence? 
The question is too absurd to ask. 

In these matters we as physicians must teach our non- 
medical friends. When they realize that the hospitals need 
medical students as trained assistants, as a part really of 
the staff; when they realize that the student need hospital 
experience to make them capable physicians; when they re- 
alize that they owe this training to the physician in order to 

The Alumiri Association Meeting. 365 

protect themselves and the public; then and then only will 
the old opposition to the instruction of students in the wards 
of hospitals disappear. The prejudice against ward teach- 
ing is largely a matter of words, of one word, the awful 
word "student," in its absurdly perverted popular meaning. 
And while incidentally praying to be ourselves delivered from 
the tyranny of words, let us strive, each one as he can, to 
educate the public in this important matter, to help forward 
the movement which has already begun toward the more 
complete utilization -of school by hospital and hospital by 


The 1908 meeting of the P. and S. Alumni Association 
will be remembered as a reunion rather than a formal meet- 
ing. The faculty had arranged an informal entertainment 
for the Alumni and provided light refreshments and music, 
but the Alumni furnished their own entertainment by in- 
dulging in in a typical reunion gathering in which college 
songs and class yells furnished an importand part of the 
proceeding. The meeting was packed, and every class 
since the organization of the school seemed to be represent- 
ed. The enthusiasm of the members argued strongly for 
the loyalty of the members of the Alumni Association to the 

It was learned from Dr. P. C. E. Mattison, of Pasadena, 
that the P. and S. men in California had formed a branch 
alumni association for the State of California. This is a 
very hopeful sign of the times, and a precedent that might 
well be followed by our members in other states. 

At the A. M. A. smoker, held at the Coliseum; on 
Thursday evening, the P. ond S. Alumni made a demon- 
stration that attracted the attention of every one present 
and showed plainly the great loyalty of our men to the Uni- 
versity of Illinois and its medical department. 

At the alumni meeting the following officers were elect- 
ed for the ensuing year: President, W. A. Evans; first vice 
president. L. G. Witherspoon; second vice president, G. E. 
Brinkerhoof; secretary, P. H. Holmes; treasurer, J. L. Abt; 
necrologist, C. A. Earle; executive committeeman, C. C. 
0*Byrne. > 





Channing W. Barrett, A\ D., Chairman. 

T. A. Davis. M. D. W. E. Gamble, M. D. 

A. R. Johnstone, M. D., Editor. 


L. H. Nowak, '08. Ray Essick, '08- Gustav Eck, '09. 

William G. Epstein, '10. 

Atheletic Editor. C. H. Tlllotson, '06. 

Alumni Editor, John Wehtherson, *00. 

Library Dept., Metta M. Loomis. 

Publisher - - - - J. E. Forrest. 

Subscription $1.00 per Annum In advance. Single copies, 15 cents. Issued 
Montnlv. Send all communications and remittances for subscriptions and adver- 
tising to J. E. FORREST, Batavia, Illinois. 

Entered at Batavia Post Office as Second-Class Matter. 

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subscription is to br fontinued and the Journal sent accordingly. 

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Send contribution* to A. R. Johnstone, M. D.. Kditor.;4147 Lake Ave., Chicago. 


By Thometz, Poet Class 1908. 
He stimulates the Phagocyte, 
He jollies him to do what's right, 
And tells him stern, "wake up and fight," 

The little opsonin. 
The leucocytes would let us nigh 
Beneath bacterial unslaught die, 
Unless in time they're aided by 

The little opsonin. . 
When filthy, foul, infectious foe, 
Would snuff out life's weak trembling glow, 
He saves us from the overthrow, 

The little opsonin. 

The Opsonin. 367 

As spicy, Eastern sauces tend, 
To make one fierce his dinner rend, 
To acts this mite, and to this end, 
The little opsonin. 


Ah there, you small, faceted wight, 
What mischief hast thou wrought, 

What untold agony produced, 
And dire misfortune brought. 

Within the pear-shaped gall-sack's walls, 

No medling doctor seeing, 
Some salts precipitated slow, 

And brought you into being. 

At first you gave no sign of life, 

Indeed a harmless gravel, 
But when you reached the gall-duct small, 

You started out to travel. 

The little duct contracted down, 
And stopped you in your frolic, 

In rage you pinched and bruised the nerves. 
Thus causing awful colic. 

No wonder then the patient swore, 

And yelled in fearful pain, 
But still you slowly progressed on, 

And left him scream in vain. 

You little know, Oh hardened fiend, 

Your agonizing ways, 
How fierce your rough and file like edge, 

The mucous membrane flays. 

From you and all your kind, my friend, 

May I delivered be. 
And from your tortures and 3-our wiles, 

Let me be always free. 

368 The Plexus. 


By E. R. Hayhurst. 

Occasions such as the present come but once in the his- 
tory of every medical class. For a period of four years we 
have met daily in class-rooms, and on various occasions we 
have met to listen to the reading of previous minutes, but it 
is my pleasure tonight to review all of the proceedings of 
the class of 1908 in a manner historical to our friends gath- 
ered here and autobiographical to ourselves. 

In the fall of 1904 there flocked to the college of Phy- 
sicians and Surgeons a band of young men and women rep- 
resenting over one-half of the states of the union, and bent 
upon the pursuit of the most serious of all life's advocations 
— the study of medicine. 

This was the nucleus of the present graduating class. 
At that time we were less than one hundred in number. 
This is quite a contrast to the class which had graduated a 
year or two previously with nearly three times that number. 
But our class has been at the swing of the pendulum in eco- 
nomical relations when those seeking professional pursuits 
have been in a minority in all branches. This is no new 
condition. When times are hard and business is out of cog 
the professional institutions fill up; when times are good 
commercial enterprises offer such attractions to the youth 
of the country that comparatively few seek the professions, 
and particularly medicine. Those who are pursuing medi- 
cine today then are those to whom the philanthropical ideal 
has appealed the stronger— those to whom, the Socratic 
aphorism "know thyself" has offered a peculiar charm. 

From the meeting in 1904, when Berry was elected its 
first president: Dornblaser, vice president; Ritchie, treasu- 
rer, and Miss Eulalie Wood secretary, our class has been 
known as one of the later day type at the College of Phy- 
sicians and Surgeons, i. e. possessed of meekness, modesty, 
immeasurable self-control and dignity, and must certainly 
have stood out in sharp contrast in the eyes of our fostering 
faculty to the unruly, furniture -breaking, rough-housy doc- 
torial aspirants, who we are told reigned supreme in these 

History of the Class of 1908. 369 

halls before us and hesitated no more to pass a front-seater 
up from the pit to the gallery in the midst of a lecture than 
to keep a Dowey anti-medical meeting animated. But we 
must give credit where credit belongs. One of the greatest 
acts of diplomacy which our class ever affected was also at 
this first meeting, when it elected as sargeant-at-arms the 
man whom the faculty must know is the most responsible 
for this revolution in class attitude, Mr. Charles J. Skwor, 
from the depths of the tamarack woods somewhere near the 
far edge of he last named state in the union. 

Early in this year one of our number, Mr. Biwer, was 
also made editor of The Plexus, the official organ of the 
College ol Physicians and Surgeons. 

But as Freshmen we will never forget the reception at 
Dr. Price's, when Lederer tangled the keys, Wallace's cor- 
net got stuck and Charley Skwor took the first fiddle in an 
accompaniment to Burnett's baritonic effort in which the 
vocalist had great difficulty in getting the range of the or- 
chestra. Anyhow class feeling ran so high the day follow- 
ing that a special meeting was held and a resolution was 
offered by Mr. Hesolution Conroy to present Dr. Price with 
a memento. After an hour or two's discussion a motion 
was made by Butchinson that a committee of two be ap- 
pointed to wait upon Dr. Price and express class apprecia- 
tion, etc. After another hour's time Dornblaser succeeded 
in getting his Charles Davison pose recognized and every 
one else backed down into their seats, when he proposed the 
first of his classical amendments; that instead of a commit- 
tee of two, the president of the class wait on Dr. Price. 
Whether Dr. Price has ever been waited on the records do 
not state. 

Many other things we did too while in the precocity of 
Freshmen enthusiasm. We won the color rush from the 
Sophomores — the first time in the history of the institution; 
we convinced Dr. Hatfield that he was the best chemistry 
teacher in the city of Chicago and the only man who could 
teach us anything. We held a great class meeting towards 
the end of the year and elected the following officers: Presi- 

370 The Plexus. 

dent, Schreeder; vice president, Pearce; secretary, Miss 
Freitag; treasurer, F. H. Reese; editor, Carl A. Meyer; as- 
sistant editor, Bates. Charles J. Skwor ran against Mr, 
Conroy for sargeant-at arms again, but poor Charles had 
fallen into disfavor because he let the former treasurer es- 
cape with $23.50. The class might still have been out this 
money had it not been for old sleuth Copeland, who worked 
his political pull until he recovered the money. We asked 
no questions how. 

As Sophomores we got busy early. The first thing we 
did was to give Spencer $6.10; the records do not state for 
what, but as I remember at the time we were all glad his 
glib tongue did not extract more. The next items are Led- 
erer, $3.45 for a spray pump, and Spear $1.60 for eggs. The 
present Junior class, then Freshmen, still remembers that 
this armamentum had considerable to do with our winning 
the second color rush. 

Color rush had barely settled down when Half-Day-Off 
Berger, who had recently arrived from Champaign sprang 
into popular favor by working Superintendent Brown for 
one-half day off on account of a ball game between Illinois 
and Chicago. 

It was on March 4th, 1906, that death claimed the first 
member of our class — William Ascott, a most worthy man 
whom the captain of death, pneumonia, claimed almost with- 
out warning. 

We worked hard as Sophomores, and the combined flesh 
we all lost I'm sure would have filled one of those hogs- 
heads in the dissecting room, but Dr. Eckley, with his 
panoramic displays, on the mesergium, gubernaculum, etc., 
kept us enlivened. It was not until the last day, however, 
that Cozy Dolan had learned in Dr. Fantus' therapeutic quiz 
when not to prescribe Castoria. 

At the last of the year we again elected officers for the 
ensuing year, but class politics had become so harmonized 
and the good men of the class were so pre-eminent that 
within five minutes we had elected President McCabe, Vice 
President Mosser, Secretary Comee, Treasurer Gearin, 

History of the Class of 1908. 371 

Editor Lescher, Assistant Editor Nussel, and then the 
machinery clogged on sergeant-at-arms. Charles J. Skwor 
and Jake Lunn both wanted the honor. The nomination 
speeches of Schuessler and Reese will never be forgotten. 
The first vote (though. the sentiment seemed to be largely 
Lunn) was a tie, according to the tellers. Skwor *made a 
speech at this juncture and saved the day for himself by a 
vote of 52 to 20. After an ''also ran'' speech by J Jake Lunn, 
we then made Skwor's election unanimous. I have some 
way always doubted Jake Lunn's sincerity in running for 
that office, anyhow. 

It was in the Junior year that we began to feel the first 
thrills of real medicine. We flopped from the laboratory to 
the clinics, so to speak. We registered for all of the pre- 
scribed and all of the elective courses and then spent the 
rest of the year trying to get Dr. Earle to let us drop some- 
thing. Many new men had come in to join us. Our social 
aspirations also began to rise. Even in the first month we 
appointed a committee to investigate the Junior Prom busi- 
ness, as to time, place and— the girl, and accordingly put 
three of our most stylish on the list, Copeland, Schroeder 
and Berger. These men figured out that, everything 
included, the Prom would cost about 445 and some odd 
dollars. But irrespective of what it cost, the committees 
attended to every detail so thoroughly that the class had 
nothing left to discuss but formality, and will, we ever 
forget those factions'? Some were for formal, some for 
informal, some for optional and some were poli-pharmacists 
and sort of mixed all ingredients, but everybody was satis- 
fied with the result which was the advent of the Junior 

It was on January 30th, 1907, that we lost a second 
member of our class, Mr. Lemey C- Gilbert, after a three 
days' illness of influenza. Death here claimed one of the 
most generous natured, kind hearted and promising men 
that ever graced the portals of our Alma Mater — a man 
whose indefatiguable worth in the field of medicine both 
faculty and students are well cognizant of. 

372 The Plexus. 

A Junior student in medicine undoubtedly puts in more 
time than any other white man in existence. He is putting 
together his previous years' training in an endeavor to make 
it fit "the more practical," which is being demonstrated 
every day in clinics. Then along came the buzz about the 
Junior Quiz Class, and the first meeting, when Dean Quine 
assures us that an internes hip in Cook County Hospital is 
worth $10,000, and a half of the class registers at once — 
for the money. 

But finally came the greatest class meeting ever held; 
when the Spencerian cohorts put up a ticket of which the 
blank ballot distributed around before hand read in this 
order: For President, George J. Spencer; for Sargeant-At- 
Arms, Charles J. Skwor; for Vice-President, Brinkerhoff; 
Secretary, Treasurer, etc. To make the details short, the 
men who were elected are those who now compose the 
officers of the Senior Class, the Class of 1908. The election 
took two days. It required most of the time to convince 
Berger and Biwer that Spencer wanted the job of President 
worse than they did. Sam Norris enjoys the distinction of 
being the only one elected by acclamation. Charley Skwor 
again drew a plum, assistent-Sargeant-at-Arms, with Big 
Durkee at the helm. It is recorded that the Will-O-The- 
Wisp Eckman was seen about the college several times 
during the year. 

When we came back to school lost fall there was plain- 
ly visible on the face of every one the determination to 
work. The Junior professors who worked so patiently had 
rounded the corners off of us, in a way, and inculcated the 
right spirit. H. C. Miller registered for Quiz Class. So did 
the Persian, Fareed Amen, until his explanation that Gon- 
eitis meant a gone-feeling in the stomach. Many new faces 
—post graduate physicians — had registered with us to swell 
our ranks to a total of 160. We came to possess the great 
amphitheatre, room 406, as the Senior classes before us had 
done, and the fifth seat on the star board side of the gallery 
row is where Gearon has slept every day since. It is not 
amiss that we should have become slightly pompous and 
officially ordered the D. J.'s out of the front seats at the Cook 
County Hospital clinics. Our predecessors effected the 

History of the Class of 1908, 373 

same, but by an other means — they used to "pass them up" 
— a proceeding below our dignity. 

Who can describe our feelings when we gathered in No. 
406 and listened to the first lecture of the year by professor 
Williamson in senior medicine. It was about this time that 
Rosenzweig got nervous and took steps to start a class for 
review for State Boards. But our class is so large that 
after reminding you not to forget the genial disposition of 
shuffle-jointed Tucker, the cynical but well meaning smile of 
Gorden, the senatorial personality of Clark, the blinking 
eyes of Mickelson, and the multiple neuritic symptoms of 
Campbell. I must deal in groups. Among us there have 
been the Pit Men, the Quiz Class Men, Laboratory Demon- 
strators and Quiz Masters, the inhabitants of the Y. M. C. A. 
room, the Hall Loungers, the Office Jolliers, the Senior 
Class Committee men who have performed like clock work, 
and finally the Polynondescripts, who have done a little of 
each and got a "con" at the end of the term. But though 
these little groups have existed there has been one hour in 
the day which brought everybody together — senior medicine 
at 4:00 o'clock in the great amphitheatre. 

In the course of time the second and last semester 
rolled around, and to start it off came the Quine reception 
on February 6th at the West End Woman's Club, where we 
will ever cherish the memory that our president, Mr. 
Spencer, presented the grand old man, our own dean, Dr. 
Quine, with a simple memento of appreciation from the 
meek class of 1908. Within a month's time we were extend- 
ed a reception by certain of the more valiant members of the 
Junior class, a fitting climax to the last of our social season. 

Finally we come to the wind-up of our Senior, year, the 
last of our pedigogical training, and just the other day that 
great farewell talk by Dean Quine. 

It is a pleasure that we can look over what has been ac- 
complished and submit the following: 

We are graduating about 151. Sixty-three of these hold 
degrees from other institutions before coming to the College 
of Physicians and Surgeons. 

Those who have been appointed internes in various 
hospitals, number about sixty. 

Then there is Alpha Omega Alpha — the Medical Honor 
Society which was started at P. & S., in 1902 and has now 
spread to fourteen of the largest medical colleges in America. 
Those elected in our class to Alpha Omega Alpha number 
21, as follows: 

374 The Plexus. 

J. M. Berger, F. A. Berry, 

E. T. Biwer, E. E. Brinkerhoff, 
W. C. Comee, G. H. Doane. 

R. E. Dowel, E. W. Goembel, 

Adolph Hartung, E. R. Hay hurst. 

A. C. Kelly, D. V. McCabe, 

R. G. McCormick, Carl A. Meyer, 

Robert Mosser, L. H. Nowack, 

W. F. Pearce, F. L. Reese, 

J. C. Schroeder, J. F. Spear, 

William Williams, 
Those who won interneships at Cook County Hospital 

number five, C. A. Meyer, Win. Williams, Warren Pearce, 

E. R. Hayhurst and F. D. Reese. 

The Honor Roll for the ten highest grades in Senior 

Medicine ranging from 91 to 81 per cent and not including 

Quiz Class men, is: 

G. H. Doane, E. T. Biwer, 

Dr. Beuker, Dr. Walker, 

Dr. Duff, E. E. Brindkerhoff, 

Dr. Kucera, Robert Mosser, 

G- W. Morrow, G. J. Spencer, 

Dr. Alkon, R. O. Ostnowski, 

F. A. Berry, Miss Dr. Von Stauffer, 
Miss Dr. Cook, A. W. Schuessler, 
Adolph Hartung, E. A. Zeigler. 

The Pitt assistants for the past year have been house 
surgeon F. A. Berry, assistent house surgeons B. V. Mc- 
Cabe and Adolph Harting; anesthetist, J. C. Schroeder; 
pathologis, J. F. Spear; historian, Copeland, and alternates 
H. C. Parish, E. T. Biwer and J. H. Evans. 

The above groups of men include, however, by no means 
all who have received various honors, positions, appoint- 
ments, etc., and there are many others whose personalities 
have so influenced us that we will remember them as long 
as we live. How fortunate we are that each may take but a 
glance at this class picture to resurrect the old associations 
of faculty and fellow students. 

We all meet together tomorrow for the last time. The 
history of the class of 1908 of the College of Physicians and 
Surgeons is finished and all thanks to the training of the 
able preceptors who have so diligently aided us. From 
henceforth we pursue separate paths, but our work is the 
same — for the good of mankind — and our motto is fideli certa 
merces. "To the faithful reward is certain." 




BAT AVI A, ILL., JUNE 20th, 1908. 

It is not often that the popular monthly magazines give 
any attention to dentistry, but the following extract from Mr. 
Prank Marshall White on the subject entitled, " Marvels of 
Modern Dentisty," will be of interest to patrons and practi- 
tioners of dentistry. In the June Cosmopolitan Magazine: 

The cavemen doubtless extracted those fangs of their 
suffering brethern that began to decay when they ceased to 
crunch their prandial bones; lead fillings have been found in 
the teeth of Egyptian mummies, and prosthetic dentistry is 
two centuries old. Nevertheless, it is within the last fifteen 
or twenty years that the art of dentistry has been brought 
nearer to perfection than in all its previous history, within 
two or three years that many of the most distressing dental 
operations have been rendered painless, and within a few 
months that the most highly improved method of filling the 
teeth has come into use. 

There are men and women still living who remember 
when the practice of dentistry, outside of the populous 
centers, was confined to the pulling of teeth, the dentist 
being primarily the village blacksmith or tinker, whose 
fitness for the lesser function was measured by the strength 
of his wrist in operating the fearsome turnkey in the patient's 
mouth. Few men whose talents would have qualified them 
for success in the learned professions were, at that time at- • 
tracted t.o dentistry, even in the larger cities; whereas the 
intellectual equipment of the up-to-date dentist of to-day is 
not less than is required of any other branch of surgery. 
Many of the foremost dental practitioners have taken the 
degree of M. D. as well as that of D. D. S. 

Although Fauchard, known as the " father of dentistry/' 

376 The Plexus. 

who flourished some two hundred years ago, was a French- 
man,- and his foremost contemporaries and successors for 
another century were Frenchmen, America has made all the 
modern improvements in the dental art. American dentists 
have not only invented the principal mechanical devices that 
are now in use among skilled practitioners throughout the 
world, but they have made the anatomical researches that 
have resulted in painless processes and prosthetic accomlish- 
ments deemed impossible a generation ago. Indeed, America 
may be said to have made dentistry a science all her own — 
with no outside assistance worth mentioning. German den- 
tists have added to the knowledge of their American con- 
freres certain minor chemical discoveries, but no other 
country has done aught else than copy American methods. 

To-day the leading dentists of almost every capital in 
the world are Americans, as they have been for the last 
twenty years, and there is scarcely a city throughout the 
United States which does not contain one or more schools of 
dentistry superior in all respects to any in London, Paris or 
Berlin. As a result of these interdependent conditions den- 
tal students from all civilized countries are flocking here to 
study the art. Not only are the principal European states 
represented at the classes in our schools of dentistry, but 
students from Australia, New Zealand, Japan and China are 
helping to carry American methods around the globe. 

The Autocrat of the Breakfast-Table maintained his 
preference for the man with the gallery of family portraits 
as against the one with the "twenty-five cent daguereo- 
type," a circumstance with which the dentistry of the period 
may have had something to do, from the view-point of that 
fastidious critic. Elderly people in the mid-century photo- 
graphs almost invariably look from their somber frames with 
shrunken cheeks and puckered iips, a melancholy condition 
due to the loss of teeth faithfully depicted by Monsieur 
Daguerre's wonderful invention, since the man or woman 
who was compelled to perpetuate his or her features for pos- 
terity through the twenty -five cent medium rather than the 
oil-painting was likewise more often than not unable to 

Dentistry. 377 

afford the services of a professional dentist, or else believed 
dental prosthesis to be impracticable, or its encouragement 

Of course the gentlemen and ladies in the galleries of 
'family portraits to which Doctor Holmes alluded may, or 
may not, have been fitted with artificial teeth that preserved 
the contour of their cheeks and lips in old age, since it was 
in the power of the artist to rectify any facial defects; but 
those of his subjects whose features had been thus artfully 
improved had undergone actual and acute suffering in the 
process, at the hands of the dentists of those days. Indeed, 
so short a time ago as fifteen years, Prof, J. E. Sweet, of 
Cornell University, in an article in Cassier's Magazine, de- 
clared, "Punishment, misery and torture cannot be avoided 
or much modified in any dental operations, except in extract- 
ing, and where negligence has led to that necessity the one 
that does not profit by the use of anesthetics (provided there 
is no heart trouble) suffers for his folly." 

Professor Sweet describes the torture he personally en- 
dured in the operating chair, under the most skilled dental 
artists of that comparatively recent period, in a manner to 
lessen our respect for the ingenuity of the ancient incpjisitors 
of Spain. He wrote with a missionary purpose, however 
(as, indeed, did some of the holy men who described the 
Inquisition— and perhaps exaggerated its horrors), his article 
concluding thus: " Should any young people read t.his some 
good will have been done if they take warning and have 
their teeth attended to when they first need it." 

To-day almost any of the ordinary dental operations may 
be performed with nothing more than slight discomfort to 
the patient, though it is only within the last five or six years 
that the extraction of a sound tooth, or the extirpation of a 
nerve, by means of local anesthesia and absolutely without 
pain, has been made possible. The very newest thing in 
dentistry is the gold "inlay," whereby the patient, while the 
gold filling is being made to fit a cavity, may read his news- 
paper or go for a walk, the filling not being put in place 
in the tooth until it is completed, when its installation is the 
matter of a few seconds. 

3 78 Tho]'lex:i». 

After the cavity has been prepared for the gold that is- 
to fill it, instead of hammering in the gold, as was the pro- 
cess until within a few months ago, the dentist r»ow takes a 
wax impression of the cavity, from which he constructs a 
mould into which gold is poured in a molten state, the result- 
ing cast being the inlay, and of course a facsimile of the wax 
model. The inlay is then slipped into the cavity, which it 
fits exactly, and is secured with cement. 

The porcelain inlay has been known in dentistry for a 
little more than fifteen years, and during the entire period 
dentists have been endeavoring to find some method of adapt- 
ing the process to gold, which is the only material suitable 
for filling a tooth at the biting edge, being malleable and 
ductile, whereas porcelin is brittle and breaks under pressure. 
It was found impossible, however, to cast a gold inlay that 
would not shrink, until the present machine was invented 
whereby pressure is applied to the metal in the mold by 
means of compressed air. The gold inlay possesses another 
advantage, aside from the relief afforded the patient in doing 
away with the hammering of gold into the cavity, in that it- 
may be employed successfuly in teeth so frail that the shell 
would collapse under hammering process. 

Wonderful results have been attained by the use of the 
X-ray by those specialists in dentristry who devote them- 
selves to oral surgery. In diagnoses the X-ray has proved 
peculiarly adaptable to the location of abnormalities in the 
teeth, jaws and face, the nature of which, in many instances, 
could not have been determined by any other method known 
to science; and aveolar abscesses, lupus, acne, enlarged 
glands of the neck, and even cancer have been cured by Its 
use. In cases of facial neuralgia, due, ninety-nine times out 
of a hundred, to some disorder of the teeth, the X-ray is al- 
most always infallible, and it is almost impossible to locate 
the seat of trouble by any other means. 

In a diagnosis by the X-ray the radiograph may be 
taken either inside the mouth or through the face. While 
the former process requires a high degree of skill on the 
part of the operator, it is a simple matter for the patient, 

Dentistry. 379 

the plate on which the picture is to appear being inclosed in 
a waterproof covering and placed over the affected teeth, 
being then subjected to the rays for a few seconds. The 
negative on being removed at once discloses any condition 
aside from normal in the teeth or gums. 

One of our leading specialists with the X-ray recently 
had as a patient a young man who was suffering from an en- 
largement of the lower jaw that might have been diagnosed 
as cancer, which would have resulted in an operation and led 
to permanent disfigurement. The use of the X-ray discov- 
ered the fact that two unerupted teeth — as dentists call those 
that have not come to the surface of the gums — had been 
forced from the lower part of the jaw into the surrounding 
tissue. The dentist removed them through the patent's 
mouth, when he was at once relieved. A somewhat similar 
case was that of an elderly lady who had been in great pain 
for several clays as the result of facial neuralgia, the cause 
of which it was impossible to locate. The X-ray showed an 
unerupted tooth from the upper jaw embedded in the tissue 
under the eye, and it was removed with little difficulty. 
Such incidents are, however, every-day matters with the 
X-ray specialists. 

Scientists tell us that the teeth that, by reason of dis- 
use, man is to lose next are the third molars, or wisdom 
teeth. In some persons they are even rudimentary, while 
with others they do not develop normally. A serious condi- 
tion is often brought about when an unerupted wisdom tooth 
develops or grows sidewise, and becomes impacted between 
the ramus of the jaw and the second molar. The X-ray is 
the most satisfactory means by which this condition may be 
discovered, as the necessity for probing and cutting is 

More marvelous than anything else in dentistry, per- 
haps, are the results obtained by the specialists in "ortho- 
dontia'' and "orthopedia of the face," the word signifying the 
moving of misplaced teeth to a correct position, and the 
phrase the correction and prevention of facial deformities 
brought about by defects of the teeth and jaws. Not only 

380 The Plexus. 

does the expert turn twisted teeth in their sockets and 
straighten those that are tilted, malposed, impacted, or oth- 
erwise out of alignment, but he brings a prognathous jaw to 
its natural position and rectifies almost any irregularities of 
the lower part of the face. While this work is easier and 
simpler with children, it is nevertheless successful, not only 
with adults, but with old men and women, although without 
ocular proof of what has been done in this direction the 
results would seem incredible. 

Most extraordinary results in orthodontia and orthopedia 
have been accomplished by dental specialists in our large 
cities. One of these practitioners has invented what he 
calls the "humane process/ ' and presented it to the pro- 
fession at large. The apparatus he has devised is trans- 
posed to meet the requirements of each particular dental 
malformation that may. come before the operator, but it may 
be described as a sort of wire harness for each tooth under 
treatment, fastened to an anchorage over other teeth, a reg- 
ulated force being applied by the use of tiny springs of 
varying strength, scientifically systematized. When the 
dental arch is to be broadened a U-shaped loop with a spring 
is fastened inside it, and thie pressure regulated in a similar 

Prom the clumsiness of this description one would 
scarcely believe it possible that such an apparatus could be 
tolerated in the mouth for even the briefest period. Never- 
theless, with so high a degree of mechanical skill are the 
wires, loops, and springs (all generally of gold), adjusted 
that the patient wears the device without serious inconven- 
ience, and is able to eat with little difficulty. It seems as- 
tonishing also that a degree of pressure so slight as not to 
cause the patient distress should be powerful enough to move 
the teeth in their sockets and even to change the shape of 
the dental arch, but there are hundreds of men, women and 
children in various parts of the country to attest the prac- 
ticability of the system. 

Dentistry. 331 



The following editorial from the "Medical Consensus" 
of March will be worthy of careful considerations by all 
dentists. It reads : 

"The Medical Consensus is highly gratified over the re- 
ceipt of letters and comment in regard to its attitude against 
praticing physicians and dentists owning stock in proprie- 
tary medicines. Prom all parts of the country we have 
heard in this connection, and that our position is in the main 
enthusiastically endersed is not surprising to us. On the 
other hand, we should have been puzzled to hear otherwise, 
since such schemes are unethical on their face and careful 
physicians and dentists understand them in this light from 
the outset. 

"In our original statement of this question, we called 
attention to the fact that there are organizations of physi- 
cians and manufacturers offering stock to dentists in various 
cities, manufacturing a number of proprietary medicines in 
imitation of standard proprietary, pharmacopoeal and na- 
tional formulary preparations. We showed that these doc- 
tors and dentists prescribe as far as possible only those pre- 
parations made by the corporation in which they own stock. 
Druggists tell us that the wholesale prices charged for these 
preparations are enormous, and that an increase of- 30 to 50 
per cent in the cost of prescriptions written by the doctors 
is a result. Most of the doctors and dentists belonging to 
these corporations are first-class, ethical men. But the 
question arises, 'Is the scheme ethical?' 

"We think it has been conclusively demonstrated that 
the effects of prescribing preparations in which the prescrib- 
er is financially interested are altogether injurious to all par- 
ties concerned. First, the effect on the druggist is undesir- 
able, for every time the doctor prescribes one of the prepara- 
tions he loses caste to a certain extent with the druggist. 
And the druggist is forced to charge his customers an in- 
creased price to cover the doctor's profit in addition to the 

382 The Plexus. 

manufacturer's legitimate returns. The increase is embar- 
rassing to the druggist and injurious to his business. 

"But a more serious matter is the effect on the patient. 
Sooner or later the people will find out the connection be- 
tween the prescriber and the manufacturer. The result is 
loss of confidence in the complete integrity of the doctor. 
Suppose a doctor earned through his small block of stock 
a profit of $10 or $20 a year, what is that compared with the 
risk of losing even one good patron? 

"It seems to us that so far as ethics go this virtual re- 
bate system is more deplorable than 'advertising' or many 
other unethical procedures. For when we come to the last 
analsysis, the essential elements involved in the case are: 

1. "An invasion by the doctor into the field of profit 
of his professional brother, the pharmacist. 

2. "A constant temptation to the participating doctor 
to prescribe his company's medicine regardless of exact in- 

3. "The placing of the prescriber in a false position 
with his paitents. 

"Therefore, this journal is glad to note that these co-op- 
erative schemes are not succeeding. Several of the smaller 
ones have gone out of business, and we understand that a 
widely advertised co-operative dentrifice concern is about 
ready to acknowledge the error of the so-called co-operative 
principle of selling mouth preparations. Professional men 
are now viewing this participating game in its true light, 
and are not taking stock, gratis or otherwise, in drug man- 

"We wish to again state that there can be no substantial 
returns for the small stockholder from these schemes, for 
they must be promoted by private individuals, who can at 
any time water the stocks of their concerns so as to make 
t'.iese stocks practically worthless; and who control matters 
so they can easily absorb all real profits in salaries, etc." 

Dentistry. 383 


The Chicago Examiner of June 2 contains this report 
from Health Department : 

' 'There are 100,000 children in the pubiic schools of 
Chicago who are backward in their studies and irritable in 
their work because they have bad f eeth,' said Dr. I. D. Raw- 
lings of the Health Department in a report, 'and there are 
85,000 who are not progressing in their studies because of 
defective vision. 

' 'There are other reasons why many of the children do 
not progress as readily as they should, such as not having 
proper and sufficient food, and there are 26,000 of them, but 
the main case of inefficiency are bad teeth and defective 

"Dr. Rawlings has returned from a tour of investiga- 
tion of the public school system of New York, Philadelphia 
and other Eastern cities where the system of physical ex- 
amination of school children and the curing of defects have 
resulted in increasing the standard of education."' 


The Digest of May contains this item: 

"Dr. Bernard J. Cigrand, president of the Chicago pub- 
lic library board, was the guest of honor, May 1, at a ban- 
quet in commemoration of the twentieth anniversary of his 
graduation from the Dental Department of Lake Forest 
University. The affair was given by the members of his 
class of '88, of which he was valedictorian, and by his teach- 
ers. All the members of his class were present." 

Dr. Cook writes on tooth powder: "I should like to make 
two or three suggestions here. First, do not priscribe 
astringent solutions that will act in a very appreciable 
manner on the mucous epithelium. Prescribe only stim- 
ulants that will act in the very mildest manner, for these 
two agents are the ones that will cause degenerative 
changes in the mucous tissue. If you have decided that you 

384 ' The Plexus. 

must prescribe any of these things, unless they are for spe- 
cific conditions that exist as pathological lesions, do so in 
the mildest manner possible, because I can assure you 
that their action on the mucous membrane is of greater 
detriment than the benefits would be. When there is some 
specific condition for which you prescribe a certain drug, 
you should know exactly what pathologic changes]are taking 
place in the tissues. 

"Now, as for tooth powders and tooth pastes, all the 
difference there is between the two is the addition of a suf- 
ficient amount of glycerine to make a thin pasty mass of the 
powder. I will here append a prescription that was sug- 
gested by Dr. C. E. Jones of Chicago, after he had gone 
over large a number of formulae, and^ after he had made up 
hundreds of batches of tooth powders that are more or less 
known to the profession- This mass as a powder should 
never be used except when it has been filtered through two 
thicknesses of ordinary silk. A powder that will not pass 
through two thicknesses of silk will cut away tooth sub- 
stance in the mouths of some people so rapidly that the pa- 
tient and dentist will become alarmed at the extraordinary 
development of erosion. 

"There are times when even an apparently healthy tis- 
sue would be benefitted by some agent that would stimulate 
the physical properties of these cellular elements. But the 
point I wish to make is that we must prescribe certain agents 
with due consideration as to what effect they will have on 
healthy tissue cells. The formula that I have given here, 
prepared in the proper manner, is the only tooth powder out 
of forty- two different samples tested in the laboratory in the 
last five years that will not produce either rapid degenera- 
tion of the tissue cells or produce certain eroded conditions 
in the mouth of animals as well as in man. The real effi- 
ciency of a tooth powder lies principally in its having no 
effects on the tissues except in a mechanical way. 

"It will be impossible for me to go into a discussion of 
mouthwashes, because to my mind this involves one of the 
most interesting problems in dental therapeutics. Suffice it 

Dentistry. 285 

say that a mouthwash should be prescribed, not with a view 
of rendering the oral mucous membrane free from bacterial 
life through its action on the bacteria themselves, but that 
it can possibly operate only as a mechanical agent. If it is 
only to be used occasionally it can be made stronger. The 
main plea that I make in this paper is for the preservation 
of gum tissue, and we cannot preserve this important tissue 
structure if we use all sorts and kinds of agents, and es- 
pecially those unknown to us. The time is past for the pro- 
fession of dentistry to rely upon empirical remedies and 
practice empirical therapeutics." 


R Magnesii oxidi 5 Forms milk of magnesia 

with water. 

Calci carbonatis 10 Pricipitated chalk, grit. 

Magnasii peroxidi .... 2 Oxidizing agent, O is liber- 
ated when brought in con- 
tact with lactic acid. 

Menthol 0.20 Antiseptic, cooling agent. 

Benzosulphiuidi. . . .0.10 Flavor (saccharinum). 

Olei menthae pip.. 0.20 Flavor aromatic. 


Sig. Apply with brush. 

Mix first three ingredients together in mortar. Dis- 
solve the benzosulphinidum and menthol in the oil and 
while adding to the powder, triturate thoroughly. — Dental 




P. M. Goodman, Ph. G. f C. S. N. Hallberg, Ph. G., W. A. Puckner, Ph.G 

H.H.Rogers, M. D., Ph. B., E. N. Gathercoal, Ph. G., 

A. H. Clark, Ph. G., C. M. Snow, Ph. G. 

WILLIAM B. DAY, Editor. 
CLASS EDITOR: W. D.Mottar, '08. 


The progress of the movement for reform in regard to 
the prescribing of proprietary medicines and nostrums by 
physicians is making great headway as was evidenced by 
many prominent physicians who expressed their views on 
this subjectat the recent meeting of the American Medical 
Association in this city. 

Everywhere the tendency toward prescribing prepara- 
tions of secret and variable composition was deprecated and 
a return to the standard and uniform remedies of the Phar- 
macopoeia and National Formulary was strongly advocated. 
This movement has developed much more rapidly than its 
friends had dared to hope for and much credit must be given 
to the Council of Pharmacy and Chemistry of the American 
Medical Association which has exposed so many flagrant de 
ceptions regarding widely advertised proprietary medicines. 

Needless to say that pharmacists are greatly interested. 
A few years ago it seemed to many that the outlook for 
pharmacy was most discouraging. Young men leaving our 
pharmaceutical schools were able to employ but little of the 
practical training which these schools had given because of 
limited opportunities as physicians prescribed so largely the 
ready made medicines. 

The changes now going on indicate that the pharmacist 
is in a fair way to fully regain his birthright and will have 

Pharmacy. 387 

ample opportunity to exercise his technical knowledge and 
skill in the preparation of medicines according to the formu- 
las of the national standards. 

The Chicago branch of the American Pharmaceutical 
Association made an exhibit at the headquarters of the 
American Medical Association during convention week which 
was an object lesson to many physicians. This exhibit in- 
cluded about 150 of the most important and most commonly 
prescribed galenicals of standard formula and was in charge 
of a committee of the members of the Local Branch who met 
the physicians and demonstrated to them the fact that 
pharmacists are fully as competent to make these standard 
preparations as are manufacturers and furthermore that 
pharmacists are willing to assume the responsibility for the 
accuracy of their work and the quality of- the product which 
they cannot be expected to assume if they are merely acting 
as agents for some manufacturer. 

Many expressions of encouragement and approbation 
were received from the visiting physicians who expressed 
their pleased surprise to find the pharmacists of the city so 
wide awake and active in participating in the new propa- 

Another important development of this new movement 
is the fact that pharmacists now realize more generally the 
necessity for improving their professional status and that 
this can only be assured by increasing the educational 
standard. This has already resulted in advancing the edu- 
cational requirements for registration as pharmacists in 
several states, notably New York, Pennsylvania and Wis- 
consin. No doubt other states will fall in line, especially 
Illinois, where the effort toward bettering conditions is now 
being made with every prospect of success. 

Altogether the outlook for professional pharmacy is 
very bright and pharmacists have reason to congratulate 
themselves and to thank the medical profession for this 
great improvement. 

388 The Plexus. 


At the April meeting of the Illinois Board of Pharmacy ,. 
F. J. Zuck and W. C. Denson of the graduating class and 
Adelaid Marcotte of the Junior Class passed for the regis- 
tered pharmacists' certificate, while the following junior 
students passed as assistant pharmacists: G. A. Ander- 
son, Harry Conners, J. L. Elson, A. T. Englund, L E. 
Elliott, S. V. R. Gross, H. C. Heimsoth, J. G. Howly, Louis 
Jodar, A. C. Peska, W. E. Ploetz, A. L. Starshal, R. Van 
Dusen, C. Waterman, L. Baker, A. F. Cover, B. C. Grosse, 
and A. P. Niemeyer. 

Professor Hallberg will deliver an address before the 
Colorado Pharmaceutical Association at its annual conven- 
tion this month. 

The Pharmaceutical Chemist class has finished first 
term's work and the students have left for their homes. 
Although the' class was small yet the work was most 
interesting and was creditably performed. Many of the 
pharmaceutical preparations made by members of the 
class were included in the exhibit of the Chicago Branch of 
the American Pharmaceutical Association at the American 
Medical Association meeting. The field work in botany 
comprised four excursions which were held to points of 
interest around the city, these being Hinsdale, Glencoe, 
West Pullman and Millers, Ind. Each afternoon of field 
work was succeeded by a morning of laboratory study of 
the material gathered. A visit to the botanical exhibits 
of the Field Columbian Museum was included. In chem- 
istry, the lectures dealt with the rarer metals, the discus- 
sion of radium and of gold being of special interest. In 
the laboratory the course in qualitative analysis was con- 


By Raleigh Earel, Quincy, 111. 
Delivered at the Forty-Eighth Commencement of the 
University of Illinois School of Pharmacy. 

Mr. President, Members of the Board of Trustees r 

Pharmacy. 389 

Members of the Faculty, Classmates, Ladies and Gentlemen: 
This is the last time our class will meet as a body and it 
falls to my lot to utter farewell words which is, indeed, 
both an honor and responsibility. With these exercises to 
which we have been looking forward these seemingly long 
years, our connection, as students, with the School of Phar- 
macy of the University of Illinois, terminates. To-morrow 
we scatter to the several points of the compass to take up 
Ihe real work of the profession for which we have been 
fitting ourselves, first as apprentices, then as students in this 
college. Through all these years we have been learning 
various lessons, some great, some, small, which however, we 
have been faithfully storing away. 

Perhaps looking back over these years our minds go 
back to the time we entered upon our store duties where we 
first studied the pharmacy and chemistry of soda water, 
learned the rules of the postage stamp trade, or studied time 
tables and the alphabetical arrangement of the directory. 
Possibly we were given Aloes and told that it was Licorice 
only to learn of the deception a moment later when we 
tasted it, or of the times we tried to master the long names 
of some of the drugs and chemicals, lessons all of which 
though seemingly trivial at the time were to prove of value 
to us later when we bumped against the legs of the chair of 

Now as we are about to enter upon the actiye duties of 
our profession, it may seem to some of us that it is already 
crowded. That however is true, in a measure, of all pro- 
fessions. It may remind one of a bill of fare that once ap- 
peared at one of the resturants, "eggs 10 cents, good eggs 
25 cents." So it is with pharmacists, of cheap pharmacists 
there may be plenty, but for good pharmacists, pharmacists 
in the professional sense of the word, pharmacists who can 
be trusted at the cash register as well as the prescription 
counter, there will always be a demand. 

Pharmacy is one of the oldest of professions for do we 
not find many articles of Materia Medica mentioned in that 
ancient historic work, the Bible? In the early history of the 

39 The Plexus. 

professions of pharmacy and medicine we find them inter- 
mingled with religious rites, charms and incantations. To 
Hippocrates, who lived about 400 years before the birth of 
Christ, belongs the credit of dissociating medicine from 
religious rites. He contended that no matter how diseases 
might be regarded from a religious point of view, they must 
be scientifically treated according to natural laws. In treat- 
ment of disease he attached great importance to diet, medi- 
cines being considered of secondary importance though they 
were by no means neglected. It may seem a little far- 
fetched but if necessary we can trace the profession of 
pharmacy from the time of our most remote ancestors down 
through the different ages to the present. We can find no 
people too isolated, no tribe too savage but that pharmacy 
is practiced; sometimes, it is true, in very crude ways. 
Were not the aborigines skilled in the use of poisons for 
their arrows? It is to these savage tribes that we are 
indebted for some of our remedial agents of to-day. Even 
such an article as Lanolin which we are accustomed to 
think of as of recent origin was mentioned by the ancient 

From the crude pharmaceutic art of these past ages to 
the pharmacy of the present day is a long step. Our present 
processes and developments have been evolved from the 
crudities and uncertainties of past generations and have 
been of very slow growth. When we look back to the 
history of pharmacy of only a century ago we realize what a 
blessing modern pharmacy really is. When we think of such 
things as cob-webs, black spiders, old coffin nails, human 
bones and other articles being used in the treatment of 
disease, we wonder that the professions of pharmacy and 
medicine have survived at all. When the fashionable lady 
of to-day swallows a sugar-coated pellet or a dose of our 
modern palatable elixir, she has little to remind her of the 
mighty boluses or nauseating draughts that her gradmother 
took upon the prescription of the country saddle bagger 
whose only treatments were the lancet and pills the size of 
billiard balls. That style of practitioner of the olden time 

Pharmacy. 391 

has had his day, has run his course and is now sleeping the 
sleep of the "has been". We may be thankful that he took 
his pharmacy with him. If he be in heaven, where all good 
doctors go, those pills will never be required and if per- 
chance he has gone to other regions those pills will surely 
never melt. 

The world does not move like a crab, but instead moves 
steadily forward. The advancement of industrial progress 
for the last two centuries has been in the direction of segre- 
gation of industries and specialization of employments. 
Formerly the physician was his own pharmacist. It is true 
we find a few still clinging to the custom but the physician 
of the future will no more try to be his own dispenser than 
his own tailor, • lawyer or shoemaker. We occasionally hear 
through the medical press of methods for emancipating the 
medical profession from the pharmacal. They then would 
enjoy the same freedom that a man acquires when he loses 
one of his legs and succeeds to the broader liberty of walk- 
ing on a tripod; a leg, a crutch and a wooden leg. The 
pharmacist stands between the patient and the physician 
and if he be worthy of the name may often detect mistakes 
which might prove serious as well as being of valuable 
assistance to the physician. 

Although pharmacy was recognized as a branch of medi- 
cine by the first school of medicine in this country as early 
as 1789, it probably did not take its place as a profession 
until 1820. The crude beginnings of American pharmacy 
may be regarded as terminating in this year, when the 
National Pharmacopoeia was established and which was fol- 
lowed shortly after by the establishment of the first school 
of pharmacy in this country. The next step in the advance- 
ment of pharmacy worthy of note was the organization of 
the American Pharmaceutical Association in 1852, which 
organization has ever since nurtured pharmacy in all its 

Although pharmacy during this time was steadily ad- 
vancing and becoming more prominent as a profession it 
was not until 1871 that legislation was sought to protect 

392 The Plexus. 

those who duly and truly prepared from those who had 
entered the field not qualified to perform the duties laid be- 
fore them. It was left to the smallest state in the Union to 
take the first step in protecting the pharmacist as well as 
the public. Protecting the pharmacist to some extent from 
those who entered the profession thinking that the only 
knowledge necessary was to distinguish Apua Fervida from 
Aqua Frigida, and protecting the public from the dangers of 
purchasing medicines compounded by persons who knew 
practically nothing about them. This example has been fol- 
lowed until to-day every state in the Union has its laws re- 
lating to the practice of pharmacy. Besides the protection 
afforded these laws have had the effect of impressing more 
forcibly on the mind of the apprentice that in order to prac- 
tise his profession honorably he must prepare himself by a 
systematic course of study and training. Following the lead 
of others our own state in 1881 passed an act to regulate the 
practice of pharmacy. Since then this law has been various- 
ly altered, a most useful amendment going into effect only 
this last year, giving credit for the time spent in a college 
of pharmacy as a part of the pharmaceutic experience re- 
quired by law. However the most important legislative ad- 
vancement of the last few years was the passage by the 
Federal government of the "Pure Food and Drugs Act", 
establishing the United States Pharmacopoeia and National 
Formulary as standards for all preparations. This was the 
first official representation on the Pharmacopoeial committee 
and the ■ adoption of the standard in the army and navy 

As before stated the first school of pharmacy in this 
country was founded in 1821. For many years those of the 
western states who wished to become more proficient in the 
profession than was possible from service behind the counter 
and in the laboratory had to journey to the eastern city to 
complete their education. In 1859 the pharmacists of the 
infant city of Chicago resolved in favor of higher education 
for the apprentice and pharmacist. As a result of this de 
termination a meeting of the most active pharmacists of 

Pharmacy. 393 

Chicago was held and it was decided to establish a school of 
pharmacy. As a result the Chicago College of Pharmacy 
was founded and incorporated in September of that year. 
Preparations were made at once for beginning the course 
which was to continue for twenty weeks, lectures being 
given at different places three evenings a week with no 
laboratory work. At the close of the first session two 
gentlemen who had fulfilled all requirements were presented 
with the diploma of the college, one of them is still in busi- 
ness in this city. Then the Civil War broke out and the in- 
struction was discontinued but in 1867 the college was re- 
organized and the-course opened in 1870 at the close of which, 
in 1871, the entire graduating class consisted of but one 
person, our present Dean and Professor of Materia Medica- 
This same year, the school was wiped from existence by the 
great fire, but was re-opened in 1872. From this 'time the 
growth of the school was rapid and in '83 the building at 
465 State St., was built for it. In 1896, the college became 
the School of Pharmacy of the University of Illinois. In 
1904 the building on State St. , was found to be inade- 
quate and the commodious building at 12th and Michigan 
Ave., was obtained. The growth of the school has been 
very pronounced and it is to be hoped that it will be as rapid 
in the future as it has been in the past, in as much as it now 
has the financial assistance of the state as well as the general 
good-will of pharmacists. Among the hundred's of names of 
graduates of the Chicago College of Pharmacy are those of 
men who have achieved more than local reputations in various 
pursuits of life. Some have become professors in our own and 
other colleges of pharmacy, some have attained eminence as 
chemists, others have become members of various legisla- 
tures and senates while one has been a nominee for the 
presidency of the United States. 

