Vol. 60, 1909 - University of North Carolina at Chapel Hill

NORTH CAROLINA HISTORY OF HEALTH
DIGITAL COLLECTION
Charlotte Medical Journal
Volume 60
(July 1909 – December 1909)
DOCUMENT NO. NCHH-21-060
HEALTH SCIENCES LIBRARY
UNIVERSITY OF NORTH CAROLINA
AT CHAPEL HILL
||www.nchistoryofhealth.org ||www.hsl.unc.edu ||

ADVERTISEMENTS.
AFTElbrOHYAlESCENCE

lARLOTTK MEDICAL lOURNAL.
^ SANMETTO GEIMITO-URINARY DISEASES. >
5^ A Scientific Blending of True Santa l and Saw Palmetto with Soothing Demulcents
in a Pleasant Aromati c Vehicle
A Vitalizing Tonic to the Reproductive System.
SPECIALLY VALUAL E IN ^
PROSTATIC TROUBLES OF OLD MEN-IRRITABLE BLADOeR- S
CYSTITIS-URETHRITIS- IE-SENILITY. 3
I' OOSE:-One Teaspoonlul Four Timet a Day. OD CK£M. CO., NEW YORK. >«
campho-phenique: |
\

ADVERTISEMKXTS.
BOVININE
Reconstructive Food
and Tonic
BOVININE represents the most aluable combination
I'ood and Tonic elements ki own to the medical pi
fession.
BOVININE has proven clinically to be most valuable m
all forms of Tuberculosis.
BOVININE enables the nerve cell to assimilate its specifu
elements, which it fully supplies.
BOVININE promotes the metabolism of fat and albumin
in muscle and blood, thereby restoring the bodily
health, strength and normal powers of resistance.
BOVININE supplies full and complete nutrition througli
its I'ood and Tonic properties.
THE BOVININE COMPANY
7S -Wrs !w York City 3
The Standard of Therapeutic Efficiency,
1
X< )'l' ( iXI.\- |.()K
.\ ci'.XTrkv IAS lIAVni'X'
'I'XDAHI.I-; RlCSl I.TS IX Till-; '
.\R BIT 1-()R '
^ \'iBrKxrM
•Ri':.\TMi-:xT ()
Till-: i.Asr \i
III'. I..\^
COM re
Dysmenorrhea, Amenorrhea, Menorrhagia, Metrorrhagia
and other diseases of the Uterus and Its appendages.
Tlieif has hetn ikj iiecessily for any cliaii«e in llit- formula of H. V. C. because
its therapeutic efficiency has made it "Standard"' and so recognized by the most
painstaking; therapeutists and jivnecologists from the time of Sims.
I'nscrupulous manufacturers and druggists trade upon the reputation of Ilay-
(len's X'iburnuin Compound, and to assure of therajjeutic results insist that the genuine
H. V. C. o/i/r is dispensed to your patients.
SAMPLES AND LITERATURE UPON REQUEST
NEW YORK PHARMACEUTICAL CO. If^lZUTsT
IIAVOKN S URIC SOI.VhNT m( inrslim.ihle v.tIus in Rhcuniatism, Cnul and olher conditions indicalint an excess of Uric AciJ

THE CHARLOTTE MEDICAL JOURNAL.
Chattanooga Medical
College.
MEDICAL DEPARTMENT OF UNIVERSITY OF CMATTANOOOA
Session ol 1909—1910.
Twenty-first Amuial Session Begins Sept. 22rd.
New buildings. Large patronage. Every facility. A full teaching corps.
I aboratories with latest equipment and salaried teachers. Modern methods
of instruction. Excellent hospital. Minimum living expenses. Requirements
those of the Southern Medical College Association, of which this institution
is a member A most desirable school for patrons from the frigid North or the
extreme South-equable climate, favorable to effective study. City one of the
most beautiful in America, both by nature and art. National Military Park,
National Cemeterv, and miles of splendid Government Boulevards. Scenic
surroundings unexcelled on this continent. Population (including suburbs)
about 7.5,000.
Rates Reasonable.
,HAY FEVER
For particulars address,
J. R. RatHmell, M. D., Dean.
CHATTANOOGA. TENN.
The followinK will often Rive relief hen everything else fails
R Ext. Suprarenal Gland
Glycerini
POND'S EXTRACT
AND sig.! Apply ith coarse spray
DHKin'O CYTDftPT ^^^^^Q^- "o.i«?>7rWcr,Wns ponds tXrRAC r'e2dus,-ve,y
r UllU U LA I nHU ! POND'S EXTRACT CO., New York and London
^.ir.. A^C^

! I
I I II ! I Imi
ADVKRTISKMHNTS,
Mlfi I II imiliiiiSm
' ~- ' - ^
Does not cause
,!i.::i.:l!i.li..:ii.,::.il! !i::!,:.;!:.!„i.
the injurious effects on the stomach,
or the other disturbances of
salicylism produced by the
sodium salicylate made from coal-tan
Furthermore the uniformly good results
fromTcngaline are secured largely by the
thorough and constant absorption of the
salicylic acid it contains because this is
made from the natural oil of wintergreen.
Samples by Express prepaid - Mellier Drug Company. St.Louis.
MMTlif aMillH
PREP/
ANTIKAMNIA £* SALOL TABLETS
Hare says " Salol renders the intestinal canal antiseptic and is the most
valued drug in intestinal affections." The anodyne properties of anlikamnia in
connection with salol render this tablet very useful in dysentery, indigestion,
cholera morbus, diarrhiL-a, colic, and all conditions due to intestinal fermentation.
ANTIKAMNIA 8l CODEINE TABLETS
Especially useful in dysmenorrhct-a, utero-ovarian pain, and pain in general
caused by suppressed or irregular menses. This tablet controls the pains
of these disorders in the shortest time and by the most natural and economic
method. The synergetic action of these drugs is ideal., for not only are their
sedative and analgesic properties unsurpassed, but they are followed by no unpleasant
effects.
The efficacy of this tablet in all neuroses of the larynx is also well known.
In coughs and colds, coryza and la grippe they will always be found of inestimable
value.
THE ANTIKAMNIA CHEMICAL COMPANY
ST. LOUIS. U.

THE BABIES «HC
thrive the best during the Summer are thos
who are fed on
Lacto Preparata
the all milk infants food.
It does not require the addition of milk to make
it nutritious,
Write for literature telling how it is made and
why it is universally considered the Summer
food for infants.
For those infants six months and older and also
for indvalids, use
Carnrick's Soluble Food,
Samples upon request.
Reed «& Carnriok:
JERSEY CITY, IN. J.
ADVKRTISEMKNTS.
fSEND for THIS CASE and DIGEST
The Uncertainty of Galenical Medicines is Acknowledged by
Every Doctor to be the Greatest Bar to Professional Success
ABBOTT^S GRANULES
of the Active Principles are the last word in
Convenience Dependability Accuracy
Ihe
:
The Biggest Value $1.00 Ever Bought For You
The case is well nwde and substantial, of convenient size, and filled with ovt
doses of the most-used emergency remedies, while the book is full of well]
success-making ideas. The regular price of the case alone is Si. 50, while the
s worth a I' to any man. We give you both for $1 .co
We Ask Every Reader fo Accept ttic Following Proposition.
Money Back i( not Satisfied.
I=^'^the'l.'
f——~— /
--- i
~i —
!
CAKE FILLINO. CHECK YOUR CHOI CE ,
. .it.ich your doll.vr.ind mail. Study
The Abbott Alkaloidal Company
Home Office and Laboratories
CHICAGO
BRANCHEI-N.w York. 2S I Slh Av.nu.
S..III., 225 Canlral B

ADVERTISEMENTS.
^
Is physiologically adapted to relieve gastro-
intestinal indigestion, caused by deficiency of
acid, enzymes, or disturbance or impairment of
function.
Elixir Lactopeptine covers and disguises the
disagreeable taste of Bromides, Iodides, Salicylates,
etc., prevents stomachic irritation and
constitutional disturbance.
It is also an efficient peptonizing agent.
"KELENE"
PURE CHLORIDE OF ETHYL
Put up in Glass Automatic Spraying Tubes
USE EOR
LOCAL ANAESTHESIA
Also as an adjuv/ant to Ether in
GENERAL ANAESTHESIA
Sole Manufacturers
FRIES BROS., 92 READE STREET. NEW YORK

VIII
THE CHARLOIVTE MEDICAL JOURNAL.
I^^ortli Oorolina IVIeclioal Oollegje
OLDEST MEDICAL COLLEGE IN THE STATE
SESSION OF 1908-1909 BEGINS SEPTEMBER 15, 1908.
W. O. NISBET, M. D.
Professor of Diseases of
the Digestive System and
Dean of the Faculty.
JOHN P. MUNROE, M. D.
Professor of Neurology and
Practice of Medicine.
I. W. FAISON, M. D.
Professor of Pediatrics and
Clinical Medicine.
E. C. REGISTER, M. D.
Professor of the Principles
and Practice of Medicine.
B. C. NALLE, M. D.
Professor of Physical Diagnosis
and Clinical Medicine.
R. L. GIBBON, M. D.
I'rofessor of Practice of
Surgery.
G. W. PRESSLY, M. D.
Professor of Principles of
Surgery.
A. J. CROWELL, M. D.
Professor of Rectal Diseases
and Genito-Urinary Surgery
and Secretary and Treasurer
of Faculty
FACULTY
E. R. RUSSELL, M. D.
Professor of Diseases of the
Eye, Ear, Nose, and Throat
W. D. WITHERBEE, M.D.
Professor of Dermatology,
and Materia Medica.
C. M. .STRONG, M. D.
Professor of Gynaecology.
C. H. C. MILLS, M.D.
Professor of Obstetrics and
Clinical Gynaecology.
C. N. PEELER, M. D.
Professor of Anatomy and
Superintendent of Dispensary.
R. H. LAFFERTY, M. D.
Registrar and Professor of
Chemistry and Physiology.
L. B. NEWELL, M. D.
Professor of Pathology.
WM. ALLEN, M. D,
Professor of Bacteriology
and Assistant in Pediatrics.
C. A. MISENHEIMER,M.D.
Clinical Professor of Surgery
J. P. MATHESON, M. D.
Clinical Professor of Diseases
of the F;ye, Ear, Nose and
Throat and Professor of
Yygiene.
DR. PARKS KING
Assistant in Surgery.
DR. WM. STRONG
Assistant in Gynaecology.
DR. C. S. MCLAUGHLIN
Assistant in Anatomy.
DR. MYERS HUNTER
Assistant in Obstetrics and
Clinical Gyansecology.
Dr. E. C. BOYETTE
Assistant in Medicine.
HAMILTON McKAY, A.B.
Assistant in Anatomy.
BENJAMIN TEAM, A. B.
Assistant in Chemistry.
S. A. HARDING
Assistant in Bacteriology.
0. M. LENTZ.
Assistant in Genito-JTrinary
Diseases.
CALDWELL WOODRUFF.
Assistant in Histology.
H. B. MALONE
Assistant in Clinical Microscopy
and Pathology.
For Catalogue address
A. J. CROWELL, M. D.. Charlotte. N. C.
IN. V. ROST GRADUATE
* me-dical School anci Hospital
A Second Miyenue and Tu/entleth Stre<
2 Oldest and leiuliiiK scl
groups Every i
coHrMfs fitr the gf ii
and

JL
iDVERTISEMENT'-
Significant Requirement
In \'ictoria, Australia, it is required of infants' foods that they "s/ial/
contain no icoody fibre, no preservative substance, and no chemical substance insoluble
in Tfater, and, unless described or sold specially as food suitable only for in/auts
over the age of seven months, shall, xchen prepared as directed by the accowpauyinji
label, contain no starch, and shall contain the essential ingredients and conform
approximately in their composition to normal mothers' mill:."***
Milk Prepared with Peptogenic Milk Powder, in the nursing bottle, ready for
feedinji^, conforms to these lejjally constituted requirements for a food for in-
fants seven months of age.
Milk jsrepared with Peptogenic Milk Powder contains no woody fibre
(cellulose): no preservative substance; no starch. It meets the requirements
fully in containing the essential ingredients of normal mother' milk, and pecu-
liarly so in "conforming approximately in composition," because of the fact
that its proteids are in the minutely coagulable, soluble and diffusible form
characteristic of the albuminoids of mothers' milk.
Fairchild Bros. & Foster New York
^Frmii Ike PliarnMceiUical Joumul and Pliaiinucist,
Ijmdim, EngUind, March U, 'oil, page J.'J.
STAFFORD WATER
Noted (or Its Remarkable Remedial Properties In
PARENCHYMATOUS NEPHRITIS,
ACUTE NEPHRrnS, ALBUMINURIA,
and It* Therapeutic Value and Efficiency in
Diabetis. Chronic Interstitial
Nephritis and Cystitis.
For Sale: THEO. F. KLUTZ &, Co., Salisbury, N. C.
For Literature write
S. M. PURCELL, .Salisbury. N C.
miRWELL & DUNN CO., Charlotte, N. C.
D. P. FRIERSON, Charleston, S. C.
PATRICK McINTYUE, Asheville, N. C.
MURRAY DRUG CO., Columbia, S. C.
COLBURN, MORCAN 6l CO.
VOS.SIU RG, ------ LESSEES.
MISS.