To-day, fellow class mates, our names are transferred 
from the roll of students to the already long list of Alumni. 
I can only urge you to carry forward as successfully as 
possible the work you have well begun. Do not think that 
your education is completed, for it is only started. As 

394 The Plexus. 

graduates of the University of Illinois the foundation has- 
been laid deep and broad, and the doors of the University 
are still open urging further advancement. The building of 
the superstructure is in our own hands; let us see to it that 
every stone is well and firmly laid. The future of the pro- 
fession of pharmacy is in the hands of the young men who 
are graduating from the colleges of pharmacy throughout 
the country at this time. Let us not degrade the profession 
by making it merely a mercantile business, but let us try to 
elevate it by practising our profession, by turning to good 
account the knowledge we have gained, remembering that 
every package of medicine scientifically compounded from 
good materials by ourselves will be a better advertisement 
for us than the cheap-rate posters supplied by mere mercan- 
tile concerns. Some one has said: ' 'A man does not do all that 
he ought unless he does all that he can."* Gentlemen, in 
order that we may do all that we ought, let us do all that we 
can to rid the profession of imposters and chalatans, and do 
all that we can to further the progress of pharmacy along 
the ideal lines pointed out to us by our able teachers, so that 
when it comes our time to pass on toward that "undiscovered 
country from whose bourne no traveller returns," whether 
we succeed in taking three, five or seven steps, let the im- 
pression remain that we did our best to raise the moral and 
social status of those of our age. 

Finally, I haltingly say for myself and for each of us — 






VOL XIV. BATAVIA, JULY 20th, 1908. NO. 7 


By D. A. K. Steele, M. D., LL. D., Chicago. 
Professor of Surgery, College of Physicians and Surgeons. 

Reprint from the Chicago Nedical Recorder. 

Mr. President and Members of the Chicago Surgical Society: 

The history of the case that I will present for your con- 
sideration tonight and the specimen submitted for examin- 
ation, seem to be unique in the annals of surgical literature 
and merit preservation in the archives of our society. 

The following is the history: 

September 15, 1907, Mrs. Mary M., age 19, married three 
years, mother of one child aged 22 months, in a fit of anger 
stabbed herself in the right side of the abdomen four inches 
to the right and one and one-half inches below the umbilicus. 
At this date she was six and one-half months pregnant. She 
was taken to St. Elizabeth's Hospital and treated for one 
week, when the wound in her abdominal wall healed and 
she returned home and enjoyed good health since. She 
states that the surgeons at the hospital told her that the 
stab wound had probably not penetrated the uterus. 

November 28 at 2 p. m. she was delivered by a midwife 
of a live male child, normal and fully developed, with the 
exception that protruding from a wound in the lateral aspect 
of the abdominal wall of the left side one and one-half inches 
above the anterior superior spinous process of the ileum was 
a mass the size of a closed fist, which on examination was 
ound to be the intestines. Dr. C. E. Brinkerhoff was called 

396 The Plexus. 

at 6 p. m. and notified me of the condition present. At my 
request the protruding bowels were wrapped in warm anti- 
septic gaze, the child enveloped in warm blankets, and was 
brought immediately to the Woman's Hospital lor operation. 

On examination a partly healed incised wound, one inch 
in length, at the point indicated, was demonstrated. Pro- 
truding through this wound, adherent to its margains, was 
the jejunum, the ileum and all of the colon down to the' 
sigmoid flexure. The lower portion of the jejunum was 
enormously dialated, being one and one-half inches in 
diamater. The lower portion of the jejunum, all of the ileum 
and colon were coiled up in the adherent, contracted mass, 
the diameter of the ilium and colon being about one eighth 
to one-fourth of an inch. 

Meconium was found in the rectum. Many firm adhesions 
were found around the margins of the wound, which entirely 
closed the peritoneal-cavity. A transverse incision across # 
the abdominal wall toward the median line from the stab 
wound was carefully made, and the abdominal cavity entered 
with difficulty. It was found empty except for the liver, 
spleen, pancreas and stomach, about four inches of duodenum 
and two inches of the sigmoid flexure of the descending colon 
and rectum. All the rest of the gastrointestinal tract lay 
outside of the body, protruding through the stab wound. 
The whole mass of intestines was agglutinated in folds of the 
mesentry and omentum and a plastic exudate, which at first 
rendered the anatomical outline of the mass somewhat 

Beginning at the pyloric end of the stomach, the duo- 
denum and upper portion of the jejunum were separated and 
traced down to a blunt extremity of the greatly dilated 
jejunum, about six inches below its juncture with the duo- 
denum. The stomach contained about two and one-half 
ounces of bloody, viscid fluid, which was removed by cathet- 
erizing the esophagus. A soft cather introduced into the 
rectum failed to pass through the mass of meconium, and 
met with obstruction after being introduced about one and 
one-half inches. Numerous adhesions, omental and fibrinous 

Stab Wound of Fetus in Utero, 397 

in character were separated, the irregularities of the small 
intestines and colon were teased out as far as possible, 
and elevating the child by the heels and widely separating 
the edges of the wound, the entire mass was carefully 
restored to the abominal cavity, the cavity filled with a warm 
normal salt solution and the operation wound closed. No 
attempt at entero- anastomosis was made. The contracted, 
tortuous condition of the jejunum, ileum and colon had 
practically destroyed the patency of the lumen of the bowel 
and rendered anastomosis impracticable. On account of the 
dense mass of adhessions around the divided bowel wall I 
was unable at this time to recognize the fact that complete 
severence of the jujuneum had occurred by the stab wound, 
and as the condition of the infant was so critical and the 
result of any further operative intervention hopeless, nothing 
further was attempted. 

The child reacted well and survived the operation eight 
hours. Post-mortem examination was made the next morn- 
ing, at which time all the abominal contents were removed. 
A further demonstration of the intestinal lesion showed that 
the jujunum had been completely cut across by the stab 
wound penetrating the right abdominal wall of the mother, 
the right wall of the gravid uterus and the left abominal wall 
of the fetus in utero, completely severing the jejunum about 
six inches below its juncture with the duodenum. 

The extraordinary feature of this case lies in the fact 
that a stab wound through the abdominal walls of the mother, 
penetrating the gravid uterus, entering the abdomen of the 
fetus in utero, completely severing the jejunum and per- 
mitting the escape of the large and small intestines through 
the wound of the abdominal wall of the fetus in utero, nor 
seriously affected the recovery of the mother. 

Another interesting fact is the complete occlusion of the 
two divided ends of the intestine of the fetus and the pres- 
ence of nearly three ounces of glairy, sanguinolent fluid in 
the stomach of the fetus at the time of operation— ten hours 
after birth. Unfortunately this fluid was not preserved, so 
that I am unable to present a chemical analysis of the fluid 

398 The Pisxus. 

or to throw any light on the problem discussed by our 
obstetrical friends as to nourishment of the fetus in utero by 
determining whether or not the fluid in the stomach was 
identical in its constituents with amniotic fluid. 

In looking up the literature on the subject for me, my 
friend Dr. William Fuller finds a case reported by Beattie 
in the British Medical Journal, 1879, Vol. I, page 1,701, 
which in some respects resemples my case, although there 
was no reference to any injury or accident to the mother, 
and no autopsy was held to determine the cause of death. 
(Beattie reported the birth of a well developed child ut term. 
The mother was a primipera and the labor was in every way 

One and one-half inches below the umbilicus and a little 
to the right of the median line was a small opening in the 
abdominal wall of the child, which had permited the escape 
of the whole of the colon and practically all of the small 
intestines, which were tightly constricted and presented a 
very contracted appearance. The opening was enlarged, the 
intestines replaced, and the wound was closed with silver 
wire sutures. The child reacted promptly from the opera- 
tion but died in thirty hours. 

My friend Dr. H. M. Ritcher, at my request, looked 
through the Index Catalogue to ascertain if there were any 
similar cases recorded, and reports to me that Finnell 
reported a case of a wound of fetus in utero in the Buffalo 
Medical Journal, 1869, Vol. 16, page, -175. Hoyt reported a 
case of a wound in utero in the Boston Medical and Surgical 
Journal, 1844, Vol. 30, page 241; and Jones reported an ex- 
traordinary case of lession within the uterus with a partial 
reparation before birth, in the Medical and Chirugical Trans- 
actions, London, 1847, Vol. 32, pages 59-63. None of these 
cases in any way resemble the one reported tonight. And in 
addition to these references a large number of papers on the 
general subject of inta uterine injuries have been carefully 
investigated — reference being made to the ordinary injuries 
from bands, etc.; so from a careful inspection of the litera- 
ture the rarity of this seems to be fully established. 

Stab Wound of Fetus in Utera. 399 

I herewith present the post-mortem specimen and call 
your special attention to the enormous dilation of the duo- 
denum and upper few inches of the jejunum, the dilated por- 
tion terminating in a blind, blunt end of the jejunam, show- 
ing beautifully how nature had completely occluded the 
divided small intestine by a plastic exudate, which became 
completely organized. 

You will observe also that the upper end of the con- 
tracted, tortuous jejunum, ileum and colon is only from one- 
eighth to one-forth of an inch in diameter, and the blunt 
end of the distal extremity is completely occluded in a sim- 
ilar manner and lies obliquely across the distended provional 
end, adherent by fibrinous exudate but the continuity of the 
bowel completely destroyed at this point. 

It is interesting to observe also that the proximal por- 
tion of the occluded bowel apparently has developed enor- 
mously and contained some gastro-intestinal fluids, while 
the distal end became atrophic, convoluted and shrunken on 
account of the absence of any function; while the rectum 
and lower two inches of the sigmoid flexure which remained 
within the child's abdomen presented a more normal ap- 
pearance, the rectum containing meconium normal in ap- 
pearance but deficient in quantity. I direct your attention 
particularly to the appearance of the bowel above and below 
the point of division, because it is analogous to what we find 
when a nerve trunk or a tendon is severed by an accidental 
wound, the proximal portion of these structures remaining 
normal while the distal portion atrophies in a very marked 
degree within a few weeks if nerve or tendon suture is not 

In cases of arrested development of the gastro-intestinal 
tube or in congenital absence of a portion of the intestine, 
we always find the lumen of the proximal and distal ends of 
the intestine about the same diameter. 

400 The Plexus. 


By A. R. Joanstone, M. D. 

Mrs. M. presented herself to me for examination when 
four and a half months pregnant. The patient was a prin- 
upara 28 years old and in good health. On bimanual ex- 
amination I found a large fibroid tumor in the posterior wall 
of the uterus, so low down and so large that it seemed as if 
it must constitute a serious hindrance to delivery. 

I informed the patient of the condition and advised her 
that she go on to full term and then enter the hospital for 
delivery and that the method of delivery would then depend 
upon conditions as they appeared at that time. I suggested, 
however, that I would be glad of some other opinion and 
sent her to Dr. Henry F. Lewis. 

Dr. Lewis after examining the patient said that delivery 
through an abdominal incision might be necessary but advised 
waiting until full term. 

July 14th the patient entered Lakeside Hospital in the 
early part of the first stage of labor. On examination at that 
time I found it impossible to reach the tumor that had been 
so prominent early in the pregnancy. The os was dilated 
sufficiently to allow of the introduction of one finger. The 
head was presenting but was not engaged in the superior 
strait. Labor pains were strong and frequent with an in- 
terval of only two or three minutes. The pains continued 
with increasing severity for five hours without showing much 
advancement in dilitation or other progress and the patient 
had become very nervous and tired. I gave her one dose 
of scopalamin 1-100 grain with morphine 1-6 grain and the 
pains quieted down so that the patient slept for an hour 
quite undisturbed. The pains then became strong and con- 
tinued for four hours by which time the os was well dilated 
and the head engaged. The membranes ruptured while an 
examination was being made. During the next two hours 
the pains were very severe but no progress seemed to be 
made and the patient was again very nervous and tired. 

The foetal heart beat was strong and the condition of 
the mother was good. 

Modern Ideas of Nose, Throat and Ear Treatment. 401 

I had the patient anaesthetized and applied forceps and 
with some difficulty delivered her of a healthy boy bady 
weighing lOi pounds. 

After delivery the large fibroid tumor with a seemingly 
broad base of attachment in the postrior wall of the uterus 
could be easily outlined. 

There was a small laceration of the perineum and while 
it was being repaired the uterus relaxed and the patient had 
a slight post portum hemmorhage which, however, was 
rapidly controlled and was not repeated. 


By Joseph C. Beck, M. D. 

An address before the United Medical Society of Iowa, held at Iowa 
City, June 23rd. 1908. 

Allow me in the first place to express my appreciation 
at having been invited to address you on the subject of my 
specialty. I take it as a direct compliment to my colleagues 
who are likewise confining themselves to the practice of ear, 
nose and throat specialty, because we know that men 
throughout the state, away from the large cities, are more 
interested in the larger branches of internal medicine and 
general surgery. 

Like all other specialists, the laryngologists believe that 
their branch is the most important in the domain of medicine 
and therefore if I should be technical in my talk 1 hope you 
will pardon that as it only expresses my enthusiasm. I will 
say, however, at the outset, that medical sciences have made 
great strides and developments in the last ten years and 
particularly in the branch of ear, nose and tnroat- Not 
only in treatment but in pathology and diagnosis have men 
achieved positive results, so that the specialist of the past 
who washed, swabbed and sprayed is a thing of the past, 

Note— Owiag to the large number of illustrations mentioned in the text it was though 
best to leave them all out- The originals may be seen in the list of references 
given at the end oi this article- i 

402 The Plexus. 

and we are willing to stand the test of scrutiny of the high- 
est art in medicine and surgery. 

In compliance with the wish of your worthy chairman 
that I confine myself as much as possible to my personal 
investigations and results I shall briefly mention the most 
important points and refer you to my publications for a 
more detailed description. 

Radiography of Nasal Accessory Sinuses — One of the most 
modern advances in our specialty has been the ability to de- 
monstrate these cavities anatomically and to a considerable 
degree show pathological conditions, as pus or granulations 
or edematous lining membrane. Plate I shows an antero- 
posterior exposure and is the most important for diagnostic 
7i>urposes. It is a normal head showing clear frontal sinu- 
ses, anterior ethmoidal cells and antra of Highmore. It is 
important in the technique of taking these radiographs that 
the rays from the tube pass through the head at a proper 
angle, and that is above the occiput through the cranium 
and frontal bone onto the sensitized plate upon which the 
patient's forehead and nose rests. The head is always im- 
mobilized. Exposures are usually about thirty seconds and 
high tubes are used. 

Plate 2 shows a lateral or side view of the same head, 
and it demonstrates the depth and height of the frontal 
sinus and also the anterior as well as t.:e posterior ethmoidal 
cells and the sphenoids, but since both sides are shown sup- 
erimposed one upon the other the value of this exposure is 
very limited — in fact not at all practical in diagnosis of dis- 
eases of these cavities. All it does show is the size and 
shape of the frontal sinuses and the presence or absence of 
the sphenoids. 

Plate 3 demonstrates an acute inflammation of the front- 
al and ethmoidal sinuses and antral infection by its shadow 
on the whole half side. Clinically, that is, by intra-nasal 
examination; this was shown to be the case by the presence 
of pus in the nose from these cavities. 

Plate 5 just antral involvement on one side. 

Plate 6 frontal and ethmoidal on both sides. 

Modern Ideas of Nose, Throat and Ear Treatment. 403 

I have a large number of plates that show the various 
pathological conditions of these cavities but it suffices to say 
that unless the radiograph is taken correctly and a physical 
examination is combined, in fact, all other important meth- 
ods employed in conjunction with radiography, this method 
is not infallable in diagnosis and it may mislead. 

Plate 6 was taken for the demonstration of the mastoid 
process. One can clearly make out from it a clear middle 
ear cavity, the attic auditus and antrum, as well as the limi- 
tations of the mastoid process with all its numerous cells. 
The dark horizontal line from the mastoid represents a 
healthy lateral sinus and the tortuous line running along 

the temporal area represents the groove for the middle men- 
ingeal artery. 

Plate 7 demonstrates a case of acute mastoid infection 
following a violent attack of grip. You observe complete 
density of all the cavities shown in the previous plate. 
These conditions were subsequently shown at an operation, 
all the cells, antrum, attic and middle ear were filled with 
pus and thickened mucous membrane. You observe the 
dark horizontal line representing the lateral sinus which 
shows that it is probably not thrombotic. 

I might demonstrate to you a number of ear and mastoid 
plates but time will not permit me to do so. I will give the 
reference of my article on this subject in conclusion. 

Irrigation of Sinuses — In acute as well as chronic sinus 
disease one can accomplish considerable good by using a 
low pressure irrigation by means of a very fine silver canula 
which can be bent to suit and passed in the various regions 
— not that one reaches the interior of the cavities as a rule, 
but one does reach the vicinity of the openings that lead to 
them, and here wash away accumulations of pus. Previous 
to the irrigations application of cocain and adrenalin is ad- 
visable. Warm normal salt is the solution that I prefer al- 
though one may use mild astringents and antiseptics, as ar- 
gyrol or zinc solution. 

Bier's Treatment in Sinus Disease — As in general prac- 
tice so in our special work we have found this method of 
treatment of value. 

404 The Plexus. 

There are three methods of application of hypersemia. 
1, By means of an elastic band worn around the neck. 2, 
Suction method. 3, Compressing the large vessels in the 
poster or nares by means of rubber tubes. 

The most satisfactory is the suction method and it is 
surprising the amount of purulent material one can draw 
out of these cavities after the nose is apparently clean. The 
method is applied by using a strong rubber bulb to which is 
attached an olive tip which fills one nostril, the other nostril 
being closed with the finger and the patient made to swal- 
low. The bulb, which has previously been compressed is 
now allowed to expand and will suck out the secretions. 
This is repeated several times. There are several other 
methods of suction, as by a nasal mask (Louderman) or 
water pressure (Brawley), but a simple method is the one I 
have mentioned and used with considerable success. 

Vaccine Therapy in Sinus Disease — Probably no other 
therapeutic measure has created such a furor in the medical 
world as this one, and the work of Wright is being followed 
by many observers, For the past year and a half I have 
been experimenting with this line of treatment in a limited 
number of cases, acute and chronic, and have made record 
of them. Careful observations were made, the necessary 
laboratory work was carried out by Drs. Fisher and Gehr- 
man, of the Columbus Medical Laboratory. I cannot go in- 
to detail on the subject at this time but will say I have been 
struck with the marked improvement that followed in some 
cases, and some cases were cured and remain so. I have 
discovered, however, that unless the sinuses were draining 
well the treatment was not followed by great improvement. 

Bismuth-parafn Paste Treatment in Nasal Accessory Sinus 
Disease — Recently Dr. Emil Beck has demonstrated a meth- 
od of treating fistulous tracts that resisted all other methods 
of treatment. He cured his cases by the above named 
method. Since then a large number of other surgeons have 
applied the treatment with equally good results. He and 
others have treated in this way suppurations of non-collaps 
ible cavities like the pleural cavity and succeeded in stopping 

Modern Ideas of Nose, Throat and Ear Treatment. 405 

the disease. I decided, therefore, to apply this treatment in 
a number of cases of chronic suppuration of the antrum and 
sphenoid in which operations had been performed but had 
failed to accomplish the cessation of the discharge. I have 
treated a number of other affections but will confine my re- 
port to you to five cases, three of antrum and two of sphenoid, 
with absolutely good results. They have ceased to discharge 

Plate 7 shows the syrringe I use. It is all metal and 
forces the paste in by the screwing motion of the piston, 
which is necessary because it must travel through a long 

Intranasal Surgery of the Sinuses — By various modifica- 
tions in technique and with improved instrumentation a 
fairly satisfactory procedure is at our disposal. In a great 
majority of the cases of chronic sinus diseases operative pro- 
cedure cures the patient, or at least, good drainage is estab- 
lished and the patient is relieved of his symptoms. Absolute 
resolution is seldom seen. My favorite procedure is to re- 
move the middle turbinate either anterior or posterior de- 
pending upon which group of cells I wish to drain, or by re- 
moving the entire middle turbinate where all the sinuses are 
to be attacked. Then break down the thin partitioned cells 
and smooth the upper nasal area. The sphenoid opening is 
enlarged by resection of its anterior wall. If the antrum is 
diseased'it may be necessary to make a large counter open- 
ing at the lower meatus with or without removing the anter- 
ior portion of the inferior turbinated body. 

Entering the frontal sinuses intra-nasally, I do not ad- 
vocate. Whenever one finds it necessary to enter the front- 
al sinuses it is much safer and better to do it externally. 
There is too much danger of injuring the posterior tables of 
the frontal sinuses and infect the intra cranial structures I 
have a method of operating on the frontal sinuses which I 
will demonstrate to you presently. 

External Operations for the Cure of Nasal Accesory Sinus 
Disease. 1 Antrum of Highmore — The former operations on 
the Antrum of Highmore by removal of a bad tooth or putting 

406 The Plexus, 

a tube through a drilled channel in the alveolar socket for 
drainage or an opening through the canine fossa are prac- 
tically not performed any more for the reason that they do 
not lead to cures, because reinfection constantly occurs from 
the lodgement and decomposition of food in the openings. 
Only in acute cases does one succeed in relieving pus ac- 
cumulation and then permitting the opening to close by these 
methods. The radical operation known as the Caldwell Luc 
is a favorite procedure and I have succeeded to a degree in 
curing chronic antral trouble by this method. Briefly it is 
to open the canine fossa and from here through the lateral 
wall of the nose at the inferior meatus an opening is made of 
considerable size. Usually the anterior half of the inferior 
turbinated body has been removed previously. Several 
modifications of this operation have since been recommended 
but the principle is the same. Usually the drainage and 
after treatment is carried on through the nasal cavity and 
the opening in the canine fossa is allowed to close. 

2. Frontal, ethymoidal and sphenoidal Sinuses — Kil- 
lian's operation is the modern procedure for the cure of 
disease in the frontal, ethmoidal or sphenoidal sinues. The 
operation will be found described in any recent text book on 
general surgery or nose and throat. There are a large 
number of cases on record of cures effected by this operation 
in which all other kinds of treatment had failed. This opera- 
tion is much more popular in Europe than in this country 
and I believe that is due to the fact that a certain amount of 
deformity must result because the anterior table of the front- 
al sinus is removed. 

In order to overcome this difficulty I devised a new 
osteoplastic method and described it at the last meeting of 
the American Medical Association. I wish to show you 
twelve plates that illustrate the method and photographs of 
the cases cured by it which show that no deformity results 
from the operation. The operation depends upon being able 
to outline the frontal sinus by the radiograph. The anterior 
table of the frontal sinus is lifted up, retaining its attached 
periostium and making a hinge at the root of the nose, the 

Modern Ideas of Mote, Throat and Ear Treatment. 407 

flap being turned down over the nose. After the diseased 
tissue is removed and the opening into the nose is enlarged 
the bone-periosteal flap is brought back into place and 
covered with the skin flap and no deformity occurs. Five 
cases have thus far been operated by this method; three are 
cured and two are still under treatment. 

Atropine Rhinitis. — This condition one usually diagnoses 
from the history of large crust formations with a bad odor. 
Usually the patient has lost the sense of smell and taste is 
much impaired. Nasal examination clears up the diagnosis. 

Recently much discussion has arisen as to the etiology 
and pathology as well as the treatment of atrophic rhinitis. 
Quite a number of authors believe that at the bottom of this 
trouble lies some chronic infection of the nasal accessory 
sinuses. I have been interested in this subject and observed 
and treated at one time 24 cases of the affection and was 
convinced that in the majority one or more sinuses were in- 
volved, especially the ethmoids and sphenoid. Simultan 
eously with the curettment and drainage of these cavities 
the ( Condition much improved and in some cases crust forma- 
tion entirely disappeared. 

Surgery of the Inferior Turbinated Body — This structure 
is constantly subject to changes in its size physiologically, 
and in a large number of cases, especially in the humid zones, 
we find it chronically inflamed, over-engorged with large 
veins and markedly thickened mucous membrane. This 
condition causes nasal obstruction which in turn causes 
secondary changes in the sinuses, ears, naso-pharynx, and 
even in the lower respiratory structures. Many methods 
are in vogue for its reduction but the only positive cure is 
the removal of the redundancy of tissue. Tnis is usually 
the lower margin and posterior end of the turbinate. Not 
much bone need be removed. The difficulties that I encouner 
in this procedure are the hemorrhage at times, and the long 
time it takes to heal. One usually has to pack the nose, 
which is disagreeable and retards healing to say nothing of 
the possibility of a middle ear involvement. 

To overcome these difficulties suture of this body was- 

408 The Plexus. 

advised which I tried, in fact, I devised a method modifying 
the original of Yonkauer but have given it up as it is too 
difficult and not practical. I have, however, developed a 
method based on this instrument (plate 20) which is a crush- 
ing forceps (angiotripe). After the tissue is removed by- 
cutting forceps and snare I grasp the cut off edges and 
crush them over the bone. This whole crushed border drops 
off in a few days leaving asmooth surface. Particularly is 
this of service in the compression of the posterior ends 
which bleed the most. 

Submucous Resection of the Septum — A new era in intra- 
nasal surgery was reached when Freer, Ballanger and others 
in this country and Killian and others abroad brought forth 
a new method of dealing with deviated septa. This condition 
was the most unsatisfactory portion of the nose to treat. 
Mutilating and unsatisfactory methods had to be employed, 
with a great deal of trauma to the neighboring structures. The 
operation consists of a resection of the cartilage or bone or 
both through an incision on one side without injuring the mu- 
cosa on the opposite side. The technique and instruments are 
nearly perfect and the operation is performed with great 
satisfaction by most of the specialists. It is not easy but by 
taking great care a good result can be accomplished. There 
is practically no after treatment and the patient is well in 
one week in a simple case. I wish only to call attention to 
one point which is original with me and which I described a 
few years ago and have used with satisfaction since. Plate 
21 shows you the dissection of the muco-perichondrium by 
blunt and bloodless dissection by the use of gauze wicking. 
By pushing this material into the pocket it peels it off from 
the various irregularities without breaking the mucous 

Adenoids — We now come to the subject which is most 
important to the specialist and the general practitioner as 
well. The public is beginning to realize the importance of 
the removal of this growth in childhood and the better class 
of people know the symptoms, so that it is not uncommon to 
have the parents bring in their children with the diagnosis 

oJ.3.- a Ideas of Nose, Throat and Ear Treatment. 409 

already made. The treatment is to remove the mass no 
matter by what method or instrument and the results are, as 
a rule, most gratifying. There has been, however, some ad- 
vance made in the technique^in that curettes are so construct 
ed that the whole mass may be removed by one sweep. The 
ring curette has a square outline and practically engages 
the whole growth. I have been doing this operation for 
some time with the greatest of satisfaction. 

Tonsils — The indications for the removal of the tonsils 
must be divided in tne first place into those of children and 
secondly those of the adult. In children, in those cases 
where the tonsils in conduction with adenoids are simply en- 
larged without any definite history of repeated attacks of 
tonsilitis one may still use the simple form of tonsilotomy 
by means of the guillotine and in such cases only. I believe 
whenever one has a history of several attacks of tonsilitis 
in a season or symptoms of absorption from the tonsils, such 
as enlarged glands in the neck, attacks of rheumatism, 
gastro-intestinal intoxications and its secondary anemias and 
malnutririon, nothing short of complete removal should be 

In the majority of cases it is necessary to use ether. My 
method is to place the child on the side, grasp the tonsil 
with volsellum forceps and draw it towards the uvula, bring- 
out the tonsil prominently against the anterior pillar. In 
most cases the finger will liberate the tonsil so that a snare 
can be engaged over it and while drawing it forcibly out of 
the socket it is snared off. The bleeding is usually consid- 
erable for a moment but by compressing with a sponge on a 
forcep it is controlled, while the anesthetist is administering 
more ether. Repeating the same on the other side the ope- 
ration is completed. As a final procedure the ademoids are 
removed as before described. 

There is usnally no secondary bleeding or other com- 
plications except that in some cases there may be consider- 
able reaction with difficulty in swallowing for a few days. 

An examination of such tonsils will reveal the capsule 
in most instances, especially the upper two-thirds of it, and 
that is the most important portion to remove. 

410 The Plexns. 

Whenever this operation can be done under local anes- 
thesia, and I will presently describe the method of produc- 
ing it, it should be done, as much more satisfactory work 
can be performed without the pool of blood, which is one of 
the most disagreeable difficulties encountered in this opera- 
tion under general anesthesia in the recumbent posture. 

In adults the same indications prevail with the addition 
of peritonsilar abscess. Tuberculosis of the lungs has been 
claimed to be due to direct infection f r,om the tonsils and 
considerable work has been done to show the wisdom of 
complete extirpation of the tonsils as a means of preventing 
tubercular infection. 

The operative procedure in the adult is much more sat- 
isfactory in as much as it can be done under local anesthe- 
sia. My technique is as follows: Swab the whole pharynx 
with a 20 per cent, solution of cocain, then inject into the 
anterior pillar, the supra tonsillar portion of the palate and 
the posterior pillar, a solution of cocain and adrenalin, using 
equal parts of a 2 per cent, solution of cocain "and nrVo adre- 
nalin, freshly mixed. The needle of the syrringe is slightly 
bent and is made to penetrate the mucosa, the solution 
forced out in the form of a bleb which bleaches the tissues 
instantly. After the three points have been injected, using 
about 10 minums to each injection point, the tonsil is ready 
for operation. 

Grasp the tonsil with volsellum forceps and draw firmly 
towards the uvula and supra tonsilar area; with very sharp 
knife incise the mucosa alone very carefully not to cut 
through the tonsilar capsule; making an inverted U-shaped 
incision. By forcible traction on the tonsil one cuts the ad" 
herent fibres to the capsule off the retro-tonsilar connective 
tissue and muscle fibres. This dissection is followed clear 
to the base and the entire tonsil is thus removed without 
the aid of snare or other instrument. By cutting close to 
the capsule one will have no difficulty either at the opera- 
tion or afterwards. 

I have made a special study of the capsule of the tonsil, 
based on a large number of tonsilectomies, and while I am 

Modern Idezs of Nose, Throat and Ear Treatment. 411 

not ready to form conclusions I have learned these few facts. 
That the capsule is a distinct anatomical structure and not a 
myth as some authors think. Its thickness varies much, 
but if a previous operation has been done as tonsilotomy, or 
abscess has formed or repeated inflammations have occurred 
the capsule Is found very much thickened from the normal 
or where only slight inflammatory trouble has existed. In 
serial sections we were able to find the main blood vessel to 
enter the capsule at the junction of the upper two-thirds 
with the lower one-third of the tonsil. In a goodly number 
of sections we found some lymphoid tissue outside of the 
capsule. Considerable muscle is found attached to the cap- 
sule no matter how carefully it is dissected- In all of sev- 
eral hundred sections we never found a tonsil with any sus- 
picion of tuberculosis. Dr. Beuker, of the P. & S., assisted 
me in the laboratory work in this study. Pate 22 shows you 
a complete section of the tonsil with capsule, and demon- 
strates all the points I have just made. Plate 23 shows the 
instruments I use in tonsil work. I have never had a serious 
liemmorhage although a persistent oozing occured in one 
case and lasted about a week; a case in which there had 
been many abscesses and operations previously. 

Direct Laryngoscopy, Tracheoscopy and Bronchoscopy — To 
Killian again is due the great honor of making one of the 
greatest advances in medicine, especially in our branch. For 
diagnostic and theiapeutic uses in the lower respiratory 
tract these methods are of the greatest value. The removal 
of foreign bodies from the bronchi has been accomplished 
many times by this means. I have not had an opportunity 
to do this operation but have used the method for diagnostic 
purposes and have operated on three cases of. neoplasm of 
the larynx in children by means of this procedure. These 
cases are on record. 

Not to mention Jackson, of Pittsburg, ih this connection 
would be unjust. His instruments for this purpose are to 
my mind far superior to the Killian set. They are illumi- 
nated directly in the tube while Killian's are illuminated b> 
reflected lio;ht. 

412 The Plexu». 

X-Bay, Radium and High Frequency Currents — These 
agents have found much warm recommendation in general 
practice. I made a large number of experiments with them 
in nose, throat and ear work, and have reported my results. 
I have since come to the conclusion that their uses in this 
line are very limited and no startling results are to be ex- 
pected. However, I have been led to believe that high fre- 
quency currents have a much wider application than the 
other two and a large experience is required before one can 
make any statement. I make use of this method of treat- 
ment for inflammatory diseases of the nose and throat as a 
routine measure, and have observed that intumescence of 
the turbinal erectile tissue and nasal respiration are made 
easier. Conversely, and strange as it may appear, cases of 
beginning atrophic rhinitis and pharyngitis were benefited 
by the high frequency current. 

In glandular enlargements of the neck associated with 
adenoids and tonsils even after they have been removed, I 
often subject the cases to X-ray treatment and find it of ben- 

I have found radium of benefit in nasal tuberculosis. 
Three cases were treated, one with radium of 50,000 radio- 
activity got well. One case with radium of one million ra- 
dio-activity recovered. One case for a time appeared cured 
and then returned, but this case resists all other treatments. 
In this case 50,000 and 1,000,000 radio-activity radium was 


Osteoplastic Operations of the Frontal Sinuses — New method. Jour- 
nal American Medical Association. July or August, 1908. 

Radiography of Sinus Diseases — Laryngoscope, Nov. 1907. 

Atrophic Rhinitis — Annals of Otology, Rhinology and Laryngology, 
June, 1907. 

Submucous Resection of the Septum — Laryngoscope, Nov. 1906. 

Experiments with Radium in Ear, Nose and Throat — Laryngology, 
June, 1907. 

The Evolution of Therapeutics. 413 


By Alvah C. Van Sycle, M. D., Hackettstown, New Jersey. 

A watchful sentimentalist was slowly pacing up and down 
the ramparts of the sullen fortress in the dead of the night, 
when there appeared a messenger saying, "Watchman, 
what of the night?" So we to-day are standing as sentinels 
on the fortress of medical bulwarks and messengers are ask- 
ing, "Watchman, what of the night? : ' How many of you 
who received your diploma a quarter of a century or more 
ago, would think of following the art of therapeutics as 
laid down by your professors at that time? There is no 
phenomenon so stupendous, so bewildering and so interest- 
ing to man as that of his own evolution in society. 

It appears that at the beginning of the 20th century the 
teaching of evolutionary science as applied to society is that 
there is only one way in which the rationalistic factor in 
human evolution is controlled, namely, through the instru- 
mentality of religious systems. Thus we have to-day the 
evolution of Eddyism, Dowieism, faith-curism, Christian al- 
liance, and last, but not least, a new cult — osteopathy. The 
latter has been knocking at the doors of our legislature now 
for two years, both to be admitted and recognized as a new 
school, and while this evolutionary doctrine has been going 
on in the systems of religious schools, it has also been ad- 
vancing in the therapeutic geld of science. One eminent 
writer has said that "all our progress is an unfolding like 
the vegetable bud. You may be a fine diagnostician, but if 
you have not the mastery of modern therapeutics to render 
your diagnotic auumen virile, what good will you accomplish 
in the curing of disease; or would you by the daring of chance 
pluck the flower of safety from the jaws of death?" 

Let us for a brief period consider a few of the newer 
therapeutics; and first we will take up the alkaloids. 

The new Pharmacopeia recognizes twenty-four alka- 
hoids and active principles. The most prominent of these 
are aconitine, apomorphine, hyoscine, strychnine, digitalin 
and veratrine. There are nine others that are unofficial but 
equally valuable. They are berberine, brucine, coniine, 

4H The Plexus. 

curarine, suboisine, emetine, gelseminine, muscarine, quini- 

As an antipyretic nothing equals the trinity of remedies 
viz.: aconite, digitalin and veratrine. Dr. Shaller has had 
quick results in pneumonia by dissolving aconitine in one- 
half to one ounce of hot water, giving it every half hour 
until a reduction of temperature is perceptible. Shaller's 
rule for children is: one granule of aconitine, . one gr. 1-134 
for each child's age, and "one extra for the glass," in 24 tea- 
spoonfuls of water; the dose of this solution being one tea- 
spoonful every 10 to 60 minutes. For children under one 
year the best plan is to divide the dose by the weight. A 
child at one year averaging 15 pounds, the close for a year 
may be divided by the child's weight so that a child weigh- 
ing 7i pounds receives one-half the yearling's close, regard- 
less of age. 

Van Renterghein says that "aconitine occupies the first 
rank among defervescents;" by virtue of its sedative action 
on the vasomotors it slows the pulse and heartbeat. Com- 
bined with strychnine and cligitalin Burggraeve considered 
aconitine invaluable as a preventive of fever or inflammation 
in the puerperal, and also surgical sepsis. With digitalis it 
acts as a diuretic- Combined with strychnine and hyoscine 
in alcoholic delirium it acts like magic. Brunton enumerates 
aconitine as being useful in pleurisy, pneumonia, phthisis, 
peritonitis, pericarditis, rheumatic fever, gout, erysipelas, 
otitis and other fevers. Butler speaks highly of this drug 
in cerebrospinal fever. Merrell pronounces it valuable in 
the eruptive fevers. O. Hutchinson found it relieved the 
pains of carcinoma; he found that it acted as a sedative in 
epididymitis and gave much relief in tobacco-heart. Ringer 
says that in spinal irritation and intercostal neuralgia an 
anconitine ointment relieved the pains. Wood considers it 
the best remedy for cardiac hypertrophy. Ellingwood 
recommends it in acute cystitis and nephritis, also in the on- 
set of diphtheria and croup. 

We will pass on to another drug the writer prizes very 
highly, viz., upomorphlne. This used hypoclermically in T V 

The Evolution of Therapeutics. 415 

grain doses relieved a patient of hiccough, of which she had 
been suffering two or three hours, in less than two minutes. 
In a dog that had been poisoned by strychnine, one of our 
veterinarians relieved the effects in less than two minutes, 
timed by three different watches, and the dog was saved. In 
cases of attempted suicide emetine far excels the old-fashioned 
stomach pump or mustard-water potions. Dr. J. S. Horsely 
injected apomorphine in a case of strychnine suicide, of which 
he had no hopes. The patient was eventually cured. Shoe- 
maker uses it for spasmodic croup, asthma, convulsions, etc. 
It is an excellent expectorant. In an adult 3 or 4 granules 
in 3 ounces of water; the above dose to be given as an ex- 

We pass on to another one of the alkaloids, namely 
veratrine. Van Renterghem says: "One should not forget 
that the rise of arterial pressure and the great loss of heat 
by the skin occasioned by the fever means something, for 
this increase of intravascular tension does not necessarily 
imply an increased oxidation in the tissues, as has been 
claimed. But it is certain that the state of depression of the 
circulatory functions occasioned by fever adds a very seri- 
ous factor to the other causes of fever-heat; that veratrine 
suppresses this state and with it its consequences." Thus 
in our arsenal of therapeutics we hold no medicament so 
powerful, so positive, so manageable to combat fever as vei> 
atrine. Van Rentenghem uses it in enteric fever, puerperal 
fever, pneumonia, the exanthemata, etc. Particularly in 
eclampsia do we find veratrine standing over this dreaded 
condition as an invincible giant and saying, "thus far and 
no farther shalt thou go. The proper dose to be given hy- 
perdermically in hot water or alcohol is gr. -^ . By this 
means we save the brain froni the imminent peril threat- 
ening it. In the early stages of athenic pneumonia it offers: 
the best-known' method of reducing the temperature and 
thereby lessening congestion. 

Dr. Edgar, in his classic work on "Obstetrics,"' refer- 
ring to the treatment of eclampsia, says that veratrine "is 
one of the most effective as well as safest medicinal anti- 

416 The Plexus. 

eclumptics.'' For the last three years he has abandoned 
the use or morphine, since it seems to prolong the post- 
eclamptic stupor, while it increases the tendency to death 
during coma, by its interferance with the eliminative pro- 
cesses. Veratrine stands second to chloroform, then fol- 
lows chloral in this most dreaded of diseases in the pregnant 
patient. Do not hesitate to keep the pulse down to 60 or 65 
beats, if you have not the alkaloid veratrine, do not hesitate 
to use 10 minims hyperdermically of the tincture. While 
under the influence of the full therapeutic dose of veratrine 
be sure always to keep the patient in the recumbent posi- 


The following ode, entitled "To the Doctors," by Mr. 
George Fitch, appeared in the Record-Herald of Peoria at 
the time of the annual meeting of the State Society in that 


Hail to the men of pills 

Who work the long nights through, 
To cure our various ills 

With lancets, splints and glue; 
With salves and oils and wine, 

With iodicls and soap, 
Sal volatile, quinine 

And many a high-priced dope. 

Hail to the men of pills 

Who cure us, with great art 
Of spasms, fits and chills 

And carburetted heart; 
Af bruises, sprains and bumps, 

And boils of monstrous size, 
Dyspepsia, chilblains, mumps. 

And jimjams and cross eyes. 

Hail to the men of pills 

Who mend us up with care 
And then once more with bills 

Break us beyond repair. 
To you our lives we owe 

The debt with sore dismay 
Has filled or bosoms so, 

That's why we're such poor pay. 





Charming 1W. Barrett, M. Do Chairman. 

T. A. Davis, M. D. . W. E. Gamble, M. D. 

A. R. Johnstone, N[. D., Editor. 


L. H. Nowak, '08. Ray Esslck, '08- Gustav Eck, 09. 

William G. Epstein, '10. 
Atheletlc Editor. C. H. Tlllotson, '06. 

Alumni Editor, John Wehtherson.VOO. 

Library Dept., Metta M. Loomis. 

Publisher - - - - J. E. Forrest. 

Subscription $1.00 per Annum in advance. Single copies, 15 cents. Issued 
Monthly. Send all communications and remittances for subscriptions and adver- 
tising to J. B. FORREST, Batavia, Illiaois. 

Entered at Batavia Post Office as Second-Class Matter. 

Any subscriber desiring the Journal discontinued at the expiration of his sub- 
scriptiOD should so notify the Publishers; otherwise it will be assumed thai the 
subscription is to be continued and the Journal sent accordingly. 

Contributions of matter suitable for publication are Invited, and should be sent 
«n not later than the 25th of the month previous to that of publication. The pub- 
lishers will not hold themselves responsible for the safe return of MSS. unlest 
lufficie^t stamps are forwarded. 

Send contributions to A. R. Johnstone, M. D., Kditor.^4147 Lake Ave., Chicago. 


John Bartoli was awarded a verdict for $10,000 against 
the Lakeside Hospital for an X-Ray burn of the abdomen 
sustained in 1901. The court reduced the amount of the 
verdict to S4,00. 

On the witness stand the plaintiff stated that the phy- 
sician who made the exposure, which was for the purpose of 
making a skiagraph, left the room after the exposure was 
made and left him exposed to the light, which was still op- 
erating, for an hour and a half. The physician who made 
the skiagraph said that the exposure did not last over twenty 

418 The Plexus. 

minutes, but was unable to say that he did not leave the 
room during the time that the light was on. 

It was shown that the physician who made the exposure 
while not directly concerned in the management of the hos- 
pital was nevertheless in the employ of the hospital and 
made the skiagraphs for the hospital. 

The burdon of this verdict, if sustained, will fall upon 
the estate of the late Dr. Henderson who owned the hospital 
at that time. 

In this relation it may be interesting to know that some 
32 X-Ray burn cases were on call in the courts of Cook 
County in April, in some of the cases large verdicts have 
been awarded to the plaintiffs. 

The attitude of X-Ray specialists who are put on the 
the stand as expert witnesses is in the main against hospitals 
that do skiagraphic work, they maintaining that X-Ray 
work in hospitals is usually done by internes and others 
who have not an exact knowledge of the dangers of the 
Roentgren ray and the technique of Skiagraphy. 




BAT AVI A, ILL., JULY 20th, 1908. 

The committee on Public Dental Education appointed 
by the Illinois State Dental Society is at work reviewing 
the literature upon the subject and hopes to have something 
to offer the members of the Society in the early part of the 
coming year., 

Its report will doubtless take the form of a booklet set- 
ting forth in popular language and concise terms some need- 
ful things the public should know concerning their teeth. 

Among other things will be things upon the following 

Care of mouth arid teeth. Mouth washes. Disease of 
the gums. How to preserve the teeth. Motherhood. Tartar. 
Dental fees. " Crown-ancl-bridge work. The first molar. 
Childrens teeth. 

These will be written by dentists who have given some 
attention to these special subjects. These booklets will be 
distributed to members of the society for circulation among 
their patients as they see fit. 

That there is a great need for some effort on the part of 
the dental profession to educate the public upon these sub- 
jects there can be no doubt. 

It is a known fact that only twenty per cent of any 
given community pay any attention to the care of their 
teeth. The remaining eighty per cent do not do so because 
they have not been educated to its necessity. The greatest 
educational impetus that the public receive at present in 
such matters is through the public press by the advertising 
"dental parlors" that have no further thought than doing 
the least and sometimes the worst amount of work for the 
greatest amount of money. It must be conceded, however, 

420 The Plexus. 

that they are rapidly popularizing dentistry through such 
media as the public prints, circulars, etc. Persons who 
have only known of extractions and artificial plates have 
come to know that the hitherto unknown and unconceivable 
thing can be done through dentistry, thus saving them the 
inconvenience of extractions and mortification of plates. 
But, as I say, this information has percolated from the 
wrong source, and in a large number of instances has result- 
ed in a serious distrust in the ability of dentists to do that 
of which they boast. No effort, as far as I know, has been 
made on their part to prevent the ravages of decay or the 
disaster of the extraction of the first molar, or a number of 
other things that make the calling of dentistry a true pro- 

If we as a profession have been derelict in this regard 
in the past, the future should hold no such indictment against 

The Illinois State Dental Society, formost in things for 
the advancement of our profession, has taken a decided step 
towards dissolving this indictment. 

Consul E. Theo. Liefeld sends the following to the state 
department at Washington, D. C. 

The following report on the results of the public dental 
service established in the city schools of Freiburg, Germany, 
on April 2, 1907: 

Up to the end of 1907, on 37 different days when ex- 
aminations were made, 2,478 children were treated. The 
number of extractions was 3,689, fillings 1,231, new teeth 
put in 102, and roots treated 64. The number of extractions 
must gradually decrease and the fillings increase before the 
real object of this dental clinic will have been attained. Of 
the children examined, only two in every 1,000 had ever be- 
fore been treated by a dentist, hence the condition of the 
mouths of the children was deplorable. 

Dental literature and editorial in the Dental Digest by 
Prof. J. P. Buckler has some good advice: 

Dentistry. 421 

It is said that the best way to judge a nation is by its 
literature. This is likewise true of a profession. If the 
public were to judge the dental profession by its literature, 
what would be the verdict? We believe that it would com- 
pare favorably with other professions. For the last few 
years we have devoted considerable time to the reading of 
our dental literature as it appears in the journals from 
month to month; and it is with a great deal of satisfaction 
that a gradual but healthful improvement is noted. It is 
true, we need more text-books, but it takes time to prepare 
these; and it is gratifying to know that, during the past year, 
several most excellent text-books have been published. 

There are many elevating influences which have been 
fruitful in the advancement of dentistry. Among these 
might be mentioned dental colleges, dental societies, state 
dental examining boards, and by no means least, dental 

A careful review of our literature will reveal the fact 
that there is a growing tendency on the part of the profes- 
sion to delve more deeply into the hidden mysteries of oral 
pathology- This is evidenced by the number of articles on 
pathologic subjects. The work that is being done to-day 
along the line of oral pathology cannot but have a broad- 
ening influence. 

From our literature, also, we learn of the great activity, 
on the part of the profession, in disseminating dental know- 
ledge to the public. It is evident that if the public are to 
be educated as to the care of the mouth and teeth, as they 
should be, the education must come from dentists. This is 
one duty that must be recognized, for it cannot be success- 
fully delegated to anyone else. It would seem that this fact 
is quite well understood for many valuable articles have 
recently appeared on the education of the public in dental 
subjects. It will be necessary, however, to go farther than 
this and include in our literature a pamphlet or book written 
in plain and simple language, to which the public has free 
access. The benefit to humanity resulting from such a 
propaganda by the profession cannot be overestimated. 

422 The Plexus. 

Dentists in the past have ever been accused of being 
poor business men. There have appeared in the journals 
during the past year several timely articles on the business 
side of dentistry, which, if read and studied, will furnish 
the busy dentist with many valuable suggestions. 

If we were prone to criticise our literature, though not 
in a critical mood, we would call attention to the need of a 
more definite nomenclature. To one who reads all of the 
dental journals it is surprising to observe the variety of 
names used by dental writers and passed by dental editors. 
It may be that the profession will never agree on one name 
for the disease which causes a progressive loosening of the 
teeth. If more time were spent in searching for the real 
cause or causes of the disorder and less time in trying to 
find a name characteristic of many symptoms, more good 
would result to suffering humanity. 'But however difficult it 
may be for the profession to unite on a name for this con- 
dition, it does seem ambiguous, and a needless use of the 
English language, to call the membrane which surrounds 
the root of a tooth by so many different names as appear in 
our literature. 

There are many other examples that could be cited to 
show the need for a more definite nomenclature. It is true 
that the committee on nomenclature from the Institute of 
Dental Pedagogics have simplified matters a great deal; but 
this cloud on our literature could be cleared more readily if 
all dental editors would adopt and use a universal nomencla- 
ture. Let us hope that this result will soon-be accomplished. 
We call attention to this phrase of our literature, not criti- 
cally, as has been mentioned, but to the end that advantage 
may be taken of every opportunity by all who are interested 
in making our literature reflect the true standing of the pro- 


A month nearer the conveying of the N. D. A., finds 
the clinic program nearing its completion. Professional 
men who expect to attend the July meeting may easily rec- 

Dentistry. 423 

ognize the fact that this special feature will be well worth a 
trip to Boston. Returns have yet to come in, but that the 
profession may have an earnest of good things to come, a 
partial program has been arranged for publication. 

It will be seen that those interested in any one or all of 
the operations in metal fillings, siliciates, porcelain inlays 
and restorations, crown and bridgework, prosthetics and 
dental surgery, will find something of a helpful value. The 
surgical clinics and laboratory exhibits will be of high order. 

George A. Bates, M. Sc, D. M. D., Auburndale, Mass. 

"Some Studies in Heredity as Illustrated by the Ovum.' ; 
H. H. Germain, M. D., Boston, Mass. 

"Tumors of the Mouth/' 
Timothy Leary, M. D., Roxbury, Mass. 
"Pyarrhea — Its Treatment by Vaccines and Other Agents." 


E. P. Damerson, Chairman. J. V. Conzett, Secretary. 

Geo. H. Wilson, Cleveland, Ohio. 

"Some Phases in the Construction of Complete Vulcan- 
ite Dentures." (Illustrated.) 
Discussion by B. J. Cigrand, Chicago. 
H. A. Pullen, Buffalo, N. Y. 

"The Relation Between Etiologic Factors and Treat- 
ments in Orthodontia." 
Discussion by H. A. Baker, Boston, Mass. 
Charles Channing Allen, Kansas City, Mo- 

Discussion by Chas. W. Rodgers, Dorchester, Mass. 
Fred A. Peeso, Philadelphia, Pa. 

"Conservatism as an Ideal in Crown and Bridge Resto- 
Discussion by T. P. Hinman, Atlanta, Ga. 


A. R. Starr, Chairman. V. S. Jones, Secretary. 

Geo. W. Weld, New York City. 

"Characteristics of Calcified Tissues in Two Complete 
Sets of Human Teeth, Free from Caries." 

2 4 The Plexru. 

Discussion by B. Hally Smith, Baltimore, Md. 
Joseph Head, Philadelphia, Pa. 

"A Tarter Solvent Especially Useful in Pyorrhea Work." 
Discussion by W. B. Dunning, New York City. 
W. L. Ticker, Pittsburg, Pa. 

"A Few Principles in Relation to Color and Their Ap- 
plication to Porcelain Work." 
Discussion by J. H. Lorenz, Atlanta, Ga. 


J. D. McMillan, Chairman. F. E. Cobb, Secretary 

Clyde Davis, Lincoln, Neb. 

"A Method of Treatment of Purulent Emypema of the 
Maxillary Sinus." 

Discussion by J. P. Gray, Nashville, Tenn. 
Eugene S. Talbot, Chicago, 111. 

"Acidosis, Iddicanuria, Internal and External Secretions; 
the Effects upon the Alveolar Process and Teeth." 

Discussion by E. P. Joslin, Boston, Mass. 
Arthur H. Merritt, New York City. 

"The Protective Substances of the Blood in Their Rela- 
tion to Pyorrhea Alveolaris." 

Discussion by Herbert L. Wheeler, New York City. 
Thomas B. Hartzell, Minneapolis, Minn. 

"Root Tip Amputation as a Radical Treatment for Api- 
cal Abscess." 

Discussion by A. O. Owre, Minneapolis, Minn. 

Dr. Auber Peebles, Wilmington, Ohio, calls attention to 
our service to the public. Having a clean, neat and beauti- 
fully furnished waiting room does not excuse us for having 
an operating room which does not harmonize. In the last 
few years I have been in probably not less than one hundred 
offices through the central and western states and wish to 
say that there is sufficient in many an operating room to 
cause the patient to lose confidence in dentistry, especially 
in these enlightened times when every one knows something 
of microbes, and a great many are well informed on the sani- 
tary management of affairs. 

Dentietry. 425 

How can we expect to make a good impression upon 
the public when our patients can see our instruments un- 
cleaned, say nothing of sterilization. I think if some of us 
who spend so much time pondering over gold and porcelain 
inlays would just spend a little of this time figuring out a 
method to conduct a more sanitary practice, with instruments 
free from all impurities, and the cabinets, dental tables, 
floors and windows scrupulously clean, people, many times, 
instead of saying, "I dread to go to the dental office"'- would 
say, "It is a pleasure, everything there is so neat and clean."' 
Another thing which I should like to mention is our negli- 
gence in regard to dental journals. I'll guess there are a 
few present who do not subscribe for more than one dental 
journal and I doubt if they read more than the advertise- 
ments in it. I am not insinuatiug that we think we know it 
all, it isn't that, it is that we allow other duties or pleasures 
to have our attention first, and in this way neglect one of 
our most important duties to the public, that of keeping up 
with the times by reading ideas and practical experiences of 
brighter minded and harder working men than ourselves. 

At a meeting of the Chicago Dental Society a few years 
ago I heard stated by a friend and intimate associate of the 
late Dr. McKellops, that this worthy gentleman received 
regularly twelve dental journals and instead of glancing 
hurriedly over them read diligently every article of import- 
ance in them. Is it any wonder this gentleman, of whom we 
all know so well, acquired such an enviable place in his 
chosen profession? 

The Scientific American states the following as good 
proceedure in sharpening files: 

"In an electrolytic method of sharpening files, the tool 
is connected with the positive pole of a battery of 12 Bunsen 
cells, and placed in a bath of 40 parts sulfuric acid in 1000 
of water. The negative electrode is a spiral of copper wire 
encircling the file without touching it. The process requires 
ten minutes, when the renovated files will be found as satis- 
factory as when first made. 

426 The Plexus. 

Legislation will be asked by the Illinois State Dental 
Society to exempt dentists from serving on juries, to amend 
the rules of the Dental Board of Illinois affecting practi- 
tioners from other states, and to have a law enacted provid- 
ing for the care of the teeth of inmates of the St. Charles 
Home for Boys, the Girls' Home at Geneva, and the Soldiers' 
Orphans Home at Normal. — Chicago Tribune. 

Massage the gums: — We are taught that one of the best 
things in the treatment of pyorrhea after medication is that 
the patient should massage the gums, rubbing the gums 
toward the crown of the teeth. That has a tendency to push 
out all foreign substances, and if any pus forms it pushes 
that out, and by wiping it away with absorbent cotton or 
napkins the pus can be kept out of the system, and it also 
causes a normal circulation of the blood in the gum tissue. 
— Dental Summary. 


The 38th annual meeting will be held in La Crosse. 
Wisconsin July 21, 22 and 23, 1908. 

A new institution to be known as the American College 
of Dental Assistants has been organized in Kansas City and 
is to be opened May 1. It is to be incorporated under the 
state laws. So far as is known this is the first institution of 
its kind to be established. Its purpose is to train young 
men and women to be dentists' assistants. 




P\ M. Goodman, Ph. G., C. S. N. Hallberg, Ph. G., W. A. Puckner, Ph.O 

H.H.Roger.-s M. D., Ph. B., E. N. Gathrrca-tl, Ph G., 

A. H. Clark, Ph. G., C. M. Snow, Ph. G. 

WILLIAM B. DAY, Editor. 
CLASS EDITOR: W. D.Mottar, "08. 


Following the lead of the Chicago branch of the Amer- 
ican Pharmaceutical Association and the Chicago Retail 
Druggists Association a successful effort was made at the 
recent meeting of the Illinois Pharmaceutical Association at 
Peoria,June 9-11, to have the State Pharmaceutical Associa- 
tion endorse the proposed amendments to the pharmacy law, 
which will require graduation from a recognized college or 
school of pharmacy as a prerequisite for full registration as 
a pharmacist. Because this proposition was not fully under- 
stood, and an altogether inadequate time was allowed for its 
discussion there was some opposition among the member- 
ship of the Association, but the amendment was finally adop- 
ed and the Legislative Committee instructed to secure its in- 
corporation into the pharmacy law. 

It is expected that when the legislature meets next 
winter this with other amendments to the pharmacy law 
will come up for action and the Legislative Committee of the 
State Association will press the amendmeats actively. 

There is every prospect of a favorable result which will 
place Illinois in the same class as the states of New York 
and Pennsylvania where graduation prerequisite laws are al- 
ready in successful operation. There has been much oppos- 
ition, among those druggists who have not had the advant- 
ages of a college education, to this new requirement, but the 

428 The Plexus. 

last two years has seen a steady progress of the movement 
and now more than ever before do pharmacists realize the 
necessity for a professional requirement if they are to claim 
kinship with professional men. 

In all the European countries except Great Britain, 
graduation from a pharmaceutical school has long been re- 
quired for qualification in pharmacy and it is worthy of note 
that recently the Council of the British Pharmaceutical 
Society, the authoritative pharmaceutical body in Great 
Britain, has recommended that no one be admitted to the 
major examination for a licensed pharmacist (chemist) unless 
such person presents evidence of having systematic phar- 
maceutical training before appearing for examination. 


Boyden NIms, Ph. G., '00 has recently opened a labora- 
tory for chemical, microscopical and bacteriological analysis 
at Columbia, S. C. Mr. Nims reported that he is doing well 
and believes that there is a promising field for his work in 
Columbia. He has had much experience in this line, having 
for several years been employed as pharmacist and bacterio- 
logist in the Federal Service and located in the Phillippines. 
After returning to America he took post-graduate work at 
the University of Michigan and was assistant in the physio- 
logical laboratories of that institution, subsequently he 
taught Materia Medica and Pharmacy for a year at the Ferris 

The alumni of the college are actively interested in the 
work of the pharmaceutical associations as evidenced by 
some of the reports of the pharmaceutical meetings and 
results of elections at these meetings throughout the 
country. Mr. S. L. Cain '95, is the retiring president of the 
Mississippi Pharmaceutical Association and Mr. C. M. Fqrd 
'74, the retiring president of the Colorado Pharmaceutical 
Association. Mr. D. Von Riesen '85, was elected president 
of the Kansas Pharmaceutical Association and Mr. W.W. 
Albers '84, president of the Wisconsin Pharmaceutical Associ- 
ation at the recent annual meetings of these associations. 

Pharmacy. 429 

Mr. Charles O. Bowman. '02 was married to Miss Bertha 
Vane at Wathena, Kan., June 17, 1908. Mr. Bowman con- 
ducts a prosperous pharmacy at St. Joseph, Mo. 

Mr. Philip C. Johnson '04 was married June 17, 1908, to 
Miss Otelia M. Anderson at Casper, Wyo. They will reside 
at Pathfinder, Wyo., where Mr. Johnson is in business. 

Louis A. Druehl '90, and Miss Amanda W. Stahl, of 
Chicago, were married, June 3, and will be at home after 
September 1, at 524 Garfield Avenue, Chicago. Both bride 
and groom are graduates in pharmacy, well known in phar- 
maceutical circles. 

Dr. James Allen Lydston '83 died suddenly at his home 
in Chicago, July 6th. Dr. Lydston had been in poor health 
for some time and the recent spell of hot weather is thought 
to have been the direct cause of his death. Dr. Lydston was 
a graduate of Rush Medical College and for a time occupied 
the chair of chemistry in the College of Physicians and 
Surgeons. He had been engaged in medical practice for 
many years and lately occupied offices with his brother, Dr. 
G. Prank Lydston in the Reliance Building. 

Dr. Lydston was well known in the Alumni Association 
having served as president of the association for several 
years and having always taken an active interest in the as- 
sociation and the School of Pharmacy. His loss will be 
deeply felt by the many alumni who had the pleasure of his 


Professor Hallberg has recently returned from a visit to 
the meeting of the Colorado Pharmaceutical Association at 
Glenwood Springs where he delivered an address. At the 
same convention the School of Pharmacy made an exhibit of 
pharmaceuticals representing the work of the students and 
which attracted much attention and favorable comment. 

There is every indication that the attendance for the 
coming school year will be large. Already students are 
beginning to enroll and there are numerous inquiries for an- 
nouncements and literature of the school. 

430 The Plexus. 


By Rexford De Tompkins. Mt. Sterling III. 
Ladies and Gentleman: — 

On behalf of the graduating class of the University of 
Illinois School of Pharmacy it affords me great pleasure to 
extend you a cordial and a hearty welcome this afternoon. 

A feeling of gladness overwhelms me as I contemplate 
the situation and I realize that this should be a joyful occa- 
sion for a great many. The faculty should be thankful, 
joyful, aye, even hilarious for now they have a chance to 
draw a short breath of relief. It should be a joyful moment 
for the whole school as at last we have squared our accounts 
and are now making a large addition to the alumni list. The 
entire profession should be in a joyous mood because such 
an illustrious bunch of young fellows is about to join their 
ranks; and the people's enthusiasm should know no bounds 
when they learn that forty able and competent pill-rollers are 
ready and anxious for work. And as for ourselves, we are 
joyful almost beyond recovery for at last we are able to disen- 
tangle ourselves from the maze of useless and disinteresting 
theory and are now ready to get down to life's work in 

Naturally, there is also a feeling of sadness connected 
with an event of this kind, but I, in my effervescence of 
happiness, seriously object to dealing with the dismal side 
of this occasion, especially as we have engaged a tallValedic- 
torian who with his seven feet of long black robes is better 
adapted to making speeches of the tear starting sort. 

Ladies and Gentlemen: — These exercises are but the 
natural sequence of two years attendance at this the best 
of all School of Pharmacy. Indeed it would be quite im- 
possible to picture any other "finale" after having sat for so 
many moons under the saccharine instruction of the Nine 
Modern Muses; Our Mighty Faculty; for by their force-pump 
methods of instruction it is simply impossible for these 
perenial excercises to fail to make their appearance. They 
come as regularly as astronomical events. 

^Delivered at the Commencement Exercises of the -University of 
Illinois School of Pharmacy April 23, 1908. 

Pharmacy. 431 

We know of no student so dull that he would fail to 
grasp the "fundamentals of pharmacy" as they are so ably 
presented at the semi-weekly exercises which the head of 
the department on top floor has been showering upon us 
during the past sixty weeks. Why at times the deluge of 
knowledge has been so great that the entire class has sought 
safety in the Land of Nod. But what difference did that 
make? Had we not the weekly quizz where we could still 
gather in a few stray threads of knowledge. That is if no 
one attempted to start an argument with the quiz-master; 
for if they did someone was sure to be SNOWed under. 

And as for chemistry? Well even though the professor 
or his major-doma have never admitted it, we believe that 
we have at least a foundation of the science concerning 
which one must not ask "why." It would be preposter- 
ous to think that we had not learned anything after 
holding down those beautiful chocolate- colored chairs 
for the past two years listening to the professor ex- 
pound and hammerpound such proplexing profundities 
as the differences between Acet-analid and Analiacetate, 
while all the time we were wondering which would 
be through first, the professor's lecture or the thirty-third 
Vertebra. We have often heard of Thirty-Third Degree 
men but never before fully appreciated the ceremony of 

We also owe very much of our present position to our 
eloquent Dean and his department, especiallly to the DAY 
light shed upon Botany and Materia Medica. For without 
this DAYLight it would have been practically impossible to 
have separated them from the maze of Mythology, Biology, 
Evolution and Darwinism with which the Dean had sur- 
rounded them. 

And in this category of our success, I must not fail to 
mention Roger's study of Old Dry Bones or the many weary 
hours we have spent listening to Mr. Gathercoal's very lucid 
descriptions of crude drugs called "Pharmacog", or the 
time spent in the Pharmical Laboratory learning to "put up" 
"slick up" and get out on record time, or of time spent in 
the Chemistry Laboratory learning to be expert glass- 
breakers. I shudder to think of what some innocent wives 
have to put up with when they hook up with one of our 

So Ladies and Gentlemen, the Nine Muses have had us 
on the skillet until you see what the outcome is: This our 
Commencement to which I again extend you a cordial and a 
hearty welcome. 

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VOL XIV. BAT A VI A, AUGUST 20th, 1908. NO. 8 


By Joseph C. Beck, M. D. 

A a address before the United Medical Society of Iowa, held at Iowa 
City, June 23rd, 1908. 


Acute Otitis Media. — It is now fairly well established that 
when a diagnosis of Acute Otitis Media is made an attempt 
is to be made to bring the process to a state of resolution 
without perforating or permitting spontaneous perforation 
of the drum membrane. If, however, the cardinal signs of 
middle ear retention of fluid and especially of purulent fluid, 
are present, then a wide incision should be made in the pos- 
terior half of the drum membrane, and the earlier this is 
done the better. A standard local anesthetic application in 
these cases consists of equal parts (about 1 dram) df carbolic 
acid crystals, methol crystals and cocaine hydrochlorate 

At this point I want to caution you against washing or 
syrringing the ears in acute suppurative cases. More cases 
of chronic suppuration result from this kind of treatment 
than any other. Drainage by means of gauze strips i to i 
inch in width by three inches in length is much more satis- 
factory. These strips are packed loosely in the canal, the 

Note — Owing to the large number of illustrations mentioned in the text it was thought 
best to leave them all out- The originals may be seen in the list of references 
given at the end of this article- 

432 The Plexus. 

inner end coming into contact with the perforation. Daily 
changing of this strip will usually bring the case to a favor- 
able termination in a week or two with perfect healing and 
without impairment of hearing. I have found this method 
of treatment to be the most satisfactory in those cases. 

Chronic Suppuration of the Middle Ear. — Conservative 
treatment in 'these cases, especially home treatment by 
means of syrringes, ear drops and powders should be dis- 
couraged, since it does not lead to cure and defers the neces- 
sary procedure until greater damage to hearing has resulted 
and given opportunity for grave complications to arise. I 
am glad to hear less often the statement thai; the family 
physician said, "As long as the ear runs there is not much 

Under the guidance of the physician and with persever- 
ing treatment of the nose, the general condition and locally 
to the diseased ear many cases of chronic suppuration may 
be cured or at least the suppuration ceases and recurs only 
with a cold or remains dry for years. At the same time 
there are a number of cases in which there are sequestra 
or deeper infections present that resist all sorts of treat- 
ment and must or should be subjected to a surgical opera- 

The local treatment should be conducted through a 
speculum under illumination by reflected light and comprises 
the washing out of the various recesses through small silver 
canulas and the local application of antiseptics. Bier's 
hyperaemia by the suction method and the vaccine treatment 
belong to the most recently accepted methods. In this con- 
nection I wish to mention the use of the bismuth paste in 
chronic running ears- I have used it in a few cases and am 
observing them carefully. Not enough time has elapsed to 
permit of definite conclusions being formed, but it is observa- 
ble that the discharge is lessened and the odor controlled. 
A full report with method of application in chronic suppura- 
tive diseases of the nose, throat and ear will be published 
in the near future in the Annals of Otology, Rhinology and 

Modern Ideas of Nose, Throat and Ear Treatment. 433 

When it becomes evident that a case is not going to get 
"well by non surgical treatment then as soon as possible 
operation should be strongly urged. 

There is a choice between the radical and the semi-radi- 
cal operation, the latter being known as the Meato-mastoid 
operation. I have performed 384 radical mastoid plastic 
operations for the purpose of curing chronic running ear, 
with one death due to pneumonia occuring on the eighth 
day. In all of these cases the discharge was cured, if the 
discharge that comes from the eustachean opening be ex- 
cluded. That discharge has persisted in quite a number of 
cases. Almost all authors agree that this tubal discharge 
does not alter the fact of a cure, although the ear is not a 
dry one as the physician and the patient would like to have 
it. The hearing is usually improved right after the opera- 
tion, but later it is about the same as it was before. In a few 
cases it remains improved, in a small number it is made 
worse. One great feature of this operation is the rapid- 
ity of healing and the short time a patient needs to spend 
in hospital or away from his work. 

Just a word as to the semi-radical operation. Its prin- 
ciple is the non-interference with the ossicles and preserva- 
tion of hearing. It has only recently been revived by Heath 
of England, although known for many years. I have per- 
formed 17 of these operations in the last eighteen months 
with the result that only two remained cured, both of them 
in young children, and with excellent results as to, hearing. 
The remaining cases have either been operated on second- 
arily and radically or are not cured. 

The greatest difficulty is that there are no definite path- 
ological conditions which furnish a definite indication for 
this operation. 

Acute Mastoiditis. — Conservatism is certainly always to 
be encouraged, and if drainage can be effected through the 
tympanic membrane route the case can be brought to reso- 
lution without mastoid operation. But it has frequently 
happened that extreme conservatism and waiting too long 
has cost lives or long continued treatment, whereas if oper- 

434 The Plsxus. 

ation had been done the patient would have rapidly recovered. 

I have in the past six months operated six cases for this 
trouble, using a new method. After thoroughly removing all 
the diseased tissue of the mastoid I fill the cavity with bis- 
muth paste, No. 3, closing the incision completely, leaving 
two strands of silkworm gut for drainage at the lower angle 
and have primary union in all but one, which had to be re- 
opened and drained. 

Another new point in these cases is the use of local 
anesthesia, injecting a solution of cocaine 1 per cent and 
adrenalin 1-1000, equal parts, under the periostium. 


Sinus Thrombosis. — Since improved methods of diagnosis 
of this complication have been discovered treatment has kept 
step with them and many cases are now cured that were 
formerly lost. The broad exposure of the entire thrombotic 
mass, including the jugular bulb if need be, is now fre- 
quently and successfully done. In regard to completely 
opening the bulb and ligation and resection of the jugular 
vein, there is still some discussion. My view and practice 
is to expose and remove the thrombotic mass from one end 
to the other, always ligating the jugular if operating on the 

Brain Abscess. — Drainage of the abscess by way of the 
mastoid or roof of the middle ear, instead of the middle 
cranial fossa, is a recent advance and enough cases have 
been operated in this way to prove its advantages. I have 
operated on eight cases of brain absress; five by the mod- 
ern route for drainage and three by the old. Four of the 
five recovered, but of the three operated by the old drainage 
route, all died. It must be said, however, that all of the 
four cases that died were in a condition of extreme septic 

Meningitis — As a complication of suppurative ear dis- 
ease, meningitis is most often of the serous variety. 

Spinal puncture both for purposes of diagnosis and as a 
therapeutic measure is a modern procedure of great value. 

Modern Ideas of Nose, Throat and Ear Treatment. 435 

I employ it universally in these cases. In a few desperate 
cases I have tried the intra venous injection of silver salts 
but have not found any particular benefit from their use. 

Facial Paralysis occus as a complication of violent in- 
flammation of the middle ear or mastoid or in consequence 
of injury to the nerve during- radical, labyrinth or jugular 
bulb operations. In a goodly number of these cases the 
paralysis will recover if the injury to the nerve has not been 
very extensive. There still remain some cases, however, 
that will not recover, and permanent facial paralysis results 
unless the distal portion of the facial nerve from the point 
of severance is anastomosed with either the hypoglossal or 
spinal accessory nerves. 

Permit me to show you now plates 24 to 30, which rep- 
resent the anatomy, surgical anatomy, methods of suture 
and results in cases recovered several months after opera 
tion. I have performed eight cases of facial-hypoglossal 
anastomosis for the cure of permanent facial paralysis, and 
have published an article on the subject of surgery of the 
facial nerve in which I have described the subject in detail. 
See reference below. I will say here that three cases have 
recovered after periods of from three months to two years, 
three other cases have. not had sufficient time to have shown 
definite results, and two cases were operated on at the ur- 
gent request of the family and the attending phycisian, but 
the cases were not suitable ones for this operation. 

The indication for this operation is failure of spontaneous 
recovery of motion in ths paralyzed facial muscles after six 
or eight months. We know, of course, that some cases re- 
cover even after a. year, but that is rare, and one should not 
take the chance, because the muscles may become atrophied. 
As long as the muscles contract slowly when the negative 
pole of a galvanic current is applied there is a chance of 
recovery alter operation. Operation should be urged upon 
the patient early enough to give a reasonable hope of 

Labijriitthian involvement, secondary to middle ear dis- 
ease, occurs more frequently than it is recognized or 

436 The Plexus. 

treated and only in the past three years has the subject 
received serious consideration. The cardinal signs of Von 
Stein and Berany, which by rotatory manipulation of the 
body and thermal tests directly to the ear are of inestimable 
value and belong to the most recent achievements in laby- 
rinthian study. Most delicate operations have been per- 
formed, some with success, on the bony labyrinth, for 
drainage of suppurative processes in that structure. I have 
had quite a few cases in which I made a diagnosis of laby- 
rinth involvement before operation but at the time of per- 
formance of the radicai mastoid I found nowhere a fistula 
aud consequently did not open the labyrinth. The symp- 
toms in most of these cases disappeared. 

The operation on the labyrinth, especially the cochlea, 
is a very dangerous procedure because of the danger of 
intracranial infection and facial paralysis. 

Chronic Non- Suppurative Middle Ear Disease. — This is 
probably the most discouraging chapter in Otologic thera- 
peutics. The reason for this is that the onset is insidious 
and by the time the case presents itself for treatment the 
changes wrought by inflammation are practically completed; 
namely, chronic adhesive inflammation about the ossicles 
and aural window and the tympanic membrane has become 
thickened. The primary cause is, as a rule, chronic inflam- 
mation of the nose, throat and eustachean tube. On post 
mortem examination by histological method, it is not uncom- 
mon to find the labyrinth involved, evidence of which can 
readily be determined during life by tuning fork tests. 

It is of great importance to recognize this trouble early 
and remove the cause by remedying obstructions and inflam- 
matory lesions of the nose and throat. Not infrequently, 
even in chronic cases, an operation on the nose and throat is 
followed by excellent results. The accepted method of 
treatment by inflation with a catheter and tympanic massage, 
is always proper and also general tonic treatment, because 
most of these patients become neurotic from the accompany- 
ing ear and head noises and the fact that they do not hear 

Modern Ideas of Nose, Throat and Ear Treatment, 437 

There is one remedy that offers some hope in the chronic 
cases and that is fibrolysin. Its. action is on the connective 
tissue which it causes to soften and renders subject to 
manipulation and absorption. It is a derivative of hiosina- 
mine and is put up in sterile ampulae ready for hypodermic 
use. About five years ago I treated a number of cases with 
thiosinamine and reported the results, which were very en- 
couraging, but I had to desist from using it hypodermatically 
on account of toxic symptoms that appeared. Since the 
introduction of the newer and purer preparation, fibrolysin, 
I have and am using it extensively, and while I am not 
ready to state definite conclusions I will say that its use 
seems promising and free from any after effects of a toxic 

Oto Sclerosis. — I only wish to call attention to this newly 
described affection. It is a nonsuppurative ear affection 
which gives much the same subjective symptoms as the pre- 
viously named disease but pathologically it is a disease of 
the bony capsule of the labyrinth. It is most frequently 
found in young women, in groups of families, and leads very 
quickly to destruction of hearing. Local treatment is of 
absolutely no avail, indeed, the condition is said to be aggra- 
vated by it. Phosphorus and potassium iodide are the only 
remedies advised. 

Deaf mutism. — Considerable progress has been made in 
recent years in the treatment of deaf mutism, particulasly in 
Europe. The treatment consists in the persistent and sys- 
tematic removal of adenoids, the use of methods to stimulate 
remants of the auditory nerve to functionate, and education 
of deaf mutes in schools. 

In conclusion I wish again # to express my thanks for 
your kind attention and to the gentlemen who have so kindly 
assisted me in presenting the slides. 

References: Surgery of the Facial Nerve. Annals of Otology, 
Rhinology and Laryngology. June, 1908. 

438 The Plexus. 



E. H. Butterfield, M. D. , Chicago. 
Medical Director Ottawa Tent Colony. 

The question whether the diagnosis of tuberculosis of 
the lung can and should be made when tubercle bacilli are 
not present in the sputum is one which has produced more 
difference of opinion among writers than almost any other in 
the whole range of diagnosis. Gerhardt expresses himself 
thus : "I know cases in which bacilli were not found for 
months, or only in the sixtieth specimen, but when the diag- 
nosis of tuberculosis was established by examination of the 
chest." Eichhorst writes: "'Now and then one certainly 
finds cases in which no tubercle bacilli are found in the spu- 
tum, even after daily examination of several specimens, in 
spite of the undoubted existence of pulmonary consumption." 
In a communication to the Eleventh International Congress, 
describing beginning tuberculosis of the lungs, Turban ex- 
pressed himself as follows : " Clinically the first stadium of 
tuberculosis of the lung may be demonstrated before bacilli 
appear in the sputum." 

In commencing tuberculosis of the lung the anatomical 
changes are of such a kind that the tubercle bacilli actually 
present in the tissues can find no means of exit, whilst the 
foci are large -enough to be demonstrated by percussion and 
auscultation. A negative result, then, of sputum examina- 
tion in no way excludes the existence of foci, producing 
physical signs, so that in these cases the earliest recognition 
of the disease can only be obtained by physical or other 
means of diagnosis which I shall only be able to touch upon 
in this paper. 


From the researches of Loomis and Pizonni, who were 
able to produce tuberculosis in animals with material from 
healthy bronchial glands, the conclusion must be drawn 

. *Read before the North Central Illinois Medical Association, Dec. 
3, 1907, Sterling, 111. Reprinted from Illinois Medical Journal. 

Early Diagnosis of Pulmonary Tuberculosis. 439 

that, like seed on stony ground, the tubercle bacilli can per- 
sist in a viable condition in an unsuspectable host. From 
this we may picture the development of tuberculosis as 
occurring at the moment when certain weakening influences, 
which we recognize as predisposing causes, come into the 
human economy. In one case we assume that many years 
elapse between the inception of the bacillus and the break- 
ing down of the prophylactic mechanism ; in the other that 
the bacillus finds a suitable soil from the moment of its 
invasion and tuberculosis develops at once ; it may be in the 
glands or in the lung. And this conception reconciles the 
contending views of heredity, fetal infection, etc. 

Now when the host has reacted to the invasion of the 
bacillus with inflammation and tissue proliferation and infil- 
tration, clinical observation shows us that there may be a 
pause before ulceration, breaking down or softening occurs; 
this is the case in various organs, e. g., joints, glands, infil- 
tration of larynx. There are many examples of stationary 
tuberculosis when death has occurred from accident or inter- 
current disease, and it is then found that the pause and 
retrogression occur either immediately after formation of 
granulations or even after necrosis has already begun. 
Tubercular changes may exist for years in the lung without 
leading to necrosis and even without the appearance of 
bacilli in the sputum. 


That apical tuberculosis may remain quite symptomless 
during life, even though of an advanced degree, we know 
well enough from post-mortem observations. Perhaps the 
very first beginnings never produced symptoms. Whether 
the disease is manifested early or late depends on the degree 
of the toxicity of the bacillus, or the production of antitoxins 
by the organism, and the consequent quicker or slower 
development of the disease, as well as on its localization in 
the bronchi and alveoli, or in the interstitial tissue. In any 
case it is quite erroneous to assume that clinical symptoms 
must begin as a rule with bacillary sputum. It may be well 
to repeat that bacilli are, in general, first found in the spu- 

440 The Plexus. 

turn when foci soften and invade a bronchus, i. e., when the 
tuberculosis, until then "closed," now becomes "open." 


Closed tuberculosis may exist without symptoms, per- 
haps throughout a lifetime, but there are, on the other hand, 
many cases in which long before the appearance of bacilli or 
elastic fibres in the sputum a series of symptoms of ill health 
develop which do not definitely point to tuberculosis. In 
others the whole array of symptoms characteristic of the 
disease appear. Between these two extremes arise those 
which have one or two symptoms, and when, as often hap- 
pens, symptoms ascribable to other organs are most promi- 
nent, then it is fiat the term "masked" tuberculosis is 
proper. Here under general symptoms might be mentioned 
disturbances of circulation, condition of the blood, of the 
digestive organs, and of the nervous system ; patients look 
pale, frequently change color, are easily excited, easily tired 
in mind and body, have but little appetite, perhaps nausea 
and actual repugnance to food, bowels may act irregularly 
and they lose flesh, associated with brittleness of the nails 
and dryness of the hair and skin. Irritable weakness of the 
heart and vasomotor system should be taken into account. 

The pulse is usually persistently frequent or may be 
very inconstant, rising from 70 to 80 or to 100 to 120 or even 
more on the slightest mental or bodily excitement. Most 
patients are not aware of this tachycardia, others complain 
of slight dyspnea and palpitation. 

The temperature may be quite normal or at least not 
raised in proportion to the pulse frequency. Flushings of 
the face on slight mental excitement and during examina- 
tion ; for instance, the patient may sweat so profusely that 
great drops run down the armpits ; this, according to Tur- 
ban, is due to tuberculin intoxication, which is also respon- 
sible for the reduced energy and psuedo- dyspepsia. If the 
temperature is carefully taken and recorded it will be found 
to show the same variation as the pulse, slight but persist- 
ent elevation after the principal meals and considerable rise 
after moderate exercise. Less common is a high morning 

Early Diagnosis of Pnlmonary Tuberculosis. 441 

temperature, but this sometimes approaches the evening one 
or may exceed it. In women the temperature may show a 
regular monthly wave, with a rising before and a depression 
after menstruation. This may last for a long time and is 
generally overlooked by the physician and patient because 
it gives rire to little or no direct trouble or, if discoverable, 
is mostly put down to gastric disturbance, malaria, typhoid, 

Pain.— -Very frequent pain is a marked symptom. Not 
so much pleuritic pain at the seat of the disease, but all over 
. the lower lobes of the affected side, occurring as a dull, bor- 
ing or stabbing pain and radiating down the arm. This 
often leads to a diagnosis of rheumatism. 

Cough, and Expectoration. — The cough may or may not 
be accompanied with expectoration. When tuberculosis 
commences insidiously, cough as a rule precedes expectora- 
tion by months or years. We all know the short, dry, 
hacking cough which is usually regarded as a precursor- of 
tuberculosis of the lung, but the cough is not always short 
and dry; the character and quantity of the sputum depend 
upon the extent to which the air cells and bronchial tubes 
are involved. 

Hemoptysis. — Closed tuberculosis is deserving of special 
notice. The streaks and spots of blood as well as the still 
less considerable traces have an origin analogous to those 
occurring in acute croupous pneumonia and are as easily 
explained. Frank hemorrhages are generally followed by 
expectoration containing bacilli. In other words, the initial 
hemoptysis would seem to usher in the open state. Hemor- 
rhages may occur without the subsequent appearance of 
tubercle bacilli. 

Besides homoptysis a number of other episodes often 
interrupt the insidious course of tuberculosis in this stage. 
Many patients are especially liable to attacks of catarrh, the 
inflammation of the whole respiratory tract, laryngitis, 
bronchitis, pneumonia and pleurisy. The various forms of 
lobular and extensive pneumonia often occur ; these radiate 
readily from the extending locus of diminished resistance 

442 The Plexus. 

and may occur repeatedly in the same subject, The exciting 
agents are the influenza bacillus, Prankel's diplococcus, 
streptococci and many other micro-organisms. . These are 
termed the mixed infection. Very often we have associated 
with a beginning tuberculosis of the lung an exhaustive 
bronchitis, purulent and otherwise. 

Mixed Infection. — That local disease affecting the respir 
atory tract may smooth the way for tuberculosis we are all 
well aware. The influenza bacillus is not to be ignored in 
the early stages, for if it is not proven that tubercular indi- 
viduals suffer more often then others from influenza, at any 
rate the infection more often passes off without pneumonia 
in the healthy .than in the tubercular, and in the latter it 
easily leads up to a "chronic influenza mixed infection," 
which shows itself in prolonged, irregular fever or in re- 
peated febrile attacks (broncho-pneumonia). 

Dissemination.— Without the assistance of a mixed infec- 
tion the disease may be widely disseminated from a small 
nodule via a bronchus or by the lymph or blood vessels. 
The serious pleurisies are two-thirds tubercular ; dissemina- 
tion often occurs from fchese ; it is difficult, however, to dem- 
onstrate the presence of bacilli in the exudate on account of 
their small numbers. Dissemination may follow hemoptysis 
— a frank hemorrhage in our experience is often followed by 
a rapid rise in temperature and an extension of lung involve- 


Inspection often reveals valuable information. Very 
early the affected apex begins to lag behind the other in 
inspiration ; there may be also a slight retraction or rather 
wasting of the muscles over the scapula, this giving a prom- 
inence to the scapular ridge on the side affected. The 
supra- and sub-clavicular fossa may be more depressed and 
the clavicle consequently more prominent, but even this 
may prove to be an anatomical imperfection. Nevertheless 
it is often associated with retraction of the lung. Palpation 
is not of great value, especially where the voice is not of the 

Early Diagnosis of Pulmonary Tuberculosis. 443 

right timbre or intensity, or when there is some laryngeal 
or vocal cord infiltration. 

Percussion. — Results of positive value can often be ob- 
tained from this method, yet we must remember that with 
the slightest infiltration at one apex the deviation from the 
normal is often so slight that acsculatory evidence is neces- 
sary to clear up the doubt. Much, too, depends upon the 
skill of the examiner as well as the extent of the tubercular 
process. In the latent and early cases the modification of 
the pcerussion note is seldom great on account of the 
limited and scattered tubercular foci. 

Ausculation- — Asculation of the lung is of greatest aid in 
determing the earliest manifestations of the disease. A slight 
deviation from the normal type of breathing known as 
roughened breathing and weak vesicular breathing or a com - 
bination of the two may be found. This may or may not be 
associated with prolonged expiration. Cogwheel breathing 
may be considered an early physical sign. Rales may be pres- 
ent very early or may long be wanting. They are usually of 
the fine cracking, crepitating variety, more rarely of the 
medium size. One writer describes, or rather calls attention 
to, a not infrequent sign at the affected apex in the absence 
of moist rales. A localized short whining, only audible after 
coughing and only on inspiration. Medium rales in any con- 
siderable numbers usually occur with commencing 'softening 
of the apices. Pleural sounds may be heard over affected 
areas, varying from a soft rub to a loucl scrape, but more 
often occur down at the edge of the lower lobes in commenc- 
ing apical diseases; in this locality one may often find small 
exudations or their remains which have given rise to no 
symptoms. It is well to remember that the very earliest 
signs occurring in the apices are usually heard in the supra- 
and inter-scapula fossae. If asculation is confined to the 
front of the chest, as is so often the case, those very slight 
but so significent deviatians of the normal breath sounds 
may escape detection. Associated with early apical refrac- 
tion we may have a symptom, namely, subclavian murmur, 
heard during inspiration and expiration. This is due to ad- 

444 The Plexus. 

hesions of the pleura to the sheath of the subclavian artery. 
This may occur in the healthy, but very much more often in 
apical tuberculosis. 

Slight symptoms of laryngeal involvement occur fre- 
quently in early cases ; it may manifest itself in the form of 
a chronic laryngeal catarrh or slight adductor paralysis. 
Unequal dilatation of the pupils, slight swelling of the 
thyroid gland and intermittent albuminuria may be men- 
tioned as occurring frequently enough to be taken into 
account in making an early diagnosis. 


After considering in detail the earlier signs and symp- 
toms, the diagnosis of tuberculosis of the lung is suggested 
to the physician, even without the occurrence of bacilli in 
the sputum, by one or more of the number of symptoms de. 
tailed, ill looks, loss of weight, tachycardia, blood spitting s 
etc. He is now called upon to make an accurate physical 
examination of the lungs, as well as watching the tempera- 
ture over a period of several days. If the examination 
reveals the slightest deviation from the normal type of 
breathing at one apex, if there occurs on inspiration or 
coughing the slightest crackel or whining, if the percussion 
note is higher in pitch, less resonant with a tympanitic qual- 
ity, we can say definitely and positively that this is an infiltra- 
tion at one apex, and we may also assume that it is tubercular 
with the same degree of probality that we can assume in 
other diseases. Chronic pneumonias, if of non tubercular 
nature, are almost always confined to the lower lobes. From 
hereditary syphilis we can differentiate from the fact that 
the white pneumonia of syphilis, both in its lobar and lobular 
form, occurs in the lower lobes; this form of lung trouble, 
together with malignant growth occurs so rarely it need 
hardly be considered. 


In the latent, obscure and closed cases I have come to 
believe that tuberculin properly administered is a safe and 
reliable diagnostic agent. Early tuberculosis reacts to 
tuberculin in the most positive manner. The limitations of 

Early Diagnosis of Pulmonary Tuberculosis. 445 

its use, of course, are febrile cases. Cases of the advanced 
type frequently give no reaction, the tissues of such patients 
having become resistant to the poison. It is said that leprosy, 
actinomycosis and syphilis react to tuberculine. For diag- 
nostic purposes the technic of administration is as follows: 
It must be first assured that the patient has no continued 
fever by noting and carefully recording the temperature 
every two hours from 8 a. m. to 10 p. m. for two days. First 
i to 1 milligram of Koch's old tuberculin is injected subcut- 
aneously, this amount being obtained by svitable dilution of 
the original solution; if no temperature is produced by this 
amount 3 to 5 milligrams may be given in a second injection 
after an interval of three days. If there is no fever reaction, 
another and last dose of 10 milligrams, after another inter- 
val of three days, is given. If fever results it is essential that 
the patient be confined to bed until it disappears. 


As to the reliability of the opsonic index in diagnosis, I 
shall quote Dr, Mary Lincoln, of St. Luke's Hospital, and 
Miss Maloney, in our own laboratory, where we are working 
on opsonins relative to their value both in diagnosis arid as 
a guide to the therapeutic administration of tuberculin. In 
answer to the question, '"Is there a normal tuberculoopsonic 
index?" Dr. Lincoln states that live different individuals known 
to be absolutely free from tubucular infection were select- 
ed as normals and tuberculo indices were determined 50 to 
100 times during the course of six months. The results in the 
total 350 opsonic indices, the range is with few exceptions 
0.8 to 1.2. We may then say that the normal tuberculo- 
opsonic index ranges from 0.8 to 1.2. Comparing this with 
the tuberculo-opsonic index of patients numbering 75, 40 
cases being treated and 36 for diagnosis, the average of the 
opsonic indices before treatment in 40 patients was found to 
be 0.68 and the range from 0.35 to 0.9; there were only four 
cases in this group tvhose clinical and opsonic index diagnosis 
did not agree. 


1. Clinically the first stage of tuberculosis of the lung 

446 The Plexus. 

may be demonstrated before bacilli appear in the sputum. 

2. Predisposition, or where one or several individuals 
of the same family have fallen victims to consumption, the 
first signs of ill health ought to prompt the physician to ex- 
haust every means and method of diagnosis in order to arrive 
at a correct conclusion and steps taken if a positive diagnosis 
is made to insure his patient prompt and rational treatment. 

3. That the latent, closed or masked forms of early 
lung tuberculosis are not easily demonstrated, and if the 
clinical findings are not of sufficient proof, diagnostic tuber- 
culin should be administered. 

4. Repeated negative examinations of the sputum do 
not preclude the existence of pulmonary tuberculosis. 


By Wm. F. Waugh, A. M., M. D., Chicago. 

Reprinted from Chicago Medical Record. 

Since Socrates carried to his lips the fatal cup, it has 
been comprehended that the spotted or water hemlock, 
cicuta-virosa, contains activities that may at least cause 
death. The endeavor to utilize these powers for the relief 
of human suffering has met with unexpected and hitherto 
insurmountable difficulties. Preparation after preparation 
has been advanced, and after a season of vogue rejected. In 
my service as hospital interne we utilized the extract conium 
as a pill excipient, the tincture as a vehicle for administering 
luplulin. The juice, succus conii, had a season of popularity. 

Some of the fluid extracts possess activity but uncer- 
tainty. Some years ago a physician was employing one of 
these fluid extracts and had advanced the dose to 40 minims 
with little effect. The pharmacist refilled the prescription 
with another makers extract, and the first dose killed the 

It is veheminently asserted that pharmacy has very 
recently developed to a point where the physician may safely 
prescribe fluid extracts without specifying the manufacturer, 
but we have our doubts and decline to take the chance. All 

Cicutine. 447 

the more, since in cicutine hydrobromide we have at last a 
reliable, staple preparation, affording the activity of hem- 
lock in acceptable form. 

By successive crystallizations cicutine hydrobromide is 
obtained in colorless prismatic needles, with no odor and 
little taste, very soluable in water. It does not really de- 
compose and remains white if protected from light. 

Although cicutine hydrobromide may be administered 
hypodermically, Laura prefers giving by the mouth, and 
says that it is not objectionable even to infants, and like 
glonoin exhibits superior efficacy when thus introduced into 
the system. 

Burggraeve praised cicutine hydrobromide especially 
in the treatment of turbercular meningitis, where he found 
it to lower or stop the fever and sedate the brain, without 
constipating like morphine. He advised it in all maladies of 
children with hyperesthesia. 

Martin-Damourette and Pilvet think that cicutine can 
"forestall, arrest in the root and prevent the development of 
the neoplasia by which the great diatheses — dartrous, rheu- 
matic, scrofulous and perhaps cancer — reveals themselves, 
and that it combats hyperplasias in the early formative 

Harley recommends cicutine against epileptic and choreic 
paroxysms. Laura thinks it is useful for spasms of the 
orbital muscles and in photophobia, in a rebelious case of 
which cited by Harley it succeeded. In epilepsy it has been 
recently employed by Gonzales, Echeverra and 'Macdonald, 
calming the nervous irritation and relieving the vital depres- 
sion so common among epileptics. 

Dujardin-Beaumetz suggested that "cicutine hydrobro- 
mide should act well against convulsive phenomena, espe- 
cially reflex symptoms arising in the pneumogastric area;'' 
whooping-cough, asthma, convulsive cough, certain forms of 
dysphagia, nervous vomiting, etc. Hufeland employed hem- 
lock in spasmodic dysphasia, Meyer in spasmodic bronchitis 
and laryngitis. With cicutine hydromide Hailly cured an 
orthopnea rebellious against other antispasmodics. With 

448 The Plexus. 

the same agent Stewart and Curry cured two cases of trau- 
matic tetanus; and Welsh and Harley reported success in 

In antineuralgic medication a distinguished place is 
given to cicutine hydrobromide by Dujardin-Beaumetz, with 
Chaussier and Dumenil. 

Tinya Kian, who lately made a study of cicutine, ascer- 
tained the easy accustoming of the organism to it, the 
prompt elimination that removed all danger of accumulation, 
the stability of the hydrobromide, the greater energy of this 
salt than of the uncombined alkaloid, its tolerance even in 
larger doses, its elimination mainly by skin and lungs, and 
the fact (in which Laura concurs) that nursing infants are 
not effected by this drug taken by their mothers. Even the 
smallest infants bear cicutine hydrobromide very well. 

Laura sums up his clinical applications of this alkaloid, 
which he finds useful in the cough of bronchitis, of phthisis 
whether nervous or otherwise, whooping-cough, epilepsy, 
the neuralgias and arthralgias, all nervous hyperesthesias, 
chorea, convulsions, tremors and even tetanus. Stoerck 
wrongly attributed to cicutine a specific control over cancer; 
it merely lessens collateral engorgements and consequent 

The dose depends on the resistance of the disease and 
the groups of symtoms in each separate case. In acute mal- 
adies a milligram of cicutine hydrobromide may be given 
every half hour until the nervous hyperexcitability shall 
have subsided, or the other symptoms have been relieved. 
In chronic maladies four to ten milligrams form the twenty- 
four hours' dose, divided as seems best in each case. 