THK CHARLOTTE MEDICAL JOURNAL.
MILK OF BISMUTH
LILLY

I inciiiiiati Heat Ray Therapeutic I.aiiip,
ith special )u c. p. heat generating lamp
ml removable coiuleiisinn lioo7.5o; new
ij

THE CHARLOTTE MEDICAL JOURNAL.
NEURILLA rOR NERVE DISORDERS NEURILLA^
If Patient suffers fromTHE BLUES (Nerve Exhaustion),
Nervous Insomnia. Nerwous Headache. Irrltabitify or
General Nervousness, .pive four hmes a day one
teaspoonful NEU RILLA 7—*#
Prepared from Scutellaria Lateriflora.
Fassl flora Incamata and Aroroatjcs.
DAD CHEMICAL COMPANY, NEW YORK «no PARIS.
EMERGENCY SURGERY
Practical C.iiidt' in Time of Stress of Uncertainty for Treatment of Accidents and
Acute Conditions
By JOHN W. SLUSS, A. M., M. D,
j/i-sso?- 0/ .Inaloiiiv. Indiana l'}iivi->sily Scliool of Medicine: formerly Professor of
Aiialoiiiv and Clinical Surgery, Medical College of Indiana: Surgeon to llie
Indianapolis Cily Hospital; Surgeon to the City Dispensary: Mem-
ber of the N^alionaal Assocation of Military Surrgeons.
PRESvS OPINION
"This is a handy volume bound in flexible leather and small enough to go into an overcoa
pocket. It is meant for the general practitioner who does not refuse his services in surgical capacity
though he has not made a specialty of that branch of practice. Accordingly the book is intensely
practical; it tells the methods of administering anesthetics, of stopping hemorrhagss, of preparing
material, and finally of operating that the author has fonnd most serviceable in his own practice.
The dogmatic character of some directions is fully made up for by the clearness gained; references
to literature are omitted because of the very aim of the book to give one or at most two methods
of operating and no more. Mo.st of the commoner operations are included in the scope of the book
from tracheotomy and a circumcision to an operation for hernia or laparotomy for appendicitis. The
treatment of fractures and dislocations is allotted sufficient space. The illustrations arc good. We
recommend the book as fulfilling the purpose of the writer, to furnish a mannal of ready assistance in
preparing for an emergency operation. The Medical Record. New York.
W^ith 584 illustrations, some of which are printed 191 Colo7S, 12mo., 692 pages. Full Limp
Leather. Gilt Edges. Rounded Corners, $3.50 net.
P. BLAKISTON'S SON & CO.,
Publishers iOI2 Walnut Street Philadelphia
THE ATLANTA SCHOOL OF IVIEDICINE
Luckie. Bartow and Main Streets
/\-rLMINT/\, GEORGIA
"In order to properly teach medicine. Medical Colleges must have hospitals either owned by them
or entirely under their control so far as ihe clinical material is concerned. This is now one of the
greatest needs of medical teaching."—Extract from Report of Council on Medical Education of
the American Medical .•\ssociafion, adopted June, T909.
The Atlanta Schoo) of Medicine -is the uni.v medical college in the Southeast which owns
and OPKR.\Ti-:.s its OWN HOSPITAI^. Wards of the Grady (city) Hospital also used for bedside
teaching.
"The uncleanliness of the buildings and laboratories of some of our medical colleges makes one
(juestion the possibility of their teaching asepsis, or even ordinary cleanliness."— Extract from Report of
Council of Medical l-Mucation of the American Medical Association, adopted June, 1909.
No effort is siiared l)y this institution to teach 1'R.\CTICAI. Sanitation. For information write
The /\tlanta Sohool of /Wedioine
Box .2^-7 /\XI_/\MTft, Ga.
•

ADVERTISEMENTS.
'BELOW PAR"
CONDITIONS
Literal
Applic;
One s nealth is " below par 'vhen the
oxygen-carrying activity of the tlood cells is
insufficient to maintaiu tlie vital force at its
proper standard.
Pept^V^div^a^iv (Glide)
by increasing the iron supply of tne nemoglotin
restores a normal metabolic balance. 56
ni
upon
M. J, BREITENBACH CO.
NEW YORK. U. S. A
oloeical Wall Chart or our DifL. ....... rial Diagnostic „...„ Chart will
b« gent to any Physician upon application
Officers of the North Carolina Medical Society.
Presirtenl, .Ian. A. Bi.i inu-hs. A..h.-vilU-.
I8t Vice President. E. J. Wood. Wilmlnclim,
2nd VIre-PresUleul. Jiio. y. .Myers, Charlotte.
3rd Vice-President, L. D. Wharton, SmithHcld.
Secretary, D. A. Stanton. High Point.
Treasurer, H, D. Walker, Elizabeth City.
COUNCILLORS (3 TEARS TEKM>.
lat District, Oscar McMullan, Elizabeth City
2nd " U. A. Whittaker, KinsVon.
3rd • Frank H. Russell. Wllmindton
4th '. E. T. Dickerson. Wilson.
fith " J. F. HlKhsmlth, Fajetteville.
Xth " Hubert A. Royster. Raleigh.
7th " C. M. Strong, Charlotte.
eth " J. B.Smith, Pilot Mountain.
9lh '• I. M. Taylor. Morganton,
lOU: " James A. Burroughs. Aaheviile.
lloiBE OK DELEOATBS, A. M. A. : Dr. .J. Howell Way.
A .1. Crowell. Charlotte; Alternate, Dr. D. S. (icorge, B:i
Mc

PHF. CHARLOTTE MEDICAL JOURNAL.
Atlanta College of Physicians and Surq;eons,
(Coiisolidatii
Atlanta Georgia
S9S of the Atlanta Medical and the Southern Medical Colleges.
A. L. Fowler, M. D.,
A. W. Calhoun, M. D., LL.D., President
T. C. Davison, M. I).,
J. S. Todd, .M. D,, Emeritus,
Dunbar Roy, A. H., M. D.,
\Vm. I'errin Nicholson, M. D., V-T.
Wm. Simpson lUkin, A. B., M. D, Dean John G. Earnest, M. D.,
Bernard Wolff, M. D.,
\V. I-. Westmoreland, M. D.,
Moyd W. McKae. M. I).,
Michael Hoke, M. D.,
J. Clarence Johnson, M. I).,
Chas. E. Boynton, A. H
II. F. Harris, M. D.,
John C. Olmsted, M. D.,
Wm. S. Goldsmith. M. D.,
Cyrus W. Strickler, M. :
Jas. B. Baird, M. 1).,
S. T. Harnett, A. B., M.
!•:. Bates Block, M. D.,
Marion McH. Hull, M. I).. F. Phinizy Calhoun, A. B., M. D.,
. . . , .
The fifty-fifth annual session of the .Atlanta College of Physicians and Surgeons begins VVednesdav,
September 22nd, 1909.
With a group of five college buildings, arranged upon the university plan, and a corps of fifty-ihree
professors and instructors, this Institution stands .second to no medical school in the country. The
laboratory facilities are unsurpassed.
The main college building contains the Chemical, Physiological and Materia Medica Laboratories,
and the Carnegie Pathological Institute contains three large laboratories, each equipped with an
ample number of microscopes and all necessary apparatus and appliances for teaching Histology, Bacteriology
and Pathology. .A separate aud distinct building is used for practical anatomy.
A four years graded course of seven months each is required, the last year of which is devoted
largely to clinical and practical work. Our students have access to the Grady Hospital, across the
street from the college, and all the principal infirmaries and hospitals in the city. A large out-docr
clinic, where more than 25.000 patients are treated a year; affords other valuable clinical instruction.
The buildings are new and commodious, and one attractive feature in the new building is the Gymnasium
with shower baths. Here the student is taught the use and application of exercises for various
diseases. For catalogue or other information, address WM. SIMPSON ELKIN, M. D., Dean.
Atlanta College of Physicians and Surgeons, Atlanta, Ca.
WILLIAMS' PRIVATE SANITARIUM
A PRIVATE HOME EXCLUSIVELY FOR
Alcoholic, Morphine and Drug Habitues and
Air Forms of Neurasthenia
GREENSBORO. N. C.
JACKSON SPRINGS SANITORIUM.
A new and modernly arranged building including modern diagnostic
apparatuses and various electrical appliances for the treatment of noncontagious
diseases. Special attention given to renal, hepatic, digestive
and nervous diseases.
Patients have free access to the celebrated Jackson Springs mineral
water which took second prize at the St. Louis World's Fair. This
water is especially indicated in above named diseases.
Centrally located in Moore County, N. C, amid the sand hills and
long leaf jniies. I>;ievation 7(10 feet above sea level. Rates reasonable.
I'or further information, address
A. A. WVcDOINALD, /V\. D.
Jnc-Uson „
0\A/n&t- and Springs,
/V\anage-r
N. C.

ADVERTISEMNTS. xV
P R FE S S I N AL. CHARLES M. STRONG, M. D.
Diseases of Women and Surgery.
DR. OEORQE W. PRESSLY. office Charlotte Sanatorium, Phone 521
Charlotte, N. C.
Practice Limited to Sukgekt
DR. W. O. NISBET
Diseases of Digestion
offices: 9 North Tryon Stkket
Phones: Office, 21. Resitlence, 1196.
OFFICE HOfRS:
8:00 to 10:00 A. M. 11:00 to 1:00 P. M
3:00 to "):oo P. M
Special Hours by Appointment.
DR. JOHN R. IRWIN.
CH.\Rr.OTTE, \. C.
Residence 609 S. Tryon Street.
Phone 144.
DR. CHARLES H. C. MILLS.
Realty Buildinq Cliarlotte N C.
Practice Limited to Gynecology
and Obstetrics.
An Advertisement In
•THE 8TATE"
COI.r.MBI.V, s. c.
Will sell it. The reason is evident. The
Special attention given to .\bdomina State covers its state. Write for rates.
Surgery and Diseases of Women THF, JOUKX.M. keeps, for the benefit of
ANDREW J. CROWELL. .M. D
ClI.VKl.oTTK, X. C.
Practice Limited To
Cenito-rrinary and Rectal Diseases.
its subscribers, the names and addresses
of all unemployed nurses who reside in
Charlotte. Direct telegrams and phone
messeges to the Charlotte Medical Journal
Hours; .S,.TO to 12. .\NL for information.
4 to 6 PM. Sunday by appointment. _^_^^._^^_:.^::^_..==:^cc=^.^.^^^.^^^_
DR A. M. WHISNANT.
18 South Tryon Street, Ch.\ri,otte N, C.
Office Hours:
S.M) a. m. to 1 p. m., and ,^ to (> p. 111
Sundavs bv apix>intment.
Practiceliniited In I've, I''nr. XoseiS: Tliro;ii
E. R. RUSSELL. M D.
J. P. MATHESON. M. D.
221 S. Tryon .Street, C .rtKi.uTTK, N. C.
Hours: 9 a. ni. to 1 p. in., and 4 to 5 p. in
Sunilays 9 to 10 a. ni.
Special hours by appointment.
Practice limited to the Bye, Ear, Nose and Thnwt
Phone 4 tH— 687
DR. (ino. M. NILES.
Diseases of Digestion.
408-9 Candler Building.
Atlanta, Ga.
John P. Munroe, /W. D.
SPECIALIST
in
NERVOUS DISEASES
offices Charlotte S,inatorinni. Cliarlotte, N. C
Consultation Pratice
Will meet physicians in adjacent towns and
country for consultation in j;eneral medical cases.
W. D. WITHERBEE, M. D..
charlotte, n. c.
Practice limited to treatment of Cancer and
Skin Diseases.
Ofkicr, Charlotte Sanatorii-m.
m^ LAXOL
I
A PURE CASTOR OIL
Rendered by a new and improved
process, which retains all the valuable
medicinal properties of the ordinary
oil, without its nauseous taste. Made
palate-appealing by the addition of
flavoring agents.
"SWEET AS HONEY"
Laxol is suited to a// ages and is re-
tained by the most delicate stomach.
Samples and literature, upon request.
LAXOL
168 Duane Street NEW YORK

AKLOTTE MKDICAL JOl'KNAL
E^legant Pharmaceutical Specialties.
Attention Is called to the EXCELLENCE and VALUABLE THERAPEUTIC PROPERTIES
ol These Preparations.
ROBINSONS IIME JUICE & PEPSIN
I'urf ('(iiifcntriited IVpsin toinbincd with
Pure Lime Juice.
An exceediiiply valuable combination in oases of
Dyspepsia, Indigestion. BiliouBness, Heartburn and
Mai-Assimilation
APERIENT AND CHOLAGOGUE
Impaired Dipestion is the conseqiienne of a seden
lar. life, .-..i.pled with nervous and mental strain.
l;llMr,ll II I'^-IN isoTieof thei.est nrr.EsTlvE
-.,-• •'! UE T.IMK .Tl'lCE with if. apeh-
1 1.: 1 rl.ararteri^lies, With the Pti.sin
till I..: lUl.le .-u..! most efficient combin-
;,ii..n I. .. I. Ml. Iv tcr the disorders named.
ROBINSON-.S LIME JUICE and PEPSIN is palatable
and QRATEFUL to the taste.
DOSE-Ad.ilt. dessertspoonful to tablespoonful,
after eatinp. Children one-half to one teaspoonful.
according to age.
Price, 6 oz Bottles. 50 cents
16 oz. Bottles. $1.00.

7?
ADVERTISEMENTS.
THE
SPECIAL
(See New and Non-Official Rtmediei)
While this remedy is of distinct service
in Hepatic and Bile Tract Affections, it
finds its WIDEST field of usefulness in
INTESTINAL AUTO-TOXEMIA,
INTESTINAL PUTREFACTION,
INTESTINAL DYSPEPSIA generally.
In such conditions it gives distinctly
satisfactory results.
SAMPLES, Ftrmula.
"Inmean Color Scjie."
lltoraturo upon rtqutit
Sapplied in 12 -ounce bottles only.
F. H. STRONG COMPANY
68 WARREN STREET, NEW YORK
"©
THE CONTROL OF PAIN
is almost invariably
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But, in obtaining effective analgesia, care must always be taken never to
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IN
ALBUMINURIA OF BRIQHTS DISEASE
PREGNANCY AND SCARLET FEVER
LITHI A
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WATER
DR. JOS. HOLT, of Ne-iC Orleans Ex- President of the State Board of Health of Louisiana,
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DR. GEORGE BEN JOHNSTON, Riehmond, Va. Ex-President Southern Surgical and
Gynecological Association, Ex-President Medical Society of Virginia, and Professor of
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value in the treatment of the Albuminuria of Pregnancy."
DR. J. T. DAVIDSON, M.D., Ne7c Orleans, La, Ex-President, New Orleans Surgical
and iVedical .Issociation, sa.ys:"l have for several years prescribed BUI'"FALO LITHIA
Wa ter in all cases of Scarlet I'ever, directing it to be drunk ar/ libitum, v!\\.\\ the effect of
relievingall traces of Albumin in the urine, and have found it equally efficacious in
enial diseases requiring the use of alkaline water."
HUGH M. TAYLOR, M. D., Projessor of Practice or Surgery and Clinical Surgery,
University College of Medicine, f'lichmond, Va: "I ]ia.v&\is^A., with good results BUF-
FALO LITHIA WATER in Uric Acid Diathesis, Gout, Rheumatism, Albuminuria of
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THK CHARLOTTE MEDICAL JOURNAL.
Photograph of Sain'l Millwee, showing atrophy and deformity of left leg and foot.
six boys and five girls.
Walter died at the age of four from diphtheria,
but was a "bleeder."
Will died at the age of 20 from a cut on
his finger.
John died at the age of 28. He had been
a great sufferer from rheumatism. His
knee became stiff and flexed so that he had
to use crutches. During one of his attacks
of pain with his knee became so swollen
that the skin ruptured and he bled to death.
Sam, a chronic sufferer from arthritis,
died at the age of 2() from hemorrage with
typhoid fever.
( )f the five girls, two are dead, one has
never married. Carrie Linebarger has recently
married and has no children. EHie
Rhyne has one male child one year old who
is not a bleeder as yet.
Mrs. Margaret Millwee, third daughter of
Sam Knox, had three boys and three girls.
One boy died at the age of four days
from hemorrhage of the cord. One boy
died at the age of fourteeii months, he fell
from the cradle and cut his upper lip and
bled to death. The third son is the patient
under discussion. Of her three daughters,
two have married.
Mrs. Mary Purnell had eight children,
seven boys and one girl. The girl died
while an infant of gastro-enteritis. Three
of her boys are dead. One died at the age
of one day with atelectasis. One at fifteen
months of enteritis, but was a bleeder. John
cut his finger when three years old and
bled to death. She has four boys living,
three of them, Sam fifteen, Charles thirteen
and the baby Albert, four years old, are
bleeders, having eptistaxis and pains in
their joints. Knox, nine vears old, has not
bled.
Mrs, Millwee's other married daughter,

'
\ fth
ORIGINAL COMMUNICATIONS.

4 THE CHARLOTTE MEDICAL JOURNAL
grains 10, lid, strychnine, adrenalin chlor- cases of urethral stricture. This short paide
grains 10, hvpodermatically, tid. The per is presented to emphasize the necessity
hemorrhages continued to an alarming ex- of the cutting operation inorganic stricture.
tent until the patient was barely alive. The calibre of the urethra may be dimin-
They gradually stopped and the patient re- ished from spasm, pressure, inflammatory
cuperated quite rapidly, and was able to be thickening of the urethral walls, or fibrous
taken home during the fourth week. He formations due to inflammation, ulceration
has had no return of the bleeding since then, or traumatism. Strictures of recent formabut
was bedridden for a good part of the tion or, in other words, chronic inflammafirst
year on account of the rheumatic pains, tory thickening of the urethral mucous
During the latter part of 1906 he began tak- membrane will readily respond to the sound
ing thyroid extract, and has taken it at ir- which assists nature in restoring the diseasregular
intervals ever since. Apparently ed membrane to its normal, or a healthy
he has improved a good deal under this condition. But where there is anorganic
treatment, and has had less rheumatism, formation that narrows the urethra, my ex-
(than for some years.) perience has been that it is useless to tem-
Casi' //.—During September 1908, Dr. J. porize with the sound. It is unnecessary
W. Flow of Kanapolis, N. C, referred for me to picture to you who treat urethral
William Wallace, male, white, five years diseases the patient who calls every few
old, to me at the Presbyterian Hospital, for months with a discharge from his urethra,
protracted hemorrhage from his tongue. to treat his old stricture. You examine the
FAMILY HISTORY. urethra and find a stricture two or three
On his father's side, negative as to hae- inches from the meatus that will only admophilia.
His mother was Miss Flora Giles mit an eighteen French sound, and, after a
of Rockingham, N. C. She has three brothers
who are "bleeders." None of her brothfew
weeks' treatment, it will admit a twen-
ty -eight, but no larger. It may be a thirtyers
have died. William is the youngest of four French sound, the normal size of the
three children, the older being two girls, urethra, will pass into the bladder and the
One of the girls died of pneumonia at the patient still have a fibrous band that a
of two years. twenty-eight or thirty bulbous bougie vpill
William began to bleed when three years pass with difficulty,
old from slight cuts, and has had four at- A resilient or irritable stricture as destacks
of hemorrhage since then. The hem- cribed cannot be removed by dilation, and
orrhages lasting from ten days to two weeks, the surgeon who relies upon the introduc-
Ten days before admission to the hospital tion of the full size sound as an index to
he fell and cut his tongue slightly. He had the stricture's being removed will be surbeen
bleeding very freely and almost con- prised should he introduce a bulbous boutinuously
up to the time of admission. He gieand still find a decided narrowing of the
was placed on thyroid extract and calcium urethra.
lactate, and continued to bleed freely for Nearly all cases of stricture of the urethree
or four days. Suddenly his tongue thra are due to gonorrhea, and, as a rule,
healed over and the hemorrhage ceased,
The patient was sent home at the end of six
as long as the stricture remains, the urethra
is infected; so it is bad surgery to attempt
days.
blood
In this case the coagulation of the month after month to remove a urethral
apparently was not delayed, large stricture by the use of sounds when a ureclots
of coaguluted blood filling his mouth,
I have been unable to hear from him since
that time, and unable to get fuller history
in this case.
REFERENCES:
throtomy will restore permanently the urethra
to its normal calibre and get rid of the
infection.
We are all aware that patients are averse
to the cutting operation and prefer the use
Anders Practice of Medicine, \'o\. 4.
Annals of Surgery, May 1907.
of the sound, but when we find a stricture
that will not respond to dilation, our ad-
La Tribune Medical, January 19117.
Keitschrift f. klin— Med., l'M)4, \'ol. .Sfi,
vice would be urethrotomy ; and my experience
has been that we can confidently as-
Nrs. 3 and 4. sure our patients that the cutting operation
will make a cure of the stricture, and also
Urethral Stricture.* remove the cause of his "gleet."
By W. L.Clianipion, M, D., Atlanta, Ga. The abnormal narrowing of the urethra
'
,p, . . . ^
', by fibrous tissue is ,
a mechanical obstruction
.
The impression IS too general that the to the flow of urine and the normal blood
use of sounds or the dilator is the proper supply to the tissues, which condition neconrs;eto
persue in the treatment of all cessarily keeps up a chronic state of inflam-
*Read at meeting of the Soutlieru
sociation, Atlanta, Ga.. I9U8.
Medical As- matioii and harbors germs: so a chronic
urethritis withont involment of the pros-

ORIGINAL COMMUNICATIONS, 5
trate ulaiid or
means stricture.
seminal vesicles usually Report ol a Case ol Pulmonary Edema
CompMcatlng Pregnancy.'
As to the various methods of treating By Dr. William L. Kirkpatrick, Pacolet, S. C.
urethral stricture by divulsiou electrolysis,
Definition.— In pulmonary edema there
dilating and cutting, the only cases in is an exudation of serum from the blood
which 1 have gotten satisfactory results j,^ ^:^^ pulmonary alveoli. In other words,
followed the latter operation. After using ^n effusion of some serous fluid into the
electrolysis in fifty-two cases, I alaandoned air-vesticles and interstitial lung-tissue,
the method on account of not getting the .^^^^ condition is scarcely to be regarded as
results looked for and claimed by others.
^^^ independent affection, but as a second-
To get permanent relief from organic ^rv condition, being in many instances asstricture
is to completely sever the fibrous ^o^iated with pulmonary congestion,
bands or tissues witU the knife, and, by £-//,/„/^^,,,_Pulmonarv edema is secondthe
use of the sound, make the cut or stric- ^^ j^ acute and chronic affections and
turedportionoflhe canal heal to the size of p„eumonia, but not with any degree of
the normal urethra.
. constancy, It is not especially liable to
The failures recorded after internal ure- ^^ associated with congestion or with low
throtomy are due to the fact that the strict- ^^ades of inflammation of the lungs. The
ured tissue is not completely severed, or ^^^^^^ ^^^^. ,^g j^^^^j^ i„ jj^g i^njediate
failure to introduce the sound at proper 111- neighborhood of a circumscribed, usually
tervals after the operation. 1 he fact that inflammatory lesion; or general, arising
we frequently find more than one stricture f^^^^ causes similar to those which produce
should not be overlooked, and the operator congestion, or constituting a terminal event
should be careful not to leave a single fi- in states of great debility. The factors
brous band uncut, as the success of the which appear to be instrumental in causing
operation may hinge on this point. ^''e transudation are increased tension in
the Pulmonary vessels, increased fluidity
As a rule, strictures in the penile urethra ' ... of the blood, an abnormal 4iermeability of
arelocatedwithm the first three inches, but
^jjg ^^^^^1 ^^.^^1,^ due to nutritive changes,
it is freciuently the case that constrictions and left ventricular weakness,
are deeper that reciuire cutting. 1 do not The diseases with which edema is most
consider it safe to do an internal urethro- commonly associated are pneumonia; the
..,..,,. , ., cachexias; grave anemia, nephritis in uU
^tomy w.thot perineal drainage deeper than
j^, f„„„,. ^^^.j^ g^.^cific fevers with much
•five inches.
heart weakness; valvular disease; and cere-
It is a fact that, if a strictured urethra is
I)roperlp cut, and the after-treatment carbral
apoplexy or injuries.
Pathology:—This consists of a transudaried
out
tion
( which is as important as
into the alveolar walls interstitial conthe
cut-
.. ,., . ,
., nective tissues, and air cells, and rarely the
,
ting, the urethra can be examined years
process is limited to the interstitial tissue,
afterwards and found free of contractions. For the sake of convenience, two forms
.Vfter internal urethrotomy, the patient may be recognized;
should be required to remain in bed three (A) Collateral Kdevia ilntlammatory
days. The sound can be passed on the
^''^^w^):—This is usually local in charac-
,, . , , , ,, ,• . ,, J, . ter, circumscribing an area of the lung that
third day, and the patient allowed to return j^ effected by pneumonia, abscess, or pult..
his work on the fourth. With a two per monary infarction, and is the result of a
cent solution of cocaine, tJje operation can mild inflammatory process allecting the
be performed with very little pain. Adren- vessel walls. When the condition follows
!>yPostatic congestion the terms "hypostat-
. , ., , , , . , . ,, . ic edema" and splenization" have been
alin used after the operation will, as a rule,
control the hemorrhage. It is advisable to annlied
pass the sound every four or five days until (y) General Pulmonary Edema.—
tlie hemorrhage ceases, then every ten days congestion be not associated, the portions
for three or four months. of the lungs involved by this type look
P^le; when pulmonary congestion is pres-
, . , f . , . , . ent, the lung appears darker than the nor-
In a brief paper of this character, the
various kinds of stricture, their location
anil symptomatology cannot be considered;
^al and the exudate is blood-tinged. The
hing tissue is heavier than in the healthy
but the point I wish to emphasize is that state, owing to the more or less airless coniiilcrnal
urethrotomy is the proper method tHtiou of the alveoli, though it does not
of curing fibrous striclme of the anterior
«Y^ea,r before recent meeting or the Tri-State
urethra. .Medical Society, Charleston, S. C.
U