While I have not yet had an opportunity to give cinu- 
tine in cerebrospinal meningitis, this remedy seems admira- 
bly suited to this malady, especially in cases where the tem- 
perature is too low to demand the closely allied remedy 

In one exceedingly difficult case of morphine habit, the 
patient had entered that terrible stage where he was un- 
able to find life tolerable either with or without morphine. 

The Lenhartz Treatment of Gastric Ulcer. 449 

His cells were so saturated with toxins that no quantity of 
morphine could prevent their discharge into the blood, with 
active antotoxemia resulting. The morphine had conse- 
quently been pushed up to the utmost limit of toleration. 
When the drug had been stopped and elimination secured 
the patient was left in a state of complete nervous exhaus- 
tion and hyperesthesia. Rest was prevented by an indes- 
cribable sensation, not painful but far more unbearable than 
pain. Spasmodic jerking of the legs occurred at intervals. 
The special senses were distressingly aggravated. The 
symtoms pointing unmistakably to hyperesthesia of the 
spinal centers with increased reflex excitability, of cicutine 
hydrobromide two and three milligrams were administered 
hypodermically, as the patient's stomach resented every- 
thing put into it and absolute rest had to be accorded this 

The immediate and decided relief following vindicated 
the treament. 

In my reading I have picked up, from some source not 
now remembered, the suggestion that cicutine is useful when 
the patient is haunted by a fear of impending evil, espe- 
cially of approaching insanity. In a few cases I have fol- 
lowed this indication and administered cicutine hydrobro- 
mide, and always the apprehension subsided, with corre- 
sponding improvement in the general condition. 

Cicutine manifests its activity within half an hour after 
it is taken by the mouth, and the cognizable effects cease 
within two hours. 


From Journal of American Medical Association. 

Dr. Samuel W. Lambert, New York {American Journal 
of the Medical Sciences, January, 1908), describes this treat- 
ment and believes that it is an advance in the therapy of this 
disease. Lenhartz published the results of his treatment in 
January, 1904, but the treatment did not at first receive the 
attention that it deserved. • 

Instead of a starvation period with rectal alimentation, 

450 The Plexus, 

Lenhartz's treatment aims to furnish more nutrition to the 
patient and improve the general condition and thus favor the 
healing of the ulcer. It also aims "to prevent distention of 
the stomach by a limitation of the size of each portion of 
food taken and of the amount of fluids taken and by the use 
of ice applications externally." And lastly it aims "to pre- 
vent the action of the excessive hydrochloric acid on the 
ulcer by combining it with food albumin and by the use of 
bismuth subnitrate internally." These objects are accom- 
plished as follows: By giving the patient nourishment every 
hour, and this nourishment concentrated and rich in albumen 
so that the acid of the gastric juice will be rapidly combined 
with the food proteid." The food should be slowly and com- 
pletely masticated, and this is best accomplished by feeding 
the patient "in teaspoonful amounts and by never allowing 
him to feed himself during the first two weeks of his treat- 
ment." Three or four weeks' rest in bed ordinarily must be 
insisted on . When there is hemorrhage an ice bag to the 
epigastrium is recommended, and bismuth subnitrate intern- 
ally. Iron should be given later for the subsequent anemia. 
"The food given should be fresh milk, iced; raw eggs 
(the whole egg is beaten up and iced). Both the milk and 
the egg are prepared in covered glass tumblers, surrounded 
by cracked ice, and kept at the bedside. The feeding spoon 
is also kept iced in the same manner.*' If the patient pre- 
fers, Lambert allows a mixing of the eggs and milk and 
feeding the mixture instead of the usual alternation as ad- 
vised by Lenhartz. After the third day, granulated sugar is 
added to the eggs. On the sixth day "raw scraped beef, 
boiled rice and zwieback prepared in the usual manner," are 
given. Lambert substituted cooked, chopped chicken for 
the raw ham in the treatment of Lenhartz. Finally butter is 
added to the diet. After the tenth day Lambert allows a 
broiled chop, beefsteak or chicken as a substitute for the raw 
beef. Later ice cream is added and the zwieback is changed 
to toasted bread, and other cereals take the place of rice. 
For the first ten days of the treatment the food is given 
hourly from 7 in the morning until 9 at night. Lambert 

Reaction of Surgical Cases. 451 

found advantage in the Lenhartz routine feeding, though, of 
course not so long continued, in several patients with hyper- 
chlorhydria who did not have peptic ulcer. 

From the recorded experiences Lambert's conclusions 
seem justified, viz., that while the Lenhartz treatment does 
not always perfect a cure and should not take the place of 
surgery where dangerous hemorrhage has occurred or an 
ulcer is recurrent, it seems to cure a patient more pleasantly 
than the starvation method; the patients are in better con- 
dition after the treatment, as they are really built up by it; 
there is less need for morphin; there is less vomiting, and 
apparently less hemorrhage. 


By Dr. Carl Beck. 

Within the last year or so quite a number of articles 
have appeared in medical literatuse on this subject. No 
matter how well founded physical diagnosis of a case of 
tuberculosis may be, it still requires a good many confirma- 
tory symptoms to make a case positively diagnosed. We 
cannot have too many signs, and especially too many signs 
for early diagnosis. 

The experiences of Von Pirquet, of Vienna, with a local 
application of tuberculin on the skin, which have led to 
most remarkable results, have brought about a great deal of 
experimenting with the use of tuberculin in the shape of a 
solution instilled into the conjunctiva of the eye, and it has 
been shown that in case of tuberculosis a rapid reaction 
takes place, and in the absence of tuberculosis this reaction 
does not appear. The names of Wolf, Eizner, Wein and 
others in Germany, of Calmette in Prance, have ( become 
quite widely known in connection with these experiments. 

It was interesting to me to find out of what value this 
reaction, (which consists in a slight degree in a congestion 
and dilatation of the blood vessels of the conjunctiva, in a 
higher degree in a regular conjunctivitis, in some cases last 
ing only a few hours, in others a few days), was for cases of 
surgical diseases which have been either manifest or diag- 
nosed during operation. 

452 The Plexus. 

Dr. C. F. Weinberger, of the North Chicago Hospital, 
was using this test, at my suggestion, on about sixty cases 
during the last two months and has reported his results 
before the German Medical Society about as follows: 

All cases of manifest tuberculosis show a positive reac- 
tion. All cases of positive absence of tuberculosis show no 
reaction. The instillations were made with a one per' cent 
of dry tuberculin prepared according to directions by Cal- 
mette. The cases were tubercular glands of the neck, 
different tubereular bone diseases, tuberculosis of the peri- 
toneum, and tubercular fistulae from different localities. 
While most of the cases were manifest tuberculosis, in two 
instances the ophthalmic reaction has led to the diagnosis of 
tuberculosis and they require special mention therefore, 
because, based on this reaction, an entirely different treat- 
ment was undertaken than would have been given without it. 

The first case is one of a young man who had all the 
typical signs of an acute appendicitis, with the exception 
that the acuteness of the process extended for a longer 
period than usual and that the exudate in the pelvis was 
suggestive of some other than septic infection. Some points 
of the history were also somewhat suspicious as to another 
nature of disease than appendicitis. The ophthalmic reac- 
tion proved positive and the diagnosis of tubercular peri- 
tonitis was made. An exploration proved the diagnosis 

The second case was one of a woman with a small tumor 
of the abdomen and a polyp of the uterus, but with symp- 
toms somewhat different than these conditions would lead 
to. She was given an ophthalmo test and showed a positive 
result. Careful observation and close examination led to the 
diagnosis of this case as incipient tuberculosis of the lung, 
and a local operation for the conditions before mentioned 
was not undertaken. 

Considering this value of the test I think it is necessary 
henceforth to give it quite extensive use and draw con- 
clusions after a large number of positive cases have been 

Education of the Public in Scientific Medicine. 453 


Abstract from address of President Herbert L. Burrell. 

What are the means by which we may reach the public? 
Newspaper articles on selected subjects, giving facts con- 
cerning a given disease, but not the treatment of the disease, 
should be furnished the press. The articles should be 
signed and published under the authority of the Board of 
Public Instruction. That these articles should be judiciously 
edited must be apparent to all. No statement issued by the 
Board of Public Instruction should fail to be the absolute 
truth. Irreparable damage to the medical profession and to 
the public might be done by unwisely exploiting mooted 
subjects. It would be unfortunate if this new duty of edu- 
cating the public in medical matters were taken up indis- 
criminately by members of the medical profession. It may 
well be appreciated that this new duty may be considered a 
legitimate means of advertising the individual. But self- 
seeking for the medical profession, or for any individual 
member of it, would be quickly recognized by the public. 
Discredit, then, would be brought on the profession and on 
the individual. 

Another means of reaching the public might be by 
magazine articles. The facts concerning certain diseases 
might well be given to skilled lay- writers, who should be 
paid for their services. A lay-witer has the art of present- 
ing a subject to the public in an attractive manner. For 
example, let the subject of animal experimentation be 
investigated by one of the magazine writers of this country. 
Open wide the sources of information to such a writer. 
Then let a series of articles be published in order that the 
public may know the truth as to the inestimable benefits 
that have come from animal experimentation, not to men 
alone but to animals as well. Reprints of such articles, 
pamphlets and circulars of information, would be a powerful 
means of educating the public- Let circulars of information 
regarding the sebject of animal experimentation and of 
vaccination be placed in the hands of every legislator in this 

54 The Plexus. 

countay; in fact, in the hands of every citizen who is misin- 
formed as to the truth. In the event of a great epidemic of 
yellow fever or cholera, let a pamphlet containing the facts 
concerning the spread of the disease be sent to every house- 
holder in the district. Every physician would be then 
obliged to know the facts. This leads me to call your atten- 
tion to one of the obvious effects on the medical profession 
of educating the public. It is to be regretted, but it is true, 
that there are ignorant practitioners in our profession. If 
the public is informed as to the facts as to the facts concern- 
ing an individul disease, a physician will be forced to inform 
himself as to the recent advances in that disease. 

To my mind, one of the most important movements in 
the Association is the establishment of county graduate 
schools in the various states. I can conceive of no better 
stimulus to this work than the adoption by the county 
schools of a plan by which one of its members shall inform 
the public, once a year, as to the facts concerning some 
selected disease. 

• The work of the Council on Medical Education is pro- 
gressing. Dilapidated medical schools are disappearing. 
Why? Publicity- When the public recognizes that in order 
to become a well-educated physician certain requirements 
are absolutely essential, then, and not till then, shall we 
have true reform in medical education. I commend to your 
consideration the work of the Council on Medical Education. 
It is dealing with the tap root of the tree of the medical pro- 
fession. Its reforms must not be too radical. There are 
still isolated areas in this great country that can not support 
the best educated physician?- But the American Medical 
Association at least can stand firmly for safe, sane and 
sound praetltioners. To my mind, one of the most important 
functions of the Council is that it has established a monitor- 
ship over medical schaols. Let the Council give to the pro- 
fession, and to the public if necessary, the facts concerning 
the various medical schools of this country; publicity will 
do the rest. 

Free lectures to the public on selected medical subjects. 

Education of the Public in Scientific Medicine. 455 

constitute ohe of the most useful methods of spreading 
information. These lectures should be given by men who 
are authorities in their subjects; and the experiment as it 
has been tried in various parts of the country, particularly 
in Chicago and at Harvard, has been a success. At Har- 
vard during the last winter the lectures have been so popu- 
lar that at times a hundred or more people have been turned 
away, being unable to gain admission. A wide range of 
subjects has been covered in these lectures. Many factors 
influenced the attendance: First, the subject selected; sec- 
ond, the individual who gave the lecture; and third, the 
condition of the weather. Sunday afternoon lectures were 
better attended than Saturday evening lectures. Inclement 
weather markedly diminished the attendance. The most 
conspicuous factor that influenced the attendance at the 
lecture was the co-operation of the press. For example, 
when a lecture was given on a subject of great public 
interest, then if the press devoted from a half column to 
three columns to noticing it, the stimulus to the attendonce 
at succeeding lectures was marked. Personally I have had 
nothing to do with these lectures, but I believe that they 
can be made effective almost in proportion to the co-opera- 
tion of the press. 

The medical profession, and many of the public, are 
afraid of the press. Whether this position on the part of 
the public is justified or not need not be discussed. I have 
never had occasion to appeal to the press for assistance and 
co-operation in any public measure without receiving hearty, 
but at times, to my mind, indiscreet assistance. The posi- 
tion of the press, as I understand it, is that it is the judge as 
to what constitutes news. Newspapers will publish what 
they think the public wants to know, but not what we think 
the public ought to know. They assume, quite properly, 
the right of decision. The greatest power that we can have 
to diffuse information is the public press. Let us be frank 
with it, and I believe that it almost invariably will be honest 
with us. Collier's Weekly and the Ladies' Home Journal have 
been wonderful forces in diffusing the truth. 

456 The Plexus. 

There yet remains, ladies and gentlemen, a means of 
educating the public which I believe will be the most potent 
of all. This rests in the hands of the family physician — the 
man who has the care of the household, who watches the 
growth of the children, who sees the father and mother 
bend under the strain of life, react and again assume their 
work, the counselor of the family — he it is who can carry 
into the homes of this country the judicious truth concern- 
ing disease. Well-educated people have recognized that the 
wave of specialism which threatened to obiliterote the 
family practitioner was dangerous for the welfare of the 
whole. The trouble is that we all consider ourselves, when 
ill, as peculiar examples of some disease, when, as a matter 
of fact, all we need is the counsel and advice of a sound- 
minded family practitioner who has known us and our 
families for many years. This does not in the least deny 
the great advantage of having the benefit of special knowl- 
edge in reference to a special subject. 

There is a distinct reaction, I believe, against the oblit- 
eration of the family practitioner. The well-educated family 
practitioner now has a new duty. He it is who should be 
the instructor of the family. This is particularly true in 
relation to the subjects which in medicine can not with 
propriety be taught the public in masses; these subjects 
may be taught most appropriately to the parents and, if 
need be, to the children by the physical counselor of the 

A great duty rests on the practitioner of medicine 
today. He must not shirk it; he must rise to his new 
burden, accept it and bear it. The reward to the medical 
profession for taking this new burden of judicious publicity 
in medicine will be a broader life for the practitioner, a 
greater consideration for his fellowman, better citizenship 
and the recognition by the world that the medical profession 
is a great public benefactor. 

The Cancer Problem. 457 


By George W. Crile. 

Cancer is widely distributed in Nature; is slightly, if at 
all,, communicable; is not yet proved to be increasing or 
hereditary; and is rarely transplantable- Its biologic char- 
acteristic is the power of endless division of its cells. The 
natural prognosis is death. Frequently there are well- 
defined predisposing causes and pre-cancer states. The 
pre-cancer stage is the preventable or curable stage. It is 
vastly better to prevent a cancer than to cure it. No specific 
therapeutic measure exists; the knife is still the most reli- 
able means of treatment. In its beginning cancer is always 
local and is curable by complete excision. The chances of 
cure diminish in inverse geometrical ratio to the lapse of 
time since its inception. There is evidence that a reliable 
blood test for cancer may be established; and there is a pos- 
sibility of utilizing for cure the immunity principle through 
transfusion of blood. 

If there is in many cases a recognizable and curable 
pre-cancer stage, if the disease in its incipiency is local and 
curable by excision, if the magnitude of the necessary oper- 
ation increases in a direct geometric ratio and the chance 
for cure diminishes in a reverse geometric ratio with the 
lapse of time since inception, what is the duty of the pro- 
fession, especially in its orgnnized function and in its altru- 
istic aim, towards the hundreds of thousands of fellow- 
creatures who now, without suspicion of the dreadful truth, 
are in the pre-cancer or early curable stage of cancer? 
What is the duty of the profession toward the hundreds of 
thousands who will be stricken next year and each year to 
follow? This duty is to undertake a campaign of cancer 
education. The public is entitled to receive from the pro- 
fession all the enlightenment required for self-preservation: 
It may be difficult to persuade a man to change his political 
tenet or his religious creed- Sentiment here may bind him 
closely. There is no tie of sentiment between a man and his 
cancer. Enlightenment ought to be easy and effective. 

458 The Plexus. 

Finally, a careful consideration of the progress made in 
cancer research and in treatment should banish despair, 
give new hope, and urge all to put forth still greater 
eddeavor to conquer in the end. 


You may talk about apartments or the finest kind of flat; 
And tell about your grand hotels — the swellest ones at that; 
You may rave about a mansion or a villa in far Rome; 
But I'll go you one still better yet— and that's my home. 

The dearest wife that ever lived, and still a bride by jing! 
Her hair is getting gray; but say! you ought to hear her 

When she puts the kids to bed at night, she murmurs soft 

and low 
Those dear old tunes our mother sang years and years ago. 

And when the babies, tired out, are off to Bylow land, 
She kisses 'em and tucks 'em in with tender mother hand. 
And then we sit together there and talk awhile and dream, 
A-building castles in the air in the firelight's dancing gleam. 

The king may have his palaces — no envy stings my heart; 
Grant him all his soul desires — I have still the better part. 
Ah! give the rich their mansions fine where'er they chance 

to roam, 
But for me my little cottage neat — 'tis home, sweet home! 





Channing W. Barrett, M D., Chairman. 

T. A. Davis, M. D. W. E. Gamble, M. D. 

A. R. Johnstone, M. D., Editor. 


L. H. Nowak, 08. Ray Essick, '08- Gustav Eck, '09. 

William G. Epstein, '10. 
Atheletic Editor. C. H. Tillotson, '06. 

Alumni Editor, John Wehtherson, '00. 

Library Dept., Metta M. Loomis. 

Publisher - - - - J. E. Forrest. 

Subscription $1.00 per Annum in advance. Single copies, 15 cents. Issued 
Monthlj. Send all communications and remittances for subscriptions and adver- 
tising to J. E. F0RKBST, Batavia, Uliaois. 

Entered at Batavia Post Office as Second-Class Matter. 

Any subscriber desiring the Journal discontinued at the expiration of his sub- 
scription should so notify the Publishers; otherwise it will be assumed thai the 
subscription is to b>= continued and the Journal sent accordingly. 

Contributions of matter suitable for publication are invited, and should be sent 
sn not later than the 25th of the month previous to that of publication. The pub- 
lishers will not hold themselves responsible for the safe return of MSS. unless 
lufflcie-t stamps are forwarded. 

Send contributions to A. R. Johnstone, M. D., Editor,;4l47 Lake Ave., Chicago. 


Dr. William M. Harsha is contemplating a trip to the 
Canadian Northwest. 

Dr. T. B. Wiggin has just returned from an automobile 
trip through Wisconsin. 

Dr. Daniel N. Eisendrath has been appointed professor 
of surgery in the college. 

Dr. H. C. Phifer and Mrs. Phifer are taking a lake trip 
to Buffalo and Niagara Falls. 

460 Dentistry. 

Dr. J. H. Port will shortly finish an interneship at Chi- 
cago Hospital and is going to his home in Iowa for a vaca- 
tion before deciding on his future location. 

Dr. Rubert H. Buck, class '07, completed his interne- 
ship at Lakeside Hospital in June and has established him- 
self on the corner of Cottage Grove and Brown Avenues. 

Dr. William W. Wood, class '06, has bought the prac- 
tice of Dr. J. H. Bong at Jasper, Piperstone County, Minne- 
sota. Dr. Wood served an interneship at the Lakeside Hos- 
pital, and has shown himself to be competent and energetic. 
We predict success for him. 

A doctor who did not graduate from the P. & S-, but 
who has been in practice for several years asked the 
writer the other day what the commissioner of health meant 
by suggesting that tuberculin be used for the purpose of 
making a diagnosis in early tuberculosis and how one could 
tell if he did use it. This doctor has a licence to practice in 
this state that is just as good as anyone elses. 


Any man who is living today without a telephone in his 
home — at a cost of a few cents per day — is refusing to econ- 
omize. It saves its cost and we haue rates for all purses. 

Chicago Telephone Company. 




BATAVIA, ILL., AUGUST 20th, 1908. 


The Inter Ocean recently published an important report 
regarding the conditions of pupils of the public schools. 
This summary may be of interest to the dentists: 

With the assistance of Dr. Herman Spalding and a corps 
of medical inspectors, the Chicago health department recent- 
ly examined 3,953 school children, and the report based upon 
this examination has just been made public. 

No less than 2,389 of the pupils examined, it is stated in. 
the report, were found to be physically defective and in need 
of medical or surgical treatment, or of both. That is to say, 
60.7 j}er cent of the children examined are pronounced 

Here are the different things which the examiners found- 
to be the matter with the defective majority: 

Defects of teeth 100 

Hypertrophied tonsils. .„ 807 

Defects of hearing 709 

Enlarged glands. 686 

Defects of palate 252 

Adenoids 226 

Anemia. 168 

Malnutrition .... 145 

Defects of nasal organs • 135 

Defective mentality ........' 78 

Cardiac diseases. 46 

Skin diseases 56 

Defective vision. 26 

Pulmonary diseases. , 18 

Nervous diseases ...» ( . 14 

462 The Plexus. 

At first blush this showing looks very bad indeed. No 
doubt it startled many a mother and father yesterday, and 
caused a melancholly feeling to obtain possession of them 
for a time. Even the mothers and fathers of children who 
had not been subjected to this examination could not help 
assuming that their little ones must also be stricken, as it 
stood to reason that the percentage named could not be con- 
fined to any particular group of children but must affect the 
entire half million included in the parochial and private 
schools as well as the public schools, and the impression 
created by the report that there were in Chicago not merely 
hundreds nor thousands nor tens of thousands, but actually 
hundreds of thousands of unhealthy children, was sufficient 
not only to depress parents but to make grandparents, 
uncles, aunts, cousins and intimate friends feel as wretched 
as they very well could. 

The following from the Chicago dailies: 

Dr. Bernard J. Cigrand. who was again chosen last 
night as president of the library board, is well acquainted 
with the work of the board, having been recently reap- 
pointed to his third term as member. He is prominent in 
school and dental circles, being a graduate of the Valparaiso 
University scientific course and the Northwestern Univer- 
sity school of dentistry. He held the chair of prosthetic 
dentistry for many years at Northwestern, later becoming 
dean of the University of Illinois dental department, which 
position he held for four years. In 1900 he was the Illinois 
delegate to the international dental congress in Paris. Dr. 
Cigrand is the author of many historical and professional 
works and lectures on themes relating to the history of col- 
onial America. 

Geo. W. Cook, D. D. S., writes: About a decade ago I 
presented some investigations on the bacteriology of decayed 
human teeth. From that time up to the present I have 
studied and observed with interest a number of phenomena 
that are striking, in that they furnish an extensive field for 

Dentistry. 463 

further investigation. I had devoted about three years 
prior to the time above referred to to investigate the possi 
bilities of tissue beyond the apical ends of the roots of teeth 
becoming infected by some of the more pathogenic forms of 
bacteria, especially those of tuberculosis and actinomynosis. 
On following up these distinctive pathologic conditions I 
have isolated, and studied with some care, a large number of 
bacteria found in and around the tissues of tooth substance. 

These observations have been verified, both by a clini- 
cal and experimental standpoint, by others. I have also 
added to the list of cases. At that time I reported a number 
of well defined cases of infection, I am better prepared at 
this time to state that the observations then made were 
founded on correct basis. 

That infection of a tubercular nature can pass through 
the pulp canals of teeth into the surrounding tissues, far 
beyond the seat of entrance, is a fact beyond any question. 
When I say pass through the pulp canals of teeth, I do not 
wish to be understood as saying that these microorganisms 
will pass through the healthy pulp tissue, but that they will 
pass through after the pulp has been completely disinte- 
grated. This has been demonstrated. 

The above appeared in the June Dental Digest. 

The National Dental Association has authorized the fol- 
lowing committee to edit and publish the history of Dentistry. 
Any person desiring copies of this extensive work may 
write to any of the members of the committee. The work 
will sell for $5.00, limited and subscribed edition only. The 
committeemen are: 

Charles McManus, Chairman, 80 Pratt St., Hartford, 

Burton Lee Thorpe, Secretary, 3605 Lindell Blvd., St. 
Louis, Mo. 

E. C. Kirk, Dental Cosmos, Philadelphia, Pa. 

H. L. Ambler, 176 Euclid Ave., Cleveland, Ohio. 

James McMannus, 80 Pratt St., Hartford, Conn. 

Wm, H. Trueman, 900 Spruce St., Philadelphia, Pa. 

464 The Plexus. 

S. A. Freeman, 262 Jersey St., Buffalo, N. Y. 

B. J. Cigrancl, -North and Milwaukee Aves., Chicago,* 111. 

C. J. Grieves, Madison and Park Aves., Baltimore, Md. 
J. Y. Crawford, Jackson Bldg., Nashville, Tenn. 

C. S. Butler, 267 Elmwood Ave., Buffalo, N. Y. 
W. E. Boardman, 419 Boylston St., Boston, Mass. 
E. R. Warner, 401 California Bldg., Denver, Col. 
C. N. Bailey, Minneapolis, Minn. 
G. O. Orr, Jordan, Minn. 

— Exchange. 

There will be a Dental Manufacturers' Exhibit held at 
the Sinton Hotel, Cincinnati. O., on Tuesday, Oct. 27th, 
Wednesday, Oct. 28th, Thursday, Oct. 29th, and Friday, 
Oct. 30th, with Monday, Oct. 26th, allowed for setting up 
the exhibits, and Saturday, Oct. 31st, for packing up. 

Clinics from Illinois at the National Dental Association, 
which meets at Boston, are: 

Lee K. Stewart, D. D. S., Chicago, 111.: " Large Gold 

Leo E. Evslin. D. D. S., Peoria, 111.: "The Evslin 
Interchangeable Teeth." 

Gustav E. Fritz, D. D. S., Peoria, 111.: "The Evslin 

A. M. Harrison, D. D. S., Rockford, 111.: " Zinc-silicate 
Lining for Porcelain Inlays." 

W. B. Young, Jacksonville, 111.: " Some of the Uses of 
a Casting Machine." 

It may be encouraging to American dentists to hear 
from the London Chronicle what fees can be collected in En- 
gland. Edwin J. Richardson, the dentist of Brook street, 
Grosvenor square, London, Eng., is claiming from Mr. 
Fremlin, a brewer of Maidstone, £570 for dental services 
rendered to his wife. The claim is contested on the ground 
that the charges were not fair and reasonable. Cross ex- 
amined, Mr. Richardson admitted that he had charged as 
much as £3,000 for putting a mouth in order. 

Dentietry. 465 

The dentists of the Southland have sent out a circular 
broadcast in which these questions are to be answered: 

Do you consider pyorrhea alveolaris incurable? 

Do you know of any cases that have been cured? 

In what stages were the cases when first under obser- 

Have you ever recognized the disease before serumal 
calculus appeared? 

What were the symptoms? 

Do you think salavary calculus has any effect on the 

Were the patients under your observation of robust or 
delicate physique? 

Have you ever seen the disease in youth, and at what 

Do you know of any properly treated devitalized teeth 
being lost by the disease? 

Did the devitalization and root canal sterilization and 
filling precede or follow pyorrhea development? 

At what time of life do you find treatment most effica- 

Do you find pyorrhea more in males or in females? 

Do you find it more in the upper or lower jaw? 

Does the disease attack all teeth alike? 

Were patients ever afflicted with syphillis, tuberculosis, 
uricaemia, chronic indigestion or chronic constipation? 

Have you ever seen patients where malocclusion was the 

Do you think auto-intoxication a cause? 

Do you think uricaemia a cause? 

Is it a disease of the gum? 

Is it a disease of the aveolar process? 

Is it a disease of the peridental membrane? 

(It is of the utmost importance, in order to insure 
the success of this vital investigation, that your society 
should take this matter up at once and favor us with an 
early answer, giving the disposition decided upon at your 
meeting and action taken.) 

466 The PlexnB. 

The list of questions which you also receive with this 
letter is to be answered by you and to be forwarded to the 
chairman of this committee. We hope in this way to arrive 
at a settlement of some of the questions, and we may in the 
future be able to obtain aid from the government to ferret 
out the cause, treatment, cure and prevention of this dis- 

Yours fraternally, 

E. H. Ramelli, Chairman. 
No. 620 Canal street, New Orleans, La. 


The arrested activity for the time being of secretion of 
the glands and mucous membrane during any of the infecti- 
ous fevers is liable to be the forerunner of some pathological 
disturbance or render the parts so that they may be predis- 
posed to diseased conditions many years after the individual 
has passed through a spell of fever. The morbid anatomy of 
the jaws and teeth, or the disturbed physiological function of 
the glands and mucous surfaces, may be the result of some 
one of these acute febrile diseases. — G W. Cook. 




P. M. Goodman, Ph. G., C. S. N. Hallberg, Ph. G., W. A. Puckner, Ph.G 

H.H.Rogers, M. D., Ph. B., E. N. Gathercoal, Ph. G., 

A. H. Clark, Ph. G., C. M. Snow, Ph. G. 

WILLIAM B. DAY, Editor. 
CLASS EDITOR: W. D.Mottar, '08. 


During the past few years the association spirit has 
been awakened among American pharmacists. This spirit 
has led to the multiplication of pharmacists organizations 
and societies in every section of the country. The Ameri- 
can Pharmaceutical Association, the first national organiza- 
tion in the field, has benefited to some extent, but not as 
much as it should, through this awakening. The organiza- 
tion of local branches of this parent association in all the 
large cities has resulted in a considerable increase in the 
membership and has been a great stimulus in developing 
new fields for the association. In this movement for pro- 
gress the monthly Bulletin of the A. Ph. A. has played a 
prominent part. 

While the American Pharmaceutical Association has 
developed largely along scientific and professional lines, 
there has been also a tremendous increase in organizations 
which are devoted chiefly to commercial interests. The 
National Association of Retail Druggists has demonstrated 
that it is in the field to stay and in spite of adverse legal 
decisions it 'has constantly increased in numerical strength. 
The state pharmaceutical associations,' established chiefly 
with a view to controlling legislation affecting pharmacy, 
have grown steady in numbers and influence. City and 
county organizations have sprung into being and have found 

468 The Plexus. 

a most effective means for bringing about desirable changes 
and modifications of trade conditions. 

Among these local associations the Chicago Retail 
Druggists Association is one of the strongest and includes 
nearly all of the proprietors of drug stores in Chicago. 
Fully 100 county organizations in;Illinois alone are doing 
good work for pharmacy, and similar conditions are to be 
found in other states. "While this constantly increasing 
number of pharmaceutical societies indicates a healthy dis- 
content with the existing conditions and a desire for im- 
provement, as woll as a knowledge of the good which may 
be brought about only through organization, still it would 
be most desirable to have these various bodies so correlated 
ai to work more effectively. 

, In both of the national organizations plans for reorgan- 
ization are being discussed. It would be a benefit for 
pharmacy if these national organizations could be consoli 
dated and governed by delegates from the local, city, 
county and state societies. The present system results in 
much waste of useful effort and is unnecessarily expensive. 
Many druggists are paying dues in city or county, state and 
both of the national organizations. It has been suggested 
that the general plan of the American Medical Association 
be followed in the reorganization and the consolidation of 
these various pharmaceutical societies, and should this be 
done there will no doubt be developed a strong journal 
which will be the organ of the new association and which 
may be relied on to greatly advance its interests. 

The pharmacists of the country are deeply interested 
in the coming annual meetings of the two national associa- 
tions, since these questions will come up for discussion. 

The American Pharmaceutical Association meets at 
Hot Springs, Ark., September 7-13, and the National 
Association of Retail Druggists in Atlantic City, September 
14th to 19th. 

Pharmacy. 469 


Francis G. J. Stieber, '96, and. Miss Mabel Kidd were 
married at Buffalo, N. Y., August 4, 1908. 

Lotie L. Huston, '07, and Miss Rena Secord were mar- 
ried at Chicago on July 22, 1908. 

W. B. Behrens, '94, is now representing the Pitman- 
Myers Drug Co., of Indianapolis, Ind., and has changed his 
home address to Mahomet, 111. 

Franklin F. Stebbings, '95, has sold his drug store at 
Bradley, 111., and has moved to Chico, Cal. 

Edwin L. Franken, '86, was recently elected president 
of the Iowa Pharmaceutical Association. 

In response to the letter of inquiry recently sent to the 
alumni of the school, the following changes of address 
have been reported: 

Fred Voegeli, '80, formerly of Fountain City, Wis., is 
now at Bozeman, Mont. 

Dr. J. L. T. Davison, '81, formerly of Pueblo, Colo., 
now at Snohomish, Wash. 

Chas. F. Sturges, '80, formerly of Buffalo, Ark., now 
at Keystone, Ark. 

Louis R. Schwanke, '04, formerly at 445 E. North Ave., 
Chicago, now at 95 Evanston Ave., Chicago. 

A. T. Schleder, '02, formerly of Peoria, 111., now "at 
Lena, 111. 

Leslie W. Kinyon, '80, formerly of Denison, Iowa, now 
at 5301 State St., Chicago. 

Dr. Chas. H. Schmidt, '02, formerly at 380 N. Ashland 
Ave., Chicago, now at 315 Haddon Ave., Chicago. 

Louis Schreiber, '00, from Columbus, Neb., to Cedar 
Bluffs, Neb. 

C. G. McDow, '06, from C, Juarez, Mexico, to El Paso, 

470 The Plexus. 

J. W. Robinson, '06, from Aurora, 111., to Peru, 111. 

Frank B. Stephens, '87, has removed from Toledo, 
Ohio, to St. Augustine, Fla., where he is now a member of 
the firm of Stephens & Speer. . 

George P. Mills, '84, is taking an active part in the 
propaganda for U. S. P. and N. F. preparations. He is 
secretary of the Pharmacological Society of Evanston, 
which society includes practically all the physicians and 
pharmacists of that progressive suburb. He reports in- 
creasing interest by both pharmacists and physicians in the 
new movement. 

Max Sobel, '98, is proprietor of a. prosperous pharmacy 
in Berkeley, California. Mr. Sobel w&s for several years 
secretary of the Alumni Association and his many friends 
will be pleased to learn of his success. 

Charles Howk, '01, has sold his drug store at 61st St. 
and Princeton Ave., Chicago. 

Alfred W. Norling, '91, died at his home, Galva, 111., 
Feb, 16, 1908. 

Elmer E. Cassin, '07, and H. A. Langenham, '08, will 
en terthe school next session and take the course leading to 
the pharmaceutical chemist degree. 

Of the last Junior class, Robt. E. Ford, recently regis- 
tered by examination in Colorado and John G. Howly passed' 
the Wisconsin Board of Pharmacy for full registration. 
Wm. Bock and Adelard Marcotte registered in full in Illinois. 
The indications are that there will be a larger number of 
juniors than usual return for the senior year. 

Pharmacy. 471 


Since I last visited Peoria there has been a marked 
change in pharmacy, more marked I fear than the change 
in the metropolis of Central Illinois, although I notice that 
the town tries to keep pace with the times by erecting some 
fine skyscrapers and having beautifully paved streets, but 
at the last time I met with the association in Peoria there 
was no particularly bright prospect for pharmacy. It was 
the same as it had been for many years past. A large 
portion of our youths would learn the business and attend 
school, some would not attend school, some would register 
by passing the examination and they fared just about as 
well as those who attended school. In fact, there was no 
great necessity for spending any particular time or money 
to qualify to practice pharmacy or to learn to conduct the 
retail drug business. The physicians after all have to be 
largely depended upon in certain localities. In a way they 
thought that a nice tasting preparation could not be made 
in a pharmacy. It could be made anywhere else, as many 
of them were made, and as we have found out livery stables 
and rolling mills are the headquarters and laboratories of 
some of these wonderful chemical companies that have been 
furnishing the public with medicine through us and the 
medical profession. 

In consultation about this time with Professor Oldberg 
about the condition of affairs he said: "There is no hope, 
there is no one to do it. Some one has got to break into 
the medical profession and through the physicians correct 
this untoward condition." 


It so happened that I with a group of leading physi- 
cians from Chicago attended the meeting of the American 
Medical Association eight years ago when the section of 
Pharmacology and Therapeutics — the only section in which 
pharmacy was represented — was to be abolished. Not 

'Address delivered by Professor C. S. N. Hallberg before the 29th annual meeting of 
the Illinois Pharmaceutical Association at Peoria, June 9th to 11th, 1908. 

472 The Plexus. 

knowing this, I wasaelected secretary in the morning while 
the section was abolished in the afternoon. But this action 
required ratification by the executive committee before final 
determination and we succeeded in having the abolishment 
of the section deferred to the next year. We then began to 
get action on some of the leading medical men of the 
country and we have hung on to them ever since. We do 
not claim any priority or credit for what we have done in 
this matter. The only credit that we might claim was that 
we stuck to it. The more difficult it became the more 
strenuously we endeavored to bring this question before the 
medical profession. It was very discouraging at times, but 
after a while we began to see the light; I shall not give you 
any details of the movement which was long and tedious, 
but simply refer to some of the results, and possibly also to 
one or two experiences. 

When we first began, medical men resented the idea 
that pharmacy was concerned in this movement, it was a 
movement for doctors and not druggists. However, as the 
matter progressed they soon saw that the movement could 
not succeed without the druggists being associated with it. 
That it was useless for the physician to give up the pre- 
scribing of proprietary medicies without having the retail 
pharmacists to rely upon to prepare the medicines. Very 
soon the attitude of the leaders of the profession was com- 
pletely reversed. It seemed as though the average medical 
man was not better posted on medicines than the average 
intelligent layman. When it is said he is only well posted 
as the average layman it is not exaggeration, and I believe 
that the medical authorities and the men who know of the 
condition are willing to concede that. When we realize 
that, then do we know where we are at. f nd we will then 
understand why we have never been able to do anything 
with the physicians. Every effort on the part of the phar- 
macists, such as have been instituted at the revision of the 
Pharmacopoeia and also of the National Formulary endeav- 
oring to line up the physicians, but it had no definite effect, 
because they did not realize, could not understand what it 

Pharmacy. 473 

was, and the only way that they could be reached was 
through their own men whom they regard as authorities, 
particularly the journal of the American Medical Associa- 


The A. M. A. membership of nearly 50,000 begins with 
the county society, then extends into the state society, from 
state into the national association. The association pub- 
lishes a journal, the greatest medical weekly in Ameriea, if 
not in the world. The revenues from this journal in sub- 
scription amount to a great sum, as do also the adver- 
tisements, but of recent years certain advertisements have 
been refused which brought to ahead this whole movement. 
All kinds of proprietary medicines were offered to the 
physicians through advertisements in the journal, and were 
accepted by the'general manager in order to make as good 
a financial showing as possible. The result was that some- 
thing had to be done and the particular head of this move- 
ment was the organization of the Council on Pharmacy and 
Chemistry three years ago. 

The chief object of this council was to pass upon the 
medicines offered for advertisement in the journal. And 
only such as received the O. K. of the council could be 
admitted to the advertising pages of the journal. Thus a 
great many of the largely sold preparations were excluded 
and now the state medical journals are following the plan 
of the journal of the A. M. A. and the advertisement of a 
medicine which cannot be admitted to the advertising pages 
of the journal of the A. M. A. will not be admitted to the 
medical journals of this country, except those which are 
conducted for the benefit of the publisher. Since this work 
began there has been not only wonderful developments, but 
great interest has been created in the movement by the 
medical profession throughout the country. 

You have no doubt heard of these exposures of false 
claims; where the formula would be printed on the label 
while perhaps the chief ingredients would be left out. 

This movement was threatened with being stopped 

474 The Plexus. 

because of attacks from boih sides. But now the move- 
ment has got so far along that it cannot be stopped. The 
physicians are taking an active part in this, not for our 
benefit — they are doing it simply to save themselves. A 
physician writes a prescription for Gray's Glycerin Tonic 
and the patient brings it to the pharmacist who puts it up. 
The next time the patient will go direct to the druggist and 
ask for it, afterwards he may get it from a cut-rate place on 
State street, and recommend it to the whole neighborhood. 
Soon the public finds that there is nothing to it, then try 
other patent medicines which are advertised, for instance 
something on the Peruna type; anything that looks good, 
is prettily colored and tastes sweet. But when no perma- 
nent relief or cure is found, the various quacks such as 
Osteopaths, Dowieites, etc., are patronized, and before long 
the end is with the Mary Baker Eddyites. The result is, 
and I believe I do not exaggerate, when I say that one-half 
of the people in Chicago are doing without pharmacists and 
physicians in the treatment of their ills; they are the people 
who have the money and we are not getting it. The other 
half who have not the money seek places where they can 
get free service. Is it a wonder that there is anything left 
of the legitimate drug business? 


I believe that the public is waking up, I think that the 
people are realizing that there is nothing to these fakirs 
and I believe that the business is beginning to indicate a 
change in our pharmacies. 

Every individual is concerned in this movement that we 
should handle the medicines of the day and put them up m 
a nice form. We are in a position to do this at the present 
time. I believe that the public is now ready to come back 
and regard the pharmacist with respect equal to the family 
physician. I believe that the pharmacist can do a great 
deal; he is in a position in ihe store where he will always 
offer assistance and be ready to belp the people and say a 
good word for the physician. It is high time that the 

Pharmacy. 475 

pharmacists and physicians be working hand in hand. To 
save his practice the physician must quit patronizing pro- 
prietary medicines. He cannot any longer be the unpaid 
peddler of these patent medicines. The patent medicine 
manufacturers are being beat on all sides and here is where 
we profit. We have a claim on this business and should be 
glad to do it. There is no reason why pharmacists should 
not be able to make and prepare the medicines in their 
pharmacies after tbe Pharmacopoeia and the National 

Some preparations, such as fluid extracts, that can be 
bought just as good as he can make, there is no objection to 
getting readymade from any of the reputable manufacturing 
houses. Some of the more difficult preparations of the 
U.S. P. and N. F. it is better to get from the manufacturer 
than not to be able to supply them. If we fail, the physician 
may also fail and think it is no use to prescribe these 
remedies if the pharmasist is not in a position to make them. 
Remember every little weakness of this kind and neglect on 
our part will injure and retard this movement for reform. 
We do not want to reduce the position of the pharmacist in 
the eyes of the public. 


We have the physician now where he will not go back 
to proprietary medicines and the young men in the medical 
schools are taught so they will not prescribe them. If we 
are not able to supply their wants and with official medi- 
cines, they will dispense on their own account, which is a 
difficult proposition as physicians are not in a position to do 
full justice to their patients. 

Now a word about the propaganda. The Chicago Medi- 
cal Society has 13 or 14 branches divided in as many districts. 
Each branch meets every month and we have no difficulty to 
arrange with the Secretaries for joint meetings of the 
pharmacists and physicians. At these joint meetings this 
last winter we introduced a Declaration on the Prescription. 
We consider it important that there should be some kind of 
an understanding about the prescription. Some physicians 

476 The Plexus. 

have quit writing prescriptions. What is the use of writing" 
prescriptions which will be copied and sometimes be used by 
the whole neighborhood? This we must correct first. It is 
not right, it should be stopped. The physicians and phar- 
macists should come to an understanding about this. So we 
formulated in conjunction with the Chicago Medical Society 
a Declaration on the Prescription which no doubt most of 
you have seen. This has been presented at eight district 
medical societies. We did not get started in time to get 
around to all fourteen, but will continue this work next 


Dr. Fantus, who is Professor of Materia Medica, in a 
Chicago medical college, has been very active in this regard 
and has helped to arrange these programs. At one of the 
branch meetings a physician reads a paper on Anemia, 
which is always an interesting subject to the physician. 
Then a paper is read on Iron, because you could not discuss 
Anemia without bringing in Iron. Then a pharmacist reads 
a paper on Iron Nostrums, giving a brief history of the 
various iron preparations, such as Iron Peptonate, etc. Then 
comes a pharmacist wilh the iron preparations of the Phar- 
macopoeia and N. P. which supplements the one before and 
who shows preparations of his own make and also other 
preparations. Then there is a general discussion among 
the physicians. Incidentally you should have all the pre- 
parations ready before any discussion. 

I believe there is scarcely a county in Illinois where there 
is not a Medical Society and even if there are only two or 
three druggists, they should attempt to get before the 
physicians. There is no particular practice in speaking 
required. Take some of the preparations with you and 
show them to the doctors. They will speak for themselves. 


In conclusion I would like to say that there are some 
80 institutions in this country teaching pharmacy. Some 40 
or 50 of these particularly have been sending out 40 and 50 
and even a hundred graduates each year to do what? To 

Pharmacy. 477 

practice making preparations of the Pharmacopoeia and 
National Formulary that they have been taught to do in the 
laboratories. No, they very seldom get into a place where 
they have an opportunity to make these preparations. Have 
these years spent in school been wasted when they cannot 
make use of the knowledge gained while going to school? 

There is only one way to maintain our position as a pro- 
fession, and that is with the physicians' aid to correct this 
proprietary medicine evil. 

Now there is hope for the first time and at last there is 
an opportunity in Pharmacy. There is no reason why more 
young men should not take up the study of Pharmacy and 
become qualified. I believe that very soon we will be able 
to recover the lost ground not only with the physicians, but 
also with the public, and when we do the pharmacist will 
come back to his own because there is really only one thing 
to pharmacy and that is to practice pharmacy. 

He then would not need to handle the innumerable other 
articles which he must now have in order to make a living 
for himself and family. 

Caps and GownS made to order and rented 
Pennants for all colleges carried in stock. 

P. & S, Pennants, Fcbs,E U 







VOL XIV. B ATA VI A, SEPTEMBER 20th, 1908. NO. 9 


By Vard H. Hulen, A. M., M. D., San Francisco. 

Final lecture to Medical Class, University of California, April 28, 1908 

This seems a fit and proper occasion to remind you who 
are entering upon a medical career that you cannot afford, 
as so many medical men have heretofore done, to ignore the 
invaluable facts to be gained concerning the general condi- 
tion of a patient by correct ocular examinations which are 
open not alone to eye specialists but to all practitioners. 

In this day it shocks us all to read in the recently issued 
Life of Nathan Smith Davis: "It is a well known fact that 
this distinguished physician had a thorough contempt for 
specialists which he could not conceal if he would and would 
not if he could." The reason for such prejudice in this great 
medical educator is contained in an address delivered more 
than twenty-five years ago by a president of the American 
Medical Association in this sentence: "It cannot be denied 
that the early and exclusive study of the affections of a part, 
and that often a very small part of the body, has a tendency 
to narrow the intellectual grasp and cramp the powers of a 
man who yields to the influences incident to such partial and 
onesided training." 

The importance of avoding this danger was through 
precept and example emphasized long ago by many of the 
eminent ophthalmologists of their day, and notably by that 
great man, Henry D. Noyes, who truly said: "The specialist 

478 The Plexus. 

must be well educated in general medicine and surgery and 
in all their departments. No part or organ can be isolated 
from the rest of the body in health nor can it be isolated in 
the phenomena of disease." 

It has long been recognized that 1 the medical graduate 
must first have some years of general practice, preferably 
preceded by a hospital interneship before specializing. 

v At this time the competent ophthalmologists all over the 
country are most actively interested in general diseases, they 
attend the general medical societies and take part in the dis- 
cussion of papers and cases there presented. No longer is 
there occasion to advise specialists of the danger that they 
may become narrow and isolated, but great is the necessity 
to warn the general physican against the danger and disad- 
vantage from his neglect to invade the fields of specialism. 
It may not be advisable for the general physician to treat the 
eye, but he should learn well the eye lesions of both local 
and general origin, not only thereby adding to his knowl- 
edge of disease but to better protect his patients- 

Recently Dr. Edward Jackson, in a masterly and oppor- 
tune address, has called attention to the fact that the physi- 
cians and surgeons who remain ignorant of ophthalmology 
and ignore eye lesions are more common than the occu- 
lists who remain ignorant of the advances in general medi- 
cine and surgery. He says: "If the general profession is to 
be brought to appreciate the importance to it of modern 
ophthalmology we must begin with the medical student. Ad- 
mit that the average medical student does not look forward 
to practicing ophthalmology, neither will he practice chem- 
istry for a profession, nor dissection, nor pharmacology. The 
great mass of medical men will leave bacteriology and path- 
ologic histology in the hands of specialists. Yet these 
branches claim a large proportion of the years spent in un- 
dergraduate study. Their educational and developmental 
value, which are unquestioned, and which justify the atten- 
tion paid to them, is less closely related to practical medi- 
cine and surgery than that of a similar training in the ex- 
amination of the eye, particularly with the ophthalmoscope. 