(,
THE CHARLOTTE MEDICAL JOURNAL
sink in water, ll is boggy to the feel, and small rales, of an unusually liquid cliaracpits
on pressure. ter, over the involved areas."
luleuia is usually noticed at the bases of Quoting from Anders: ".Since the bron-
Ihe lungs, though it may become general, chioles contain serum, small rales, having
and as a rule the surface of the pleura is a liquid character, are audible with inspimoist.
Mydrothorax may be present. ration over the .seat of the edema."
It is not yet definitely known just how Diagnosis.— Butler says, "This depends
pulmonary edema is produced. On the one mainly upon the presence of numerous unhand,
increased fluidity of the blood, and usually moist rales, both large and small,
on the other an increased tension in the and slight dullness at the bases, particupulmonary
vessels, seem to be influential larly if the temperature is around the norfactors
in a great many cases. Another mal." Caille states that: ''The diagnosis
factor entering into the production of this depends mainly upon the presence of n ucondition
is is an increased permeability of merous moist or dry rales and percussion
the vessel walls, due to impairment of their dullness of the base of the lungs, indicative
nutrition and "disturbance of the cardio- of an effusion of serum into the air cells."
pulmonic innervation." This usually arises Treatment:— -The treatment sliould be diin
connection with toxic and infectious dis- rected to the associated or causati\'e affecteases,
when the blood also exhibits some ions. The transudation should be limited
change, as in the cachexias, general septi- as far as possible, and the removal of the
caemia, uraemia and the like. There are effusion from the lu:igs is of great importinstances
met with in which pulmonary ance. The position of the patients body
edema, due to vasomotor relaxation, come must be changed frequently to prevent the
on quite suddenly. gravitation of blood to the dependent por-
Syiiiptoins:— Il.are, in his volume on tiou of the lungs. Some practitioners adpractical
diagnosis, enumerates the symp- vise the employment of a large number of
toms as follows: dry cups to the thorax. Strychnine and
"The physical signs of pulmonary edema digitalis or strophanthus are indicated to
may develop suddenly as a result of an in- strengthen and stimulate the circulation,
jury to the vagus, or in acute disease of the For the dyspnea and restlessness some form
lungs. Generally however, their onset is of opium, preferably morphine and atropine
slow and insidious, but the rapid breath- given hypodermically, must be resorted to.
ing, crepitant rales, the limitations of these In aggravated forms that develop ([uickly,
signs to the lower part of the chest, com- prompt venesection is imperatively demandbined
with dullness on percussion, the ab- ed. Lissaman reports a case of acute suf- '
sence of fever, the frothy sputum, and, it focating pulmonary edema in which he
may be, the history of renal disease all tried amyl nitrite withunsatisfactory results,
point to the true state of affairs. A very He then tentatively employed chloroform
liquid watery sputum is seen in this condi- with the best of success. lie holds that
tion, particularly when due to Bright's dis- this condition is a sort of wet asthma, and
ease or heart failure. Hurried speech is relies on chloroform as the remedv in the
also a very constant sign." future.
The air-space is lessened in direct pro- Case:—Was called Jan. 4, 1909, at 2:00
portion to the amount of serum occupying A. M. and arrived at the house at 4:00 A. M.
the alveoli; consequently dyspnea is always to see Ella R., colored, age .U, weight 210
present and is sometimes a very prominent pounds. Had had four confinements,
symptom. Cough is frequent and the ex- First child died at the age of one year and
pectoration is raised with difficulty. Bron- five months of diphtheria. Second child
chorrhea is present, and the sputum is died at nine months and one week of age
abundant and frothy. If congestion be of "teething." Third child breathed only
combined with edema, it is blood-stained, a few times. Fourth child is living and
The pulse is fast and feeble, and, in ex- healthy at two years and nine months of
treme cases, cyanosis appears. age. This child I delivered with forceps
Butler, in his work on "Diagnostics of after the mother had been in labor for about
Internal Medicine," says: "The symp- ,% hours, and in charge of a midwife. The
toms of pulmonary edema are increasing delivery bv forceps was made necessary on
dyspnoea cyanosis, cough, and an abun- account of inertia, there being no other
daiit, frothy, watery, rarely tenacions, ex- complication present. Upon entering the
pectoration, which may be blood-stained sick-room, the first thing that attracted my
It congestion 1)6 also present. The phvsi- attention was the patient's rapid breathing,
cal signs are impaired resonance or slight and when being interrogated, her hurried
Uullness over the bases, with absent or answers. When asked what was the trouweak
perhaps broncho-vesicular, breath ble she replied that "She had a cold and
sounds. There are abundant large and was in labor." I proceeded to make a

ORIGINIAL COMMUNICATIONS. 7
careful examination and found her symp- hours if bowels did not move freely. They
turns as here recorded. Pulse 144, temp, had begun moving however before I left
')'>.6 F., resp. 40. Patient complaining of
uneasiness in chest and severe headache.
She was having regular uterine contractions,
but said it was not time for her confinement.
She was coughing almopt constautly
and expectorating freely a very
liquid, frothy, blood-stained fluid. The
cough and inc eased respiration began Dec.
.51, 191)8— four days previous to my visit,
the house, between 7:00 and 8:00 A. M.
Upon reaching my office an examination
of the urine was made and found to be load-
ed with albumin. At my second visit the
following day patient's mother, who was
nursing her, reported to me that there had
been more than twenty movements of the
Ijowels. Her pulse was now 128, temp.
V9.6, resp. 30. Digitalis was now given
and became so severe that patient felt as if with the strychnine to increase the volume
she would choke to death. There were nu- of the pulse which at this time was small,
merous moist rales in the chest, and slight
dullness on percussion over the bases with
Morphine and atropine punctures at visits
for restlessness, and Dover's powder in my
diminished resonance over the apices, absence. The bowels were kept open with
There was
face or the
no edema
extremities.
of either the salts and the position of the patient's body
Then I made changed frequently. Also, Hasham's mixta
vaginal examination and found the urein tablespoon ful doses was given after
OS dilated sufficiently to readily
two fingers. A diagnosis of
admit
"pulmeals.
fruits.
The diet was restricted to milk and
Jan. f)th, pulse \20, temp. 99.6,
mouary edema complicating pregnancy" resp. 28. Jan. 8th, pulse KM, temp. 99.2,
was made, and 1 thought it best to termi- resp. 24. Jan. 24th, pulse 100, temp. norm,
uate the labor as ciuickly as possible. This resp. 20. At this visit 1 catheterized pawas
4:00 A. M. Deeming it advisable to tient again and urine was still highly albuset
up free purgation as well as to hurry the ininous. Jan. 17th, i>ulse 8), temp. norm.,
labor, five grains of calomel and two ounces resp. 20, urine albuminous. The urine was
of l-lpsom salts were administered, and the examined at regular intervlas and was almembranes
punctured. There was a large buminous till Jan 27th, when it was found
amount of amniotic fluid, and when it drain- to be normal. The abnormal signs in chest
ed away 1 proceeded to give special atteu- iminoved in proportion as did the pulse and
tion to the presentation; which proved to resp., and i>dtient made a complete recovbe
transverse, the right elbow over the in- ery.
ternal os. With two fingers in the os and
indirect or external version, Braxton Hicks'
method, was quickly done without an an- Personal Experience In Proslatic
aesthetic. Instead of bringing down a foot, Surgery.*
the right knee was drawn into the os and
the labor left to nature's efforts mainly, an
and was completed at (,:M) A. M.—just two
p.- ,,y j. ,,,^3,, m. I)., Riclnnon.l, Va., Professor
of Descriptive Anatomy an.l Oeiiilouriiiary Sur-
gery, fniversity College of Medicine,
and and one-half hours after the membranes ^y,^^^^ ^ ^^^^ ^^^^^ ^^ ^^^^ ^ ^^.^^
were punctured. After performing the
^ hesitated to accept, as my ex-
'
version, in, 1 ascertained from trom patient the date .
, , _ ,. .,., ',, . , ,,
,
p
perience has been so limited that I deemed
of last menstruation and 'ound that the .^ ,11 r ,• 1 r.n ,
.
, ,
, .it would be of comijaratively little value to
labor was six weeks or more premature. ,
c ,1 \ i„
., „M , , ,. , ^ , , f any member of the Academy. ^
1 he child was alive about one hour before -'
delivery, the foetal heart beats num- It is so frequently the case that vye membering'l60;
but was still-born on account bers of different medical societies hear paof
time required in delivering head. When Pers upon the observations deduced from
the labor was completed, twoComp. Cathar. tlie consecutive outcome of .100 cases of appillsandtwo
ounces of salts were given pendicitis, or 700 or a 1000 cases of hyster-
The respirations now numbered 44, an in- ectomy or some other operation, that the
crease of four after my entering the house: "Perator whose opportunities along special
due, I suppose, to the muscular exertion lines has not been of such numerical dimenduring
last hours of travail. Kelieving my S'ons feels a hesitancy in asking the attenpatient
to be suffering from albuminuria, ^'o" of a medical body to review the outshe
was thoroughly cleansed to avoid get- ^'"me of a few cases only; and further feels
ting any blood from the vaginal discharge H^at he would much rather wait, even if it
mixed with the urine, and catheterized with is a considerable time, until his numbers
a sterile catheter. Patient being five miles too become possibly a little more hyperfrom
my office, I gave directions that she trophied, that the experience gained from
have a tablet (coiitaiiiiiigstrych.gr. I-6O)
every two hours, a small amount of water
when thirsty, and a dose of salts every two
»Reaa t)efore tlie Kicliniond Aca.leniy of Medi-
ciueand Surgery, April 13, 1909.

8
THE CHARLOTTE MEDICAL JOURNAL.
these more frequent operations of greater 75 percent, were farmers, the remainder
clinical value, the observations and conclu- constituted by mechanics, laborers, etc.
sions obtained from their outcome of some Nor could the writer bring to bear any vesurgical
significance, and that the carefully nereal history which would seem to be of
followed results accurately recorded and significance or pertinent to hypertrophy of
fearlesslv set forth would then be of not the prostate.
only greater interest, worth and benefit to Diagnosis should be easily completed,
himself, but, doubtless, also to the medical According to Thompson, 33 percent, of all
fraternity. Since, however, the call of the men over 00 have enlarged prostate, and 16
committee has gone forth, the writer pre- percent, of this number seek surgical intersents
to your attention to night, the results ference. The frequent urination of prosiu
2(> instances of prostatectomy and the tatic enlargement is essantially nocturnal
personal observations derived from this as opposed to the diurnal polykiuria of
rather limited series of cases. stricture of the neck of the bladder. This
Of these 26 cases, 9 were negroes and 17 is directly traceable to the actual massage
white. I recall some ten years ago having the prostate gets during the dav by the
heard one of the most prominent surgeons encircling fibres of the levator ani, the
of this day, one of those peerless pioneers, periprostatic plexus of veins which run in
say that he did not belie\e the negro was the substance of the sheath having its consubject
to enlargement of the prostate. The tents hurried along and emptied in the phyopportunities
of the present day for greater siological act of walking by this muscular
clinical work, the development of different activity. At rest, during the night, this
and distinct regional specialties, the per- action ceases; pericongestion means central
fecting of technique and, pari passu, a les- congestion and the demands for evacuation
sened mortality and, consequently, a greater are consequently greater,
confidence in surgery on the part of the Frequent urination is not the factor which
public, now bring to the knifeof the speialist
cases which, formerly, would have hardly
attracts the patient's attention to himself
He thinks this to be one of the concomitant
expected tohave gotten the results which the phenomena of advancing years, as much as
contriljuting operators of the present day
give forth to the many medical journals,
gray hair and wearing of spectacles, and
pays but little attention to it. IX. in painful
But these same pioneers moved without urination or hcemaiuria; whether in turn,
trepidation or hesitancy, their thirsting this be caused by stone-formation, infecforces
into the unknown depths of the path- tion, varices or great distension makes no
ologicallforsets, blazedltheir way over seem- great difference. One of those two factors
ingly unsurmountable public prejudices, carries the unfortunate prostatic to surgical
threw pontoon bridges of antiseptic dress- help.
ings over swollen lympathic streams and The degree of retention, urinary phenofelled
with crude knives gangrenous mem- mena and physical embarrassment are not
hers which threatened life and limb. But dependent upon the size of the prostatic
for their heroic leadership and courage,
surgery would not have appreciably advanced
within the last half century.
hypertrophy, but upon the angulation of
the prostatic urethra or degree of closure of
the vesical sphincter. This latter is directly
In this series of 26 cases there were 3 depependent upon pedunculated, intradeaths,
or about 11 percent. Cases 3, 7 vesical overgrowts. The finger in the recand
24 died. Case No. 3, colored, perineal, turn may find no enlargement, the catheter
died of pulmonary embolism on the second reaches the bladder easily, and yet the gateday
after operation, confirmed by autopsy, way is obstinately plugged. The writer
Case No. 7, white, suprapubic, died of would call attention to specimen No 1, as
ileus on the fifth day after operation, which an instance of the intrave.sical prostatic
the writer believes to have been due to too overgrowth which was removed by supragenerous
doses of sparteine sulphate pubic cystostomy.
which were falsely given to stimulate con- A tumor gro-vs in the line of least resistgested
kidneys; this errorhas not been per- ance. Prevented anteriorly and inferiorly
formed since. from spreading out, the prostate gxows in
Case No. 24, white, aged 79, suprapubic the course of its hypertrophy upwards and
cystostomy was performed for enlarged backwards, the neck of the bladder is
prostate. The prostate was never attacked, raised. This means the formation of a pool
simply drainage instituted; but the old man below the level of the neck. With replacegradually
lost grouml, and refusing nour- ment fibrosis or eccentric dilatation, this
ishment, died of nunulion about ten days pool is never emptied. The opportunities
after operation. for infection and stone formation are, therein
looking over the ages, I find they fore, greatly encouraged, and with the derange
from .i3 to />. I'he occupations in velopment of these complications, the pa-
.

;
THE CHARLOTTE MEDICAL JOURNAL. 9
tieiit now gets disturbed about himself and this condition under his observation. Perconies
for examination.
There are many classifications and divisineal
section, stellate rupture of the stenosed
ring ( which would not admit a No. 12
ions of the degrees of prostatic hypertro* I-\) by means of uterine dilators, dilatation
phy. The writer had the opportunity be- to 4.5 F. bj' Kollman's dilator, insertion of
fore the Medical Society of \'irginia, in a large perineal tube and usual after-treat-
1007, to make the following: nient were followed by most gratifying and
I. Enlarged prostate characterized by durable results. Large sounds must be
moderate frequency of urination.
lix>>ninatwyi— Bladder healthy; residual,
passed at regular intervals to maintain this
patency,
two ounces or less and clear; organs nor- Just here, the writer would call attention
nial; health good; patieiK does not know he tothe following personal observations which
has it. are that contracture of the neck of the blad-
II. Enlarged prostate characterized by der occurs more frequently than is supposed
"catheter life" or overflow.
F.y.amiiiation— Bladder tired out and inand
that the sound inserted on deep dilataion
never gains the bladder cavity and,
fected. Residual, large amount and nasty therefore, does not dilate the internal
kidneys and heart compensating; able to sphincter; that the stenosis is shoved on
attend to work. ahead of the sound which is not sent home,
III. ]*)nlarged prostate, really Class II the operator is deceived, the condition not
plus infection (general and local).
Exaviination—Kidneys and heart not
relieved and the patient ultimately comes
to the operating table seeking permanent
compensating; urosepsis; delirium. relief.
Those cases in class 1 1 constitute the Along with this series of cases also, there
larger percentage of the instances which
the surgeon sees. We rarely see those in
were three cases of cancer of the prostate
which proved inoperable. In the early
Class I. for they are like the boy whoswallowed
the nickel,—they have got it and
don't know they've got it.
stages of cancer, the stony hardness, iramo-
bility and glandular involvement point to
the condition, and, later, these same epi-
Class II. is also essentinlly the class for phenomena and particularly the doing-away
operation. They cannot be convinced in with the sulcus posteriorly stamps the dis-
Class I. that surgical procedures are justi- ease as malignant and beyond surgical re-
fiable; and in Class III. the urosepsis and lief. The writer would call attention to a
systemic infection are so profound that op- case of cancer of the floor of the bladder,
eration must be attended with a large mor- A suprapubic cystostomy was performed; a
lality. tumor the size of a child's fist was removed.
The writer would call attention to the the base seared, and for five weeks, every
prostatic pouch as a reservoir for urine, other day. the x-ray was applied through
which, at times, is misleading. This pouch the bladder wound ujion the stump by Pifistliedilated
firoslatic urethra liounded ante- fard's protecting tul)e. Dr. Cray tiien conriorly
by the triangular ligament posteriorh- sidered the patient sufiiciently progressed
by the iiedunculated, ball-valve, intravesical to allow him to leave the hospital. This
growth. The catheter inserted, now draws operation was performed January .S, 1906.
off two or more drams of urine which has The old gentleman gained rapidly in weight
collected there, by trickling around the ball, and strength, and is today about his parchand
retained by the external cut-off muscle ial vineyard. A letter dated April 9. 1909,
deceives the surgeon as to the actual length says; "My general health is good, but I
of the urethra. The ball-valve must be have been troubled considerably of recent
passed before the bladder is reached, when by the urine being thick and bloody."
a generous gush of urine signalizes the Again, cystoscopy is scientific, accurate,
cavity proper. I'urther, about the diag- pretty, interesting. But the writer would
nosis; There is only one more condition forcibly condemn any instrumentation
which can be justifiably confounded with along the urinary channels of the engorged
prostatic enlarnement— "contracture of the prostate except for positive diagnosis. It
neck of the bladder." This is an actual is in but few instances that we are unable
stenosis by fibrous tissue following a pre- to make a diagnosis when a rectal examivious
gonorrheal invasion. The retention, nation has been thoroughly carried out, the
the overflow, the frequent demands, keenly history carefully gone into and a large-size
simulate prostatic obstruction. Theyounger catheter inserted. Salol and urotropin, five
age of the patient, the previous history, grains each, three times daily, copious warectal
examination and insertion of a goodly ter drinking, the bowels well opened with
sized sound which gains the l)ladder with salts, simple diet, the bladder gently and
difficulty, if at all, settles the c|uestion. carefully irrigated with warm boric acid
The writer had recently an illustration of solution two or three times daily, a little

10 THE CHATLGTTE MEDICAL JGURXAL
slryclniiiie, enforced rest for several days moval en masse, is not touched; a large
before operation, persuasively prepare the drainage tube is inserted and the usual
organs, heart, kidneys and bladder for the after-treatment is carried out.
coming insult of the operaiion. By Bry son's subprapubic method, the
Since about 1887, when it was first ap- wound is packed with vaseline and iodopreciated
and anatomically understood that form gauze. His results have been most
the prostate could be removed, there have encouraging, he claiming that impotence,
been many suggestions, innovations and urinary fistulse and incontinence are not so
modifications about the course of and the frequent as by the perineal route. This
best method to do away with this overgrow- operation, however, is primarily contraining
pathological hypertrophy. dicated in very fat persons and in con-
It is with no fear that most surgeons will tracted bladders.
boldly enter the peritoneal cavity, and un- The writer has had no absolutely satissex
a woman by removing her uterus and factory syphon age of the bladder after the
appendages, or uterus alone, for a poor, suprapu1)ic removal, the constant leaking
little unoffending, subperitoneal oi mural and excoriation of the skin being sources of
fibroid, and yet, when it comes to their own considerable discomfort to the patient,
sex with the operation outside the peritoneal By the perineal route, the mortality at
cavity, the urinary channels olDStinately the hands of the various operators is 5}4
blocked to the passage of urine, the patient percent., or one-half that of the suprapubic,
house-ridden and a source of ammoniacal The operation is extra-peritoneal, and in a
annoyance to himself and friends, the sur- field where nature has been peculiarly gengeon
hesitates, since the operation, though erous in her blood supply. This means an
not attended with any unusual risk, "emas- early union and a quicker repair. It does
culates, " does away with procreative pow- not seem to be thoroughly understood how
ers and, consec|uently, should be most cau- the prostate can be removed from around
tiously considered. Surgical measures de- the urethra without injuring the tube. The
vised for the relief of this condition have writer would liken it to a tunnel, with its
been many: Prostatic dilatation; Ilawley's appropriate masonrj', going through a
suggestion of doing away with the pelvic mountain; the mountain might be removed
floor; Bier's iliac ligation; Ilelferich's re- and still leave the tunnel with its masonry,
section of the vas; White's castration; The trouble is, however, that the line of
Ridygier's resection; Delageniere's luxa- cleavage is not accurately determined, and
tion of the prostate; Dittel's coccygectomy in the haste of the operation the mountain,
followed by prostatectomy; Ismardi's ex- tunnel and all are taken away. The hull
cision of the vas, leaving testicles; Bottini's is left— it is extraperitoneal, it is outside
urethral cauterization; Chetwood's canter- the bladder—the floor of the bladder has
ization; transvesical prostatotomy; subpra- not been injured or torn, union is happy
pubic prostatectomy and parineal prosta- and results are good. By the suprapubic
tectomy are some of the most important. It route, the hole left behind must permit of
is Mr. b'reyer, of London, who, having for leakage and extravasation with consequent
many years operated at St. Peter's Hospital chances of infection.
for stone, now leads the subprapubic school The writer believes that the inverted Y,
for the radical attack on the prostate. The starting well anteriorly with the divergent
mortality gathered from the many opera- branches on either side of the anus posteritors
who remove the prostate by this route orly, is the incision of choice. It is carried
is about II percent. down upon the bulb which is now better
Having had the opportunity to observe dissected and turned to one side than inthe
operation of Mr. Iacro-sciatic ligament. It now breaks
method of choice, in the last 17 cases the into several divisions," and running centralwriter
has performed this operation alone, ly, spreads out upon the perineum. This
.\s IS tlie danger to the peritoneal cavity in artery being cut, has retracted deeply and
the subprapubic method, so is the danger more than once caused serious and fatal
to the rectum in the perineal method. By hemorrhage. The writer would call atlen-
!• reyer's method, the resultirg blood-clot in tion to its anatomical location. Pressure
he sheath caused by the subprapubic re- firmly applied to the inner surface of the

ORIGINAL COMMUNICATIONS. 11
tuber ischii must control this hemorrhage, water, following the operation slaitngs nicrc
as it crushes the artery against its bony will be temporary, for they will take up
background. their duties as soon as the^^ can. if left alone
The incision in the membranous urethra and are not goaded to desperation by the
allows Young's retractor to be slipped into unnecessary use of stimulants,
the bladder and the prostate pulled down The writer has had in this series, three
toward the operator but still covered by the cases of cancer of the prostate which have
muscles and fascia. It is the posterior layer been denied operation. Starting centrally,
of the levator ani, which converging around concer manifests itself only when it has
the anterior margin of the rectum, splits gained sufficient size to obstruct the normal
again and encircles the prostate. These outflow of urine. It is then that it can be
fibres are the rectro-urethralis muscle and felt, per rectum, to be hard, that the gland
must be severed at right angles between the is slightly, if at all, movable, at syrametrirectum
behind and the i)rostate in front to cally enlarged and the finger swept up about
allow the gland to be pulled into view. A the internal ring and the concavity of the
large, flat retractor is put into the wound sacrum, may already notice metastatic enand
shoves back against the sacrum the largement there. As in the operation of pananterior
wall of the rectum. This is the hysterectomy, where the lumbar, retroperikeynote
to the operation. The levator ani toneal and iliac glands must be thoroughly
is now stripped from the median line to removed from beneath the peritoneum which
either side, the retractor pulled down upon, is stripped up, so in its anologue. cancer of
not using it as a lever against the under the prostate, the operation without removal
surface of the pubes to force the prostate of the enlarged glands is palliative only and
into view, but by firm, gentle traction down- cannot prolong life for any great length of
wards. With gauze, the surrounding ves- time. Again, when springing ])erii)herally,
sels and small structures are stripped back it soon manifests itself by the ulcerations in
and tiie sheath formed by tlie recto-vesical the rectum and bladder. The escape of
fascia is incised in the middle line, the fin- blood is large and uncontrollable. The
ger inserted between it and the capsule, and measures now adopted are for the relief of
the gland is ready for partial or total enu- the hemorrhage and pain, and not for the
cleation. relief of the condition.
We have already mentioned that the peri- The writer has sent letters to each patient
prostatic plexus of veins runs in tlie sheath of the series, and about .SO jiercent. have so
laterally andmesially. l"ew veins are found far replied. One says that he still has some
inferiorly, The sheath, then, may be in- leakage through the perineum. This parcised
in the middle line, strii)ped from the ticular operation was performed 17 months
capsule and, carrying with it the veins, ago. Two say they have to get up at night
there is no trouble about any great hemor- to urinate. In no instance was there an
rhage for they are still left behind intact, injury to the rectum. One states that he
\ large perineal tube, 2S I"., is inserted in has not lost his courage; one that he drips
the membranous urethra, the bladder irri- some after he passes his water. The latter
gated with a clierry-red iodine solution, the was a suprapublic evacuation en masse, a
wound sewed in layers, a small strip of one- thorough control of the sphincter never havfourth
inch gauze brought up on either side ing been established,
for the escaping serum and drainage, the In conclusion, the writer would call atskin
sewed together tightly and the patient tention to a complete prostatectomy as a
returned to bed. radical cure for chronic, relapsing, gonor-
In criticizing the operation as now per- rheal prostatitis. In this instance, the
formed in most of the hospitals, the writer young man contracted gonorrhea 10 years
would call attention to the fact of insuffi- ago. Since then, he has had innumerably
cient preparation of the operation. When outbursts characterized by severe diswe
recall that the back pressure which has charge, frecjuent and painful urination and
been maintained for so many years, is sud- relapsing epididymitis or epididymo-ordenly
removed, the necessary hypersemia cliitis. The prostate was moderately enand
congestion wliich follow the relief of larged, boggy and painful. Massage exthi
smechanical obstruction does not allow pressed on each occasion, pus cells, gonoof
the functional capacity of the organs in- cocci and broken-down products. Sitz-tubs
volved. l"or this reason, drugs are used to and rectal irrigations were religiously carstimulate
these congested organs. The ried out at each erujjtion, until wearied with
writer does not believe that this is based the fre(|uency of the attacks and underupon
the liest therapeutic principles. If standing that the source of infection was
before the operation the alimentary canal is the prostate, through realizing the severity
emptied f)f its contents, the kidneys helped of the operation, he willingly subject
to activity by drinking large