The Medical Man's Eye Knowledge. 479 

Twenty-eight years ago Gowers suggested that all medical 
students should be taught to use the ophthalmoscope as a 
part of their course in anatomy. Has not the time arrived 
when this suggestion should be carried out? In the enor- 
mous swelling of the choked disc and in the great changes 
in the color of the disc and in retinal or choroidal pigmenta- 
tion compatible with full vision, we have evidence that ana- 
tomic appearances may prove misleading." 

There is no more profitable and practical thing in medi- 
cine than the study of the eye in its relationship to general 
medicine, and no more fascinating and instructive subject 
than that of ophthalmoscopy, this has been the experience 
of all practitioners of medicine who have advanced beyond 
the initial stage in the use of the ophthalmoscope. With the 
ophthalmoscope functionating arteries, veins, nerves and 
nearly all varieties of tissue may be minutely examined in 
their relation to physiology and pathology. And yet world 
renowned physicians who spend years in the investigation of 
dead and artificially prepared tissues ignore absolutely the 
study of similar living elements to be seen in the eye. 

The palpation of the radial artery in every patient is 
universal and constant, then how can medical men consist- 
ently disregard the study of the circulation as seen so beau- 
tifully in the eye ground and when it offers so much more 
than the commonplace radial pulse. 

In addition to the great variety of tissues in the eye 
their complete accessibility and transparency supply a field 
for profitable study with which no other part of the body 
can be compared. 

The eye must yet and may soon have its day with the 
student of medicine. One dares not predict what advance- 
ment the study of the ophthalmoreaction to the tubercle 
and typhoid baccilli may be the beginning of along similar 

There are few general diseases that do not sooner or later 
show changes in the eye, for to repeat, nearly all the tissues 
found in the body are present in the eye so that the occular 
changes are a part of the general pathological process- On 

480 The Plexus. 

the other hand many abnormalities of the eye extend their 
influences to other parts of the body and there appear to the 
general practitioner, who must recognize the ocular origin 
to properly treat the patient. 

That syphilis does frequently invade the various parts 
of the eye is well recognized, but it is less known that an eye 
lesion may be pathognomonic of lues and when observed 
with the ophthalmoscope the patient need not be submitted 
to embarrassing questions which only tempt prevarication. 

That nephritis will produce characteristic ocular lesions 
is generally known, but it is also as true that the eye lesions 
may appear months before renal examinations will show any 

The eye is involved in many of the diseases of the brain 
and spinal cord but sometimes simple ocular changes may 
enable us to diagnose, for instance, tabes years before other 
conclusive symptoms appear. 

With six of the twelve cranial nerves distributed to the 
ocular apparatus and with the arterial, venous and lymph 
channels in the eye minutely visible while in connection with 
their central stations, we can well understand the truth as 
well as appreciate the poetry of the remark that with the 
ophthalmoscope we may '-get the first intimation of disease 
in remote and seemingly unconnected organs, so as to read 
as if in a book the written troubles of the brain, the heart, 
the spleen, the kidneys and the spine." 

All physicians without exception should use or have used 
for them the ophthalmoscope and perimeter, also obtain the 
corrected vision and results of intelligent ocular inspection 
as aids in general diagnosis and treatment. 

Furthermore, physicians in general practice should be 
able to make a positive and prompt diagnosis of many exclu- 
sively occular diseases, such as iritis, where only one drop 
of a solution of atropine may save the patient weeks of suf- 
fering and absence from business, if not his sight; glaucoma, 
in which, if mistaken for iritis, just one insillation of atro- 
pine would cause unmeasurable suffering and hopeless 
destruction of the vision. They must be able to recognize 

The Medical Man's Eje Knowledge. 48V. 

sympathetic ophthalmia and direct at once correct treatment 
without the danger of removing an invaluable though dam- 
aged eye. They must recognize the toxic amblyopias and 
direct with a definite medical purpose the positive abstinence 
from alcoholips and tobaccos, leaving the impression on the 
patient that the advice is that of a physician and not of a 
temperance advocate. 

He must make a bacteriological diagnosis of the differ- 
ent forms of conjunctivitis if he hopes to correctly treat 
them. The family physician must be ever ready to advise 
prompt interference in strabismus, no matter how young the 
patient, and explain to the parents the necessary methods, 
of treatment to gain their co-operation at the correct time; 
to hold out the disastrous hope that the child will "outgrow r " 
squint is now nearly criminal. Then we may have no more 
cases of disfiguring cross-eyes, lamentable amblyopias, ab- 
sences of binoccular vision, etc., in adults. He should be 
able to recognize the different varieties of cataract and 
advise intelligently the kind and time for treatment. He 
should understand the importance of eye strain and the 
methods of its correction. Many otherwise informed physi- 
cians believe that people who see remarkebly well in the 
distance are "farsighted,'' that those who hold the print 
close to the nose are nearsighted, and that "everybody has 

He should know the correct methods of measuring-, 
refraction, then he will understand that the refraction of the 
eyes in most patients under forty and many over that age 
cannot be accurately estimated without using a drug to sus- 
pend the accommodation, and therefore only a physician 
should prescribe glasses. 

He should remember that insanity, epilepsy, choreEK,. 
migraine, hysteria, neurasthenia, vertigo and headaches- 
may be in part or entirely due, directly or indirectly, to cor- 
rective eye strain; that menstruation, pregnancy, and 
lactation may profoundly affect the eye; that influenza may 
produce serious ocular lesions, especially retrobulbar neur- 
itis; that in malaria severe keratitis may appear, and in 

482 The Plexus. 

diabetes cataracts are not rare; that dipththeria often causes 
paralysis of the various occular muscles, both internal and 
external, as well as a most destructive ophthalmia may fol- 
low infection from the Loeffler bacillus. 

So in gonorrhea in addition to the violent ophthalmia 
from infection iritis and uveitis sometimes occur. 

In vaccinia destructive infection of the eye sometimes 
happens. Rheumatism may affect the ocular muscles as 
well as cause severe inflammation of the iris, sclera, and 
ciliary body. 

In all diseases of the kidneys, heart, brain, especially in 
suspected cerebral tumors and abscesses, should the eye- 
grounds be examined for significant changes. 

Pent up secretions in the frontal, sphenoid and maxil- 
lary sinuses, caries and necrosis of the ethmoid and sphenoid 
bones may produce "neuralgic pains,' and give orbital 

Chronic purulent inflammations of the ear and mastoid- 
itis endangering cerebral complications may show lesions of 
the eye-grounds. 

The medical student should become at least familiar 
with correct ophthalmic surgery in order to direct disrrimi- 
natingly eye cases to the proper sources for skillful treat- 

In fact there are so many things about the eye for you 
to know that, fearing to discourage rather than encourage 
you in the further study of ophthalmology, I must desist and 
bid you at this the practical beginning of your medical 
journey, bon voyage. 

Why I Write for Independent Journals, 483 


By Frank G. Lydston, Chicago. 

Professor of Genito-Urinary Surgery, University of Illinois. 

While attending one of the sections of the A. M. A. at 
the recent Chicago meeting, I was asked by a certain ethic- 
ally (?)hyperesthetic medico-literary snob, who industriously 
seeks for motes in his confrere's eye regardless of the beam 
in his own, why I wrote articles for "that fellow X's jour- 
nal." My answer was that it pleased me so to do. Although 
I am heartily in sympathy with the moral of a certain 
Rabelaisan story, which, in effect, is "to h — 1 with the other 
reasons," I'm going to expatiate, enlarge, amplify, elucidate 
and — "conflagrate" the thing a bit, earnestly hoping that 
the multitudinous ultra-ethical self -labeled medico literary 
perfecto will eventually be told what I have to say. Indeed, 
I'm sure he will, and, moreover, that he will stop browsing 
.among the thistles of discontent just long enough to gather 
new notes for his raucous, discordant bray — that bray of 
narrow-minded, illogical protest wherewith alone he attracts 
the attention of the professional rank and file to himself 
and, incidentally, of course, to his literary holy of holies, 
choked to the brim with intellectual sweepings from other 
men's garrets. 

Obviously, I am not bidding for popularity with certain 
self-styled journalistic "leaders." 

The feature of the better class of independent journals 
that appeals most strongly to me is the mere fact of their inde- 
pendence in wearing no brand or collar. As matters medico- 
literary are now trending, the day is not fardistant when the 
average practitioner of medicine will have no medium of 
expression, no literary representation and no literary pabu- 
lum of practical value within the comprehension of the 
average medical mind. Medicine is fast becoming so scien- 
tific, so turgid with "things that ain't so," or which are at 
least "under suspicion," that the main purpose of medicine, 
the healing of the sick, bids fair to be lost in the maze of 
laboratory experimentation and illogical deductions from 
mentally indigestible "facts" — scientific bricks without 

484 The Plexus. 

straw — from which none but a wizard could build an endur- 
ing fabric. What boots it to the practitioner of the cross- 
roads that there be opsonins and opsonic indices? He has 
neither the technical training, the appliances nor the time 
to practically apply them in his daily work. Besides, who 
knows how soon the opsonins will be gathered in the snows 
of yester-year? 

I fancy I hear the ultra-scientific ones cry, "Let the 
practitioner of the cross-roads and the hamlet hie him to the 
post-graduate school and cultivate — at so much a cultivate — 
'the optic nerve I ween that sees things which are not to be 
seen.' Let, also, the student of medicine be more thor- 
oughly prepared in things scientific.*' 

As to the post-graduate sohool, it often makes confusion 
worse confounded. Abdominal and other special surgeons 
"made while you wait"; men who entered the mouth of the 
hungry P. G. school, passed immediately through its short,, 
angleworm- like primae viae and promptly tumbled down the 
back steps with a special course certified in their hands, 
have not seldom outheroded Herod — which means that 
where the haughty professor of the P. G. course hath slain 
his dozens, some of his half-baked special students have 
slain their scores, aye, hundreds- 

Once on a time I was asked to respond to the toast, 
"Post- Graduate Schools."' (Be it understood, I myself was 
a P, G. professor then.) My speech was short and sweet. 
It was as follows: 

"Gentlemen, in response to the toast I will merely relate 
a story: Mascagni, the great composer, was once visiting 
New York. Whilst standing at his window in the Fifth 
Avenue Hotel, he chanced to hear the agonizing shrieks of a 
hand-organ. He listened and to his horror caught the 
strains of a discordant attempt at his own favorite composi- 
tion, the Cavalier ia JRusticana. He rushed madly down the 
stairs, seized the greasy organ-grinder by the shoulders, 
shook him and cried, 'You play eet horrible! De tempo is 
wrong! Play eet dis a way.' Suiting the action to the word 
he proceeded to illustrate as best he could on the wheezy 

Why I Write for Independent Journals. 485 

old organ. The next day as Mascagni was strolling in the 
neighborhood he saw a crowd gathered around an organ- 
grinder who was murdering the Vavalleria Rusticana. The 
great composer approached the crowd, peered through and 
saw his compatriot industriously working away at the same 
old organ. On the front of the battered musical relic was a 
large placard which read, 'Signor Pietro Sylvestre — Pupil 
of Mascagni.'" 

Our medical schools are responding with alacrity to the 
demand for ultra-scientific training. The ultima thule of 
medical teaching in some quarters apparently is the manu- 
facture of half-educated scientists, not trained physicians. 
Here is an illustration of some of the brilliant results. I 
recently had occasion to inquire into the knowledge of ma- 
teria medica and therapeutics possessed by a recent gradu- 
ate of a well known school, who, by the way, was one of the 
ten "Honor Men" in his class: 

Question — "What is the botanic name of the plant from 
which opium is derived?" 

Answer — "Poppy, I think." 

Q. — "What is the papaver somniferum?" 

A,— "Poke root." 

Q. — "What are the alkaloids of opium?" 

A. — "Morphine and atropine." 

Q. — "What preparation of aconite would you ordinarily 
prescribe internally?" 

A. — "Why, aconite." 

I suggested that the tincture was an eligible prepara- 
tion, and informed him that there were two tinctures. 

Q. — "What tincture would you give to a child?" 

A. — "The tincture of the root, because it's the milder." 

Q. — "What dose of the tincture of the root would you 
give to a child. six months old?" 

A. — "Oh, about half a drachm every hour," 

Q. — "Given the same child and a stimulating expector- 
ant being indicated, what would you give?" 
-A, — "Carbonate of ammonia." 

Q.— "In what dose?" 

486 The Plexus. 

A. — "Oh, twenty grains every three hours." 
Be it remarked that materia medica and therapeutics 
are taught in the sophomore year in the school from which 
this gentleman graduated. The treatment of disease is 
taught before the raison d' etre of treatment has dawned on 
the student's mind. But, this newly-fledged graduate knows 
a lot about the embryology of the chick — he had watched it 
for weeks — the nervous anatomy of the frog, neurons, opso 
nins and things — which knowledge is not likely to save from 
massacre the first hapless infant he treats. 

The independent medical journal meets the demand of 
the every day practitioner who wants to know "what to do." 
The self-styled high-class medical journal — and there is 
really only one "high-class" journal, you know, which is 
climbing so high that its head looks from below very like 
that of a pin — often gives him a stone when he asks for 
bread. He seeks for light on the treatment of disease, and 
on looking over the menu card presented by the "most 
high," he finds such things as "My Last Thousand Cases of 
Excision of the Calamus Scriptorius," "My New Postular 
Method of Catheterizing the Iter a tertio ad quartum ventri- 
culum" "The Opsonic Index in the Care of the Second 
Bicuspid," etc., and editorials in which the mantle of dignity 
conceals vast intellectual abysses. In despair he turns to 
that cemetery in which so many fond therapeutic hopes lie 
blasted and buried under tons and tons of therapeutic nihil- 
ism, Osier's Practice— and still he finds no balm in Gilead. 
And then he turns to the independent journal and is con- 
soled — which is a blessing, e'en though he be sometimes 
cajoled into belief in things unsubstantial. And the proof 
of the pudding is that thousands upon thousands of doctors 
buy and read the very journals upon which the "lily whites" 
of medical journalism frown so blackly. 

The practitioner knows full well that his patient wants 
something more than a diagnosis. When that has been made 
the ultra-scientific (?) dootor may be satisfied, but the afflict- 
ed one, like Chimmie Fadden, says, "That's all right, Doc. 
But, what fell?" And jujt because medical science has 

Why I Write for Independent Journals. 487 

whored too much after strange and weird scientific gods and 
has not told the patien "What fell?" quackopathy flourish- 
eth in the land and the high priestess of modern humbug, 
Mary G. Eddy, hath built sundry and multitudinous gold 
and marble palaces like unto the temple of Solomon. And, 
by the same token, any quackopathy which is not intrinsic- 
ally murderous and is a harbinger of hope, is often better 
than acute paranoia anti-therapeuticum Baltimorensis, which 
sets forth in dismal colors the disease, and threads the 
gloomy picture with not one silver strand of hope. Given a 
little hope, even though it be ill-founded, and the patient is 
likely to be better off than in the possession of the ' most 
accurate diagnostic knowledge which a pessimistic, ultra- 
therapeutic nihilist can offer. 

Be not vainglorious and puffed up, O ye macrocephalic 
ultra- "ethical,'' ultra- "scientific" Philistines. Time was 
when Hahnemann was the medical anti-Christ, the black 
beast of medicine. And here we are in the midst of an 
organo therapy which suggests that the sometimes befud- 
dled Samuel builded wiser than he knew. Auto- vaccination 
suggests to me that my unfavorable opinion of my old hos- 
pital chief's — Dr. Carnochan's — prescription of triturated 
chancrum durum for syphilis, expressed nearly thirty years 
ago, might have been a bit hasty. 

Do you know, brethren, that my admiration is daily ex- 
cited by the magnanimity of the Homeopath? And he 
excites my sympathy, also. Of late years he has been tumb- 
ling over himself to get into our band wagon. If he had 
only bided a wee! We are fast climbing into his. We call 
things by different names, but — "a rose by any other name 
would smell as sweet." Auto- vaccination and similia simili- 
bus do not make good rhyme, but they smell an awful lot 
alike — so much so that I have taken the sole surviving copy 
of my lecture on "Homeopathy and Its Congeners," deliv- 
ered a quarter of a century ago, and hidden it under my 
study floor. And now daily am I reminded of Poe's "Tell 
Tale Heart" and of his Raven's doleful "Nevermore." 

The ultra-scientific one who does not overmuch believe 

488 The Plaxus. 

in treatment and recognizes naught but the scalpel and 
hemostatic forceps sometimes marvels that any one could 
condescend to read, much less contribute to our independent 
journalistic media of medical expression. "Nothing in 
drugs," he wails; "send 'em to me and I'll cut 'em." He 
forgets that modern science has not yet conquered the lay 
aversion to the knife, nor the honest practitioner's belief 
that, after all, the knife is often a confession of our limita- 
tions and weakness. And there is much in the training of 
the experienced practitioner which inspires him with thera- 
peutic hope in a vast number of the ills of the flesh. By 
drugs he can produce anesthesia, local or general, relieve 
pain, produce sleep, stimulate or depress the circulation, 
allay nervous irritability, aid digestion, relieve constipation 
and hepatic torpor, produce emesis, diaphoresis and diure- 
sis, antidote malaria, and cure syphilis. What wonder that 
he has confidence in drugs per se whilst rather skeptical of 
our knowledge of them? "There must be a remedy. If I 
only knew" — is a brow-contracting reflection familiar to the 
conscientious practician. And so long as there are sick ones 
to heal so long will he search for remedies— and so long will 
he read and believe in the literature that offers therapeutic 

"While writing this I recall with some amusement the 
comparative merits of the gentleman who asked me why I 
wrote for X's journal and of X himself and his staff of jour- 
nalistic colaborers. Nature did much for both men, but X 
made his own opportunities while fate fairly showered them 
on his critic. Death's remorseless scythe swept out of the 
critic's path life after that stood between him and profes- 
sional position. What fate did not accomplish, great wealth 
and high social position wrought — and wrought well. What 
he is was made by he hand of fate — albeit I grant that the 
original material was pretty good stuff. As for X, the good 
stuff in him was molded by the hand of X himself under the 
stimulus of grim necessity. And now he owns ond operates 
a medical journal which reaches, instructs and holds more 
of the rank and file of the medical profession than most ex- 

"Why I Write for Independent Journals. 489 

tant publications. Associated with him are two of the wisest 
and best therapists that this country has ever produced. 
And the journal is doing good. It is not always right and is 
sometimes a bit "woolly," but in the main it is doing good 
by giving the average practitioner not only instruction, but 
a medium of expression. 

Apropas of the snobbish question, "Why do you write 
for X's journal?" I myself have something of an eye to the 
"medium of expression" end of medical writing. If I have 
anything of value to say, I fancy that it does the greatest 
good to the greatest number in the journal that reaches the 
largest number of average general practitioners. Moreover, 
there's where it does me the most good — and be it remarked, 
I am not one of those who profess to be writing "for the 
good of humanity" first, last and all the time. I believe the 
product of my pen which does the profession and humanity 
the most good, is the stuff that is most likely to do me good, 
and vice versa. The hypocrisy and conceit of the medico- 
literary snob with a heaven-born "message" make me sea- 
sick. The pinheaded egotist wasting midnight oil in com- 
piling ideas — or "facts," rather, for an idea would addle his 
composition — from other men's work for his message to an 
eagerly expectant scientific world is a spectacle for gods and 
men! And what shall we say of the toiling brother, primar- 
ily infertile of brain and who, dreading the pains of even the 
mechanical operation of literary parturition, merely affixes 
his name and manifold unearned titles to a compilation pre- 
pared by some poor devil of a medico-literary hacli? I once 
heard vociferous and earnest applause at an overflowing 
meeting of a great medical society rendered a paper that 
had but one original line in it — the name of the author — and 
that was composed by his parents and written by his type- 
writer. Alas! poor literary Adam. And this is the sort of 
stuff that fills some of our ultra "high-class" journals to 

Once on a time an inky handed pirate on the literary 
high seas published as his own in a high-class Eastern jour- 
nal an article of mine written and published more than 

490 The Plexus. 

fifteen years before. He did not alter a line — scarcely even 
a word of it. Yet it was taken as original stuff by the afore- 
said journal. The literary buccaneer is now editing an 
ultra-classy medical journal to which none but the literary 
elect among authors need apply. Those who are interested 
will find the matter well ventilated in the Journal of the A. 
M. A. several volumes ago in an article by me entitled, 
"How to Write a Medical Article — A Plea for Plagiarism," 
— the which is a sad commentary on some "high-class" jour- 
nals and their recondite editors. 

"Humanity?" "Science?" For the pinheads, "humanity 
is I, writ large,*' and science is an incoherent jumble of indi- 
gestible "facts" and dangerous excreta from the intellectual 
bowels of threadless wanderers in up-to-date laboratory 
mazes. But the flies on the chariot wheel, the "ultras," do 
not " 'f ess up," so let's pretend that we believe their snivel- 
ing hypocritic "science and humanity" drivel, whilst con- 
tritely acknowledging the hope that whatever we do for 
science and humanity may incidentally do some good to 
ourselves — and some more vice versa. 

One of the principal objections the "super-perfects" in 
medical literature offer to the independent journal is the 
character of its advertisements- Time was when that jour- 
nalistic mentor, the Journal of the A. M. A., would take 
almost any old thing in the way of a paid ad. Wherein lies 
the change of front? Is it a matter of conscience, or a fat- 
bellied prosperity that no longer needs or craves the flesh 
pots of Egypt? Once upon a time this ad appeared in its 
columns: "Wanted — A gentleman, past middle life, who 
has been incapacitated by a surgical operation for the per- 
formance of his conjugal duties, would like to meet a lady 
similarly situated. Address, No. 1001, Journal office." What 
has happened? The same editor— salaam, please — is in 
charge, and the trustees haven't changed all around. Item: 
They couldn't; the political machinery is too perfect. This 
is not a kick, but a compliment. Once more, salaam, O ye 

No official notice was taken of the ad above mentioned, 

"Why I Write for Independent Journals. 491 

so I 'infer that it "went/' as a matter of course. Really, 
somebody must recently have injected a large dose of ultra- 
ethical serum into the veins of the reigning medical dynasty. 
The tin gods will please sit up and take notice. They can 
not hide their light of goodness under the bushel of modesty. 

But the reigning dynasty has not yet ceased straining at 
gnats and swallowing camels. It is still possible to advertise 
in its columns "legitimate" preparations that would under 
no circumstances be admitted into its reading matter. Under 
which king, Bezonian — Hypocrisy or Flesh Pots? 

A special feature of the independent medical journal 
which commends itself to me is the possibility of individual 
expression in its editorial pages. Vigorous independent 
thought trenchantly expressed is what the medical man 
most needs. And the thought expressed should not always 
be medical dry bones. Medicine is broad. It should embrace 
things literary, political and sociologic. Take the editorial 
colums of the independent medical journals away from him, 
and the overworked practitioner will be in a bad way for 
intellectual pabulum. The editor of an official "society 
organ" who should venture to express himself in terms 
stronger than a literary milk shake couldn't hold his job for 
more than twenty-four hours. Take away editorial inde- 
pendence and what would the organizers of a professional 
monopoly or a medico-political trust have to fear? What 
check would there be on their system? Why, they would not 
meet even criticism of any degree of potency. 

The leaven of consolidation, unification and trustifica- 
tion is working most potently. By and by, the firmament of 
American medical literature will contain naught but a cen- 
tral literary sun and his satellites, the "State" journals. 
The independent journal has been the representative at 
court and the great educator of the medical rank and file 
will be no more — and the rank and file will die of intellectual 
inanition, starved to death on the mental breakfast foods 
prepared by the great medical trust whose bat-like wings 
are already casting baleful shadows over the profession. 
"The average practitioner will hunger and thirst for intellec- 

492 The Plexus. 

tual pabulum^-and he will get the shavings and gelatine 
broths dispensed by the hierachy. The handwriting is on 
the wall. 

Oh, for the pen of a Moliere or the merciless and clever 
literary caustic of a Voltaire! Nay, I do but overglorify my 
theme; the drollery of a Josh Billings, an Artemus Ward or 
any wearer of the cap and bells would be about the right 
size of shot to fire at this particular bird. 

If only I had the genius — big or little — what a picture I 
would now paint on my reader's mental screen. The inci- 
dent I am about to relate apropos of ethics in high places 
combines more diverse elements of sincerity, hypocrisy, bun- 
combe, drivel, humor and pathos than anything I ever 
heard of : 

A certain medical man, big, brainy, square-toed and 
altogether lovable, felt called upon to explain to a certain 
official medical body the publication of his picture amid a 
group of other distinguished physicians in a certain news- 
paper. ' k I called at the newspaper office," he explained, 
"and demanded the picture. I was informed that it was the 
property of the paper. I find that I have no legal means of 
redress," etc., etc. This in face of the fact that the eminent 
gentleman's name has appeared in connection with the 
treatment of prominent citizens oftener than any physician 
in the country. Why, I once saw it in two or three separate 
places in the same paper! Not long since his attendance on 
a certain multi-millionaire and his large fee for the same 
were newspaper talk by the column for days and weeks. 
Oh, fudge! old man; why didn't you tell 'em to go plumb 
straight to h — 1? Manly expression — and you are a man, if 
ever there was one — is cheaper and thicker — aye, and more 
beautiful — than whitewash of the auto variety. Why should 
not the eminent medical man be as much public property 
and of as much public interest as though he were a lawyer 
or a statesman? 

The struggle of the medical babies to keep their erythe- 
matous rear elevations covered with the ethical garments 
inherited from our medical daddies is agitating to one's 

Why I "Write for Independent Journals. ♦ . 49& 

sense of humor. No use; our professional daddies didn't 
employ wool soap! Still less did they use good horse sense 
— if they had, they would have realized that the medical 
man is a creature of his environment and must adapt him- 
self to it or be a social anachronism and a political nonentity. 
Moral — Don*t be a clam merely because the palezoic 
senilescents of a dead and gone medical age were content- 
edly stuck in the fossiliferous mud on the shores of the 
ocean of progress. Let the dead past bury its dead— and 
bury it deep, and — let us not often open the doors of our 
ethical museums. 

It has occurred to me that the ambition of the doctor to 
own and operate a medical journal is conducive to the best 
interests of the profession. The medical editor has in gen- 
eral stood for what is best in medicine. He has often gone 
astray, it is true, and has sometimes pandered to the pro- 
prietors of worthless or doubtful drug preparations, but on 
the whole the profession has benefitted by the influence of 
the independent medical editor. He has been our watch dog 
in a way, and while by no means perfect — he is human, you 
know — has been a pretty creditable part of the body profes- 
sional. Where he has made a living out of his journal he 
has been useful by demonstrating a bread and butter outlet 
for the energies of medical men, and we have, alas! only too 
few such resources for physicians. 

Had I ever wavered in my opinions as to the ethics of 
contributing to independent medical journals my faith and 
courage would have been restored by something I saw a few 
short weeks ago in a journal which the ethical ultras regard 
so unfavorably that they throw an autotoxic fit and roll up 
their eyes like a dying jack rabbit whenever they hear it 
mentioned. It was an article by "Saint George," of Phila- 
delphia. And, mirabile dictu, it was headed by his picture! 
Think of it — the peerless Saint George, the erstwhile arbiter 
elegans of medical literature, slayer of ethical dragons and 
mastodonic medical hypocrites and humbugs, peerless 
knight of the medical ink pot, had an article and picture in 
a journal owned and controlled by a manufacturer of pills. 

494 The Plexus. 

and "sich!" And — oh, joy! I had an article — with picture 
— in the same issue of that proscribed magazine. Shall it 
longer be said that Munyon with his awe-inspiring index 
sweeps unopposed on his majestic way? No, a thousand 
limes no. 

Verily, "the world do move." — Texas Medical Journal. 


By Emil G. Beck, M. D., Chicago, 111. 

Abstract from Illinois Medical Journal. 

I shall demonstrate to you this evening a new method of 
diagnosis, which will enable the surgeon to see every por- 
tion of the sinus or fistula even before an operation is de- 
cided upon. He will know exactly the extent and direction 
of the sinuses and plan his operation accordingly. I shall 
further demonstrate a new method of treatment of fistulous 
tracts, which in the majority of cases makes an operation 
altogether unnecessary. 

The new method of diagnosis of the above affections 
consists in filling the fistula or abscess cavity with a bis- 
muth-vaselin paste and then taking a radiograph of the 
region affected. A radiograph so taken clearly marks out 
the boundaries of the fistula, showing every part of the 
channel, no matter how extensive or how tortuous it may 
be. Bismuth, as is well known, offers great resistence to 
the penetration of the a-rays and is, therefore, a very suita- 
ble material for this class of radiograph work. The shadow 
obtained by its use represents the true picture of the shape 
and ramification of these cavities within the tissues. They 
show what can be done in exploring the origin, course and 
the extent of a fistulous network. In some instances the 
most surprising and unexpected findings are detected in this 
way. This method of diagnosis proves, for obvious rea- 
sons, a great advantage over the methods now in vogue, 
such as the probe, the injection of colored fluids or peroxid 
of hydrogen. 

A New Method of Diagnosis and Treatment. 495 

The diagnosis with bismuth radiographs has ascertained 
the cause why certain cases have not been cured after sev- 
eral operations have been performed. It demonstrated the 
uselessness of an operation which does not reach every part 
of the diseased tract. A subsequent operation under the 
guidance of this skiagraph diagnosis has, as a rule, proved 
successful. This method of diagnosis was developed by 
us since March, 1906, and has proved in our hands indispen- 
sable in the treatment of fistulous tracts. Before I describe 
the new method of treatment I desire to review briefly the 
methods now in vogae. 

Surgery has done more than any other method so far. 
The surgeons aims to convert a fistulous tract into a healthy 
wound and thereby facilitate healing by granulation. In 
cases of osteomyelitis the sequestra are removed and all dis- 
eased tissues eradicated, so that a healthy cavity remains for 
granulation. Several methods have been devised to obliter- 
ate cavities thus created. One of these consists in the fill- 
ing up of the cavity with decalcified bone chips, orignated 
by the late Professor Senn. Another is the covering of raw 
surfaces by skin grafts on skin flaps. The Mosetig-Moorhof 
plug is another favorite method with surgeons for this treat- 
ment. Each of these methods has its merits and most cases 
will yield to this treatment. 

But there still remains a class of cases to which neither 
of these methods is applicable, as, for instance, a fistula fol- 
lowing psoas abscess. Other cases, again, will 'keep on 
suppurating in spite of all skilful treatment. Patients are 
willing to undergo many operations before they give up en- 
tirely. With each successive operation undertaken the 
patient and surgeon hope to achieve a cure, only to meet 
with another disappointment. In the interval of these oper- 
tions other methods are usually tried. Irrigation with anti- 
septic watery solutions, as, for instance, boric acid, solu- 
tion of 1 per cent- iodin or a weak solution of silver nitrate. 

The habit of irrigating these fistulous tracts with any 
water solution is to be condemned. It is more harmful than 
beneficial. The fluid fills up the sinuses and keeps their 

496 > The Plexus. 

walls in a "macerated condition, thereby preventing the for- 
mation of healthy granulations. I would sooner advocate 
the drying out of these cavities by strips of gause instead of 
macerating them in water. This, however, is often impossi 
ble. Injection of alcohol, however, on account of its desic- 
cating property, is permissible in these wounds, provided 
they do not communicate with hollow organs. 

That is, then, a resume of the principal method of treat- 
ment in vogue at the present time. Most cases will yield to 
either one or the other methods, but a percentage will remain 
uncured after all have been tried. This statement is sup- 
ported by the fact that cases travel from year to year in 
clinics, then try osteopathy or other similar or inefficient 
methods, until finally they are resigned to their fate and are 
content with daily dressing. 

The new method of treatment is quite as simple as that 
of diagnosis; in fact, the same process applies to both; it 
consists likewise in the filling of the fistulous tract with bis- 
muth paste. The injection of liquified bismuth-vaselin paste 
is not only valuable for diagnostic purposes, but for cura- 
tive purposes as well. The first case injected for diagnostic 
purposes led us to this important discovery. It disclosed 
the method of treatment. After one single injection of the 
bismuth paste a fistula following a psoas abscess, which 
had existed nearly two years, had entirely closed up and has 
remained so up to date. Other cases were subjected to the 
same treatment with similar results. To illustrate this I 
shall report Case No. 1 at this point: 

Case 1. — A. D., who is now six years of age, presented 
herself at the hospital in March, 1906, with a fistula result- 
ing from a psoas abscess which had continned to discharge 
pus for nearly two years and required daily dressing. Bis- 
muth injection for diagnosis was made April 23, 1906. The 
skiagraph demonstrates the fistula extends from Scar- 
pa's triangle along the psoas muscle up to the junction 
of the second and third lumbar vertabrse. A small cavity 
of the size of a hazlenut is also found on the opposite side 
of the vertebra] column. 

A New Method of Diagnoiis and Treatment. 497 

The parents returned a few days later stating, that for 
the first time in two years the fistula stopped discharging 
pus. They were told that this might be only temporary, we 
having-often observed a temporay cessation of fistulous dis- 
charge. They returned, however, on June 22 (two months 
later), the fistula still remaining closed and the child had no 
symptoms which would indicate any retention of pus. There- 
upon we took another skiagraph and found that the bis- 
muth had disappeared. It had probably been absorbed, be- 
cause the parents stated that none of the material had been 
found on the dressing. The patient is well, the fistula hav- 
ing remained closed up to this day. 

A series of cases subsequently treated by this method 
proved to us that the cure in Case 1 was not accidental but 
that we could obtain equally good results in other similar 

Up to this day we have tried 14 cases; 2 cases of spon- 
dylitis and psoas abscess, 2 and 16 years' duration; 1 case of 
tubercular hip joint, 16 years' duration; 1 case of tubercular 
knee joint, 7 years' duration, 1 case tubercular pelvis, 3 
years' duration; 1 case tubercular ulna, 6 months' duration; 
1 case of chronic osteomyelitis of femur, open since 1899; 1 
case of fistula after resection of tubular kidney, 1 years' 
duration; 3 cases of rectal fistula, 2 and 1 year and 6 
months; 1 case of abscess of lung, 9 months duration; 2 
cases of abdominal fistula following laparotomy, 4 months 
and 1 year's duration. 

The method is applicable to all fistulae or abscess cavi- 
ties except intracranial sinuses or biliary fistulae. 

We desire to give a history of some of the cases in detail 
and the results of our treatment. By doing so, however, I 
wish to speak of the method of injection and give the 
formula of the paste: 


Bismuth subnitrate 30.0 grams. 

Vaselin 60.0 grams. 

Mix while boiling. 

498 The Plexus. 


Bismuth subnitrate 30.0 grams. 

White wax 5.0 grams. 

Soft paraffin 5.0 grams- 

Vaselin 60.0 grams. 

Mix while boiling. 
In some cases we have added 1 per cent, formalin. It is 
generally believed that paraffin does not absorb in the 
tissues. This applies only to hard paraffin. The soft par- 
affin is absorbed. This has been amply proven by the 
experiments of Drs. Kirchner and Eckstein, of Berlin, in 
1905 and 1906. 

Care should be taken that no water should accidentally 
be spilled into the paste during the process of boiling, and 
the glass syringes must likewise be sterilized by the dry 
process and the plunger dipped in sterile oil, instead of 
water, before charging the syringe. 


The fistula should first be dried out, if possible, by 
packing into its depth a strip of plain gauze, one-half to one 
inch wide, and removed just before the injection of the 
paste. The emulsion is sterilized before using and the 
syringe charged while the emulsion is hot and liquid. (It is 
sufficiently cooled by allowing cold water bo run over the 
syringe until the contents are of the right consistency.) A 
glassjsyringe similarly to that of a Valentine irrigating tip 
should then be loaded with the bismuth paste and tightly 
pressed against the fistulous opening; the emulsion is forced 
in very slowly until the patient begins to complain of pres- 
sure. The syringe is then removed and a small gauze sponge 
is quickly pressed against the opening to prevent the escape 
of the paste until it has sufficiently hardened. An ice-bag 
may be used to hasten the hardening of the material. I 
inject the bismuth-vaselin paste until pus discharge ceases, 
and then use the harder preparation containing wax and 
paraffin, after which it usually remains closed. The injec- 
ions are painless and produce no unpleasant symptoms. In 

A New Method of Diagnosis and Treatment, 499 

several hundred injections we have had no accidents, such 
as hemorrhage, sepsis, embolism, etc. 

The composition of these substances is subject to 
further experiments. There are probably substances which 
will prove superior to those which we have used. It is my 
opinion, however, that the healing does not depend very 
materially on the particular chemical substance as long as it 
is a material which is liquid when injected and rapidly solid- 
ifies after injection. The solid substance acts as a frame- 
work for the formation of healthy granulations. 

Besides, it is probable that the bismuth, which becomes 
radio-active by the exposure of the cc-rays, aids the forma- 
tion of granulation on the walls of the fistulas, with which it 
comes in direct contact. To increase the radio-activity I 
have in some cases added strontium salicylate and exposed 
the patient to the cc-rays for one or two minutes after 

Later the bismuth- vaselin is undoubtedly absorbed and 
the connective tissue remains and contracts, thereby obliter- 
ating the sinus. This principle of bridgework as an aid to 
healing of suppurative processes has lately been demon- 
strated in many instances. For example: the filigree of 
Bartlett in healing suppurative wounds. The filigree serves 
as a trestle-work for the formation of connective tissue, but 
has the disadvantage of not being absorbable. I venture to 
say that If I placed a filigree spiral into a straight fistula it 
would serve a similar purpose of a bismuth plug. The. 
Moorhof wax plug probably acts on the same principle and 
likewise the decalcified bone-chips of Senn. 


1. A successful surgical operation of fistulous tracts 
depends principally upon the exact knowledge of the extent 
and direction of the sinuses before operation is undertaken. 

2. Radiographs taken after the fistulas have been 
injected with bismuth paste show distinctly the extent and 
direction of the fistulous tract. 

3. Skiagraphs of all fistulous tracts should be taken 
before an operation is decided upon. 

500 Tbe Plexus. 

4. Fistulous tracts, tubercular sinuses, or abscess cavi- 
ties, including empyema, can be cured by injection of 
bismuth paste. 

5. Cavities and fistulae should be as clean and as dry as 
possible before the injection of bismuth paste. 

6. The bismuth paste, when mixed with wax or soft 
paraffin and injected in liquid state, solidifies in the fistula 
and serves as a framework for new conjunctive tissue. The 
paste is absorbed and the fistula obliterated. 

7. Bismuth paste injection will not heal out sinuses 
where sequestra are present. Same must be removed before 

8. The bismuth paste injections are painless and pro- 
duce no unpleasant or dangerous symptoms. 





Channlng W. Barrett, M D., Chairman. 

T. A. Davis, M. D. W. E. Gamble, M. D. 

A. R. Johnstone, M. D., Editor. 


L. H. Nowak, '08. Ray Essick, "08< 6ustav Eck, '09. 

William G. Epstein, 10. 
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The last paper prepared by the late Prof. Senn was on 
this subject and it may not be amiss at the beginning of the 
school year to quote some of his remarks on this very 
important subject. 

In his paper he referred to the fact that in medicine it 
was infinitely more important that the student equip himself 
with practical knowledge before beginning theOpractice of 
his profession than it was for the divinity student or the 
student of law because the doctor in his work must deal with 

502 The Plexus, 

the most and only immediately vital question of his client — 
his life. 

Dr. Senn dwelt upon the insufficiency of college instruc- 
tion alone as a preparation for the practice of medicine and 
spoke of the fact that the students who obtain interneships 
are the ones who start their studies with the idea of making 
the most they can of themselves and are therefore the ones 
who prosecute their studies with the greatest energy and 
earnestness and who make their time count to the greatest 

The advantage that the hospital gives the interne for 
the closest clinical observation and laboratory study of the 
cases under his care, the rivalry in his work with his fellow 
internes, the association with his seniors who are on the 
hospital staff, the association with many physicians and the 
public while he is in the hospital, all tend to give him prece- 
dence over the less fortunate students who fail to obtain 
hosptal appointments. 

To the student who obtains an interneship and who 
recognizes it as an opportunity to fit himself, by close appli- 
cation to his work, many great and immediate advantages 
often present themslves at the end of his service and his 
superior preparation makes the road easier for him and the 
possibilities for success in practice far greater than if he 
had not had such an experience. 


The twenty-seventh annual course of instruction of the 
college will begin September 28th. The inaugural address 
will be delivered by Prof. Channing W. Barrett. The enroll- 
ment prospect for this year looks better than it has for 
several years past and there is every evidence that the 
school year will be a very active one. 

Dr. Fitch C. E. Mattison, class of '87, who resides in 
Pasadena, California, spent last Friday, Saturday and Sun- 
day in Chicago and visited the college and a number of 
hospitals. Dr. Mattison was on his way east with his. 

Notes. 503 

daughter, who is about to enter one of the eastern colleges 
for girls. 

Dr. William W. Wood, writing from Jasper, Minnesota, 
speaks most encouragingly of his new location. He has had 
a large number of cases in the short time he has been there 
and has been successful] in his management of them. The 
greater part of the service he has rendered has been 
promptly paid for so that hisj, start has been auspicious. 
Dr. Wood is well equipped^to maintain the reputation of his 
school for efficiency! and energy in his work and we wish 
him^the largest measure of success. 

Dr. William M. Harsha has returned from the Canadian 
Northwest and is ready for active college work for the 
winter course. 




P. M. Goodman, Ph. G., C. S. N. Hallberg, Ph. G., W. A. Puckner, Ph.G 

H. H.Rogers, M. D., Ph. B., E. N. Gatherooal, Ph. G., 

A. H. Clark, Ph. G., C. M. Snow, Ph. G. 



Upon the authority given in the amendments at the 
regular session of the 45th General Assembly, the Illinois 
Board of Pharmacy has adopted the following rules govern- 
ing the recognition of colleges of pharmacy, schools of 
pharmacy or departments of pharmacy of universities. In 
order that attendance by applicants for examination at such 
schools or colleges shall be accredited upon the service 
required under registered pharmacists, they must comply 
with these rules: 

1. The school must be a legally incorporated or chart- 
ered educational institution or a department governed by 
such institution. 

2. It must possess an equipment of furniture, fixtures, 
apparatus, books and materials for its pharmaceutical course 
to the value of not less than &5,000. 

3. It must give reasonably adequate courses of instruc- 
tion in the subjects usually taught in pharmaceutical schools, 
which subjects shall include at least pharmacy, chemistry 
and materia medica. 

4. It must have not less than three teachers, of 
sufficient education, special training and experience, and at 
least one of these teachers shall have had not less than five 
years' experience in pharmacy. 

Pharmacy. 505 

5. The obligatory courses for graduation shall include 
not less than 500 hours of lectures and recitations and not 
less than 600 hours of laboratory instruction, and shall 
extend over two annual sessions of at least twenty-five 
weeks each. 

6. The courses of instruction must be given in proper 
logical sequence, according to approved educational 

7. After July 1, 1908, the entrance requirements shall 
include a preliminary general education of not less than one 
year of satisfactorily completed high school work or its full 
educational equivalent of studies of similar grade in academ- 
ies or other schools or colleges. 

8. Only schools maintaining day sessions are recog- 


By C. S. N. Hallberg, Ph. G., M. D., Chicago. 

Read at the Philadelphia College of Pharmacy, April 21, 1908. 


When in the city of Philadelphia some forty years ago 
several pharmacists began exploiting the local physicians 
with some unusually elegant preparations, who could have 
dreamed that from this small beginning would evolve the 
modern manufactured pharmaceuticals. 

These preparations were at first limited to a few elexirs, 
then included syrups and wines, and rapidly increased by 
the addition of dosage-forms untilthey finally comprised the 
entire gamot of therapeutic agents in every conceivable and 
inconceivable form. Their manufacture was originally con- 
fined to a few ambitious retail phamacists, but was followed 
by some of the more enterprising old-time wholesale 

506 The Plexus. 

drug houses and eventually by regularly established manu- 
facturing chemists and even by some herb collectors, such 
as the shakers at Lebanon, N. Y. While educated pharma- 
cists even at this early period regarded the exploitation of 
the physicians by these ready-made preparations as an en- 
croachment on their prerogative and sometimes resented the 
idea that there was any necessity for them, there was no 
general opposition and they grew andmultipled. 


It was often charged that some of these preparations 
could not be duplicated even in skillful hands from the pur- 
ported formula, and that their medicinal strength was over- 
stated so as to give rise to the oft repeated charge that their 
therapeutic vaiue was often sacrificed for palatability and 
elegant appearance- The tendency toward these prepara- 
tions was also lergely promoted by the numerous specialties 
from France, where the "pharmacie elegance'' had its in- 
ception and always thrived and flourished- 

These ready-made preparations were, however, not so 
objectionable, because they were, as a rule, fairly true to 
the alleged composition and were introduced under regular 
pharmaceutical titles which thus avoided mystery and largely 
disarmed criticism One of the pioneer manufacturers fixed 
a label to his preparations containing a statement to the 
effect "that no proprietorship or exclusive right in its man- 
ufacture was claimed, only that the purest and best ingre- 
dients were used and that they were carefully and skilfully 


These preparations had thus the advantage of proclaim- 
ing in their titles their composition, which was of great con- 
venience to the physician, and yet from their technical and 
often composite character such knowledge was not easily ac- 
quired by the laity and would have been still less so when 
latinized. They relied for their preference on being speci- 
fied by the maker's name and, of course, as such were of 
great disadvantage to the pharmacist, who often was re- 

Pharmacy. 507 

quired to keep half a score of different brands of the same 
preparation on hand- 


While a few proprietary preparations, such as "Iodo 
Bromide of Calcium Compound" and "Elixir Peruvian Bark 
and Protoxide of Iron" had appeared, it was not until about 
thirty years ago that a peripatetic preacher from North Car- 
olina began in St- Louis to exploit the doctors with certain 
specialties which were in a category different from any 
former kind of medicines. He evidently appreciated that 
the medical practitioners at fiat time, especially in the great 
southwestern country, were not well prepared to write 
prescriptions, that qualified pharmacists were few and far 
between, and furthermore that the character of the practice 
often required the doctor to carry medicine with him. So 
this genius, possibly with the aid of the editor of a certain 
medical journal which is the reputed sponser for the pro- 
ducts of this "chemists' corporation," coined short euphoni- 
ous and suggestive names for a number of preparations for 
which "brief" and interesting articles appeared. 


These contributions to medical literature were originally 
from more or less prominent medical men of '"the south- 
western metropolis," who appeared to have formed a syndi- 
cate for the promotion of clinical therapeutics, but eventu- 
ally had to share their position with previously unknown 
''coming lights" of the profession, from such great centers 
of medical lore as Arkadelphia, Ark-, Shreveport, La-, and 
Coffeyville, Kan. As this kind of proprietary medicine bus- 
iness grew because of the success made by this pioneer, 
medical journals sprang up at nearly every crossroads and 
with them developed a peculiar profession — the paid-for : ar- 
ticle doctor, The members of this profession was chiefly 
distinguished by the characteristics that their names were 
unknown to medical literature until suddenly they burst in 
all their own effulgent glory in some communication to the 
"Medical Gold Brick," telling the credulous and unsuspect- 

508 The Plexus. 

ing doctor how to treat his patient by doping him with 
"Dopine," by sweating him with ''Sweatine," by nerving 
him with "Nervine," and don't forget it — eliminate his uric 
acid with "Uricadine." He had solved the great problem. 
He had reduced the practice of medicine to a science — to an 
exact science. No groping in the dark— no experimentation; 
no chance of failure — everything cock-sure- If not satisfied, 
money back. 

Pardon this last lapsus. This never appears in the doc- 
tor's learned communication, but in the advertising pages 
where the especial thereapeutic, secernent and synergistic 
actions of the various wonderful discoveries are proclaimed. 

Many of these prolific contributiors have been gathered 
to their fathers, but they are by no means extinct and they 
exist in places where they would be least expected— even in 
medical colleges. It is some satisfaction to know that their 
fame will not be lost; that they have all been carefully listed 
and tabulated and sometime in the near future posterity will 
know how numerous were the species of Iscariots who sold 
their birthrights in the most noble profession for a mess of 


The business of publishing a medical journal by a doc- 
tor, or a coterie of doctors, for the express purpose of 
"working" their colleagues with a line of proprietary medi- 
cines became so common that one or more such journals 
were started often in places devoid of the least reason for 
the existence of such journals, except the editor's ambition 
and desire to make some money off his readers in the guise 
of a clinical authority. These journals, though having a 
nominal subscription price, were sent to selected lists of 
physicians in tributary territory so long as the results were 
satisfactory, and since they were entered in the postoffice as 
second-class matter at one cent per pound they formed the 
cheapest and most effective kind of advertising. The doctor 
proprietor usually had his identity under alias representing 
anonymous chemical companies; one such journal published 
in Connecticut masquerading as some different company for 
each of its specialties. 

Pharmacy. 509' 


This "Wily" concern issued a quarterly devoted to the 
"Uric Acid Diathesis" and its control by a very ordinary 
effervescent salt sold at an extortionate price, which from 
being for the exclusive use of physicians has recently been 
distributed to the laity and the medical testimony used to 
extol the wonderful virtues of the salt to the public. These 
journals are certainly not entitled to the reduced postage of 
second class rates since the publishers are also owners of 
the medicines, which are constantly being extolled, not only 
in the advertising pages but in "clinical notes" and "ans- 
wers to correspondents" and sometimes in leading articles 
accompanied with the portraits of the distinguished author. 


Since one of these journals pays $6,000 a year postage 
instead of $48,000 as it should pay at the regular rates, in- 
vestigation by the postoffice department would seem desira- 
ble. While some of these journals have retired during the 
past two years and others have consolidated specimens of 
their kind may be found in the following places: Burling- 
ton, Vt. ; Danbury, Conn. ; New York, Philadelphia, Chica- 
go, St. Louis, North Carolina, Wisconsin and Texas. 


Indulgence is asked for this extensive reference to med- 
ical journalism, but this subject is indissolubly connected 
with the discussion of the Proprietory Medical Question. It 
brought the issue to the American Medical Association and 
led to the organization of the Council on Pharmacy and 
Chemistry as a consequence. 

As pharmacists we may easily imagine the state of 
knowledge of medicines by a considerable portion, probably 
one-half of the practising physicians of this country, when 
the character of the literature is considered. Some of these, 
medical publishers, always optimistic in the use of drugs, 
may also have been altruistic — actuated by motives other 
than purely mercenary and sordid — in extolling their spe- 
cial manufactures. But as manufacturers they are helpless. 

BIO The Plexus. 

often downright ignorant as to the chemical or pharmaceu- 
tic character of their preparations or their constituents. Re- 
lying mostly on some manufacturing pharmacist for their 
preparations, they were often at the mercy of those who, 
becoming aware of their lack of knowledge, imposed on 
them to the disadvantage of the medicines- In several well 
known specialties from such proprietors the composition has 
been changed without change in the formula until attention 
thereto was directed. Important ingredients have been 
omitted and others substituted with perfect abandon with- 
out changing the formula or the literature, and upon the 
correctness of the latter being challenged such changes or 
substitution has been frankly, sometimes naively, admitted 
as being of no special importance or consequence. One of 
these medicine manufacturing publishers, who is exploiting 
doctors with a line of quack specialties and with unloading 
on the credulous leaders of his journal, self-perpetuating, 
gold-bearing bonds of the company, and who poses as a 
great authority on alkaloids, is continuously waging relent- 
less war on the uncertain, instable and unsafe galenicals, and 
insists that every doctor should employ active principles, 
and of course these only in the form of this company's 


Among these are found tablets of digitalin as a perfect 
substitute for digitalis; cicutine for conium and atonitine for 
aconite, which, at least until recently, was not the official 
alcaloid, the only dependable substitute for this drug. Tab- 
lets of veratin are extolled to the doctors as far more certain 
than veratrum, the tincture of which is the cardiac sheet- 
anchor to the physicians, especially in the south — this great 
alkaloidical exponent being apparently perfectly oblivious 
to the fact that veratrim is not the active principle of verat- 
rum viride, but an indefinite mixture of principles from the 
cevadilla seed, whose only therapeutic use is an irritant ex- 
ternally, applied a$ an ointment or oleate and popularly 
used as a parasiticide. 

Pharmacy. 5 LI 

These few examples indicate the very serious condition 
caused by these doctor publishers and suggests that the at- 
tention of the medical profession be directed to this perver- 
sion of the literature and also that the privilege of second 
class mail rates, through which the postoffice department is 
robbed of many thousands of dollars anually, be denied 
these publications. 

Without these privileges these journals could not exist. 


There are now nearly a score of journals published by 
State medical societies, and the number is steadily increas- 
ing. It is hoped that in the near future every State medical 
society will have its own journal, or that the smaller socie- 
ties jointly publish an official organ. This will drive out the 
undesirable class of journals referred to, and since these 
State journals are responsive to their State medical societies 
it will be comparatively easy to keep their pages clean and 
accept advertisements for medical articles only that have 
been approved by the Council. 

To maintain these journals is, however, difficult, since 
limited in advertisements they often cannot secure sufficient 
acceptable advertising to pay expense of publication, and 
since the journals must not be too much of a drain on the 
revenues derived from dues, their continuance is often a 
difficult problem for solution. This embarassing situation 
might be relieved if local pharmacists, or possibly societies, 
could extend some patronage in this direction. 


Another agency which must be aligned for co-operation 
in this work is the instruction in the fundamental branches 
in the medical schools. This will require not only that the 
courses be extended to cover more practical work under per- 
sonal instruction, but that more time be devoted and that 
the construction of prescriptions be done in the last year of 
the course instead of the first, as has been the case. The 
methods of the dispensaries and hospitals and the training 
of internes must also be radically changed. As now con- 

512 The Plexus. 

ducted in most institutions it is simply a drilling into the 
habit of designating numerical mixtures, often without in- 
telligent discrimination, a sort of picking the winner and 
trusting to chance. 


The Council on Pharmacy and Chemistry has now been 
actively at work a little over three years, although consid- 
erable preliminary work was done principally through the 
Section on Pharmacology and Therapeuties of the American 
Medical Association. 

Loading up the medical journals with advertisements for 
all kinds of quack nostrums irritated the better informed 
physicians and caused them to "protest, which found vent in 
the Section. Year after year the subject of nostrums was 
discussed in its various phases and resolutions adopted by 
the Section, until finally the trustees of the American Medi- 
cal Association arranged for the formation of the Council 
and began to throw out all advertising not acceptable. 
While the work does not make a formidable showing it nev- 
ertheless has done wonders in these few years and has en- 
tirely changed the attitude of the medical profession to pro- 
prietary medicine. The physicians, as far as their societies 
and authorities are concerned, are committed to the form of 
the Materia Medica. 

The first public utterance of the publication of tlie an- 
nouncement containing the rules, etc., was the report of the 
analysis of the acetanilide mixtures. In this was nothing 
new, only what every pharmacist knew. 


But it was startling information to the physicians. Hav- 
ing occasion to cross the continent to attend the meeting of 
the A. M. A. in Portland, Ore., shortly after this article had 
appeared in the Journal and thus meeting a great many 
medical men, the expose proving these wonderful synthetic 
coal-tar derivatives to be nothing but cheap acetanilide mix- 
tures with alkalies, was the general theme of conversation 
and was actually starling in its effect on the doctors. They 

Pharmacy. 513 

felt that they were the victims of misplaced confidence, that 
they had been swindled, and that possibly they had been the 
innocent cause of their patients' suffering. 


From this time on many similar articles were examined 
and proved to be, instead of difinite compounds, produced 
by intricate reaction of synthesized product possessing new 
and often marvelous therapeutic propensities, simple mix- 
tures of well-known substances without any special value. 

Similarly many articles were reported to be materially 
different from the alleged formula, the maker sometimes 
frankly admitting that the formula had been changed for the 
better, while others refused to acknowledge the error, sim- 
ply because of ignorance as to the difference in the action of 
the constituents. Others as laymen not having the remotest 
idea — pharmaceutical, medical or ethical — simply refused to 
explain, believing that the formula was their property with 
which they could "do as they pleased." 


The false therapeutic claims and dishonest methods of 
exploitation also came in for their share of attention. Thus 
the fat-free cod liver preparations — the petroleum emulsions, 
the hyoscine-morphine-cactin combination, etc., were dis- 
sected and their shallow pretense of therapeutic virtues ex- 
posed. The startling disclosures of the methods employed 
to sophisticate scientific government reports in order to 
boost a certain preparation, which, after having served as 
an ordinary "Frauen Medizin" in Germany, had been 
brought over to this country to be pushed on to the medical 
profession as an eclusive product, proved a shock to many 
physicians, especially since it was discovered that the won- 
derful preparation was actually inferior to Blaud's pill. 


Some 300 articles have been accepted by the Council and 
admittad to the book, "New and Non-Official Remedies." 
Many more have been examined, but only such are reported 
as have been found to be entirely false in composition or for 

514 The Plexus. 

which absolutely unwarranted statement concerning thera- 
peutic properties have been made. Former efforts for re- 
formation in this direction have been made sporadically only 
to fail because of some criticism appearing, which either 
could not be proved beyond peradventure or could not be 
completely substantiated when challenged. The work of 
the Council has been successful largely because no state- 
ment concerning any article has ever been made that could 
not stand the most rigid scrutiny. 

Nearly one half the articles accepted are foreign, mostly 
German manufacture, the remainder being fairly representa- 
tive of the principal American houses. 


It should be remembered that acceptance of these arti- 
cles by the Council and their publication in the New and 
Non-Official Remedies, and monthly in the Journal of the 
American Medical Association, does not carry with it any 
recommendation; simply that they conform to the rules 
adopted by the Council to govern the selection of such pro- 
prietary articles as physicians may be safe in using and 
therefore eligible to advertising in medical journals. 

In brief, the articles must be true to the composition 
alleged and no unwarranted therapeutic claims be made for 
them. The Council would not assume, even were it practi- 
cable, to pass judgment on their therapeutic value or clinical 
efficiency. This is the physician's prerogative with which 
he can allow no interference. 

All he wants to know is that the maker states the truth 
concerning his products. 



At the appearance of every revised edition of the U. S. 
P., as well as the N. F., there have been more or less efforts 
directed toward securing physicians' attention to these 
works, that they may accept the pharmaceutical prepara- 
tions therein contained and give them preference over the 
proprietary articles. These efforts have been largely futile 
because there was no general sentiment among the physi- 

Pharmacy. 515 

cians suggesting its desirability and no awakening to the 
turpidity of the proprietary medicines. 

Now it is different. 

With the entire medical profession aware of its perilous 
position, should the exploitation by the proprietary interests 
be permitted to continue, with the medical societies and 
their journals alive to the issue, with the recognition by 
their authorities that the official preparations to which they 
have themselves contributed, are equal if not superior to 
proprietary articles, there is an entirely different feeling, 
and here is the opportunity for the pharmacist. 


The effects are already apparent. In the larger cities 
where the movement has been longest in progress there is 
already a marked falling off in the prescription of proprie- 
taries and a corresponding increase in the preparations of 
the U. S. P. and the N. F. Meetings are being held jointly 
with the physicians 'for the discussion of this and related 
questions. This of itself cannot fail to be of mutual advan- 
tage, since bringing the pharmacist and physician together 
will result in better understanding and appreciation of each. 
In Chicago five such meetings have been held during the 
•past two months, in which pharmacists have read papers, 
participated in the discussions and sometime exhibited pre- 
parations of the U. S. P. and N. P. Such a thing was 
unheard of only a few years ago and not thought possible, 
until the branches were organized of the American Pharma- 
ceutical Association. 

The physicians seem to show the right spirit, and while 
not always mincing words in speaking of the unprofessional 
practices of some druggists, such as counter prescribing, 
substituting and pushing patent medicines, as a rule will 
patiently "take their medicine" when told of their short- 
comings, such as self- dispensing, prescribing proprietaries 
and forcing multiplication of identical articles. The phar- 
macists in smaller places may secure at nominal cost the 
literature prepared by the A. M. A. for distribution to phy- 

516 The Plexus. 

sicians and by showing their own make of the official pre- 
paration, do equally as well as in the cities. See: 

"New and Non Official Remedies." 

"A Propaganda for Reform in Proprietary Medicines." 

The greatest difficulty lies in having the physicians 
realize that the use of short, euphonious names for medi - 
cines is simply inviting lay self -medication. They .should 
constantly be impressed with the danger of using such 
names as are designed for patent medicines. No physician 
should patronize any medicinal article which has not a 
scientific pharmaceutic, preferably Latin, title. 

The public is now using scores of these proprietaries 
which they would not have become acquainted with if they 
had Latin titles. Liquor ferri peptonati cum mangano 
would not be sold on bargain counters, nor would they now 
be calling for aspirin if it had been prescribed as acidum 
aceto-salicylicum. The excuse that the physician cannot 
learn or remember these names is apocryphal. How can 
they remember the names of the bones of the body or the 
names of some new diseases such as trypanosomiases? The 
official titles must be insisted on and no pharmacist should 
encourage their abbreviation or simplification. All persons 
engaged in any scientific pursuit must learn the technical 
terms that constitute its language- 

We should also observe strict compliance with the phar- 
maceutical nomenclature, i. e., that when a preparation can 
be classified with any official class it should bear the class- 
name in the title. Dosa,ge-forms are being pushed with a 
simple name when they should be designated pilnlae, 
capsulae, etc. 

Matters of this kind are suitable subjects for discussion 
at these joint meetings, which may result in agreements. 
Thus the Chicago joint meetings have discussed the pre- 
scription and several have already adopted this declaration 
on the subject. 


First. The prescription is an utterance of the preserv- 
er who alone should direct and control its employment. It 

Pharmacy. 517 

should, whenever practicable, carry the name of the patient, 
the age in years, if a minor, and the date when written. 

Second. The pharmacist who prepares the medicine 
should retain the prescription as reference for his services 
and as record for a certain limited period, not less than five 
years, for the protection of the prescriber, himself and the 

Third. The medicine prescribed should be supplied not 
more than once on the same prescription: (1) If ordered by 
the prescriber "not to be repeated" (N. rep.); (2) if contain- 
ing medicinal substances commonly called narcotic or habit- 
forming drugs; (3) if called for by some person known not to 
be the original holder. 

Fourth. Copy of the prescription may be furnished and 
should be written on an especial blank, containing a declar- 
ation that it is a copy of a prescription which has been 
delivered to the original holder and is not to be refilled 
except on order of the prescriber. The copy is made with- 
out recourse to possible error. 

Since many physicians have quit writing prescriptions 
because they cannot control them, this declaration has been 
formulated by a joint committee of the Chicago Medical 
Society and the Chicago Branch of the American Pharma- 
ceutical Association. 

It has already been adopted by one-half of the branch 
medical societies in Chicago, and it is believed, when gener- 
ally observed by pharmacists, it will be instrumental in 
causing physicians to resume writing prescriptions more 

There is nothing new or radical in the requirements — 
nothing but that every reputable pharmacist will agree to. 
A definite expression like this is deemed necessary that all 
concerned may understand their positiou to the prescription 
and to each other, and to give the pharmacists who so desire 
the authority and the opportunity to *align with the profes- 
sion. Similarly many subjects may be considered at these 
joint meetings and eventually be formulated in declarations 

518 The Plexus. 

to guide the relations of the pharmacist and the physician 
and, it is hoped also, the public. 


With the fulfillment of such a programme the pharma- 
cist will soon come into his own. For years our institutions, 
like this old Philadelphia College of Pharmacy, with a 
record nigh on to a century, have been sending out thous- 
ands of youths — trained in the preparations of pharmaceuti- 
cals, qualified for the compounding of medicines — to do 
what ? To practice pharmacy— hardly. The encroachment 
of the proprietary medicinemen left but little of the prac- 
tice. Now it is going to be different. 

With the medical profession earnestly, actively interest- 
ed in this movement, with the impetus given to our great 
works— the U. S. P. and the N. F. — by the Federal Act, 
with the branches of the American Pharmaceutical Associa- 
tion aggressively at work in the principal cities, the refor- 
mation is now progressing. 


And it is high time for the alignment of the two profes- 
sions of medicine and pharmacy. The public has lost faith 
in medicine and has been doing without either physician or 
pharmacist. The layman has discovered that he can buy 
patent medicines without paying a physician a fee for re- 
commending them. Many of them have tried all the princi- 
pal proprietary pharmaceuticals, even' synthetics. From 
this they have fallen victims to the regular patent medicine 
literature of the press and sometimes the symptom-questions- 
list of the advertising quack. 

They have thus by natural evolution or selection gradu- 
ated from Osteopathy to Hypnotism, Dowieism, Eddy ism, 
and through every imaginable fad, fake or faith cure. 

The public has run the gamut and is ready for a change. 

There is an inherent feeling or instinct in the average 
human being that chemical therapeutics is after all the saf- 
est and most certain to remedy ills or to cure disease. 

It is believed that now is the psychologic moment. 

Pharmacy. 519 


Let us then join the medical {profession in placing the 
materia medica on a safe basis andjperfect our great medici- 
nal standards for the' promotion of bur professions and the 
restoration of public'confidence in our practices. 

The pharmacist, always;accessible and in contact with 
the public, should be the medium'through which this confi- 
dence may be restored into'humanity's greatest friend — the 
physician— let him figuratively give the public the glad hand. 

Let pharmacy assume'its traditional position as a hand- 
maiden to medicine as symbolizedlin the historical figure of 
virile old Esculapius, ever ready to combat disease with the 
aid of the poison pressed from the serpent's fangs by Hygeia 
— the goddess of health— the symbol of pharmacy. 





The twenty-first annual meeting of the Northern Illinois 
Dental Society will be held at Freeport, Oct. 21 and 22, 
1908. Mark the date in your appointment book and be sure 
and come for both days. The supervisor of clinics and 
program committee promise one of the best meetings of the 

Virginia districts, through their state association, have 
launched a movement looking to their recognition as medi- 
cal specialists. Vigorous reference to the present state of 
affairs was made in the annual address of the president, who 
declared that ,; the most remarkable fact recorded in the 
history of auy branch of the healing f rt is that we, who 
have full charge of the oral cavity and the various diseases 
which manifest themselves there, have for more than a 
half century remained content, or -apparently so, to be 
classed as mechanics, or artisans, and as doctors only in 
name, while every other branch of the profession has been 
recognized as a legitimate specialty of medicine or sur- 

Don't go to church on Sunday just to get patients. 
Don't make the mouth of a rich patient a young gold mine 
merely because he has money. Don't be a hog if you make 
a discovery — tell the world about it, <: The ethics of the 
profession of a dentist are exacting," said Professor Mix, 
"more so than any other one. You should be men. Don't 
join churches and clubs merely to become a petty grafter. 
Don't tell one of your patients that he has thirty cavities in 
his teeth just to get his money. Tell him the truth, and try 
to educate the public to take care of its teeth so that in 
time there will be no more dentists. Try to advance in your 
profession, but never do it at the expense of your honor." 

Dentistry. 521 

The annual program of the Chicago Odontography 
Society has been issued. Meetings are held in the Pub- 
lic Library building the third Tuesday evening of each 
month. Meetings start promptly at 7:45 p. m. Make note 
of the following dates on your appointment book: 

Sept. 15 — Operative Dentistry Quiz. 

Oct. 20— "Our Little Patients," by C. B. Rohland, D.D. 
S., Alton, 111. 

Nov. 17 — Forty or Fifty Table Clinics. 

Dec. 15 -A Symposium on "The First Permanent Mol- 
ars." "From the Viewpoint of Orthodontia." By L. S. 
Lourie, D. D. S. 

"Development and Pulp Treatment," by F. B. Noyes 
D. D. S. 

"Filling Previous to Full Development and After 
wards," by C. N. Johnson, D. D. S. 

Jan. 19 — Dental Economics and Ethics. Election of 

Feb. 16 — "Dental History,'' Illustrated by Lantern 
Slides, by Chas. McManus, D. D. S., Hartford, Conn. 

March 16 — "Diseases of the Soft Tissues of the Mouth, '* 
by T. L. Gilmer, M. D., D. D. S. "Treatment of Same," by 
Wm. Allen I'usey, M. D. 

April 20 — A Symposium on "Pathology and Treatment 
of the Peridental Membrane." Elgin Mawhinney, D. D. S. ; 
G. V. Black, M. D.. D. D. S. ; Geo. W. Cook, D. D. S. 

May 18 — Prosthetic Dentistry Quiz. 

Program Committee — Don M. Gallie, Chairman; Arthur 
D. Black, James P. Smith. 

Commenting on the program Dr. Gallie adds the follow- 
ing: "The society is in excellent condition. There yet 
remain many ethical members of the profession who are not 
enrolled as members. Let us make this year memorial by 
bringing up the membership to the thousand mark. To 
this end the program committee present a program for the 
year of exceptional merit, one that covers the important 
phases of our work, presented by men eminent in their 
respective spheres. From a great number of questions sent 

522 The Plexus. 

in by members of the prosession the committee have select- 
ed a number and assigned. The questions selected are ones 
that are of vital importance, and some leave room for 
difference of opinion. After each question is answered, a 
brief discussion of the subject will be made. We believe 
this will be one of the most interesting and instructive 
progroms ever given by the society, and we hope that a 
record attendance will be present to give the work the 
stimulus that is so much desired." 

Extract of paper read by Dr. B. J. Cigrand at Michigan 
Dental Meeting at Grand Rapids: 

If the root or roots in question are still possessed of 
sound or healty tooth substance there is no reason why they 
should be extracted. If you can attach to them a firmly 
anchored, well fitting crown and accord to that root the 
natural exercise of mastication, you restore to its peri- 
dental membrane a renewed circulation of blood and in turn 
recreate a vigorous dental antagonism, — the basic principle 
of sound dental organs, — while if the root is allowed to 
remain uncrowned and its exposed portion is denied contact, 
certainly nature will inaugurate an effort to throw off the 
useless member. But observe the rules of mechanics, and 
apply a crown to this apparently drone root. The change 
which proceeds is astonishing and the prosthesis is perfect. 

The method is simple, and effective. Prepare the badly 
decayed root as one in ordinary practice, ream out all the 
broken-down tissue and depend on sound structure; fit the 
crown, be it Logan, Davis, Brewster, Justi, Twentieth 
Century, or other crown of that character, in the usual 
manner; just before setting same, apply a bit of wax to the 
metallic post and inset in cosmolined canal. At first intro- 
duction you may have an excess of wax; remove and soften 
over alcohol flame and trim where indicated, then re-insert 
and after getting a good, accurate adaptatioD, the initial 
step is complete. Then take the crown, with its wax 
encased post, and invest entirely in the ring of your casting 
apparatus, and after freeing the wax from investment and 

Dentistry. 523 

being assured of the perfect dryness of the case, proceed to 
liquidate the gold and by means of air, root to receive the 
metal post. Choose a small reamer, and by giving it an 
anterior. posterior movement you are enabled to cut an open- 
ing of an elliptical character, and you leave the root struc- 
ture thick at its lateral sides, where the major strain falls 
and where the root must of necessity be the strongest. 
Further, this rhomboidal opening thus affords additional 
anchorage to the crown. 

It is evident that a crown set as recommended cannot 
loosen or fracture the root unless the post first stretches, 
and this, I. believe, is the cause of many of our crowns 
loosening. The primary cause does not lie hidden in this, 
however, but in a factor of which I will speak later. If the 
posts in the Logan or in any of the full porcelain crowns 
were made of iridio platinum instead of pure platinum, there 
would be less likelihood of the yielding process, and the 
stability of the crown would be more assured. 

This form or casing so accurately fits the canal and 
adjacent parts that independent of cement the crown would 
be held firmly in position; but with a film of cement or 
insoluble varnish or fluid the crown is definitely lodged. 

Then there are cases, not infrequently met, where the 
anterior half of the root is partially broken away and these 
cases tax the ingenuity of all operators, but by the method 
I advocate, these distressing cases are made simple indeed. 
Just pack cotton or guttapercha into the space, crowding 
away the gum tissues, then dismiss the patient for an ap- 
pointment on the following day. When full and easy access 
is accorded to the space, and after packing in wax both in 
root canal and broken anterior aspect, you remove the 
entire mass of wax and cast as already noted. 

In the event you wish to employ facings to harmonize 
with remaining teeth the method is also very adaptable, 
since the facing is ground to fit, being backed up by wax, 
and after removing entirely you have produced a very 
acceptable crown, and not only saved a bad root but restor- 
ed a denture. 

524 The Plexns. 

It may seem like an extreme statement, but this method 
should be employed in the setting of every crown and 
bridge, since it gives promise of permanent work. Besides 
it is in accord with the science of mechanics, an element 
which deserves our constant attention. 

The all-gold shell, when telescoped over a large amal- 
gam filling, often results in failure because of the action of 
the mercury in the filling, and when this filling is anchored 
by screws or other than gold or platinum, it will invariably 
result in failure, notwithstanding that the gold crown was 
constructed without a fault. The anchorage was insuf- 

In a case of this character just adapt the wax and build 
up same to conform to a natural crown properly shaped,, 
then remove and cast, set same with cement and you have 
formed an anchorage for the gold crown not only congenial 
with the surrounding tissues, but absolutely compatible 
with the gold telescope it is to receive, since Acolite in this 
instance is preeminently indicated because of its virtues in 
conjunction with gold and tissue. 

Now, this method of restoring badly decayed roots is 
not advocated by me because of its production of.restorations 
in a simple way, though it does accomplish this event, but 
because it conserves dental organs, and brings to our en- 
feebled humanity an element of redress, and accords to the 
philosophy of mastication — an attribute indispensable, and 
yields pronounced results. — Dental Summary. 

In the recent issue of the Dental Era the following from 
the pen of A. F. Strange is worth reading: 

You yourself know what your services should be worth, 
and do not be afraid to value them too high. The most 
expensive things in the world are those you get for noth- 
ing. Dr. Tilden once said, "there are thousands of people 
in the world, poor, miserably poor, and keep constantly in 
this state by their desire to get something for nothing." 

Do not use cigars nor alcoholic stimulents at a time 
that it may be noted in your practice, and if not used at all,. 

Dentistry. 525 

the more sure you will be of success. I once heard a 
cigaretist defined as one who is late every morning and 
fresh every evening. Prosperity not earned is like good 
cheer gathered from drink and drugs. 

This exposition would not be complete without a few 
maxims that I find of service as stepping-stones toward 
success. They are mostly by Hubbard, but I consider them 
worth repeating and remembering. 

Responsibilities gravitate to the man who can shoulder 
them and power to the man who known how. 

The things we fear, we bring 1 to pass. 

A dead fish can float down stream, but it takes a live 
one to swim against the current. 

The cheerful loser is a winner. 

The leader of the orchestra is a man who has played 
second fiddle. 

When in doubt, mind your own business. 

Before you can manage others, you must learn to 
manage yourself. 

Experience is the germ of power. 

Folks who never do any more than they get paid for, 
never get paid for any more than they do. 

Let your dress be quiet, neat and not too fashionable: 
to have a prosperous appearance helps you inwardly and 
helps your business. 

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VOL XIV. BATAVIA, NOVEMBER 20th, 1908. NO. 11 


By William M. Harsha, M. D., Chicago. 

' (Portion of Address to Students of Mount Morris College.) 
First I wish to assure you of my appreciation of your 
invitation and to thank you for suggesting a subject along 
lines familiar. At the present time talk of the use and abuse 
of medicine is appropriate, for it has become fashionable for 
people who are in the best of health, and sometimes the 
worst of spirits, to decry everything medical, and assure a 
too credulous public that there is no virtue in anything but 
pure air and correct thinking. From the fact that there is 
such virtue in, these, and that the normal condition of peo- 
ple is healthy, the case against medicine can be made out to 
look plausible. If such a thing were possible that every- 
body could keep well and uninjured for a year or two, the 
whole public could easily believe it had risen superior to 
medical needs. But the sick, like the poor, we shall have 
always with us, as long as ignorance, folly and crime exist, 
and the medical profession will continue to do its work of 
discovery, prevention and healing, and to evolve greater 
efficiency in these lines, as it has in the past — and at no time 
in the past more efficiently than during the past two decades, 
when it has been most decried and its work most disparaged. 
What I term the scientific medical profession is a unit 
the world over. In law. when you cross State lines, the 
practice varies. It will change more in different countries. 
In theology there is a wide difference in teaching and belief. 

590 The Plexus. 

In medicine, and especially in surgery, tho practice of the 
best men is the same in Tokio, London, Paris, St. Peters- 
burg, New York and Chicago. What one discovers or 
invents is given to the profession, and in medical journals is 
published in every language. 

No one in the learned professions has made more 
progress or given better account of itself than the medical 
profession. I do not include in the term the various sects or 
isms. Science knows none, and medicine has come to be a 
science and an art as well, the art for the most part being 
based upon a scientific groundwork. Quinine was used for 
years in what we call an empirical way; we knew it exerted 
a curative effect on malaria before we knew what malaria 
meant. Now, in the past two decades, the microscopic 
organisms that, getting into the blood, cause chills and 
fever, have been discovered, and the effect of quinine is to 
destroy these organisms in the blood. The medical profes- 
sion has gone further and found the source of these organ- 
isms in the body of the mosquito, and now we are preventing 
malaria by destroying or shutting out the little buzzing 
pests. The great work now is prevention; prevention of 
smallpox by vaccination; the prevention of yellow fever by 
sanitation, including the destruction of the peculiar mos- 
quito in which breed and disseminate the germs. It is the 
crowning glory of the medical profession to prevent the ill- 
ness of the masses rather than to effect the cure of individ- 

I was out on the Pacific Coast last spring, and I met an 
ex-army surgeon whose whole work was, practically, to aid 
in the destruction of rats, as these had been brought in 
ships from the Orient diseased, and were scattering fleas, 
which convey the disease known as bubonic plague. 

Under the guidance of the medical profession the world 
over, smallpox, cholera and the plague are being robbed of 
their terrors. Sanitary work in Cuba and the Panama Zone 
has all but abolished yellow fever. On the Pacific Coast a 
like policy is preventing Bubonic plague. Our late Tuber- 
culosis Congress was bent on devising more and better 

The Use and Abuse of Medicine. 591 

methods of preventing tuberculosis. Statistics show that in 
dead bodies some form of tubercle infection has been present 
in more than fifty per cent. A continued agitation and 
education of the public and of individuals, of which the pub- 
lic is made up, will some time crush out this great white 
plague. So far I have spoken of the profession. I consider 
no calling higher; and there is no body of scientific men the 
world over who are more zealous and persevering. In this 
country the work has progressed almost entirely through 
unendowed institutions or by men doing private practice. 
There has been little State aid to research work looking to 
the betterment of the human family, although millions have 
been voted in legislatures to favor the domestic animals. 
Our medical institutions in this country are taking high 
rank, and right now thousands of bright young men and 
women are starting in to learn, first, what the normal actions 
of the various organs of the body are, passing from that to 
diseased conditions and then the methods of prevention and 
cure. There is no knowledge taught of greater importance. 
I recall that when I attended my first course of lectures at 
the University of Michigan, now more than a quarter of a 
century since, I felt that if I should never practice medicine 
for a day I should never regret the small knowledge I gain- 
ed. From what has been said, you will readily see that the 
greatest work of medicine is discovering causes of disease, 
and education of the people, to the end that they* may keep 

There has been too much faith in drugs, as well as too 
little. I know a man in Chicago who drinks several glasses 
of whiskey a day for eleven and a half months, and then for 
two weeks he goes for what has been termed an immunity 
bath, to one of the springs, which do more harm than good 
by holding out the hope of immunity from the certain effects 
of intemperance. He did not realize that the organic 
changes, the hardening of his liver and kidneys and blood 
vessels could not be soaked by any kind of water or medicine 
until they were soft; and now he has dropsy and is prema- 
turely old, and his time on earth is short. 

592 The Plexus. 

The physician every day has people come to him who 
complain of their stomachs, when the trouble is with their 
judgment. If you drink three or six cups of coffee a day, or 
smoke three to six cigars a day, and eat lobster at midnight, 
you cannot have normal nerves or normal digestion, and the 
greatest source of discomfort to the most people in this 
country is probably traceable to badly treated nerves. 
Through these they suffer from indigestion, insomnia, irrita- 
bility, insanity, and a host of troubles. To be well, keep 
clean, work, eat and play moderately, get plenty of fresh 
air and sleep eight hours a day. Then cultivate equanimity, 
a cheerful mental attitude and think of other people. 

Once I attended a dinner given in celebration of the 
eighty-third birthday of one of my old teachers- Congratu- 
latory messages were sent him on his age and condition. He 
wired back to that company this short sentence: "Equanimity, 
moderation, work and love will enable you to reach eighty- 

Do not people need medicine? Yes, sometimes. There 
are cures for many of the most dreaded diseases, and it is 
usually a crime to allow people to die from diphtheria, ma- 
laria and some of the most fatal and loathsome blood dis- 
eases. Surgery will also cure a large number of ailments, 
and will largely add to the sum-total of years and of com- 
fort. Medicine aids greatly sometimes where the cure is 
effected by nature in ways we have not learned, but in which 
we have large faith. Pain can be relieved and mental and 
physical comfort promoted by your good friend, the doctor. 
Further, this timely advice may help you to prevent an- 
other attack. Then, when you get well, you can joke with, 
him and congratulate yourself in spite of him. A physician 
was asked if he thought people were ever buried alive. He 
said, "None of my patients ever was." Another expressed 
it as his opinion that a patient would die. A friend asked if 
he was sure he would die. Another spoke up: "Of course, 
he's sure he knows what he's giving him." In another case 
a doctor was asked if his patient was out of danger. He 
said, "No, I am still treating him." When you are well, 

Tuberculin in Pulmonary Tuberculosis. 593 

keep well, which most of you can do most of the time, but 
which not all of you can do all the time. 

Mental healthfulness requires unselfishness; happiness 
requires the same, for when we constantly look at ourselves 
taking account of the things wherein we compare unfavor- 
ably with our neighbor, we are supremely selfish, and we 
are sure to find the comparison painful the greater part of 
the time. The cure is to think of other people or other 
things and get busy. A cheerful mental attitude conduces 
to health. Herein is the kernal of the so-called mind heal- 
ing. I do not know of any school or sect that has a patent 
on it. Good physicians have always aided the sick by en- 
couragement and hope. A reasonable optimism is essential 
in keeping well and contented. 

What has been called an "ingrowing disposition" will 
insure unhappiness in a saint, and may point the way to the 
"foolish house."' 


By Paul H. Ringer, M. D. 

An Abstract from a Paper in the Journal of the American Medical 
Association, May 2, 1908. 

It is generally accepted that in tuberculin we possess a 
most valuable remedy in the treatment of tuberculosis. In 
my opinion one of the dangers of tubercclin therapy lies in 
the fact that patients and physicians place too much trust in 
tuberculin and slight other elements of treatment. It is 
natural that the patient should do this, but the physician 
should insist that the hygienic treatment should be carried 
out faithfully and conscientiously. 


Koch's original tuberculin consists of 5 per cent, glyc- 
erin bouillon on which human tubercle bacilli has been 
grown, evaporated by heat to one-tenth of its volume and 
filtered through a porcelain filter. Denys' tuberculin or 
bouillon filtrate consists of the bouillon or broth on which 
human tubercle bacilli of known virulence have been grown, 
filtered through porcelain and not exposed to heat. It can- 

594 The Plexus. 

tains, in addition to the toxins manufactured by the living- 
tubercle bacilli, only those soluble proteins which come from 
the dead tubercle bacilli into the culture fluid. Denys' 
tuberculin possesses the advantage over Koch's original 
tuberculin in not having been exposed to heat, so that the 
chance of the toxins and proteins being affected by thermal 
influence is eliminated. 

Koch's other products, tuberculin new and tuberculin 
new bacillen emulsion, contains the pulverized bodies of 
crushed virulent tubercle bacilli, much weakened in virulence 
by repeated dryings and not capable of reproducing tuber- 
culosis. ' 

Prom what is known of artificial immunity it would 
appear that Koch's original tuberculin and Denys' tuberculin 
would confer the greatest amount of antitoxic immunity; 
bacillen emulsion would excel in the production of an anti- 
bacterial immunity. 

Denys' tuberculin appears to be best suited for the pro- 
duction of an antitoxic immunity. Containing, as it does, the 
soluble toxins and proteins of the tubercle bacillus, not sub- 
jected to heat, it would seem to be the most logical tuber- 
culin to use. 


Tuberculin may be employed in: 

1. All incipient cases, cases of closed tuberculosis in 
which ulceration has not taken place and bacilli are not to 
be demonstrated in the sputum. 

2. Uncomplicated non-febrile, first and second stage 

3. Fibroid cases not running a febrile temperature. 

4. Febrile cases in which the temperature does not 
drop under treatment by rest, and where fever is due to the 
tubercule-toxin alone and not to mixed infection. In such 
cases tuberculin should be administered with the greatest 
caution, in the most infinitesimal doses, with long intervals 
between successive doses. 

5. Advanced, third stage cases. Tuberculin can here 
occasionally be used, not as a curative agent, but to aid in 

Tuberculin in Pulmonary Tuberculosis. 595 

relieving distressing symptoms. It will often relieve the 
tight, harassing cough that is so exhausting, render expec- 
toration easier, do away with thoracic pain, and help to 
make the patient more comfortable. In such cases its 
administration should be most guarded and the dosage very 


1. Greatly emaciated or greatly weakened individuals- 
The general body strength must first be raised by rest and 
proper diet before such patients will be able to supply those 
defensive forces which tuberculin stimulates to action. 

2. Third stage cases with mixed infection. Those 
cases constitute the most absolute contraindications to the 
use of tuberculosis. In them a hypersusceptibility is easily 
excited, violent reactions are prone to occur, a general 
aggravation of the symptoms may set in, and great harm 

3. Hemorrhage: Hemoptysis occurring during the ad- 
ministration of tuberculin is a signal not for the permanent 
withdrawal of the drug, but for its cessation at once and 
until sometime after subsidence of all hemorrhagic symp- 

4. Heart disease: A contraindication only if it is feared 
that owing to possibility of reactions compensation may be 

5. Marked increase in pulse frequency, beginning and 
persisting during administration of tuberculin. 

6. Marked loss of weight, beginning and persisting 
during the administration of tuberculin 

7. Complications: Diabetes, nephritis, hepatic cir- 
rhosis, hysteria, neurasthenia, epilepsy. 

The patient about to take tuberculin should be impressed 
with the necessity of conscientiously carrying out the physi- 
cian's orders. Before treatment is begun the physician 
should acquaint himself with the course of the patient's tem- 
perature, a two hour record being most satisfactory, the 
temperature being taken preferably on the odd hours to 
avoid the 2 p. m. temperature coming immediatelv after a 

596 The Plexus. 

hearty meal, which may, in some individuals, be responsible 
for a temporary rise of as much as four-fifths of a degree. 
This preliminary record should be kept at least three days, 
from four days to a week is better. At the conclusion of the 
preliminary observations injections can be begun' if advis- 
able. They are given preferably in the morning, between 9 
and 12 o'clock; injections given in the evening are open to 
the objection that very mild reactions may set in and pass off 
during the night, and are thus overlooked. The injection 
being given in the morning, the patient should be instructed 
to take very little exercise for the rest of the day (if any be 
allowed). By very little exercise I mean one-third of a mile 
at a slow walk as a maximum, and, in general, patients tak- 
ing tuberculin should be allowed less exercise than others. 
The temperature should be taken every two hours for the 
rest of the day, the thermometer being left in the mouth five 
minutes if the weather is warm, ten if cold. In very cold 
weather it is best for the patient to go into a warm room and 
remain there ten minutes before taking his temperature. 

Two- hour temperature records on the day of injection 
are the best. Occasionally a three-hour record may be kept, 
a four-hour record is useless, for mild reactions may come 
and go in the four hour interval. Except on the day of 
injection, a three-hour record will suffice. A temperature of 
100 F. is the mimimum reactionary temperature, unless there 
is headache and general malaise, with a temperature of, let 
us say, 99.8 degrees, when a reaction can be assumed. 


We may define a reaction as that clinically demonstrable 
symptom-complex exhibited by a patient as a result of too 
large a dose of tuberculin. Reactions are of all grades; 
many are so mild as to be overlooked; some have been so 
severe as to result fatally. Reactions may be divided into 
three elasses: (a) Cutaneous, (b) local or focal, (c) general 
or systemic. 

Too little stress has been laid on the cutaneous and local 
reactions, the physician generally contenting himself to wait 
for the onset of a systemic reaction before allowing his 

Tuberculin in Pulmonary Tuberculosis. 597 

dosage to be modified. Reactions are the most important 
objective phenomena in connection with tuberculin adminis- 
tration, for they serve as the one infallible guide for the 
regulation of dosage. 


The cutaneous reaction is seen but seldom. It consists 
in the appearance at and about the site of injection of a red, 
tense, slightly edematous, tender, painful swelling, in size 
usually not over the diameter of a silver dollar. There is no 
sense of fluctuation. The swelling makes its appearance in 
from three to ten hours after the injection, lasts a variable 
time — two days to a week — disappearing gradually. It may 
be confounded with a hypodermic abscess, but shows no 
tendency to suppurate, and disappears far sooner than does 
the other. It has been my good fortune to witness three 
such reactions, two in the same patient. In each case the 
mouth temperature failed to reach 99 F. and there were no 
subjective signs of systemic disturbance. 


The local or focal reaction is of far more frequent occur- 
rence and can very often be demonstrated at the height of a 
systemic reaction, when, of course, its presence from the 
practical standpoint of dosage loses weight. It consists in 
an increase in the physical signs in the lungs and occasion- 
ally in the appearance of physical signs where formerly 
none existed. Cough and expectoration become more 
abundant. These changes are due (1) to hyperemia about 
the focal process, caused by the administration of tuberculin; 
(2) to increased bronchial secretion; (3) to increased local 
leucocytosis. • 

Focul reactions, when moderate, are not undesirable; 
they rid the system of pus and septic material, and we have 
no better expectorant than tuberculin. 


The systemic reaction is well known and classical. In 
from six to thirty hours (the latter being rare) after injec- 
tion of tuberculin, the temperature rises to anywhere be- 
tween 100 F. and 106 F. The patient may not complain of 

598 The Plexus. 

any subjective symptoms, but usually there is discomfort, 
chilliness amounting at times to a definite rigor, headache, 
nausea, at times vomiting, pains in limbs and body, general 
malaise, and increase at times in cough and sputum if a focal 
reaction co-exist. These symptoms are usually proportion- 
ate in severity to the height of the temperature. The tem- 
perature drops in from two to ten hours (depending on the 
severity of the reaction) and save for a feeling of weakness, 
all symptoms except cough and sputum have subsided and 
the patient is himself again in twenty-four hours in the ma- 
jority of cases. Sometimes, however, a systemic reaction 
appears late, thirty hours after injection, and fever persists 
for two or three days, gradually dropping to normal. 

The desirability of reactions has long been a mooted 
point, but now they are considered to be distinctly undesir- 
able. At the time of his discovery of tuberculin Koch be- 
lieved that the organism should be subjected to many power- 
ful reactions in order to produce focal necrosis and the elim- 
ination of both tubercle tissue and tubercle bacilli. This 
idea is not practicable and does not now hold good theoreti- 
cally. It has been abandoned entirely, but many still cling- 
to the idea that occasionally reactions are beneficial; morally 
they may be, but physically they are not. A moderate hy- 
peremia, with serous exudation in the peri-tuberculous tis- 
sue, unquestionably has a good curative influence, but this 
can occur without a systemic reaction appearing, and it is 
the universal verdict that marked constitutional symptoms 
are bad. 


Tuberculin has as its object not so much the effect on 
tubercle tissue and bacilli as the protection of healthy tissue 
against the bacilli and tuberculo-toxins. To attain this end, 
reactions are unnecessary- Were reactions necessary, then 
the greater the reaction the greater the immunity, but, as a 
matter of fact, we not only see that we can acquire immuni- 
ty without reactions, but also that we can get many and re- 
peated reactions without immunity. Moreover, reactions 
favor the production of hypersusceptibility. To quote 

Tuberculin in Pulmonary Tuberculosis. 599 

Trudeau: 1 "By hypersusceptibility we do not mean the usual 
susceptibility to an increased dose which shows itself by an 
ordinary reaction, but an exaggerated and growing sensitive- 
ness to the toxin which follows a reaction without any pre- 
vious warning. For instance a patient having reacted in the 
usual way to 1 mg., and all the symptoms of the reaction 
having disappeared and the temperature became normal for 
two days; an injection of .05 mg., is followed by a marked, 
even more marked disturbance than the one produced a 1 
mg. dose; another interval of rest being given, and the dose 
reduced to 0.1 mg., another strong fever reaction manifests 
itself, and this continued and sometimes increasing suscepti- 
bility of the organism to a decreasing dose of toxin consti- 
tutes tuberculin hypersusceptibility. " 

If this condition occurs it is not necessary to discon- 
tinue tuberculin permanently. All injections should be 
stopped until the temperature has been normal for ten days, 
then a dose of 1-100 of that causing the beginning hypersus- 
ceptibility should be given, and the subsequent increase in 
dosage should be more rapid than before, in fact, more 
caution is needed. Of course, if marked hypersusceptibility 
recurs two or three times the case is not a suitable one and 
tuberculin will have to be abandoned. 


Diluting the tuberculin. — As a diluting fluid physiologic 
salt solution is used, to which 0.5 per cent, carbolic acid has 
been added to prevent decomposition. A pipette of small 
calibre, containing 1 c.c. and accurately graduated to tenths 
of a cubic centimeter, is used. This is sterilized and filled 
with 1 c.c. of pure bouillon filtrate 2 , which is then emptied 
into a sterile bottle. Then, using the same pipette or one 
exactly similar, 9 c.c. of the diluting fluid are added. This 
makes a ten per cent, solution, each cubic centimeter of 
which contains 100 mg. of tuberculin. Preceding in like 

1. Tuberculin immunization in the treatment of pulmonary tuber- 
culosis. Am. Jour. Med. Sc, June, 1907. 

2. DeDy?. J.: Le Bouillon Filtre du Bacille de la Tuberculose dans 
le traitment de la Tuberculose humaine. 

600 The Plexus. 

manner, we make from this 10 per cent, solution a 1 per 
cent, solution, each cubic centimeter of which contains 10 
mg. of tuberculin, and in similar fashion we proceed to the 
weaker solutions. 

The solutions should be kept in a cool place, in the dark 
or in brown bottles, and the weaker ones (0.1 per cent, and 
under) should be renewed after four weeks. All turbid 
solutions are worthless and should be discarded. 

Eight solutions are used, each one tenth the strength of 
the next higher. No. 1 contains 1-10,000 mg. per c.c. and is 
for febrile cases only; No. 2 contains 1-1,000 mg. per c.c; 
No. 3 contains 1-100 mg. per c.c; No. 4 contains 1-10 mg. 
per c.c; No. 5 contains 1 mg. per c.c; No. 6 contains 10 mg. 
per c.c; No- 7 contains 100 mg. per c.c; No. 8 is pure tuber- 

A syringe is used holding exactly 1 c.c. and carefully 
graduated to tenths of a cubic centimeter. Injections (if no 
reactions occur) are given twice a week. With a febrile 
patient solution No. 1 is used, and intervals between in- 
jections should pe four or five days. With a non-febrile 
patient solution No. 2 is employed, containing 1-1,000 mg. 
per c.c. and an initial dose of 1-10,000 mg. is given. In 
other words, as the syringe contains 1 c.c, we give one- 
tenth of a syringeful of solution No. 2. Increase is made at 
first by 1-10,000 mg. consequently at the subsequent dose we 
give two-tenths of a syringeful, then three-tenths, then four- 
tenths, and so on, until we have given 9-10,000 mg. or nine- 
tenths of a syringeful. 

We then change to solution No. 3, ten times stronger 
than No. 2, containing 1-100 mg. per c.c Beginning with 
1-1000 mg., or one tenth of a syringeful, increase is made by 
one-tenth of a syringeful, but we must remember that while 
with solutitn No. 2 we were increasing our dosage by 1-10,000, 
we are now increasing by 1,1,000 mg. When we have reached 
9-1,000, or nine-tenths of a syringeful of solution No- 3, we 
use solution No. 4, containing 1-10 mg. per c.c, and proceed 
as before, bearing in mind that now we are increasing each 
dose by 1-100 mg- When solution No. 6 is reached the in- 

Tuberculin in Pulmonary Tuberculosis. 601 

terval between doses should be lengthened to five days, in- 
crease still being made by one tenth of a syringeful of the 
solution used. When the patient is receiving 100 mg. six 
days should elapse between doses, when 400 mg. are reached, 
from ten days to two weeks. The maximal dose is 1,000 mg. 
or 1 c.c. of pure taberculin. This dose may, if reached, be 
repeated a few times; but, as a rule, tuberculin should then 
be dispensed with for a time. If no reaction occur the 
course will consume about a year. Reaction will, of course, 
greatly lengthen the time; in the majority of cases the max- 
imal dose is never attained. 