^ -, THE
CHARLOTTE MEDICAL JOURNAL. I
thought Stood a fa,r chance of bettering choice, except in ball valve and borse-
1st, b\ perineal ^^'^"f" '"L' niii^nt left the eiaculatory ducts is unnecessary and
^k'ST 'th^rrof th tftlfS; the m:yTe the caL of further trouble^
r;d1>acl Inyely healed. DaUy irriga- IV- W-b out the bla^^^^^^
S^-;.-h^.:t^'c:;^r^:nr:; -;^r;hr^^;;;S^^.Hedasion.as
'riseT th^" is ab^^^^^^^^ no discharge, you think he should in other ma.or operathe
patient retains his urine throughout the tions.
^ , , ^.l.r
nicht and from four to five hours during ^'i. Cancer of the prostate and bladder
the day and has already gained much in uiav be attacked by the method already
weight and spirits. The focus of the infec- described, followed by the x-ray.
tion having been removed, the writer beyjj
The writer has had no experience
lieves this patient to be much better off than
^^jth the Bottini, Chetwood and White opit
would have been possible ever to have
grations, and, therefore, cannot speak of
accomplished by medication, instrumenta-
^j^^;^ value,
tion or washings. Fifth and ^lain streets.
With a greater familiarity with the ana- ^
toraical relationship of the structures in the
^^ Abdominal Gun-Shot Wound
perineum, with a clear cut and well defined
,n,estinal Perloratlons, with
idea of what one is attempting to do.
Relercnce to the Alterwith
the right recognition of the
f ructures
^ ^,^^„, ^,,^ ..S3„„^ „rip.disguised
as thev may be by dislodgement
By Theodore Maddox, M. D., Union, S. e.
and maceration, the operation has been re-
.
centlvmoreshortenedthanformerly. Again, The following case is presented because
following the operation, we now allow the ^j-,g results of the after-treatment were so
thickened, tortuous arteries, the congested satisfactory, restoring seemingly a hopeless
kidneys, the pulmonary, cardiac and cen-
^^^^
tral strain of the anesthetic to gradually
Abdominal gun-shot wounds with intesdwindle
by enforced rest and quietness in
^.^^^^ perforations occasion much suffering
bed for several days; for we were formerly
^^^^ ^^^^^ ^^^^^^ deaths. It is therefore of
taught that like the old horse who one got
^^^^.5^,,^ importance to warrant a word of
down never to get up, the tired and shocked
^ojj^jjjendation regarding anything which
patient should be made to get up after-the
^^^ ^^^ consider conducive to recovery,
operation despite the energetic protestations
^^ ^^.^^ ^^^ intention to review this subof
inability to do so. This certainly ap-
.^^^ ^^^ ^^ second thought 1 concluded
pears uiore humane and surgical. Ihe ^^gj-gW t^ present the case and briefly make
writer recalls one casein which the enlarge-
^^ f^^^ s^,„„estions, especially on the aftermeiit
of the prostate was of such unusual
^reatmeiurto those who may see this report,
dimensions that by pressing upon and dis-
^^^ treatment must be prompt lest the
tressing the obturator nerve, there was a
^-^^^^ become exsanguinated. The surconstant,
tonic spasm of the adductor mus-
^^^^^ ^j^^^^^^ ^.^ equipped for anv and all
cles of the thigh. In this instsnce the re-
^^^^o^jj^al work, as I shall demonstrate to
suits were very satisfactory following per-
^^^ .^^ ^^ ^^p^^^ ^f ^^^^ ^^^^^ ^^^^ ^^„gg of
ineal prostatectomy. In another instance
^ ^^^j^^ ^^^^^ penetrating the abdominal
of acute, gonorrheal follicular prostatitis,
.^ ^^ unknown in manv instances,
the prostate, as large as a lemon so serious-
^^^ ^^^^^ ^^.^.^ intestinal perforation with
ly embarrassed urination that, by straining
^^^^^ ^^^^ ^^^^j ^^^^^^^ poured into the
and pressing there was a most pronounced
^^^,.^^ thereby carrying the infectious maand
disfiguring subconjunctiva ecchy-
^^^.^^ ^^.^^ ^^^ ^^^^.^^ surface, we know that
mosis. This IS the only instance of its kind
j^^j ^j^^ ^^jn ,.^,,,^^.^ o,.,^ Uie non-adherthe
writer recalls ever having seen
particles. Sponging will remove much
Balsam peru and castor oil, equal parts
^^ ^^H^ adherent matter, but is very irritatpoured
into the wound is a most excellent
^^ ^^^^ ^..^^^^^ ^^^^ ^^,^ ^^^^^^^ 1,^ ^ery
stimulant to the tissues, IS absolutely pam-
^^^^tious or a more violent inQammatory
less and possesses the added virtue o being
^^j^^ition will ensue, thereby adding addipowerfnlly
antiseptic. 1 he oniy ill-effect
^^ ^,^^ i^,^^
the writer has ever seen following its use ,s
^^ ^^^^ ^^^^^ demonstrated that irrigation,
'
"^rtl'll^^Sf^:i^!:^:rf^it... spongmg and ordinary drainage is insuffic
The writer would conclude as follow
ient in this class of patients, as the perito-
I . Treparc the patient for two weeks for
the surgical ordeal. *Read before Tri-State Medical Society, Charles-
II. Perineal operation is always one of ton, South Carolina.

ORIGINAI, COMMCNICATIONS lo
neum absorbs the infectious material too it imbedded under the iliacus or psoas musrapidh'.
The object then must be to make cles. A careful examination failed to locate
an excreting instead of an absorbing mem- it, or even find a passage leading o£f from
braiie. For this purpose f think the "saline the wound in anj- direction. It is possible
drip" is superior to all other methods, and for the ilio-lumbar, or lumbosacral ligathe
technique is so simple that the novice ments to have closed the passage so thormay
operate it with the greatest ease. An oughly that it could not be found with the
ordinary fountain syringe with a rectal probe, or the bullet could have rebounded
tube, or large catheter is all that is neces- and removed with a blood clot, there being
sary. The syringe should be elevated only no less than a quart of these in the cavity,
about two feet above the level of the pati- or it might have jammed the intestine
ent, and the clamp should be so arranged against the ilium iu such manner that it
that only one drop of a normal saline solu- rebounded and was left within the lumen
tion should drop into the bowel about every of the gut, or it may have been flattened
second. Should this quantity prove to be and imbedded to such an extent that it was
more or less than is required the clamp on impossible to outline it. The blood clots
the tube can be regulated accordingly. The were examined, but 1 think some had been
solution should be kept warm if possible, removed before the examination was made,
as this will materially aid absorption from The stools were examined for several da3's
the bowel. but failure to recover it was likewise met
I make no claim of originality in the with,
treatment herein described—it has been ab- Owing to the great loss of blood, which
sorbed doubtless from the teachings of made the prognosfs extremely unfavorable,
others, but from whom, or at what time 1 and feeling that to continue the search
cannot say. would only jeopardize the life of the patient
Russell P., age 3 years. On December without accomplishing the desired result
23, 1908, he received an accidental gun- the abdominal cavity was closed. A large
shot wound with a 22 calibre parlpr rifle, iodoform gauze drain was placed well down
The bullet penetrated the abdominal wall in the pelvis in order that I would be sure
about 2,'-j inches below umbilicus and one of getting the pus.
inch to the left of median line. It ranged On the second day the patient developed
backward and slightly upward making nine peritonitis vomit, and inasmuch as there
punctures in the ileum. The first section was great abdominal distention it looked as
of intestine brought into view contained if death was inevitable, but this gradually
three punct\ires, two of which were separ- subsided and on the fourth and fifth days
ated by about yi inch of tissue, while the he was only occasionally nauseated,
third was some two inches from the first After 48 hours the drain was removed
two. These were held by an assistant and and the incision, intestines and peritoneum
the search continued. About 20 inches were in an unusually healthy condition and
from the first three, four other punctures free from pus. The appearance of the viswere
found, ranging from :"4 to three inches cera indicated that drainage through the
apart. These were in like manner held by bowel had been very decided, inasmuch as
the assistant and the search continued, there was not a trace of odor other than
About 12 inches distant two additional from the iodoform, which latter was very
punctures were discovered, one of wliich faint. A light iodoform gauze tampon was
was at the mesentery border of the intestine. i)laced ii- the wound down to the perito-
The search was continued for several feet, neum and dressing re-applied. In 48 hours
but as nothing was found I decided to re- this was removed without pus, wo&nd still
pair the damage already discovered, which having a good healthy appearance. A light
was done with a Czerny-Lambert suture, a iodoform gauze tampon was again placed
resection of intestine not being considered in the wound, but not quite so deep. as beadvisable.
After all the punctures had fore, and dressing re-applied. Owing to
lieen repaired I inspected all the abdominal rectal irritation and healthy condition of
viscera that could possibly have been with- wound and lessening of abdominal distenin
range of the bullet, which included both tion, which latter had been very marked
large and small intestines, left kidney, throughout, the "saline drip" was disconureter,
bladder and anterior surface of pos- tinned.
terior abdominal wall. Owing to the fact that the patient was
It was found that the ball penetrated the not doing quite so well on the fifth day the
iliacus muscle about an inch below the wound Wiis ;n:!i"i tbessed and "saline drip"
crest of the ilium, and about the same dis- resumed. At this time the wound was not
tance from the sacrum. It did not pene- c|uite so healthy, slill it was thought advistrale
the bone, but instead had been de- able to clo.se one of the two remaining
fleeted, so quite naturally I expected to find sutures, thereby reducing the ventral drain-

14
,
THE CHARLOTTE MEDICAL JOURNAL.
age by about half. The "saline drip" was ulcer or because the symptoms were masked
continued for about 36 hours, at which time by other conditions.
wound was again dressed. At this time
Statistics shows that 5 per cent, of autopthe
tissues wore much improved and the
gj^^ j-eveal g-astric ulcer in some stage,
wound was closed with the remaining suture
^here have been many theories advanced
and ventral drainage discontinued.
as to the cause of ulcer, most of which have
On account of rectal irritation the "saline been exploded, and, unfortunately, we are
drip" was discontinued on the following yet without a definite cause for the trouble.
day, but several small saline enematse, after 'x'o say that we are dealing with a chemical,
the Murphy method, were used daily for 48 mechanical or thermic lesion does not alhours,
after which time they were discon- ways explain the facts in the case, for we
tinued. have many cases that show no such previ-
Recovery was uneventful after the tenth ous lesion. On the other hand, many such
day, and today the patient is enjoying the lesions have been known to recover without
same degree of good health as before the producing ulcers,
accident. To attribute the cause to over-production
In considering this case I am impressed of hydrochloric acid is not satisfactory, for
with the following facts well worth con- we have hundreds of cases of double the
sidering:
normal amount of hydrochloric acid which
1st. In using the '
'Saline drip' ' vou create show no ulcers in the gastric walls To say
an excreting instead of an absorbing peri- that vegetarians seldom, and that flesh eat-
^''^
toneum
frequently, have ulcer does not give us
„ J V .,^. ^, 1- 1 .. t a cause. Some think that chlorosis and
2nd. In permitting the saline solution to . , , , . , . j , . ,, *
.'^
. J , . , ^ ,, ," , ..
gastric ulcer go hand m hand, but this too
, „„„
drip high into the bowel it can be so regu- ?, r, ^ , ^ -u ^
1 . 1 .1 * u f ^ -A \^ f Z^A has been proven false. Occupation has but
lated that absorption is decidedly favored ... ^ j .,, ,,