This is the method of dosage employed by Denys. 
Naturally the dosage must be suited to each indi- 
vidual case, and in giving such an outline we are, of 
necessity, forced to generalize. Each physician will learn 
by experience what tuberculin will do in his own hands and 
will modify his dosage accordingly. Some patients will with- 
stand rapidly increasing doses, others will have to be dealt 
with most cautiously. 

It is found that patients react most frequently at the 
second or third dose of a new solution. This is not strange, 
for with each new solution employed the increase in dosage 
becomes ten times that of the proceeding solution. Conse- 
quently, when proceeding to a new solution, it may be well 
to increase by five centigrams instead of by one decigram of 
the solution, for two or three doses, to avoid possible re- 

With the occurance of a systematic reaction no further 
dose should be given until the temperature has returned to 
normal and has remained so for two days. If cutaneous or 
focal reactions occur it is well to repeat the offending dose 
once before proceeding to an increase. After a systematic 
reaction the offening dose should not be repeated, but a 
smaller one substituted. Thus if a patient reacts to 1 mg. 
the subsequent dose should be 1-5 mg., then 0.5 mg., then 1 
mg., the interval between doses .remaining the same as be- 
fore the reaction. 

If a second reaction occurs before the dose causing the 

602 The Plexus. 

first reaction is reached or surpassed, tuberculin should be 
stopped until the temperature has been normal for four days, 
then a still smaller dose should be given. Thus, if 1 mg. 
causes a second reaction, the next succeeding dose should be 
0.1 mg. and progression upward should be made by 0.1 mg. 
to a dose. If reaction again occurs before the primarily of- 
fending dose is reached, tuberculin hypersusceptibility is 
probably setting in and should be dealt with as stated above. 

SchnOller, 3 of Davos, advocates the administration of 
Denys' tuberculin in a slightly different manner. He employs 
two methods, the conservative and the radical. His con- 
servative method is indicated in: (1) all extensive lesions, (2) 
patients with slight resisting power, (3) patients with much 
emaciation, (.4) patients with mouth temperature over 99.4 F., 
(5) patients with inverse temperature, (6) patients with hemo- 
ptysis, (7) children, (8) pregnancy. 

He advises in these cases the administration of solution 
No. 2 daily, Nos. 3 and 4 every other day, of Nos. 5 and 6 
twice a week; thus, even in his conservative method, his 
contention is for more rapid dosage with weaker solutions 
than are suggested by Denys. I have made a practice giv- 
ing solutions Nos- 2 and 3 every other day, if no reactions 
appear, beginning bi-weekly injections with No. 4, and have 
not seen any bad results from this proceedure. 

Schnoller uses the radical method with patients in good 
physicial condition and manifesting strong tolerance in order 
to establish an active immunity as rapidly as possible. His 
radical method consists simply in starting with solution No. 
4 and following out practically the same schedule of dosage 
as that outlined by Denys. I have had no experience with 
this method. 

The time necessary for a course of tuberculin can not be 
estimated in advance, but in every case the patient should be 
told that it must be administered for several months to be 
of benefit. We again quote Denys: "The two most im- 

3c Theoretisches und Praktisches Uber Immunisierung gogeu 
Tubevkulose nebst Statistik von 211 miih Deny's schem tuberculin be- 
handelten Lungenkranked. 

Tuberculin in Pulmonary Tuberculosis. 603 

portant factors in obtaining results are the length of time 
over which the treatment is extended and the dose of toxine 
the patient can be made to tolerate. . . . Not much per- 
manent good can be expected from a short treatment extend- 
ing over a few months, especially if the highest dose 
reached at the end of that time be a fraction of a milligram. 
on the other hand, when full doses have been reached they 
should not be continued indefinitely for fear of exhausting 
the patient's power to respond, by the formation of antibodies 
to the stimulus of the injection of toxin. " r 


Patients tolerating increasing doses are not so prone to 
the exacerbations and relapses exhibited by those not so 
treated. More permanent cures have resulted when tuber- 
culin has been used than where it has been omitted; many 
patients running a slow but steadily downhill course, in spite 
of open air treatment, improve and get well under tuberculin. 
Tuberculin has a favorable effect on the chronic toxemia of 
of tuberculosis, which disappears under its use to an as- 
tonishing degree. Cough and sputum frequently cease, or 
persist greatly lessened in amount. 


1. Tuberculin is the most valuable adjuvant to fresh 
air, rest, good food, we possess in the treatment of pulmo- 
nary tuberculosis. 

2. Denys' tuberculin appears to be best suited to estab- 
lish an active antitoxic immunity, the type of immunity 
capable of doing the greatest good. 

3. Tuberculin is indicated in many types of cases, and 
in the hands of a competent administrator will do no harm. 

4. Reactions are often overlooked: they are not to be 
desired, and when frequent or violent are distinctly harmful 
to the patient. 

5. The dosage should at first be infinitesimal; increase 
should be very gradual; the word "haste" has no place in 
tuberculin therapy. 

6. Time and tolerance bring success in the treatment" 
by means of tuberculin. 

7. Tuberculin should never be used save in conjunction 
with strict hygenic and dietetic measures. 

GO 4 The Plexus. 


Mr, Rudyard Kipling delivered— without notes — a bril- 
liant speech to the Middlesex Hospital students, whose 
prizes he distributed. 

"It may not have escaped your professional observa- 
tion,"' he said, ''that there are only two classes of mankind 
in the world — doctors and patients. I have had a delicacy 
in confessing to the patient class ever since a doctor told me 
that all patients were phenomenal liars where their symp- 
toms are concerned. But, speaking as a patient, I should 
say that the average patient looks upon the average doctor 
very much as a non-combatant looks on the troops fighting 
on his behalf, and thinks that the more trained men that are 
between him and the enemy the better. 

"I have the pleasure of meeting a number of trained 
men who, in due time, will be drafted into that permanent 
army which is always in action, always under fire, fighting 
against Death. It is unfortunate for the doctor that Death 
— the senior practitioner — is bound to win in the long run. 
We patients must console ourselves with the idea that your 
business is to make ,the best terms you can with Death on 
our behalf, to see that his attacks are delayed as long as 
they may be, or diverted, and to see that, when he insists 
upon driving the attack home, that he does so according to 
the rules of civilized warfare. 

"Every sane human being agrees that this long drawn 
fight for time that we call life is one of the most important 
things in the world. It follows, therefore, that you, who 
control and oversee this fighting, must be among the most 
important people. 

"The world decided long ago that doctors have no work- 
ing hours that anybody is bound to respect. Nothing except 
your extreme bodily illness will excuse you, in the world's 
eyes, for refusing to help mankind at any hour of the day or 
night. In your bed, bath, or on your holiday — if any of the 
children of men have pain or hurt— you will be summoned, 
and what little vitality you have accumulated in leisure 
hours will be dragged out of you again. At all times — in 

The Autocracy of the Medical Man. ■ 605. 

flood, fire, famine, plague, battle, murder and sudden death 
— it will be required of you that you should report for duty 
at once, to go out on duty at once, and to stay on duty till 
your strength fails you or your conscience releases you — 
whichever may be the longer period. 

''And I do not think your obligations will grow less. 
Nobody has heard of a bill to promote an eight-hour day for 
doctors. No change in public opinion will allow you not to 
attend a patient when you know the man never intends to 
pay you, or protect you from the people who, although per- 
fectly well able to pay, prefer to cadge around a free hos- 
pital for their glass eyes or cork legs. It seems to be 
required of you that you must save others; no one has laid 
down that you need to save yourselves. 

"You belong to a privileged class, and some of your 
privileges are these: 

"You, and kings, are about the only people whose ex- 
planation a policeman will accept if you exceed the legal 
limit in a motor-car. 

"On presentation, your visiting card will pass you 
through turbulent and riotous crowds unmolested. 

"If you fly a yellow flag over a dense centre of popula- 
tion it will turn into a desert. 

"If you fly a Red Cross flag over a desert it will turn it 
into a centre of population. Men will crawl to it on their 
hands and knees, as I know. 

"You may forbid a ship to enter a port, and if you 
think the exigencies of an operation demands it, you can 
stop a 20,000-ton liner, with her mails, in mid-ocean. 

"At your orders, houses, streets, whole quarters of a 
city will be pulled down or burned. 

"And you can call on the armed cooperation of the 
nearest troops to see that your prescriptions are efficiently 
carried out. 

"To do patients justice, they do not often dispute their 
doctors' orders. You have been exposed, and you always 
will be, to the contempt of the gifted amateur— the gentle- 
man who knows by intuition everything you have learned 

606 The Plexus. 

through long years of study. You have been exposed to 
the attacks of those persons who consider their own emotions' 
more important than the world's most bitter agonies, and 
who would hamper and cripple research because they fear it 
may be accompanied by a little pain and suffering 

"Such people have been against you from the begin- 
ning — every since the earliest Egyptians erected images of 
cats and oxen upon the banks of the Nile. But your work 
goes on, and will go on- You remain the only class that 
dares tell the world that we can get no more out of a ma- 
chine than is put into it, and that, if fathers have eaten 
forbidden fruit, the children's teeth are very likely to be 

"At a time when few things are called by their right 
names, when it is against the spirit of the time to hint that 
an act may entail consequences, you are going to join a 
profession in which you will be paid to tell the truth, a pro- 
fession which exacts from its followers the largest responsi- 
bility and the highest death-rate — for its practitioners — of 
any profession in the world. 

"I will wish you in the future what all men desire: 
enough work to do, and strength enough to do that work." 
—London Daily Mail, October 2, 1908. 


President James of the University of Illinois issued the 
following address to the students of the University on the 
subject of hazing: 

To the Students of the University:— There should be no 
misunderstanding on the part of the student body or the 
general public as to the attitude of the authorities of the 
University of Illinois on the subject of hazing. 

It is a rule of the Board of Trustees that students found 
guilty of hazing shall be dismissed from the University. 
Since this rule went into effect, all students who have been 
clearly proven guilty of hazing have been dismissed. 

Hazing is a violation of good manners and of the right 
of individual liberty. It is provocative of public disorder. 

Reubn's Philosophy 607 

Public opinion throughout the state has very properly set its 
seal of condemnation upon it. On all counts it must be put 
under the ban of the University. 

In its milder forms it is a nonsensical and almost idiotic 
form of amusement, unworthy of the support or favor of 
any sensible university student. It was looked upon as a 
comparatively slight offense perhaps twenty years ago in 
small institutions. It is today altogether unworthy of the 
traditions and reputation of a national institution such as 
this has become. 

In its coarser forms hazing is vulgar, brutal, always 
demoralizing and sometimes dangerous form of sport which 
the University cannot countenance or tolerate. It naturally 
leads to reprisals and may thus become a source of serious 
disorder within and without the University. In its worst 
forms, which fortunately have not prevailed here, it may, 
not inaptly, be compared with night-riding, white capping, 
and other similar forms of outrageous interference with 
private and public rights. 

Surely these are reasons enough not only to forbid its 
existence at the University, but to use every legitimate 
means to stamp it out. 

All loyal and law abiding students are especially re- 
quested to cooperate with the authorities in putting an 
absolute end to this custom, which, in addition to the evil it 
does within the University, brings dishonor upon the fair 
name of our alma mater throughout the state and country, 
and naturally begets a prejudice against us which influences 
unfavorably the prosperity of the institution. 

Urbana, November 5, 1908. 


By H. K. Hodes, Houston, Tex. 
I hear some people say this world is full of dark despair, 
That clouds and shadows, dread and fear, surround us 

While others say its full of hope and beauty, joy and bliss, 
Effulgent rays of sunshine always scattering the mist. 

608 Tbe Plexus. 

Some say that evil, infamy and vice are all around; 
Corruption and iniquity are always to be found; 
Yet I believe that virtue, truth and purity do prove 
The omnipresence of a God of righteousness and love. 

Then hatred, spite and malice seem to fill the world, to some, 
And obloquy and rancor are some things that's overdone; 
Yet when we see around us so much tenderness and love, 
We know we're just a stepping stone to that great world 

There's fraud, intrigue, deception and deceit surround us, so 
That the meanness of their machinations startles us I know; 
We turn our faces toward the light and there before our 

Integrity, sincerity and honesty arise< 
The pride and envy, callousness and coldness of our kind, 
Make vanity and fickleness leave better things behind; 
Yet charity is world wide and lowliness is here, 
Solicitude for others is a thing that's ever near. 

Though cruelty is practiced upon beast as well as man, 
And cowardly abuse has shocked us since the world began, 
There's still enough compassion left and kindness too, in 

To make our lives worth living and to fill the world, and 

As we walk among the lowly, then the world to us appears 
So full of want and poverty, our eyes are moved to tears; 
We think of all the splendor and the riches made by greed, 
And out of our abundance we divide with those in need. 
Life's filled with bitterness and grief and misery and woe; 
It seems remorse, distress and fear will ever haunt us so, 
Until the charm of life appears, the charm of hope replete, 
With courage faith and comfort, and makes our living sweet 
A flood of levity comes on, or folly or satire, 
Or what is worse, of apathy, and halts us in the mire, 
A resolution then we make, we see that life is real; 
With fortitude we strive to reach the goal of our ideal. 

Reuben's Philosophy. G09 

We are never out of danger and ne'er from trouble free; 
The world is full of chaos, tumoil and jeopardy; 
But it's also full of blissfulness, there's peace on every hand, 
For equity and justice hover over all the land. 

Now I learned when just a schoolboy, 'fore I ever learned to 

That two things could never occupy the same space at a 

So I tried my best to figure out just how these matters 

How the world, though full of wickedness, was also full of 


I 'came to this conclusion and to me it looks quite clear; 
That every individual upon this mundane sphere 
Establishes his own world, its limits and extent, 
So in speaking of the world it was his own world that he 

We can make our world just what we please, from North, 

South, East or West 
And limit all the people from the meanest to the best. 
We can have a world of darkness, we can have a world of 

Fill with shadows to obscurity or shine with radiance 


And instead of heaven above us, in the distance far away, 
We have heaven right within us, so the Bible pages say. 
The thing to do to make improvements in our world I'm told 
Is to get as much of heaven as our carcasses will hold. 

Then we'll be just like a magnet and will draw none but the 

For I learned that like attracts its like and leaves alone the 

Then as the center of our sphere, the things we have inside 
Will emanate and radiate and in our world abide. 

When discord comes, we should devote ourselves with 

To purify it in a flood of love and harmony. 
We fiill our lives with worry over cares and yet we may 
Make this old world we're living in be brighter every day. 

So cast environment and luck and such things to the wind, 
And if our world is faulty let's another world begin; 
And instead of the periphery, use the center for the start, 
And we'll never need to worry much about the other part. 

£10 • The Plexm. 


By C. H. Long, M. D., Chicago. 

The antrum operation as I observed it performed by- 
Mr. Heath, of London, in April, 1908: 

1. The patient was prepared as for the simple and rad- 
ical mastoid operation. 

2. With his hoe-shaped knife he incised the superior, 
posterior and inferior walls of the external auditory meatus, 
about 8 mm. external to the drum-head, leaving the anterior 
portion of wall for nourishing purposes. 

3. He exposed the bony external wall of the mastoid 
antrum and cells by an incision in the crease behind the ear, 
commencing about lm below the attachment of the auricle 
to the head and continued downward until opposite the up- 
per part of the external wall of the meatus, circled back- 
wards 9 mm, continuing to the tip of the mastoid, cutting to 
the bone, except the upper portion where the temporal mus- 
>cle was exposed. Here the flap was dissected backward, 
leaving the fibres of the muscle uninjured, thus avoiding 
a troublesome oozing of blood. The circle backwards is 
made topanticipate the possibility of finding it necessary to 
make the radical instead of the antrum operation. 

4. He removed the external bony wall of the antrum in 
the ordinary way, studiously avoiding the wounding of the 
tympanic membrane and the ossicles of the cavum tympani, 
by probing or other instrumental procedure. If this pre- 
caution is not observed the ossicles may be dislocated and 
the hearing impaired. Then he removed the posterior wall 
•of the bony meatus as far inwards as the incision in the soft 
parts of the meatal wall, thus* providing free drainage and 
access to the exenterated antrum and mastoid cells through 
the auditory meatus during the after treatment. Plastic 
flaps were formed after Panse's method. By retracting 
these flaps the tympanic membrane was brought into view, 
showing a perforation too small for counter drainage, so its 
size was increased. Then a proper sized cannula with a 
rubber bulb was carefully inserted into the adantrum via 

The Health Operation. Gil 

-the antrum, taking care not to disturb the incus. Blasts of 
air were sent into the vacurn tympani, forcing secretions, pe- 
dunculated granulations and all other debris through the 
perforation in the membrane into the external auditory 
meatus, where it was readily wiped away. Then using the 
same apparatus, cannula and rubber bulb, a warm solution 
of boaic acid was used instead of the air. This treatment 
was repeated until the cavity seemed free and open, the air 
following the solution for drying purposes. Then a small, 
moist pad of cotton was placed over either opening to pre- 
vent blood and bone chips from entering the middle ear. 

5. Then turning his attention to the meatal flaps, he 
thinned and anchored back the external corners by stitching. 
The posterior auricular incision was closed throughout its 
entire length by sutures, as in the radical operation, thus 
allowing exclusive meatal drainage. 

6. He introduced a large drainage tube 1 cm in diame- 
ter, by the external auditory meatus, into the mastoid cavi- 
ty, avoiding contact with the tympanic membrane. He re- 
tained the tube in position by a stitch of gauze packing, 
covered this with absorbent cotton and applied a two-inch 
gauze bandage to the head, thus completing the operation. 
No change of dressing for four or five days, depending on 
the amount of character of the discharge. The tube served 
a double purpose, drainage and fixation of flaps to wound. 

7. Mr. Heath recommends his operation for acute, sub- 
acute and chronic otitis media. He speaks of the new pa- 
thology that he studies on the living subject and claims it 
differs from the so-called Vienna pathology studied on the 
dead subject. Having thus completed several ear courses at 
Vienna, I failed to distinguish the merits of Mr. Heaths 
pathology. In Alexander's classification of otitis media, 
when a case continues up to six months he calls it acute, 
from six months to two years subacute, after two years 
chronic otitis media. 

8. Since returning home I have performed the Heath 
operation three times, and the radical mastoid twice. All 
the cases operated by Heath's method came in Alexander's 

612 The Plexus. 

subacute class; period of discharge from eight mouths to one 
and a half years; the radicals, period of discharge from three 
to six years, thus coming under the head of the chronic 
variety of .the otitis media. In the iirst three cases, not be- 
ing able to diagnose dead bone before or after the operation, 
I did not hesitate to open and drain antrum according to Mr. 
Heath's method. But in the chronic cases, dead bone was 
found before and at the operation. Facial paralysis was one 
of the pre-operative symptoms in one of the cases and was 
not improved by operation. 

9. You might ask why I did not do the Heath antrum 
operation instead of the radical. From observation and in- 
formation gleamed while in London I learned that the pro- 
longed chronic and fetid discharge from caries of the bone 
often caused a troublesome dermatitis of the auricle and 
walls of the external meatus, and that the majority of these 
cases eventfully came to a radical mastoid operation. 

Admitting there is a risk of impairing the hearing in 
the radical operation which does not apply to the antrum 
operation, we must concede that in the end the radical opera- 
tion is so frequently necessary that we may often save our 
reputation and avoid the criticism of a long suffering and 
disgruntled patient by performing the radical operation in 
the beginning. If we would hurry our patients to operation 
in the acute and subacute cases of otitis media, whether a 
simple or antrum operation or a Heath antrum operation is 
to be performed, there is no doubt but that the hearing would 
be equally conserved. Mr. Heath's strong argument is that 
the hearing is conserved in his operation. 


William T. Belfield, M. D., Chicago. 
The physician occasionally finds a patient suffering from 
complete retention of urine, which cannot be relieved 
through the natural channel, usually because of false pas- 
sages that have been made in endeavors to pass a tight 
tricture or hypertrophied prostate. When satisfied by a 

Belief ef Retention of Urine. 613 

patient trial that his efforts to pass a catheter through the 
urethra must be futile, the physician must make an artificial 
exit for the urine. How shall this be done with the least 
detriment to the patient? 

Our text-books advise (1) suprapubic aspiration, repeat- 
ed if necessary, if the patient still fails to void urine natur- 
ally; (2) a cutting operation, perineal or suprapubic. 

The objection to repeated aspirations, which honeycomb 
the suprapubic tissue, is sufficiently obvious; and the diffi- 
culties and dangers of perineal urethrotomy without a guide 
are well known to all who have performed it. 

For many years I have done neither, but have employed 
a measure which is as little dangerous to the patient and as 
easy for the physician as if aspiration, and yet solve the 
problem completely- I have never seen this simple pro- 
cedure described in our text-books; yet it is probable that 
others have used and described a device that so easily 
relieves the patient from the distress and danger, and the 
physician from the perplexities of a serious situation. 

This patient whom I now present is one of many illus- 
trations of the value of this measure. Seven days ago he 
sought my aid for relief from the agonies of complete reten- 
tion of urine that had existed 36 hours. The cause was a 
tight stricture of the bulbous urethra; and false passages 
already made defeated a patient effort to enter the bladder. 

Without anesthesia a trocar and canula, No. .14 French 
scale, was passed into the bladder in the median line about 
an inch above the symphysis; the trocar being withdrawn, a 
soft catheter, No. 8 French, was passed through the canula, 
far enough to carry its end to the bottom of the bladder. 
The canula was then withdrawn, leaving the catheter in its 
place. The catheter was attached to the skin by adhesive 
plaster; and after the urine had escaped, the free end of the 
catheter was tied in a knot to prevent dribbling. The 
patient, who was allowed to be out of bed, was instructed to 
untie the knot every 5 or 6 hours, void urine through the 
catheter, and then retie the knot. Urotropin was given 

CH The Plexus. 

For five days no attempt was made to pass the stricture, 
although during the last two or three days some urine 
trickled out of the meatus when the patient urinated through 
the catheter. During these five days the false passages in 
the urethra were healing, and the edema of the bladder-neck 
and prostate was subsiding. Two days ago a cautious 
attempt to pass a Banks bougie was successful, and the 
stricture was immediately dilated to 21 French. As the 
urethra was now open, the suprapubic catheter was with- 
drawn, and its track left to heal spontaneously. The patient 
states that since the withdrawal of the catheter no urine has 
escaped through the puncture, which, as you see, is scabbed 
over and dry. It always heals when the obstructions in the 
natural channel are removed. 

Sometimes one fails to enter the bladder through the 
urethra after four or five days' rest; in this case the supra- 
pubic catheter may be left in position two or three days 
longer. Should the urethra still be found impassable (which 
in my experience has never happened) a cutting operation 
may then be considered, the patient being in far better con- 
dition to stand it because of the week's rest of the bladder. 
Should still further delay be considered best, the catheter 
should be removed, cleansed of the adherent urinary salts, 
and reinserted; the track into the bladder will remain patul- 
ous for a short time. 

Should the obstruction be an enlarged prostate, and 
prostatectomy be considered unwise, the patient may wear 
the suprapubic catheter for an indefinite time, withdrawing 
it every day or two for cleansing. Patients easily learn to 
remove and reinsert the catheter through the fistula: one 
elderly patient of mine wore the catheter in this way for six 
years. Another, who had a cancer of the prostate that pre- 
vented urination, secured entire freedom from urinary 
troubles during the last nine months of his life through this 

Other conditions in which the suprapubic catheter is 
useful are sometimes met, such as severe prostatic suppur- 

Three Year's Experience with Pneumonia. 615 

In case the physician decides to make perineal section 
for an impassable stricture, a small curved trocar and canula 
can be passed into the bladder above the symphysis, and a 
filiform passed through the canula into the deep urethra as a 
guide; indeed, one is sometimes fortunate enough to pass the 
filiform through the stricture from behind, when it cannot 
be made to pass from in front. 


By W. G. Wolverton, M. D., Linton, N. D. 

During the four years I spent in one of the foremost 
medical schools of this country, where the internist was in 
thorough accord with Osier as regards the treatment of 
pneumonia, I had it pretty constantly pounded into me that 
pneumonia is a self-limited disease, whose course cannot 
be shortened or in any way favorably influenced by any 
known method of treatment; besides, this professor was one 
of the greatest pathologists of our time before he took the 
chair of Internal Medicine, and so never did have much 
faith in the use of drugs in the treatment of disease. His 
entire list of drugs in pneumonia consisted of strychnine, 
calomel and ammonium chloride. 

But while I was attending school, a kind Providence sent 
to my hand a copy of the then Alkaloidal Clinic, whose 
teachings at once appealed to me as being both t optimistic 
and logical. I at once subscribed for the The Clinic, and 
have read it and its successor, Clin ice J Medicine, ever since, 
and this good missionary neutralized and rendered innocuous 
the nihilism taught me at my school. 

When I was graduated and began to practice, three 
years ago, I at once applied the principles of "'active princi- 
ple therapeutics" I had gleaned from The Clinic and '"Shal- 
ler's Guide.'" Especially was I anxious to learn what there 
might be in the "abortive treatment'" of pneumonia. I have 
been practising just three years now, and while I have not 
sesn so many cases of pneumonia as do men whose practice 
is mainly in city hospitals, still I believe that a report of the 

616 The Plexus. 

pneumonia cases I have treated in my three years experience 
will lead any reasonable person to draw certain conclusions 
regarding the "alkaloidal"' or "abortive-' treatment of pneu- 

In the past three years I have treated just sixty cases 
of pneumonia, always using the same general plan of treat- 
ment, modified to suit individual cases; one must remember 
that he is treating the patient, not the disease. Of these 60 
patients, 12 were under 5 years of age; 6 between the ages 
of 6 and 10 years; 11 between 10 and "20 years; 5 between 20 
and 30 years; 10 between 30 and 40 years; 7 between 40 and 
50 years; 3 between 50 and 60 years; 2 between 60 and 70 
years; 4 were over 70 years of age. Of these 60 patients, 
33 were males, 27 males; 8 had bronchopneumonia, 52 were 
of labor type. Of these 60 cases, only two ended fatally; 
one was an infant of 11 months, having its second attack 
within five months; the other was a man of 40 years, a very 
excessive user of alcohol. 

The drugs mainly used in these cases were veratrine, 
amorphous aconitine, strychnine, digitalin, and calomel. 

When a pneumonia patient came under my care, I gave 
him 1 grain each of colomel and soda every hour for from 
4 to 6 hours to clean out thoroughly the gastrointertinal' 
tract. This insures the prompt Absorption of the medica- 
ments aimed at the trouble proper, and, besides, does away 
with intestinal putrefaction and consequent symptoms of 
autointoxication. With a loaded colon it is useless to give 
veratrine and aconite and expect really satisfactory results. 
The next thing to be done, in all sthenic cases, is to ad- 
minister veratrine and amorphous aconitine, each gr. 1-134 
to gr. 1-67, every twenty or thirty minutes until the pulse 
softens and is reduced in frequency to 90 or even 80 per 
minute, the temperature begins to fall, and the harsh, dry 
skin becomes moist. The best way to administer the vera- 
trine and aconite is dissolved in a spoonful of hot water, but 
if the patient objects to the bitter taste of the alkaloids, he 
may take the granules or tablets whole, followed by a little 
water, hot being preferable as a rule. 

Three Year's Experience with Pneumonia. G17 

In asthenic cases it is well to add strychnine and digit- 
aim to the veratrine and aconitine, or even to admit the 
aconitine and use a combination of veratrine, strychnine and 
digitalin. Many "active-principle therapeutists'' use a com- 
. bination of aconitine, veratrine and digitalin (defervescent 
comp.) in sthenic cases, and aconitine, digitalin and strych- 
nine (dosimetric trinity), in asthenic cases; but, personally. 
I ; kike best the veratrine and aconitine, guarded by occa- 
sional doses of strychnine. 

When defervescence has begun, and the pulse softens 
and slows and the skin becomes moist, it is time to diminish 
the frequency of administration of the veratrine and aconit- 
ine; they should then be given every hour, of each gr. 1-134 
for adults, until the pulse is about normal and temperature 
is down to 100° F. at least, After that they are to be given 
every one to three hours, as necessary to hold the pulse and 
temperature down. 

If any signs of undue cardiac depression should appear, 
give strychnine and digitalin. (And right here let it be said 
that doses of 1-100 grain of digitalin will not produce re- 
sults, and that is why there are so many failures with it; gr. 
1-15 to gr. 1-4 must be given to produce results.) But if 
veratrine and aconitine are given in dose of gr. 1-134 to gr. 
1-67, every twenty or thirty minutes, to effect, and then just 
often enough to maintain that effect, there will be no undue 
cardiac depression. These are powerful drugs, but are 
perfectly safe if given as above outlined. 

I rub the whole chest with hot camphorated olive oil, to 
which a little oil of turpentine has been added (or camphor 
and lard melted together), and then apply a cotton jacket, 
made by lining an undershirt with a thick layer of cotton 
held in place by a few stitches here and there. Heat is ap- 
plied to the affected side of the chest and to the feet; cold 
compresses to the head if headache is troublesome. Plenty 
of fresh air and not too high a room temperature are insisted 
upon. Tepid sponging gives much comfort to the patient. 

Liquid diet, or better, no food at all, is given, until 
convalescence is established. The bowels are kept clean by 

618 The Plexus. 

the use of calomel or salines. If tympanites is a troublesome 
symptom, the sulphocarbolates of zinc, soda and lime, with 
plenty of water, are given. If cough is persistent and pain- 
ful and expectoration scanty and viscid, codeine or morphine 
with syrup of hydriodic acid will give relief. 

Under the above treatment only 2 of the 60 cases ended 
by crisis, and they were seen too late to be aborted, one 
patient being seen for the first time on the fifth day of the 
disease. None of the other cases went longer than the fifth 
day before apyrexia was established; in many cases lysis 
was complete on the third day. But the really aborted cases 
constituted at least one-third of the total number treated, 
and they were practically normal as to pulse, temperature 
and respiration in from twelve to forty -eight hours, with the 
lung rapidly clearing up; in fact the patients were practical- 
ly well, at least well enough to sit up. 

A few days ago I was called to see a Russian farmer, 
aged 34, whom I knew to be a syphilitic (had typical saddle- 
nose: his wife also syphilitic), and who was my first pneu- 
monia patient when I located here two years ago. So this 
then was his second attack of pneumonia; he had also had a 
severe attack of influenza the preceding winter. This time 
I found him very ill, in his sodhouse, twelve miles in the 
country. He had a severe "stitch" in his left side; had ex- 
perienced a rigor; there was a troublesome cough; tempera- 
ture 101 F.; respiration 35; pulse only 55, very irregular and 
weak, and every little while drooping a beat; wife told me 
the patient's lips had been very blue before I arrived. 

Percussion showed dullness over the left lower lobe; 
auscultation revealed diminished breathing-sounds over left 
lower lobe anteriorly; with fine crepitant rales: posteriorly, 
no breathing-sounds were audible over the affected lobe. 

I at once administered gr. 6-68 Merck's Germanic digi- 
talin, with strichnine arsenate, gr. 1.15. For the pain in 
the side morphine was given. In a few minutes the pulse 
became stronger and more regular, so that I thought it safe 
to begin with the veratrine, and he got gr. 1-67 of it. When 
I left, about an hour later, the pulse was 64, regular and 

Three, Year's Experience with Pneumonia. 6] 9 

full though soft. I left granules of veratrine gr. 1-134 of 
which the patient was to get two every hour; digitalin, gr. 
1-97, three to be taken every three hours; and strychnine 
arsenate, gr. 1-30, two every three hours. A big flax-seed 
poultice was also applied to the affected side of the chest. 

While making this visit I had with me a medical student 
from one of the leading Chicago schools, who had just com- 
pleted his third year; he is fast becoming a "dyed-in-the- 
wool therapeutic nihilist," and the sight of my alkaloids 
scared him. He examined the patient with me, and ex- 
pressed it as his opinion that the man would almost surely 
die, as he did not believe the heart would hold out over 
twenty-four hours. In fact I myself was not very optimistic 
as to the outcome of this case. I must acknowledge that I 
was surprised when I callecl to see the patient next day, and 
found him sitting in a rocking-chair, holding the baby. 

I expect that the "nihilist" will say that most of the 60 
cases I have reported were not pneumonia; but when I see 
a patient with flushed face, respiration 30 to 60, pulse 100 to 
140, temperature 101° to 105° P., cough, sputum streaked 
with blood, "stitch in the side," percussion- dulness over one 
or more lobes of the lung, breathing-sounds obscured and 
vocal fremitus increased over the affected area of lung, then 
either that patient has pneumonia or is rapidly heading to- 
ward it, and if treated on the "expectant" plan of treatment 
will certainly have pneumonia. And that is the set of symp- 
toms observed in practically every one of these 60 patients. 

Of these 60 cases reported, 53 had pneumonia as the 
primary disease, while in 7 cases it occurred as a complica- 
tion of influenza last winter; 2 patients had two attacks each, 
one had had five attacks previously; one' was undeniably 

As to the patients who died (there were but two), the 
first was an infant of 11 month, whom I did not see until he 
was dying; this was the baby's second attack in five months. 
The other fatal case was that of a man, aged 40, who was a 
chronic booze -fighter. When I was called to see him I found 
him lying in the harness-room of a livery barn, and he was 

620 The Plexus. 

a hopeless case then: the only available place to keep him 
was in one of North Dakota's "blind pigs," his nurses being 
the bartender and a cow-puncher. The patient was wildly 
delirious from the start. 

The other 58 patients recovered, Even though the 
course of the disease had not been shortened in these cases 
by this treatment, the fact that 97 per cent of the patients 
recovered should speak well for the treatment; for that is 
certainly better than the ''expectant'' treatment ever does. 
— Clinical Medicine. 



It is a privilege to acknowledge through the Plexus 
the gift of the Class of 1908 to the Quine Library. 

As has been the custom for some years, the outgoing* 
clsss voted to expend a sum of money on a class memorial, 
as a gift to the Alma Mater, which every loyal P. and S. 
man loves, and for this purpose a certain amount was voted 
for the purchase of a gift for the Quine Library, After con- 
sulting w*th several members of the class, as well as others 
interested in the welfare of the college, it was decided to 
purchase a suitable picture for the reading room. 

Through the kind offices of a friend of the Quine Library 
who spent the summer abroad, there were two pictures 
purchased; the fact that they were bought for an education- 
al institution entitled them to come in free of duty. 

One of the pictures is a reproduction of the famous oil 
painting called ' 4 The [Anatomy Lesson," the other is a fine 
etching of an old portrait of William Harvey, the discoverer 
of the circulation of the blood. On the frame of each pic- 
ture is a neat brass plate bearing the inscription, "Presented 
by the Class of 1908." 

The following books were recently purchased for the 
Quine Library: 

Dudley. Principles and Practices of Gynecology. New 

Masonic Club. 621 

Colbeck. Diseases of the Head. 

Tigerstedt. Text-book of Human Physiology. 

Lindsay. Lectures on Diseases of the Lungs. 

Ortner. Treatment of Internal Disease. 

Williams. Manual of Bacteriology. 

Bier. Bier's Hypermic Treatment. 

Stewart. Manual of Physiology. 

Church and Peterson. Nervous and Mental Disease. 

Gray. Anatomy. New edition. 

The Library is pleased to give space to a small tuber- 
culosis exhibit which the Pathological Department has 
placed in the general reading room. As there is no place in 
the college where an object lesson of this kind can be seen 
by so many persons, the Library was glad to give space to 
this worthy cause, although the reading room is sometimes 
very much overcrowded and students are obliged to leave 
the room or stand while reading. 

The following articles have been contributed to recent 
medical publications by various members of the faculty of 
the College of Physicians and Surgeons: 

D- F. Tice — The Tuberculosis Crusade. Chicago Medical 
Record. October. 

Dr. Aime Paul Heineck — Perforating Wounds of the 
Uterus Inflicted During the Course of Intrauterine Instumen 
tation. Surgery, Gynecology and Obstetrics. October. 

Dr. A. J. Ochsner — Hospital Construction. Illinois 
Medical Journal. October. 


Reorganization of the P. and S. Masonic Club was 
effected Wednesday afternoon, November 18th, with a mem- 
bership of 50- The following officers were elected: B. J. 
Voigt, '09, president; R. R. Rupert, '12, vice-president; E. 
W. White, '10, treasurer; Wm. F. Glasier, '10, sentinel; W, 
S. Firey, '10, secretary. 

Meetings will be held each month during the college 
year. Social sessions will be frequent and plans are now in 
progress for a banquet to be held in the near future. 





Channlng W.Barrett, M. D., Chairman. 

T. A. Davis, M. D. W. E. Gamble, /W. D 

A. R. Johnstone, A1\. D., Editor. 


L. H. Nowak, 08. Ray Esslck, '08 Gustav Eck, '09. 

William G. Epstein, 10. 

Atheletlc Editor. C. H. Tlllotson, '06. 

Alumni Editor, John Wehtherson, '00. 

Library Dept., Metta M. Loomis. 

Publisher - - - - J. E. Forrest. 

Subscription $1.00 per Annum in advance. Single copies, 15 cents. Issued 
Monthly. Send all communications and remittances for subscriptions and adver- 
tising to J. B. F0RRBST, Batavia, Illinois. 

Entered at Batavia Post Office as Second-Class Matter. 

Any subscriber desiring the Journal discontinued at the expiration of his sub- 
scription should so notify the Publishers; otherwise It will be assumed thai the 
subscription is to be continued and the Journal sent accordingly. 

Contributions of matter suitable for publication are invited, and should be sent 
id not later than the 25th of the month previous to that of publication. The put- 
ishers will not hold themselves responsible for the safe return of M33. unless 
ufflcie_t stamps are forwarded. 

Send contributions to A. R. Johnstone, M. D., Editor, 4147 Lake Ave., Chicago. 


Wonder when the P. & S. orchestra will give the first 

Dr. Fisher: "Now ladies and gentlemen, unless you 
get one of these schematic eyes there is no use in your tak- 
ing this course." 

Dr. Eisendrath is giving a fine course in Senior surgery. 

Dr. Ferguson (quizzing on biceps brachu): "Where 
does the longhead arise?" 

Student: "Acetabulum." 

Notes. 623 

Professor: "In cancer of the breast what glands would 
you remove?" 

Ochsner: "Inguinal." 

Our bedside clinic, given by Dr. Tice, is one of the most 
valuable that we have. 

One thing that every Senior can be truly thankful for 
is that there isn't another story added to our building where 
we could have the lecture in medicine. D. J.'s, get a pull 
with Nathan or a place in the pit and your gastrocnemti 
may profit thereby. 

Stromberg looks almost as happy as he did before it 


Since the issue of last months Plexus the editor has 
received several results of his editorial. Czeslawski shaved 
off his ciliated upper and Thomas his sides. McGarry ex- 
pressed the desire that his personal affairs be left out of all 
paper work hereafter, and Miss Laybourne came down on 
all fours. She said she couldn't see what there was to the 
article about her. There was no sence to it, and yet she 
considered it a downright insult. 

We don't know why Miss O'Sullivan is sitting on the 
second row, but we have our suspicions and ideas. It takes 
editorial work to accomplish things. 

Of course these side issues were expected, but for the 
sake of good ethics there is an apology offered, and if there 
is anything the editor is sorry for he is willing to be for- 

The first examination in medicine came off, and all took 
it except the last section. Dr. Earle forgot to phone each 
one of the boys personally and tell them about it, and they 
got offended and walked out, but to show his regret for such 
an unpardonable sin, the doctor presented each member of 
the section with a nice, large goose-egg which they could 
keep. It was very kind of him, and we all wish to give 
thanks for his thoughtful consideration of our welfare. 

624 The Plexus. 

Since Thompson has been forgetting to wash the black 
off his face we are getting him mixed up with Dr. Simon. 
The only way we have of telling the two apart is that Tony 
can't tell as many good yarns as the doctor. 

Loomis, the mascot of the class, told another striking 
story of an adventure he had with his watch. The other 
day he was going along, wasn't thinking of much, as usual, 
when he went to look for the time. All at once a wind 
storm came up and off went his hat. As he went to catch 
his hat with the hand that held the watch he threw the 
watch twenty-five feet in the air, It came down and hit an 
iron fence, and broke the fence, and the watch shows no 
signs of injury. He got first prize. 

At the request of the class the editor wishes to announce 
that he has on new sox, that are mates, and the same are 
open for inspection at leasure. 

H. E. Rich, Class Editor. 

Whereas, Death has removed from our midst our class- 
mate, James Ignatius Donahue, and, 

Whereas, In this event each of us has lost a true friend, 
and a congenial, straightforward fellow student; therefore 
be it 

Resolved, That we, the Junior Class of the College of 
Physicians and Surgeons of the University of Illinois, do 
hereby take this opportunity to express our respect for the 
deceased, and to extend our sympathies to the bereaved 
family; and be it further 

Resolved, That these resolutions be published in the 
Plexus, and a copy of them be presented to the family. 

Edna V. Dale 
L. H. Athon 
L. W. Cary 
Nov. 16th, 1908. Committee. 


The sudden death of Nova I. Supinger, '11, by his own 
hand, on Saturday, November 14, was a severe shock to his 

Notes. 625 

fellow students and many friends. He had been a student 
in the college of Physicians and Surgeons only a few weeks 
and consequently was not well acquainted with his class- 

His home was in Fillmore, 111., where his parents are 
living as prosperous farmers. 

Mr. Supinger came to the P. & S. from Barnes Medical 
College of St. Louis, where he had taken his first year's 
work. He was a hard, earnest worker, and it is thought 
that the cause of his rash act was due to brooding over his 

Every man in the Sophomore Class, who was intimately 
acquainted with him, speaks highly of him as a man of 
almost perfect habits, honest and upright in all his dealings, 
and a pleasant man with whom to associate. He was a 
comparatively young student, being only twenty-one years 
of age. 

The Sophomore Class, as well as all the students and 
faculty of the College of Physicians and Surgeons extend 
their deepest sympathy to the bereft parents and home 


Dr. White: What nerve passes through the Great 
Sacro-Sciatic Notch? 

Pedot: Pouparfs ligament. 

As the result of an overweaning interest in biology, cer- 
tain members of the class have succeeded in capturing a 
new nogellated, encapulated crustacean. The specific differ- 
ence between this individual and other members of his Phy- 
lum lies in his beautiful antenna, a portion of which we 
were able to secure only after a desperate encounter. Par- 
ties wishing further information ask Mr. Bloom. 

Quiz Master: Describe synovial fluid. 
Gage: It resembles axle grease. 

L. M. Kane. 




BATAVIA, ILL., NOVEMBER 20th, 1908. 


Haven Emerson, M. D., of New York City, writing in 
the New York Medical Journal says: ''I had the opportunity 
of examining the teeth of 2,301 applicants for the Sea Breeze 
Health Home at Coney Island, under the auspices of the 
New York association for improving the condition of the 
poor. The rapidity with which the examinations were made 
and the lack on the part of the examiner of technical skill 
in observing dental defects, are- responsible for at least a 
very conservative estimate. Of the 2,301 applications ex- 
amined, 189 were infants, 1,478 were children from one to 
fifteen years, and 634 were women and girls over fifteen 
years. Of the 1,478 children, 273, or 18.8 per cent had no 
defective teeth, leaving 1,200 or 81.2 per cent. Among these 
1.200 children I found 5,996 decayed teeth, almost 5 apiece, 
or an average of 4.7 decayed teeth for each one of the 1,478 
examined. Of the 634 applications over fifteen years old, 
only 19 or 3 per cent, had no defective teeth, leaving 615, or 
97 per cent, in whom 4,022 teeth were found to be decayed. 
This makes an average of 6.5 decayed teeth for each of the 
634 examised. There were also found in this group, 1.655 
teeth missing, and in addition, 1,444 artificial teeth, making 
a total of teeth which had been removed, presumably for ad- 
vanced caries, of 3,099, or an average of 4.8 for each one of 
the 634. Combining the numbers of those removed and 
those at present decayed, we have an average 11.3 teeth de- 
cayed, or 28.8 per cent of all the teeth of 634 adults, severely 
enough diseased to be more or less permanently ineffective. 

Dr. Lawrence W. Baker, in the Boston Medical and 
Surgical Journal, reminds us that diseased teeth are the 

Dentistry. 627 

cause of other diseases of the human body, and that the con- 
trol of these dental diseases is a factor in preventive medi- 
cine worthy of attention, and says that dentists should be 
placed upon the staff of medical inspection of the public 
schools, for the condition of the child's mouth is just as im- 
portant to its health as the condition of its throat and nose, 

Dr. Wadsworth, in the Journal of Infectious Diseases, 
October, 1906, says: 

"Prom the hygienic standpoint the secretions of the 
mouth constitute the chief, if not the only, source of respira* 
tory infection, and the infectious material is transferred 
from one person to another, in some instances through the 


Two thousand years ago Christ uttered these memora- 
ble words: "The poor ye have with you always." They 
are still with us, an ever present thorn in the side of the 
merry makers, an everlasting burden to civilized society, 
but in those two thousand years great progress has been 
made. They are no longer considered as outcasts and 
slaves, but as unfortunate brothers. Schools are every- 
where for their mental and moral development; homes are 
founded for unfortunate homeless; hospitals maintained for 
the care of the sick and injured; township physicians are 
for those in country districts too poor to have a physician, 
and in the cities district physicians are furnished for those 
unable to employ a family physician. Almost from every 
standpoint has society seen fit to care for his physical and 
moral health, but from the dentists' viewpoint he has been 
sorely neglected, and the object of this paper is to awaken 
in the dental and medical professions a keener interest in 
the dental welfare of the poor, especially the children of the 
poor. The poor could not enjoy their dinner as they should, 
because of aching teeth and sore mouths. Can you imagine 
a more pathetic picture, little children suffering constantly 
from a disease that is the most prevalent that attacks man? 
And why? Perhaps the primary reason is because of the 
ignorance of the parents. A second and more effectual 

628 The Plexus. 

reason is their inability to pay for the services of a dentist; 
and a third, the lassitude of the dental profession in educat- 
ing the public, and even a part of the medical profession, in 
the importance of the care of the teeth and mouth. 

I asked for the privilege of examining the teeth of the 
children of this settlement. It was pointed out to me that 
they did not have the legal right to conduct a physical ex- 
amination of any of the children, but they said they would 
be glad if I would give them a lecture on the teeth, and they 
suggested that I might, after gaining the confidence of the 
children, examine their mouths. This I did, and after talk- 
ing to them for a short time about the teeth, and after ex- 
plaining to them that micro organisms and bacteria, which 
we called bugs for the sake of simplicity, might crawl around 
in the mouth and eat up the teeth and tonsils, just the same 
as that unspeakable bug might live in the hair and fairly 
eat up the scalp, I succeeded in persuading twenty-five out 
of the forty-five to allow me to examine their teeth. Twenty- 
four out of that number needed the services of a dentist. 


By Grace Pearl Rogers, D. D. S., Detroit, Mich. 

That every dentist is responsible for the dental educa- 
tion of his patients, will be admitted by any one who has 
given the matter serious thought. This responsibility is of 
vital importance to the oral prophylaxis specialist, since a 
large portion of his work necessarily consists in their proper 

The dental profession is at fault here because but a few 
members of our honored number have given the matter any 
study. The author woi.ders how many dentists there are 
who have no soft deposits on the lingual surfaces of their 
lower molars, or on the buccal surfaces of the upper third 
molars. Blessings on the dentist who knows how to care for 
his teeth, and does so. Like every reform, it is best to 
begin at home, so every dentist should have a healthy, 
wholesome mouth before he even considers practicing den- 
tistry, let alone oral prophylaxis. 

Dentistry. 629 

Before using an instrument of any kind in the mouth, 
take the trouble to show your patient the exact condition of 
his mouth. Tell him that he is responsible for the soft de- 
posits which you point out to him. It makes a deeper im- 
pression on his mind if you have him watch you in a hand 
mirror whiie you loosen some of the soft deposit, for then 
he is sure to see it to advantage, as it shows up larger than 
when lying against the tooth. Call his attention to the 
irritated gum margin, which you always find with the soft 
deposits, for in this way you can impress him with the fact 
that he must care for his mouth, not only for the sake of 
cleanliness, but for the health of the mouth tissues as well. 
After he has watched you work around a few teeth he will 
be so disgusted with the condition that he will hand you the 
mirror and apologize, or say something that will reward you 
for the extra trouble you took to open his eyes. 

I hear some one say. "That is all right for people who 
do not take care of their mouths, but my patients brush their 
teeth." Now in oral propholaxis we do not consider ap- 
proximate cleanliness, we must aim for absolute cleanliness, 
and so we judge from that standpoint. The oral prophy- 
laxis specialist objects to the slightest deposit on any tooth 
surface, and to him a small amount is as disgusting as a 
large amount. 

It has been proven that many cases of so-called erosion 
have been produced by the eating of acid fruits. ,The author 
has had several patients under her care who started eroded 
areas by seeding grapes with the two upper central incisors 
and the tongue. In one instance quite marked areas on these 
two teeth were eroded within a period of one month. Lemon 
juice, even in a dilute form, attacks the enamel readily, and 
our patient should guard against indulging too freely in this 
acid fruit. During the fruit season, patients with gum re- 
cession are apt to complain of their teeth being sensitive. 
Acid fruits irritate the exposed cementum and these unfor- 
tunate ones should choose the fruits they eat with caution, 
although the warm solution of bicarbonate of soda will keep 
them fairly comfortable. 

630 Tbe Plexus. 

The most difficult places for patients to care for are the 
distal surfaces of the third molars, the buccal surfaces of the 
upper molars and lingual surfaces of the lower molars. The 
first difficulty can usually be overcome by carrying the den- 
tal floss back over those teeth and polishing the distal sur- 
faces. The other difficulties can usually be met if the patient 
is taught to carry the brush high enough (or low enough, as 
the case may be) to feel the brisles on the gum tissue. In 
this way they have a guide to work by and are sure to care 
for the surface next to the gum margin, which so far as the 
health of the gum tissue is concerned is most important. 

Dental floss should be used at least once each day and 
then just before retiring. When you have convinced your 
patients of the importance of this you will be surprised at 
the number who will tell you that they have to use it after 
every meal in order to be comfortable. This can do no harm 
if properly done so as not to injure gum tissue, and the 
mouth will certainly be much more wholesome, and the lia- 
bility to decay of proximal surfaces much lessened. You 
must teach each patient how to use the floss with care and 
to explain to them its purpose, that upon the dental floss 
depends the care of two surfaces of each tooth. It is not 
enough to simply pass the floss between the teeth past the 
contact point, but each proximal surface should be polished 
with the floss. 

It is the especial privilege of the oral propholaxis spe- 
cialist to explain to all intelligent patients the process of de- 
cay and tooth development. Patients ought to know the 
names of their teeth, something about filling materials, tooth 
anatomy, bacteria, and the difference between an abscess 
and an ulcer, also between nerve and tooth pulp. They 
should be taught that a repaired tooth is never as good as a 
perfect tooth, and not to be proud of a filling. Teach them 
to value their teeth and to take pride in them and their 
healthy mouths. 

Oral prophylaxis is doing much for dentistry since it is 
raisiag the public's demands of us, and with their increased 
demands we shall certainly have to rise to meet their expec- 

Dentistry. 631 

tations. The oral prophylaxis patients know the value of 
their teeth and mouth health, and have no use for the den- 
tist who does not. If they must have a repair they consider 
that the best imitation of nature is noae too good, so they 
demand the best. By passing floss between their teeth 
every day in an intelligent way they discover fillings with 
overhanging margins, so woe unto the dentist who puts in 
such a filling. These patients appreciate, too, the artistic 
dentistry and want it when it can be had. 

The author is confident that every dentist who has con- 
scientiously and intelligently practiced oral prophylaxis 
will say that it has changed for the better his attitude to- 
ward his profession, and raised his ideals so that his work 
is now more af a pleasure than a duty. 

In oral prophylaxis we have made mistakes because we 
are in an undeveloped field of dentistry and there is much 
yet to learn, but these mistakes are so small compared to 
the good that has resulted, that we know we are in the 
right. So give us a helping hand, at least a word of en- 
couragement, and it will be appreciated.— Dental Summary. 


The recent work of Dr. R. W. Shufeldt, entitled "Stu- 
dies of the Human Form" is a publication which must appeal 
to all who truly manifest admiration for the physical career 
of mankind. The author has shown his wisdom in dealing 
with this subject in a bold, broad way, indicating" his liberal 
spirit in the inclusion of the normal types as they represent 
the various divisions of the civilized peoples. He has not 
limited his tireless research to the American or even to the 
English speaking families. He has gone forth with a keen 
regard for all the lines of perfection regardless of climate, 
government or habitation. 

The work covers an extent which a brief summary can 
scarcely attempt to describe, but it is evident that the pages 
are intended for those only who hold in their heart a high 
and reverential consideration for all that relates to the 
nobler aspect of the human race and its uncertain destiny. 

632 The Plexus. 

Evidence is everywhere symbolized, that the author hoped 
to raise our admiration and inculcate our love for the purer 
and better impulses of the artist, the scientist and philoso- 
pher as pertains to the study of the evolution of our present 
conception of figure perfection of man. The atmosphere of 
the book is that of the laboratory, the studio, together with 
the art and science of both. 

The crude, the vulgar and even the unschooled should 
not be afforded the opportunity of glancing through its 
pages, because of their likelihood of misconception of its 
wholesome purpose. The illustrations, paper and general 
construction is in keeping with the high ideals of real lovers 
of nature. The doctor is to be congratulated; his efforts 
will find among the cultured high praises. 

Some consideration is also given to the mythological as 
it relates to forms. 

The work contains a chapter on the teeth and a chapter 
on the normal mouth and both are liberally illustrated. Dr. 
Shufeldt being a graduate of medicine he was in a position 
to recognize the anatomical valuations of the elements which 
harmoniously adapt themselves to form the natural as well 
as the abnormal. 

The work is from the press of the well known P. A. 
Davis Company, of Philadelphia. The prices, full Morocco 
$25,00, heavy buckram $15.00. 




P. M. Goodman, Ph. G., C. S. N. Hallberg, Ph. G., W. A. Puckner, Ph.G 

H.H.Rogere, M. D., Ph. B., E. N. Gatherooal, Ph. G., 

A. H. Clark, Ph. G., C. M. Snow, Ph. G. 

WILLIAM B. DAY, Editor. 


An entrance examination based upon high school work 
was given for .the first time by the School of Pharmacy this 
present session. The examination questions were prepared 
by Mr. J. E. Armstrong, Principal of the Englewood High 
School, Chicago, and the papers were rated by him. Although 
but few students applied for entrance examination and still 
fewer were passed, yet a start was made and it seems likely 
that the entrance examinations will be of greater service in 
the future. The examination was based upon the first year's 
work in an accredited high school and included English, 
Algebra, Latin and Physiography. It was decided to offer 
German as an alternative for Latin and it is likely that next 
year one or two more branches may be added. 

There were nine candidates for examination, of whom 
one was passed in full and one conditionally. , This poor 
showing was due, undoubtedly to the lack of preparation on 
the part of the candidates. Having made a start, however, 
it is planned to give the examinations larger publicity 
through the announcement and to more fully define their 
scope. The questions are printed in this number of the 


The class of 1908 has contributed to the Alumni Ebert 
Fund, the class fund which remained at the close of the 
school year amounting to $25.20. There is now $210.20 
in the Ebert fund. In addition to this, $320.00 has been 

634 The Plexus. 

pledged. It is expected that a general appeal will be made 
to the Alumni very soon with the expectation of increasing 
the fund to two thousand dollars and of complying with the 
conditions of Mr. Henry S. Wellcome, who offered to donate 
one thousand dollars to the fund. 

I. V. S. Stanislaus, '95, visited the school recently. Pro- 
fessor Stanislaus is Dean of the School of Pharmacy of the 
Medico- Chirurgical College of Philadelphia. He reports that 
his School together with the medical and dental departments 
will soon be affiliated with the State College of Pennsylvania, 
the combined institutions to constitute the State University 
of Pennsylvania. 

W. T. Klenze '85, has sold his drug store, 1301 Belmont 
Ave., Chicago, to A. E. Bennett. Mr. ^KlenZe has been in 
business in that location 23 years. 

Henry Heine '00, died October 21 at his home in Chicago. 
Mr. Heine was prominent among Chicago pharmacists. 

S. V. Justus '03, has taken a position in Savage's Phar- 
macy, Miles City, Montana. 

C. A. Biese '99, is the owner of a prosperous pharmacy 
in Irving Park. 

Herbert E. Kraft '08, left recently for Florence, Italy, 
where he has engaged with an American drug store. 


The students of the school and many of the Alumni 
turned out to "root" for Illinois on the occasion of the Illi- 
nois-Chicago foot ball game- School was closed for the 

E. R. Squibb & Sons have presented to the school an 
attractive cabinet of specimens of chemicals and pharmac- 
euticals, which has been installed in the pharmacy lecture 
hall. Lehn & Fink have contributed a collection of fifty 
typical specimens of crude drugs in neat containers. Bauer 
& Black have donated a supply of purified cotton for the 
pharmaceutical laboratory work and Allaire, Woodward & 
Co. have furnished, with their compliments, the ground 

Pharmacy. 635 

drugs for the pharmaceutical laboratory exercises in per- 



1. Classify as noun, verb, etc., every word in the fol- 
lowing sentence: "I rank highest in a very large and 
brilliant class.'' 

2. In the following sentences point out (1) a phrase 
used as subject of the sentence; (2) a clause used as object; 
(3) a dependent clause; (4) a proper name; (5) a participial 
phrase; (6) a transitive verb; (7) an example of the passive 
voice; (8) a predicate adjective: 

A. I do not doubt that you mean well. 

B. The door was shattered by De Bracy's onset. 

C- Raising his voice, he said solemnly: "Never shall I 
behold your faces again." 

D. When my ship comes in, we shall all be rich. 
3. Improve in any possible way these sentences: 

A. I will be hung if this mob catches me. 

B. The man before you is no other than him who you 
ask for. 

C. You walk like you was tired out. 

D. The principle of the Cleveland school has worked 
like the old harry to get manual training put 'in the school; 
but he can't affect his purpose, 

4. Rewrite with punctuation: 

Dear master I'm tired out no further can I go farewell 
remember old Adam your faithful servant 

5. Write a theme of not less than 250 words on one of 
the following subjects: 

The Panama Canal. 
Two Kinds of Airships. 
What Ought a Druggist to Know? 
A Big Fire. 

The Shade of George Washington Visits Chicago in 
1908— Some Things That Surprised Him. 

636 The Plexus. 


1. Describe briefly the origin of the following: dune, 
delta, talus, canon. 

2. Give five evidences that a continental glacier once 
covered the northern part of the United States. 

3. Give several ways by which lake basins have been 
formed. How are lakes destroyed? Explain the effect of 
the Great Lakes upon the climate of the surrounding lands. 

4. Explain the low temperatures at high altitudes and 
high latitudes. 

5. What conditions cause the heavy rainfall at the 

What conditions cause the heavy rainfall along the 
Pacific Coast of Northwestern United States. 

6. What are the characteristics of a typical Low'? 
Where do the 'Lows' enter the United'States? Describe 
their paths. 


I. (a) How can you tell to what declension a noun 
belongs? (b) How is the conjugation of a verb determined? 

II. Decline together (a) exercitus audax in the singular 
(b) miles validus in the plural. 

III. For terreo in the active voice and duco in the pas- 
sive, give the third person plural of each of the tenses of the 
indicative and subjunctive moods, giving the meanings of 
the forms of the indicative. 

IV. Translate: 

(a) Scisne quot equites ab imperatore ad castra missi 

(b) Cives multos dies audacter pgnavorunt ne urbs 

(c) Epistulis scriptis adventum amicorum expectaverunt. 
V- Compare magnus, fortis, fortiter. 

VI. Translate into Latin: 

(a) They said that they had seen the ships of the enemy. 

(b) The king ruled so wisely that he was loved by all. 

(c) The sailors whom the king praised had been 

Pharmacy. 63T 

VII Decline in all genders is in the singular and qui in 
the plural. 


1. Translate into English: 

Der Hund, Die Katze, Das Pferd, Die Kuh, Das Schaf, 
Das Schwein, Die Ziege heiszen Haustiere- Alle Haustiere 
sind sehr nutzlich. Die trenen Hunde bewachen unser 
Haus. Die Katzen sind nicht wachsam, aber sie fangen die 
schadlichen Ratten und Mause. Die starken Pferde ziehen 
den Wagen. Die Kuhe und Ziegen geben uns Milch. Das 
Schaf giebt uns seine Wolle und das Schwein und der Ochse 
geben uns ihr Fleich. Auf den Feldern sind viele Fiichse 
und in den Waldern sind Baren und Wolfe- Das Kammel 
und der Elefant leben nur in warmeren Landere. Die 
Lowen, Tiger und Baren sind wilde Tiere. Sie sind sehr 
blutdtirstig und fressen Menschen und Tiere. 

2. What cases do the following prepositions govern — 
make sentences as examples: mit, durch, fur, von, nach aus- 

3. Write out the cardinal numbers from 10 to 20 and 
the ordinals from 1 to 10. 

4. Write a short paragraph on any one of the following 
subjects: The schoolroom, a garden, a house. 

5. Make a sentence with the following terms: was fur; 
gem; sondern; aber; schon; schon; wieviel; man- 


Take any seven questions. 

I. If a=2, b=3, c=5, find value of 

(b+c) 2 ( 2b— c) (a-j-c) 

2c — a a"* 

II. x 2 x a =? x 8+ *-\-x a+1 =? a°=? 

III. Simplify 

1 _ 1 j_ 2y2 

x 2 — y 2 x 2 +y 8 ' x 4 -y* 

IV. xy— y^ ■ y 8 =? 

x 8 -|-2xy-|-y 2 ' x 8 =y 2 
3 X — 5 4 9 X 

V. Find value of x : — - — : 12= — ^- — x. 

VI. x-hy— z= 3 j ~ 

x-hy-|-z= 1 )■ Find values of x, y and z. 
x— y-|-z=ll ) 

VII. Raise (a — b) to the fifth power. 

VIII. Find the cube root of: 

8a 3 — 84a 2 b-|-294 ab 2 — 343b 3 . 




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VOL XIV. BA.TAVIA, DECEMBER 20th, 1908. NO 12 


By Dr. Adolph Gehrmann, Chicago. 

The time is past when there is any need of a dispute be- 
tween ordinary gross clinical methods and the diagnosis la- 
boratory in the general examination of patients. The med- 
ical diagnosis laboratory needs no defense. However, there 
are yet those in our profession who have not adopted its pos- 
sibilities as an aid to their daily work. It has been natural 
that as medical science becomes more complicated, because 
of the many new discoveries that are being made, that the 
chemical and biological changes in the body as shown by 
special tests must become part of the study of the patient. 
If these tests and investigations are omitted in those cases 
where they are understood to be of value, I believe there is 
a cause for actual neglect on the part of the physician. 

Cases of diseases ought to be studied as scientific objects 
up to the point where the altruistic side of the treatment en- 
ters into the case. This is necessary in order that the physi- 
cian may be fortified in his diagnosis, and in the prognosis that 
he would make, as well as to decide the iine of treatment to 
be followed. No person who has regard for himself would 
select glasses from a pile of spectacles without any know- 
ledge as to the actual changes that have taken place in the 
eye. Nor should a physician have a case of headache before 
him and neglect to examine the urine of such a patient. The 
days of this kind of guess-work have passed. The scientific 

6i0 The Plexus. 

study of the patient proves what is going on, either by 
showing the abnormal or by a negative finding. Cases of 
diseases are constantly passing from doctor to doctor because 
they are not examined completely, and the phenomena that 
point the way are not seen by the medical man. 

The laboratory or technical examination should be part 
of the routine study of each case. Tests should be made in 
sufficient number and at such times to positively prove the 
normal, so that the side of exclusion of disease can be satis- 
fied or to show the advent or the progress of the abnormal. 
There is frequently an undue reliance on a single test. Such 
a test may be negative today, but perhaps positive one or 
two days later. Certainly we have to take into account and 
explain to patients that the effort put on their case is neces- 
sary to reach a full understanding of the conditions. The 
public is beginning to see the value of such examinations, 
and it is often the case that they demand repeated examina- 
tions just as well as the regular visits of the physician. 
Many families today expect a throat culture to be made 
when there are any symptoms of sore throat, and are surpris- 
ed if no culuure should be taken- After the technical exam- 
ination has assisted in establishing a diagnosis, such tests 
can help in indicating the progress toward recovery, the 
disappearance of infecting organisms, as well as a failure to 
gain improvement and the possible unsatisfactory termina- 
tion of the case. We are coming to the day of exact tests 
for defects in our health as well as specific remedies for 
these defects. 

The laboratory investigation may be histological, biolo- 
gical, chemical, or physical. The histologic examination co- 
vers all manner of microscopic studies. The biologic exam- 
ination, the finding of specific infecting organisms upon or 
in the tissue. Chemic determinations prove perversions of 
secretions or function, the present of toxic bodies, or the 
presence of immunizing substances that develop during di- 
sease. Some of the newer tests that have come up within 
the past few years may be summarized under the following 

Laboratory Methods. 641 

Physical tests: Here we have the study of the electri- 
cal conductivity of body fluids, the changes in specific gravi- 
ty, and in viscosity of various fluids. Some of this work has 
been interesting in connection with studies of the urine and 
such fluids as the cerebral spinal fluid- The histologic pro- 
cedures have developed cytodiagnosis, or the enumeration 
of cells in various normal and pathologic body fluids, as dif- 
ferential counts of the blood, 'differential counts in pleuritic 
exudates, or in fluids from the spinal column, as well as pus. 
Some of these in connection with nervous diseases have been 
shown to be of great value when the spinal fluids are steady. 

Under the biologic examination, the discovery of spirilla 
has opened up a new field of research, especially as regards 
syphilis. The demonstration of spirochaeta pallida in sy- 
philitic lesions by the dark field illumination has made this 
line of investigation very popular, and not alone such mate- 
rial but juices from tumors are also being studied by this me- 
thod. Our further knowledge on the infecting organisms in 
blastomycosis and streptothrix infections has added consid- 
erable to our methods of diagnosis. A recent line of work 
that has been introduced is the differentiation of some of 
these species of organism by biologic methods, or the pro- 
duction of antibodies to them by means of which specific pre- 
cipitates can be obtained for the different organisms under 

Under the chemical examinations, investigations of 
purin bodies and of amonia in the urine has been of a good 
deal of interest, but not as yet proven of very great practi- 
cal value. A study of the feces as regards the presence of 
occult blood and the amount of fat has been shown to be of 
value in infections and tumors of the intestinal tract. The 
pancreatic reaction of Cammidge is of great interest in 
helping to clear up a series of vague diseases of the deeply 
located pancreas. The general introduction of this test will 
no doubt be of great service in diagnosis, and will greatly 
assist in the treatment of patients ha'ving pancreatic or al- 
lied diseases, Under the head of chemical tests there is also 
to be not 3d a very important line of investigations that is 

642 Tbe Plexus. 

gradually coming into prominence in a practical way, name- 
ly, the serum reactions. . Ever since Bordet, in 1899, discov- 
ered certain principles by which the sera of animals were 
capable of of agglutinating and dissolving red blood corpus- 
cles, these investigations have been prosecuted with great 
activity. They may be now considered as being developed 
along two lines; first, that in which there is hemolysis or 
laking of blood corpuscles owing to changes in a serum. 
This may occur in two ways: the serum of the individual 
may be altered in such a way that when it is applied to the 
corpuscles of this species it will take these corpuscles, or 
the corpuscles may be altered so that they will be laked by 
the serum of a normal individual. Crile has shown that in 
cancer the serum of the cancer patient will hemolyze normal 
human corpuscles, while in tuberculosis he finds that cor- 
puscles of the tubercular patient will be hemolyzed by nor- 
mal serum. The other step in this line of investigation is 
what is known as the deviation of complement. If a serum 
having properties of causing hemolysis is heated to 55 Q C, 
it loses its property, but when any fresh serum called the 
compliment is added, this property is returned, Now if a 
mixture is made up it has been found that pathologic mate- 
rial can be added which will detract the compliment from 
the blood cells and the inactivated serum, and laking of the 
blood corpuscles will fail to occur. This is known as devia- 
tion of the compliment. It is made use of in the serum di- 
agnosis of syphilis, or the Wasserman reaction. Similar 
investigations are being tried in other conditions, especially 
in scarlet fever, measles, and in general diseases where the 
etiologic factor is still little understood, with a posibility 
that a definite diagnostic method will be evolved. 

Another chemical method of interest is the production 
of antibodies along the line of the precipitants, and their 
use for diagnostic purposes. As one example of this pro- 
cedure, it is known that the presence of worms in the body, 
either in the intestine or in the tissue, cause the production 
of antibodies to the albumins existing in these worms, and 
that the blood serum of such a patient will cause a precipi- 

Don't and Its Significance. 64- 

tafe with extracts of the worm. In this manner the type of 
tape worms can be determined, and the procedure is now 
being tried on a number of different tropical affections due 
to these larger parasites. 

In conclusion it must be said that the chief difficulty in 
most of the modern laboratory diagnostic methods is in their 
complicated and time consuming details. This renders them 
more and more a necessity of the laboratory rather than the 
bedside. A practitioner therefore, finds them difficult to 
use and a certain allowance must be made for this, but it is 
hoped that as knowledge increases a simplification of meth- 
ods will result by which they can be placed in the hands of 
the bedside physician for his daily use. 


By Dr. Frederick Tice. 
In one of the small folders issued by the Department of 
Health of New York City, the negative but imperative 
"Don't' 1 occupies an important place. These folders contain 
the following: 

Don't get tuberculosis yourself. 

Keep as well as possible, for the healthier your body, 
the harder for the germs of tuberculosis to grow therein. To 
keep healthy observe the following rules: 

Don't live, study nor sleep in rooms where there is no 
fresh air. Fresh air and sunlight kill the tubercule bacilli 
and other germs causing other diseases, therefore have as 
much of both in your room as possible. 

Don't live in dusty air; keep rooms clean; get rid of dust 
by cleaning with damp cloths and mops. Don't sweep with 
a dry broom. 

Keep one window partly open in your bedroom at night, 
and air the room two or three times a day. 

Don't eat with soiled hands. Wash them first. 

Don't put your hands or pencils in your mouth or any 
candy or chewing gum other persons have used. 

Don't keep your soiled handkerchiefs in your pockets. 

Take a warm bath with soap at least once a week. 

644 The Plexus. 

Don't neglect a cold or a cough, but go to a doctor or 


If you or anyone in your family have tuberculosis, you 
must obey the following rules if you wish to get well: 

Don't waste your money on patent medicines or adver- 
tised consumption cures, but go to a doctor or dispensary. 

If you go in time, you can be cured; if you wait, it may 
be too late. 

Don't drink whiskey or other forms of liquor. 

Don't sleep in the same bed with anyone else and, if pos- 
sible; not in the same room. 

Good food, fresh air and rest are the best cures. Keep 
out in the fresh air and in the sunlight as much as possible. 

Keep your windows open winter and summer, day and 

If properly wrapped up you will not catch cold. 

Go to a sanitorium if you can before it is too late. 

A person who has pulmonary tuberculosis or consump- 
tion is not dangerous to those with whom he lives and works, 
if he is careful and clean. 


Many grown people and children have pulmonary tuber- 
culosis or consumption without knowing it, and can give it 
to others. Therefore every person, even if healthy, should 
observe the following rules: 

Don't swallow your expectoration, but— 

Don't spit on the sidewalks, playgrounds, or on the floors 
or hallways or your home or school. It spreads disease, and 
is dangerous, indecent and against the law. 

When you must spit, spit in the gutters or into a spit- 
toon half filled with water. 

Don't cough or sneeze without holding a handkerchief 
or your hand over your mouth or nose. 

Don't blow your nose with your fingers. 

It is a deplorable fact, demonstrated daily, in defiance 
of experimental and clinical evidence that pulmonary tuber- 
culosis is contracted as a result of ''spitting," that the per- 

Deaths from Pneumonia. 645 

nicious habit still continues. That this should be so of tht 
ignorant and non-instructed is to be expected, but that it 
should be so among the educated and instructed is almost 
beyond comprehension. 

It is absolutely impossible to understand how so many 
physicians and medical students, knowing the dangers, will 
constantly violate the laws of dececy and health. That they 
do so can be determined by attending any lecture or clinic, 
or examining the floor at the conclusion of the hour. That 
this is so is no credit to the college or student and, in gen- 
eral, it may be accepted as a criterian, the student who does 
not profit by the knowledge gained will never reflect credit 
on his instructors, and even his own future must ever re- 
main in doubt. The ignorant person who expectorates is 
possibly excusable, but the person who knows better com- 
mits a double offense, is a "double monstrosity." In the 
light of our present knowledge the man who deliberately 
robs and murders one of his fellow men is a gentleman, far 
to be preferred when compared with the one who knows 
better but continues to expectorate and perhaps infects not 
one but dozens. 

Don't spit and don't allow your fellow students to spit. 


In the report of the Chicago Health Department of Sep- 
tember 5, 1908, appears the following significant paragraph: 
"The great saving of the last eight months is due chiefly to 
marked reduction in mortality from pneumonia. There 
have been 1105 fewer pneumonia deaths." 

Under the old teaching, that pneumonia is a self-limited 
disease in which medicinal treatment is of little avail, the 
mortality has crept up and up. Today this disease rivals 
tuberculosis as the most frequent cause of death. The med- 
ical profession and the general public are thoroughly 
roused as to the menace from the latter disease, but there 
seems to remain the same condition of apathy concerning 
pneumonia, which is not only second on the mortality-tables 
but one of the most important predisposing causes of tuber- 
culosis, which heads the list. 

616 The Plexns. 

Thank God! There are signs of a change for the bet- 
ter. We believe that the methods for which we have con- 
tended so long are at last finding lodgment in the conscious- 
ness of the profession, and that some of the betterment in 
the death-rate is due to this fact. Thousands of physicians 
are using the alkaloids and allied remedies in treating this 
disease — learning the importance of a clean and clear ali- 
mentary canal, of proper equalization of the circulation, 
combined with support of the heart, stimulation of nervous 
control and of the immunizing forces of the body. 

It is wonderful what may be done in the treatment of 
pneumonia when these factors are grasped and put into 
practice. Thousands of physicians who under the expect- 
ant methods lost case after case now approach the bedside 
of the pneumonia patient with the confidence born of results 
achieved. Many believe (as we do) that when these cases 
are seen at their inception the progress of the disease can 
be arrested — that it can be aborted. Heresy? Perhaps,, 
but it is the teaching of experience. 

Can we not persuade our nihilopathists to look farther 
into this matter? Isn't it worth while to go to the bottom of 
these claims (no matter, Brother, if they do seem "absurd" 
to you) and find out for yourself if there may not be some- 
thing in them. Thousands of human lives are at stake. 
Isn't it worth a passing thought — a little close personal con- 
sideration? — Clinical Medicine. 


In the Bulletin of the American Pharmaceutical Associa- 
tion for November we note a suggestion so significant that 
we feel impelled to quote it; it is as follows: "The pro- 
posed publication of the Quarterly Medical Journal is now 
pending the reports of the Branches and other members in- 
terested. It is sugge ;ted that those who desire to try this 
method of exploiting their local physicians with the official 
preparations promptly respond to the Editor." 

That word "exploiting" fits the case so exactly that we 
must congratulate the writer. "Exploiting" is a euphonious- 

Phamacal Funnies. 647 

synonym for "work." The profession has been "worked" 
so much that it is getting a little tired of it, perhaps. But 
the unblushing effrontery with which our drug friends pro- 
pose to do it again is refreshing. Possibly it may pay as 
well as teaching pharmacy by correspondence. 

Some of the pharmacists are commencing to sit up and 
take notice. In the address of Chairman J. W. England we 
note the following significant statement: "Today the ten- 
dency of the medical profession is to make a god of hygiene 
and sanitation, and a corpse of therapeutics, and it is this 
attitude which has so greatly decreased the number of pre- 
scriptions written in recent years and forced retail pharma- 
cists, in self-preservation, to sell "side-lines" that have no 
legitimate place in drugstores. I do not believe that drug 
therapeutics is dead or even dying. I have unbounded 
faith in the abiding good sense of the rank and file of the 
medical profession. I believe that the medical pendulum, 
in the matter of therapeutics, has swung to an extreme, and 
will soon swing back to the mean; and that the art of thera- 
peutics, the greatest of all human arts, will be given new 
life, and will come into its own." 

Just so; and under the able leadership of Mr. Hallberg 
the pharmacists will continue to fight to the death the 
people who have instituted this reform, who have caused 
the "pendulum to swing back toward common sense," and 
the rational use of drugs. Just as the A. M. A', ring man- 
agement fights to the bitter end this group of men, who 
originated the movement against quackery and occupied an 
ethical ground far in advance of the said ring, so the phar- 
macists with like inconsistency continue to fight their bene- 
factors. But then, our ideas of reform are real. There is no 
sham about them, and the people who could not go far 
enough on the ethical road to condemn the furnishing of 
dope for quackery by their favored pharmaceutic houses, 
might be expected to fight "the real thing" when presented: 
— Clinical Medicine. 

The Plexuc. 


By Herbert F. Pitcher, M. D., Haverhill, Mass. 

When Dr. Oliver Wendell Holmes made the classical re- 
mark, "If all the drugs were cast in the sea, it would be 
well for man and bad for the fishes," he little realized that 
his fling at drugs would become a fact and that a large por- 
tion of his prof essional brethren would become drug nihi- 

I believe Osier's "Practice of Medicine" is considered 
by good judges of medical lore to be the best work on that 
subject in the English language. His definitions of disease, 
pathology, etiology, histology, diagnosis and prognosis are 
all quite voluminous, but when he comes to treatment it is 
dismissed in a dozen lines or less. What does this indicate? 
Are the best teachers losing cenfidence in drugs? 

Drug medication in itself has always been more or less 
uncertain. An old practitioner once said, "There are only 
two drugs of which I am sure, one is opium and the other 
castor oil." 

We pride ourselves upon the position the family physi- 
cian occupies in the world, but it is humiliating, after we 
have burned the midnight oil as students, toiled night and 
day as practitioners, run at the beck and call of the rich and 
poor, the good and bad; laid awake nights thinking and 
worrying over the ills of our patients, and perhaps be greet- 
ed the next morning with the salutation, "We have conclud- 
ed to try Christian Science." 

I know people are prone to run after "false gods," but 
it seems to me they continue to run, and, like sheep jumping 
over the wall, they have many followers. 

We "pooh" at Christian Science, osteopathy, and other 
cults, but when quite a large per cent of our patients take 
up with that kind of foolishness, we begin to wonder why. 

The same conditions may have existed in times past, but 
not in our time. I believe matters religious are passing 
through something of the same kind of evolution, and our 
reverend brethren complain of their parishioners thinking 
for themselves, and they do think to some purpose. 

Phototherapy in General Practice. 649 

Our patients are beginning to think, and many of them 
are tired and sick of being drugged, and they are calling for 
a more rational treatment. Undoubtedly drugs will always 
be used in acute diseases, but in the so-called chronic dis- 
eases I think other and better remedies can be used. Some 
great man has said, "To electrical forces and animal serums 
and extracts must we look in the future, in all probability, 
for the remedies to combat many diseases now called incur- 
able." Looking back ten years we can note many new and 
wonderful discoveries. Some of them have overturned law 
which seemed as fixed as the hills- Could we but look into 
the future a few years, our eyes would be dazzled by the 
brilliant achievements. Although we live in an age of pro- 
gress, our knowledge is quite limited as to the real cause of 
many diseases. 

It is only a few years since Koch made his name immor- 
tal by discovering the tubercle bacillus. Well has tubercu- 
losis been called the "great white peril," for it has killed 
more people than all the wars. For ages the profession 
has tried to discover a remedy to successfully combat it, but 
until within a few years have all theories, experiments, and 
sinecures, one after another, been tried and found . wanting. 
But at last a real remedy, a real sure cure, has been discov- 
ered. From the most fatal malady known, it is now looked 
upon as quite amenable to treatment. Some authorities 
claim a cure of seventy-five per cent if the disease is recog- 
nized and treated in its early stage. What is this wonderful 
treatment? Have drugs accomplished all this? Alas, no! 
This priceless remedy has always been with us, free and 
without price, and it was reserved for the present genera- 
tion to apply it: all we have done and are doing is to open 
the doors and windows and let in good, pure air and the 
glorious sunshine. Sunlight is undoubtedly the best and 
most universal remedy. The ancients worshiped the sun as 
the most glorious object in nature, and, as the sourse of light 
and heat, idolized it as the Godhead of life itself. 

"Sunlight is the most intense radiance at present known. 
It far exceeds the brightness of any artificial light yet in- 

650 The Plexus. 

vented. The calcium light and the most powerful electric 
are interposed between the eyes and the sun's surface ap- 
pear as a black spot upon the disk. The candle-power of 
the sun is said to be about fifteen hundred and seventy-five 
billions of billions," 

I will not go into the physics of radiant heat and light, 
as its origin and transmission are pretty well understood. 

Larkin says: "Man lives only by the radiance from the 
photosphere of the sun. By this great energy everything 
within its radius is purified, every object it penetrates is 
disinfected, and every known form of germ life is either de- 
stroyed or its development arrested. 

''To this sourse can be traced directly nearly all the 
energy involved in all the phenomena, chemical, mechanical, 
or vital. 

"In this solar energy is to be found the simplest and 
most natural method of using light therapeutically." 

The inhibitory power of sunlight upon the growth of 
tubercle bacilli was established some years ago and is too 
well known to admit of discussion. Its action upon tuber- 
culosis of the lungs, joints, bones and glands, as well as 
upon bronchitis, asthma, and many other diseases, is recog- 
nized and utilized as much as possible. 

In the crowded cities where the greatest need exists for 
radiant energy is just the place we cannot obtain it. Here 
we find a good substitute in the electric light. 

The utility of light and heat as a therapeutic agent is 
now so generally recognized by the medical profession all 
over the world that the better equipped hospitals and infirm- 
aries are provided with apparatus for administering this 

There are several different methods used in producing 
radiant light. For giving body treatments the arc-light 
bath and the incandescent-light cabinet are used. Dr. 
Cleaves, of New York, has used tbe arc-light bath for nearly 
twelve years, with great benefit in all forms of tuberculosis, 
many skin diseases, nervous affections, diabetis, albuminuria, 
and other diseases. Strebel has used it in a number of cases 

Phototherapy in General Practice. 651 

of diabetes with great improvement in general health and 
complete disappearance of sugar. 

Crothers, of Hartford, has made many practical experi- 
ments with the radiant-light bath -in many conditions de- 
pendent upon toxemias. His conclusions are that: 

"It penetrates to the deeper tissues of the body and is 
turned into heat and so transformed into nerve energy more 
positively than administrations of dry, hot air. 

"The clinical effects of the radiant-light bath prove its 
power as an eliminating agent, and as a corrector of neurotic, 
nutrient, and capillary disturbances. Its physiological act- 
ion depends upon the heat and chemical rays coming in 
contact with substances that are resistant to their passage 
and thus transforming them into heat and light energy. 

; "The skin is a poor conductor of heat, but readily trans- 
mits light and radiant energy. Thus in the deeper tissues it 
becomes changed into heat. 

"Radiant energy has two marked actions on the skin 
and tissues— one of stimulation and the other of sedation. 

"The stimulating action falls first on the sensory, then 
on the vasomotor and heat center, and lastly on the secret- 
ing centers. The vasomotor centers, controlling the con- 
striction and dilatation of the walls of the arteries, respond 
very quickly to surface changes. 

"Light has a special action on the vasodilators of the 
arteries, stimulating increased activity and permitting the 
blood to flow more rapidly to the surfrce. This takes off 
the burden of the heart's action and relieves the constric 
tions to the arterial circulation and to the cappilaries. Oxi- 
dation is increased, with an increase of elimination. There 
is a fall in arterial tention and a uniformity in the action of 
the heart and respiration." 

The effects of this method of treatment on arteriosclero- 
sis is rational and beneficial. In albuminuria, Dr. Lebon 
has had many cases which were improved. Good results 
follow this treatment in rheumatoid arthritis, also in gout, 
rheumatism, asthma and neuralgic conditions. In the local 
application of light I have used with great satisfaction the 

The Plexus. 

high candle-power incandescent lamp (five hundred candle- 
power), using twelve amperes of current. 

This lamp seems to possess the actinic or chemical rays 
and the heat rays — radiant heat — which are powerfully 
stimulating and penetrating. These lamps produce dilata- 
tion of superficial blood vessels, relieving congestion of in- 
ternal organs, affording an analgesic action which is most 

When we stop to consider that the skin is capable of 
holding, when these vessels are fully distended, one half or 
two thirds of all the blood in the body, we can readily see 
the immense benefit we can obtain from this form of ' treat- 

Dr. Kellogg, in his article in Cohen's "System of 
Physiological Therapeutics," shows the relation of the blood 
supply of internal organs to the skin. He shows how freely 
the vessels of the brain are connected with those of the 
scalp and nose, how the circulation of the middle ear is con- 
nected with the skin of the face and head of the same side 
through the common carotid artery. ''The circulation of 
the internal ear, on the other hand, is associated with the 
skin on the back of the neck, being derived from the verte- 
bral arteries. The vessels of the mucous membrane of the 
nose and pharynx are associated with those of the face and 
sides of the head through the common carotid. The circu- 
lation of the lungs is collaterally related with that of the 
skin covering the arms, the chest and the upper part of the 
back. The pericardium and parietal pleura of the anterior 
portion of the chest are connected with the skin covering 
the anterior portion of the chest wall through the internal 
artery, while the pleura of the posterior portion of the chest 
is related to the intercostal vessels. A collateral relation 
also exists between the bronchial arteries, the nutrient ar- 
teries of the lungs, and the intercostals. The skin covering 
the arms is related with the pleura and anterior portions of 
the chest through the subclavian artery, the nutrient 
vessels of the lungs and the vessels covering the anterior 
portion of the neck through the branches of the internal 
iliac artery." 

Phototherapy in General Practice. 653 

There are still other connections which show the exten- 
sive communications between the pulmonary circulation 
and that of the cutaneous surface, all of which are of high 
therapeutic interest. The kidneys are associated with the 
skin covering the loins through the renal branches of the 
lumbar arteries. The vessels of the prostate in man, the 
uterus and ovaries in woman, the bladder in both sexes, are 
associated with the cutaneous vessels overlying the sacrum, 
the buttocks, the perineum, external genitals, the groins, 
the inner surface of the thighs and the suprapubic regions; 
these parts being chiefly supplied by branches of the inter- 
nal iliac arteiw. 

Space forbids extending this interesting subject. We 
all know the important relationship, both venous and arte- 
rial, between the stomach, liver, spleen, intestines, and 
even the pancraes, and the skin of the trunk which overlies 
those deeply-seated organs. 

How well every mother recognizes the benefit following 
the application of a mustard paste to the stomach when the 
children have a pain therein, or a hot flaxseed meal poul- 
tice, or other hot fomentations to the chest when they have 
bronchitis. They know it relieves and does good by bring- 
ing the blood to the surface. 

How much more beneficial must be a method of treat- 
ment whereby the vessels are more fully dilated than is pos- 
sible by any other method except that of radiant heat which 
penetrates beyond the surface. It is not the heat alone 
which is so beneficial; it is the light rays which ' penetrate 
the tissues and stimulate the vasodilator nerves and relieve 
congested internal organs. 

Although the tec'mic of this high candle-power lamp is 
simple, there is clanger in giving treatments too long and too* 
frequently. We must remember it is a potent remedy, and 
evil results might follow too enthusiastic applications. Like 
other modalities new to the world, we should carefully study 
our cases and watch the effect of the treatments, being 
careful not to bring a valuable remedy into disrepute. 

A few cases treated within the past year will illustrate 
its beneficial action: 

654 The Plexus. 

A boy, nine years of age, whose ancestry on both sides 
was tubercular, was always a very delicate child. He had 
two attacks of pneumonia and frequent attacks of bron- 
chitis. A year ago last January he was operated on for tu- 
bercular peritonitis, and several large mesenteric glands 
were removed. He did not react well from the operation, 
and although he lived outdoors all the summer and autumn 
and received the best possible care, he remained weak and 
delicate. I saw him in October, when he returned from the 
country. He had an evening temperature of one to two de- 
grees above normal and very little appetite. He was easily 
fatigued, had some enterocolitis, and complained of his left 
thigh paining him. There was some lameness in his left 
leg, especially at night after a little extra exercise. I or- 
dered rest, most nutricious diet, and continued life in the 
sun and outdoor air when possible. As he did not improve 
for about six weeks, I sent him to Boston to consult an or- 
thopedic surgeon. He said there was undoubtedly a tuber- 
cular focus in the hip -joint, and thought we had better con- 
tinue present treatment a while longer. 

December 15 I gave him a light treatment, and from 
that time he has taken two treatments per week. After six 
treatments there was no pain or lameness. His general 
health improved rapidly, appetite became good, and bowels 
normal. At the present time I do not know of a more 
rugged looking boy; he runs and plays all day and says he 
never gets tired, and never felt so well in his life. 

After the first two or three treatments the rays were 
applied as strong as he could possibly bear, up and down 
the spine to the abdomen'and chest, to the left hip-joint and 
thigh. I continue the treatment only because his people 
wish to ^keep him well through the changeable spring 
weather. He has not coughed or had a cold this winter, 
which breaks the record for him. 

A case of sciatic neuritis which had resisted other forms 
of treatment was cured by the light. This was a very se- 
vere case which had existed about six months. The patient, 
a lady fifty years of age, was very much worn and debil- 

Phototherapy in General Practice. 655 

itated by the constant pain which had kept her from taking 
proper nourishment and sleep. The light was applied to 
the spine, which increased the general metabolism and 
stimulated the nerve roots. 

Then the light was applied with all the heat the patient 
could possibly bear, up and down the course of the sciatic 
nerve, and especially over the sciatic notch. 

A case of mastoiditis was cured in five treatments. This 
case, a woman, thirty-six years of age, had been treated a 
week by the usual remedies before I saw her. She com- 
plained of a very severe pain in and around the ear and 
mastoid, with tenderness on pressure and pain on percus- 
sion over the mastoid bone. The membrani tympani was 
red and inflamed, and temperature 100.2 degrees without 

Application of strong light was made over the mastoid, 
in and around ear, side of the face, head and neck of affected 
side for fifteen minutes. She returned next day with report 
of a_ good night's rest, but some pain yet. Another appli- 
cation, the same as before, was made. The patient said 
there was absolutely no pain when she left the office, -and 
there was no pain whatever after that. She received three 
more applications with complete subsidence of the inflam- 
mation, and there has been no trouble since. 

A man, sixty-three years of age, weighing two hundred 
and forty pounds, had la grippe, followed with severe pain 
in right side of his head and ear for three weeks. ,The last 
week the pain was so severe he could neither eat nor sleep. 
When I saw him he was a wreck. There was a profuse 
purulent discharge from the ear, the membrani tympani 
was ruptured, and the typical conditions with the symptoms 
of acute purulent otitis media. After thorough cleansing of 
the canal I applied the light for fifteen minutes to the pain- 
ful side of the head and neck and into the orifice of the ex- 
ternal meatus. 

The patient returned next day saying that "he had had 
the first good night's rest for three weeks." He received six 
treatments, with the result that pain and inflammation have 

658 The Plexus. 

entirely subsided, discharge ceased, and the patient was 
feeling as well as usual- There has been no return of ear 

I could enumerate many cases of like conditions, and 
results. It is a source of great satisfaction to me to be able 
to relieve and even cure poor suffering humanity of a disease 
at once so painful and possibly dangerous to the loss of hear- 
ing and even life itself. 

I do not contend that it will cure all cases of severe in- 
flammation of the middle ear or where the mastoid has be- 
come affected, needing operative relief. But if the light 
could be used in early stages it would abort the inflammato- 
ry conditions in most cases. 

I have also used this light in several cases of inflamma- 
tion of the accessory sinuses with equal success. When we 
hear patients who have suffered for days and nights from 
that terrible pain which is the result of inflammatory condi- 
tions confined in those narrow bony cavities like the ear and 
accessory sinuses, exclaim, "Oh, how good, how blessed!" 
we cannot help reminding ourselves of the old remedies we 
have used without even obtaining relief, until we found re- 
fuge in the use of morphia with its baleful after-results. I 
would like to relate many other cases benefited by the light 
treatment, but time forbids. 

I do not claim light as a panacea, neither should any one 
method be used exclusively. We should study each case in- 
dividually and treat it accordingly. Because a patient has 
a cancer or a synovitis of the knee joint, does it necessarily 
prohibit him from accumalating other disorders'? We would 
consider a man demented if he now bled all his patients, as 
did the physicians in the dark medical ages. 

We are supposed to be broad-minded practitioners. If 
we think after a careful examination of our patient and in 
accordance with our best knowledge and judgment he needs 
a dose of salts, salts he should get. But if we think a 
"light" treatment will best eliminate the toxins and their 
action upon the nerve centers, that by dilating the peri- 
pheral circulation we relieve the congestion of internal 

Medical Interne. ► 657 

organs and thereby help metabolism, that is the treatment 
we should employ. 

If we can cure a case of acute brachial or sciatic neure- 
tis by the application of the peculiar current or modality of 
electricity indicated, quicker and with better results than 
by the use of drugs, that is the method to use. If we are to 
advance with the rest of the scientific world we should put 
away prejudice and jealousy, open our minds to all knowl- 
edge, cling fast to that which is good and reject the bad as 
useless. It would be foolish to set any limits to the bounds 
of human power, for we live in eternal expectation of a com- 
plete and final answer to the most momentous questions of 
all time. 


The United States Civil Service Commission announces 
an examination on January 13, 1909, at Chicago, to secure 
eligibles from which to make certification to fill a vacancy in 
the position of medical interne (female), Government Hospi- 
tal for the the Insane, Washington, D. C, at $600 per annum 
with maintenance, and vacancies requiring similar qualifica- 
tions as they may occur in that hospital. 

The Department states that it reserves the right to ter- 
minate the appointment at the expiration of one year of ser- 
vice if it is deemed advisable to do so. 

As the Commission has experienced considerable diffi- 
culty in filling this vacanuy, no eligibles having been secur- 
ed as the result of the examination held on June 17, 1908, 
qualified persons are urged to enter this examination. 

The examination will consist of the subjects mentioned 
below, weighted as indicated: 

Subjects. Weights. 

1. Letter-writing (the subject-matter on a topic relative to the 

practice of medicine) 5 

2. Anatomy and physiology (general questions on anatomy and 

physiology, and histologic or minute anatomy) 10 

3. Chemistry, materia niediea, and therapeutics (elementary 

questions in inorganic and organic chemistry; the physio 

658 The Plexus. 

logic action and therapeutic uses and doses of drugs) 15 

4 . Surgery and surgical pathology (general surgery, surgical di- 

agnosis, the pathology of surgical diseases) 20 

5. General pathology and practice (the symptomatology, ethi- 

ology, diagnosis, pathology, and treatment of diseases).... 25 
(\ Bacteriology and hygenic (bacteriologic methods, especially 
those relating to diagnosis; the application of hygenicme- 

thods of prophylaxis and treatment) 10 

7. Obstetrics and gynecology (the general practice of obste- 
trics; diseases of women, their pathology, diagnosis, symp- 
toms, and treatment, medical and surgical) 15 

Total 100 

Applications will be accepted only from persons who in- 
dicate in answer to question 17 of the application form that 
they have been graduated from reputable medical colleges 
not more than two years prior to the date of examination. 

Unmarried women only will be admitted to this examina- 

This examination is open to all citizens of the United 
States and aliens who have declared their intention to be- 
come citizens, who comply with the requirements: Provided, 
That these aliens, if found eligible, shall not be certified for 
appointment so long as persons are eligible who are citizens 
of the United States. 

Age limit, 20 years or over on the date of the examina- 

Applicants should at once apply to the United States 
Civil Service Commission, Washington, D. C, or to the se- 
cretary of the board of examiners at Chicago, for application 
Form 1312. 





Channlng W. Barrett, M D., Chairman. 

T. A. Davis, M. D. W. E. Gamble, M. D 

Oliver S. Olson, Editor. 


M. E Bennett, '09 

L. C. Qulrm, '09 

H. E. Rich, 10 

Harry Knott, '11 

L. M. Kane, 12 
Senior Poet, J. G. Ingold. 

Publisher - - - - J. E. Forrest. 

Subscription SI. 00 per Annum in advance. Single copies, 15 cents. Issued 
Monthl}. Send all communications and remittances for subscriptions and adver- 
tising to J. B. F0RWEST, Batavla, Illinois. 

Entered at Batavia Post Office as Second-Class Matter. 

Any subscriber desiring the Journal discontinued at the expiration of his sub- 
scription should so notify the Publishers; otherwise it will be assumed thai the 
subscription is to be continued and the Journal sent accordingly. 

Contributions of matter suitable for publication are invited, and should be sent 
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ufficie-t stamps are forwarded. 

Send contributions to A. R. Johnstone, M. D., Editor, 4147 Lake Ave., Chicago. 


The youug child looks forward with fondest hopes and 
longings to the Christmas holidays, and the grown child as 
he matures does not fail to regard this as a time of rejoicing, 
rest, over-feeding