The chief causative factors of gastric
ulcer, so far as our present knowledge, are
localized loss of nutrition, mechanical irritation
and chemical destruction.
Pathology.—The macroscopic appearance
of the serous membrane or external surface
of a non-perforating ulcer is that of a lump
or nodule in the wall of the stomach, usually,
almost invariably, in the course of a
bloodvessel. From the interior, it presents
a funnel shape, "the edges clean cut, the
base smooth, or it may show little islands
sometimes covered with coagulated blood,
or tough, dark mucus." The size of the
ulcer varies from that of a pea to several
centimeters. The most usual seat is at or
near the pylorus, though it may be in any
part of the stomach wall.
The microscopic appearance of a fresh
ulcer: "The glandular tubules present a
trough shape as if cut off. In old ulcers a
reactive inflammation sets in at the periphery
and leads to the formation of a calloused
margin;" the fibrous framework is
thickened, the glandular epithelium has
undergone a change, and the lab cells have
been replaced by cubical or cylindrical
cells. Their nuclei are not recognizable by
ordinary staining; their protoplasm has
undergone a hyaline degeneration, "the
sub-mucous is permeated by a profuse,
small-cell infiltration and a strong, vascular
network." "The layers of the muscularis
are separated l)y fibrillary, intermedi-
ate tissue. '
"
The entire process is surround-
ed by a zone of irritation. There is always
a tendency for the floor of the ulcer to adhere
to the tissue Iieneath it. Cicatrization
begins and the fibrous network is soon covered
by the mucous membrane, though it
may continue to contact beneath the membrane,
thus causing a constant source of
irritation and distorted shape to the walls
of the stomach, especially when adhesions
to neighboring viscera have taken place.
Necrosis continuesuntil cicatriza tion takes
place and so long as peptic gastric juice
comes in contact wilh the ulcer. There is
a tendency to thrombosis caused by the
corrosive effect of the gastric juice, but this
thrombus is destroyed as soon as sufficient
juice comes in contact with it, thus producing
hemorrhage. If the necrosis extends
to the serosa, an adhesion to neighboring
organs is formed witli peri-gastritis: or if in
the dependent part of the stomach, perforation
into the cavity occurs and is followed
by general j)eritonitis, frecjuently by death.
Sometimes there is perforation which is
stopped by adhesions to the omentum, and
sometimes a circumscribed abscess forms.
Symptoms.—The symptoms of a tyjiical
gastric ulcer are pain, tenderness, vomiting,
ORIGINAL COMMUNICATIONS. 15
hemorrhage, constipation and increased
hydrochloric acid. As the development of
the ulcer is gradual, so will the symptoms
be insidious. In most, if not all cases of
peptic ulcer, we have a well developed pain
or great discomfort after eating. The time
of the appearance of the pain depends upon
the seat of the ulcer, and the severity depends
very largely upon the quantity and
the quality of the food. The pain is due
to mechanical, chemical and thermic irritation.
Coarse foods and foods not well masticated
produce more pain than liquids.
The food causes a secretion of hydrochloric
acid, and larger particles take up less acid
than finely divided particles: hence, we
have more pain from this source. The ulcer
produces more or less irritation to the ner\-es
of the stomach which causes an increased
amount of acid to be secreted. The excess
of hydrochloric acid and the irritation of the
ulcer causes a firm contraction of the pylorus
and prolonged retention of food;
hence, fermentation of starches and fats
which distends the walls of the stomach,
thus increasing the tension of the ulcer,
with exaggerated pain, often reversed peris-
talsis and vomiting. The pain is also increased
by swallowing food that is very hot
or very cold. I'sually, the pain ceases as
soon as the stomach is empty either from
vomiting or food passing into the intestines.
If the ulcer is in the fundus of the stomach,
the pain will come on immediately
after eating; if near the pylorus, a little
later; if in the duodenum, still later. Vomiting
seldom occurs when the stomach is
empty, generally after meals—and is usually
caused by a spasm of the pylorus and
reversed peristalsis. The siiasm is produced
by the irritating effect of the hydrochloric
acid add the food particles coming in contact
with the raw surface of the ulcer. The
vomited material consists of undigested
liarticlesof food (usually starches and fats,
as the proteids have been digested by the
abundant gastric juice), mucus and, sometimes,
streaks of blood, occult blood and
free hydrochloric acid. There is more or
less tenderness in the epigastric region.
Hoaz lavs considerable stress uii the pressure
points in the median line half way between
the umbilicus and the ensiform cartilage
and the dorsal points over the 10th and
12th dorsal vertebrae. There is an excess
of hydrochloric acid in most cases of ulcer,
esi>ecially if there is much irritation caused
by the nicer. This is a nervous or irritation
hyperchlorhydria. Constipation usually accompanies
excessive hydrochloric acid.
Many cases of ulcer run their course without
distinct hemorrhage. It is said that
hemorrhage occurs in from about .% to 40
per cent. Hemorrhage may be independent

of a paroxysm of pain or the ingestion of
food. It frequently comes on without warning,
sometimes several hours after taking
food, during the night or in the early morning
hours or when the patient is about his
usual duties. On the other hand, hemorrhage
may be produced by circumstances
which accelerate cardiac action or increase
mechanical irritation; or coarse articles of
food may cause hemorrhage. Frequently,
there is considerable hemorrhage without
vomiting, the blood passing into the intestines.
The ulcer may be in the duodenum;
in such case the stools have a tarry appearance.
The patient may present none of the
classical symptoms, yet the suspicion of
ulcer is so strong that we begin to take circumstantial
evidence in the case and by
exclusion, linked with some positive proof,
arrive at a conviction. A patient showing
loss of weight and strength with no history
of severe pain, no vomiting, no distinct
hemorrhage from the stomach or bowels,
slight discomfort after eating, at times loss
of appetite, nervous and, in spite of rest
and ordinary treatment, continues to grow
pale and weak; finally, he presents a waxy
pallor with extreme emaciation. The heart,
lungs, liver, kidneys and spleen show no
lesion, the stomach contents may be normal
or present a slight excess or deficient
amount of hydrochloric acid, but no lactic
acid or Oppler-Boaz bacilli. Haemoglobin
is deficient, erythrocytes greatly reduced,
leukocytes not increased and there is no
evidence of diarrhea. We would naturally
suspect a leaking ulcer in the pylorus or
duodenum; in such case the stools- would
show occult blood, and from this symptom
complex we would diagnose ulcer.
Diagnosis.—Given a case presenting the
classical symptoms, pain, vomiting, hemorrhage,
hyperchlorhydria, etc., we must decide
whether Ihey are caused by gastric
ulcer or some other trouble, Is the pain
due to ulcer or simple hyperchlorhydria,
cardialgia, gall-stone or cancer? In hyperchlorhydria
we do not have hemorrhage or
occult blood, the dorsal pressure points are
absent. Cardialgic pains are not dependent
upon food and there is no hemorrliage.
In gall-stones the hydrochloric acid is generally
decreased; we usually have jaundice;
the pressure points are further to the right.
Paroxysms do not depend upon food, but
are often increased by overloading the
stomach. Cancer is generally found in
older subjects: pain does not always depend
upon the intake of food, but is frequently
relieved by it; hydrochloric acid is
more often decreased;lactic acid and Oppler-
Boaz bacilli are usually present. The duration
of the trouble may aid very materially
THE CHARLOTTE MEDICAL JOURNAL.
in making the diagnosis. I'lcer may continue
for years; cancer does not often last
more than 18 or 24 months. When a cancer
springs from an old ulcer and in the
early stage of cancer the diagnosis is diflBcult.
Is the hemorrhage due to ulcer or some
other cause, such as tuberculosis, cancer,
cirrhosis, varicose veins, traumatism, scurvy
or some acute infectious disease? The history
of the case and the general symptoms
will usually clear up the diagnosis.
TnatmeHi.—This may be considered under
three heads—the rest cure, nitrate of
silver and bismuth.
The rest cure.—A patient who has hemorrhage
should be kept absolutely quiet for
several days—at least one week. The bedpan
should be used for evacuations of the
bowels and urine. For 24 hours no food
should be administered by the mouth, not
even ice water. For 24 or 48 hours, no
food should be administered at all unless
the patient is ver}' weak, and then only
nutrient enemas should be given, such as
solid peplonoids, alcohol and warm saline;
or milk, yolk of egg, salt, flour. They
should not be given oftener than every
eight hours, ice bags should be applied to
the epigastrium. Drugs that often prove
beneficial are ergot, adrenalin and chloride
of calcium.
2nd week.— Rest in bed; hot poultices to
the epigastrium; warm milk; beef tea; liquid
peptonoids; albumen.
3rd week. —Morning and evening, while
in the recumbent position, the patient should
take a glass of alkaline mineral water; hot
poultices should be applied to the stomach.
The diet is the same as in the second week.
If there is no tenderness or discomfort over
the stomach, the patient may sit up in bed
at the end of the third week.
4th week.—The patient may be up in the
room and about the house. The diet should
be bland, such as mashed potatoes, purees
of vegetables, tender, rare meats.
The nitrate of silver cure is highly recommended
bj' Gerhardt, beginning with nitrate
of silver, .25 to 120 cc. of water, taking a
tablespoonful in a wineglassful of water on
an empty stomach three times a day. During
the second week the silver may be increased
to ,3, and the third and fourth weeks
to .4. He also recommends washing the
stomach with 1;1000 nitrate of silver solution.
Bismuth is administered in very large
doses on an empty stomach, two or three
times a day, and it is said that these large
doses do not produce constipation.
If the pain is very severe, it is necessary

ORIGINAL COMMUNICATIONS.
to administer morphia hypodermically; if it
is only slight, it may be relieved with chloroform
water and bismuth or some of the
milder anodynes.
Where perforation has occurred, a surgical
operation is the only hope of saving the
patient's life. Where there is a slight but
constant bleeding which does not respond
readily to rest and treatment, surgical intervention
is indicated.
Typhoid Fever. Importance ol Early
Diagnosis —Fasting — Special Diet —
Surgical Rest of Bowel ~ and
Simplicity of Treatment.
By Dr. A. J. Burkholder, Mt. Sydney, Va.
This disease has a very interesting history,
and was for several centuries confused
with typhus fever. Ancient writers describe
in part what we recognize as typhoid; but
to a physician of this country justly belongs
the distinction of first differentiating, and
setting forth clinically and pathologically
this fever as a separate and distinct d.sease.
F.om American sources even today we are
able to study this disease with greater satisfaction
than from foreign observers.
The time allotted will not permit of a discussion
of the complex manifestations and
types of infection, modes of entrance, systemic
effect, and complications. Therefore
we will confine this brief to the consideration
of a few points found in the sick room
—leaving those winged questions until our
aeroi^lane is sufficient thereof.
With the advancement of medical science
we are able to delve into the depths of mystery,
defy disease by immunization and antitoxin.
Vet we must not forget that njany
of these valuable agents are only in their
infancy of development, and many of the
valuable tests employed in diagnosis are
not infallible, are confirmatory if positive,
and if negative in no wise proves that disease
does not exist. The time has not yet
arrived, and never will, when we can in
our laboratory diagnose the patient. That
is what we propose to treat, therefore let's
come down. With the adv'ancement of our
profession, there is a growing tendencx- to
wander away from convictions of bedside
study. Yet what evidence has been produced
to show that the clinical conclusions
of eighty-five years ago should be displaced
by the observations of today? The longtail
coat, the solemn face, the silent tread,
the modulated tone, the lancet and depleting
measures have gone, and with them the
impression plate, bedside diagnosis. The
clinical picture of typhoid fever as drawn
by Chapman, by Wood, and by Thompson
eighty-odd years ago stands as a living
monument today to those profound students;
and when compared with our most recent
writings, those not yet dry from the printer's
ink, they define clearly in every line those
diagnostic symptoms observed at the bedside,
upon which alone they depended.
We would here enter a plea for a closer
clinical study of disease, especially typhoid
fever; for upon an early diagnosis, immediate
in many cases, depends the life of the
patient. Even where the least suspicion
exists it should be regarded typhoid and
treated as such until you go and develop
your cultures, search through available
literature, and make several mathematical
calculations as to possibilities. These means
of diagnosis are to our credit. Yet let us
not forget that too often valuable time is
lost. The life of the patient and our success
demands that we act then and there
no future time offered. To do this requires
a higher degree of trained powers of observation;
and such should be our aim, our
first and main dependence.
—
Years ago—and so it is today universally
admitted that the food factor is one of the
most important questions to be solved,
livery writer and every practitioner holds
to his own belief, however, all with varying
degree of success. Many claiming that
in the event such diet produces disorder it
should be withdrawn. The most natural
question suggested by that direction is this:
l)y withdrawing the offending agent, can
you also always withdraw tht evil effect
l)roduced? If such diet is competent of
producing disorders, is it rational to employ
it in a single case? Withdrawn, after the
stomach rebels, after the cripjiled bowel
has been unduly excited, after mixed infection
has been favored, after the toxic system
has been borne down to the very brink
of the grave by increased sepsis, after the
\ital forces have lost all power of resistance,
after cell activity ceases from profound
toxemia? And, we might add, after distention
favors a long list of dangers.
That life-giving fluid that stands par excellence
hermetically sealed, transposed by
transfusion, possessing all the nutritive elements,
the proximate principals, kind for
kind, gives abundant evidence of its utility
in its natural sphere. This connecting link
that spans the chasm from darkness to light
ceases to be food at a certain period. Nature
so says. We will jjatiently await evidence
to the contrary.
Let's leave off the milk and give beef
bullion, possibly we will grow a better
culture.
In the administration of drugs we consider
the physiological action, the therapeutical
action, and the toxic action; and
we are very careful to carefully guard the

J8
THE CHARLOTTE MEDICAL JOURNAL.
latter action. Whv should we be indifTer- is begun early and increased as required,
ent in regard to other substances that like- The time of commencement and dosage
wise have indirect toxic eiTect? Pathologi- being indicated by toxemia, which should
cally the gravest lesions exist in the bowel, be given at time antiseptic is given, and
we all admit that we are in the presence of both at regular time for nourishment in
gastro-intestinal catarrh with hyperplasia, order that frequent administrations may be
and that irritating food increases peristalsis, avoided.
which increases absorption of toxins, and All nourishment is iced, and the patient
sepsis thus produced increases nitrogenous is encouraged to drink freely of water.
waste more raoidlv than the typhoid to.x;in. Good results are often secured in this direc-
Therefore, let us regard these cases from tion by offering a full glass through a glass
a surgical standpoint, and treat them as we tube at time medicine is administered,
would any other lesion of the viscera. Rest, The usual lemon flavor of albumin water
perfect rest, not only of every vital organ, may be displaced by a dash of nutmeg if
but bowel rest. This means that nothing desired.
within nor anything from without should No change is made in this diet unless
disturb the p'alient; even the ver\' atmos- patient rebels, until practically all acute
phere he breathes should carry nothing but abdominal symptoms subside. After which
oxygen; not even one of those innocent one to three raw eggs a day are allowed,
lynx-eyed members of the winged fraternity Oat meal gruel next is given. When the
should receive admittance to the sick cham- evening temperature becomes normal a
ber, for he is on no mission of mercy, neither small piece of toasted sweet yeast bread
when he goes forth does he bear good tid- may be allowed twice daily, fresh butterings.
A quiet room, a nurse not afraid of milk from cream not over two days old
work and possessing sufEcient intelligence given in quantities of one-fourth glass may
to realize that nursing consists in attending be allowed with toast, or the yolk of a soft
to directions given by the physician, are boiled egg is often preferred on the toast,
essential. At this period the albumin water is omitted;
The following treatment has been em- but liquid peptonoids are continued at interployed
by the writer in quite a number of vals between semi-solid or solid nourishcases
without a single death, and only two ment. Enforced use of bed pan during encomplications,
which however quickly made tire illness,
complete recoveries. The cold pack is used for half hour every
1st visit. If only suspicious of typhoid, two hours during the day and up to 10 p.
mercurial purge, fasting 24 hours, water m., while temperature remains above 103;
only allowed. , from 8 a. m. to 10 p. m. if over 101; after
2nd visit. If digestive tract has been this, usually at 1, 4, 6 and 8 p. m. will be
cleared, albumin water is allowed every ample to insure a good night. Enemas are
two hours; if not, small dose of salts or oil resorted to if required. A broken dose of
is administered, fasting continued until mild chloride at bed time is now frequently
laxative acts. in order.
3rd visit. Albumin water continued. If The ice cap is used in many cases and is
symptoms produced by full bowel have of especial advantage in children. In chilsubsided
liquid peptonoids are added to dren the intestinal antiseptic is not usually
diet, either independentor alternating albu- required.
min water. Intestinal antiseptic is now The patient is kept in bed until the evenbegun,
ing temperature remains normal, until
My favorite is: reasonable strength has been regained,
R Bismuth sulphate until absolutely all symptoms of fever have
Bismuth salicylate aa 3 ss disappeared. After this we may with com-
Zinci sulphocarbolate gr. iij parative safety permit the patient to sit up
Guaiacol gr. iv a while every morning; and my rule is to
M capsules 24 allow them to find their way out after arriv-
Sig: 1 capsule every two hours until ing at this stage. Tonics are usually given
diarrhoea ceases—then continue one cap- for several weeks,
sule every four hours. In detailing this simple treatment, I do
4t:h visit. Tea and coffee added to diet if not mean to convey the idea that simply a
desired. mechanical rule is followed; but I am on
Nourishment has been given only during the other hand fully convinced that more
the day up to this period, which after this fever patients would recover if the doctor
is given once only from 10 p. m. to r> or 6 in charge possessed only such drugs as are
a. m. Provided we are dealing with a clearly indicated to conserve the vital forces,
strong patient, no stimulant is given. Mow- In this disease greater danger lies in the
ever with the majority sulph. of strychnia administration of medicine than in the dis-

ease itself. The deportment of the physician
should inspire confidence, and little
fluctuations uecessarily met with should be
silently watched; but not treated through
fear: for generally by the next visit they
will be different. The constant and frequent
change of medicine does serious
harm.
Complications demand appropriate treatment.
The Value of Employment in Cases of
Dementia Praecox.
By I'aiil V. Aiider.son, M. I)., State Hospital, Mor-
gaiiton, N. C.
In attempting to write on any phase of
dementia praecox, 1 realize fully that the
groutid has been covered in every respect
and my only reason for selecting this subject
is to call attention to the importance of
early emjiloymeut iu these cases and to plead
for a more systematic attemjn at their reeducation
before they are cast aside as hope
less derelicts. At least, give them the ben-
efit of a trial.
We should not be absolutely pessimistic.
Advanced methods of treatment have robbed
many other diseases of their horrors.
Therefore, is it not possible that the baneful
after-effects of dementia praecox may—to a
degree, at least—be mitigated?
It is conceded that many of these cases
retain to a considerable degree the knowledge
and skill formerly acquired. livery
physician can easily call to mind numerous
individuals in his own jiractice who have
suffered physical loss, but who, in spite of
serious handicap and because of enforced
adjustment to a changed bodily condition,
live fairly active and productive lives.
Almost every vocation has in it the semicripple,
those who have lost a leg, an arm,
an eye, the function of an ear, or who have
chronic hepatitis or nephritis or cardiac
or pulmonary disease and yet, some of these
men and women have, l)y sheer force of
circumstances and will i)ower, taught themselves
to disregard the thorn in the flesh, and
have given full proof of their ability to add
to human progress. The proposition that
brain disease and the consetiuent intellectual
disorganization is more serious than
the loss of any limb, I have no wish to deny.
I do wish, however, to emphasize the humaneness
and the hopefulness of the modern
view point which encourages us to look
upon the mentally defective—especially
upon the praecox cases—as those who, because
of cerebral disorders, have entered
again only into an intelleetual infancy, and
•Read before TriState Med. .Society, Charleston,
S. C.
ORIGINIAL COMMUNICATIONS.
that it is possible to educate, literally to
lead out of this mental gloom many of these
cases, I shall hope to establish.
The physician, especially the phy.sician
who works with the insane, should have
always in mind that he has two duties to
perform. The first of these he owes to the
patient, and this highest obligation is to
make the patient comfortable and happy.
The other duty is to society and that duty
is the awakening in the mentally enfeebled
the dormant tendencies to provide for themselves
and thereby lighten the State's everincreasing
burden. The few cases to be
cited will tend to make these propositions
seem the more plausible.
A woman now thirty-two years of age
has been in the Hospital for twelve years.
L'ntil the past three years, she spent most
of her time on the floor, took no interest in
her personal appearance or her surroundings,
kept her head covered with a shawl
almost all the time, and had occasional violent
outbursts of temper. By careful persausion
she was induced to sit in a chair.
Next she was given a broom and was persauded
to help with the sweeping; then she
was encouraged to sew, and as she improved
she became more careful of her appearance.
She was sent to the mattress factory and
there did excellent work. Xovv, she works
in the laundry, is tidy and goes regularly
to the dances and to chapel.
Another case occurred in agirl of eighteen,
whose father, ijrother and uncles have been
])atients in this Hospital. For quite a while
after admission, she had to be dressed
and taken to the dining room. She would
hide under the bed, lay on the floor most of
the time, was silent and sullen and resisted
every effort made in her behalf. She manifested
no pride at all in her dress. By patient
effort she was induced to dress herself,
to sit iu a chair, then to help on the ward,
then to sew and finally she was sent to the
laundry. She soon became cheerful and
very industrious. She gained weight and
took quite a pride in her dress. Later, she
was able to go home and has been doing
nicely there for more than two years. Her
brother, also a praecox case is, now at home
and is doing very well.
.\ woman of twenty-nine had been in the
Hospital one year. For several months
after admission, she was obscene, profane
and filthy in her habits and tore up everything
she could lay her hands on. At times,
she fought viciously. The dementia seemed
to be marked. Yet, she was by degrees
induced to help on the ward and to sew.
As she improved, she dressed more neatly,
ceased fighting and tearing her clothes, and
as in the other cases went to the laundry
and soon became one of the best irouers.
19

20
THE CHARLOTTE MEDICAL JOURNAL
She was quite cheerful and finally was to take a new lease on life. Unfortunately.
allowed' to go home and has been able to she developed pulmonary tuberculosis. [
carry on her household duties fortwo years. Hsd she lived, possibly she mighthave im-
Another patient was a school girl of proved sufficiently to go home.
eighteen. She walked in a stilted niaiiner These cases might be added to indefinite- i
and never spoke. Much of the time she ly, but I have given a sufficient number to I
spent on the floor with saliva drooling from show what may be done with cases of. a
her mouth. She was filthy in her habits varying degree of impairment. Much of I
and would not wear her clothes. The de- the necessary work of the Hospital, i.e., the
mentia seemed to be permanent. She was laundry work, sewing, mattress making, \
gradually induced to wear her clothes and bottoming chairs and basket making, is
whenthis was accomplished she was finally done by females, many of whom show a
prevailed upon to help with the sweeping marked degree of dementia. The occupa-
|
i
\
•
]
and the ward work. By degrees she be- tion not only makes them happier and more
came tidy, and then she went to walk each contented, but helps to provide for their
jiay and gathered flowers for the ward, and own maintenance.
finally she began to sew. Next she went The same policy has been carried out on
to the laundry and did efficient work. She the male side and to a greater extent, bebecame
permitted
so
to
much
go home
improved
and has
that she was cause of
been able to ployments
the fact that more congenial emcan
be found for the men of this
]
stay there a year. class. Two are employed as mail carriers;
Another girl was twentv-one when admit- eight are working in the garden; largely in-
ted. She has been in the Hospital for nine depeudently most of the time. One of these .
years. Until three years ago, she sat in the cases is quite interesting, and to quote his |
same place on the ward all dav with her words, he is ' a leetle slow and awkward."
head bent forward and her hands hanging It takes him quite a while to get to his
listlesslv at her side. The nurse had to work as he finds it necessary to turn around
start her before she would go and she could »"

ORIGINAL COMMUNICATIOXS, 21
process of construction ou a nearby farm,
Colony buildings for one hundred men. The
you upon to-day, many subjects present
themselves to my mind, but it seems to me
agreeable employment provided in this way the question of the relation of the medical
will undoubtedly result in the mental reawakening
of many who otherwise would
be doomed to a vegetating existence on the
profession to the people along the lines of
hygiene and preventive medicine, is one of
the vital questions of the day. And cerwards.
tainly along these lines science looks to us
Ouite a number of cases occurring in
young men and women from seventeen to
twenty-five in whom the deterioration was
not so marked might be cited who stayed
for enlargement of the boundaries, by con-
quest over the domain of ignorance of the
people.
It is probably true that in no other dein
the Hospital for periods varying from a partnient of learning has education been
few months to a year or two and have gone advanced so rapidly as in medicine. Leghome.
Many have remained there; some islatures and leaders of the people everyhave
been able to take quite an active part where are more and more looking to us,
in the battle of life and some have had to the medical profession, for proper informtake
a less important part, but no matter ation in the passage of laws to guard pubhow
little the production, society has been lie health.
the better for it. Ours is the noblest of professions, there-
Xow, I do not mean to say that all cases of fore, it is our duty, as special guardians of
dementia i)raecox can be improved by any
methods whatsoever— I do not mean to say
the people, to allow no false modesty to
stand in our way to prevent us bodily and
thatany great number can be cured, for irre- righteously doing our duty to prevent in
parable damage has been done to the brain every way jxissible the spread of that which
tissue as a rule, but I do say that a vast makes the lives of the innocent miserable.
number can be made productive in the out- As we are to consider the enlightenment
side world under proper supervision, and of the people as to personal and municipal
others can be made permanently productive health and hygiene it might be well lo
and take a more or less prominent place in briefly call attention, among ourselves, to
the affairs of the world. some of the advances of the medical profession
in the past few years. The past
President's Address. thirty years have been the most active
By J. F. Iliglisinith, JI I)., l-ayeltevillu. N C. period in tlie ac(|uisition of medical knowl-
, ,. , ,. , „ ,, .^ ,
Ladiesand (.aiijemm. below Member, oj
formation frtnn the old to the new. It is
the Medical Society oJ the State oJ North
eharacterized by the most fruitful endeav-
Larolina:
^^^^ ^j,^ ,jj^, j^^^^^ brilliant achievements
To be the official head of this assembly that have >et been added to the chronicles
is an honor for which I am grateful. Here of the profession of medicine. The lime
and now 1 desire to assure you of my sin- has past when this art is associated with
cere appreciation of the honor of presiding
over this, the .S^th annual session of this
learned body. It is my heart's most earnwitchcraft
and superstition, but established
on a firmer basis—when men are spending
their lives investigating, experimenting and
est desire to maintain the excellence of this
organization and the high standard of my
giving reasons.
Even less than twenty years ago the studistinguished
predecessors. dent could be graduated in medicine after
Fellow members, once again we ha\ e two years of study. Only the crudest premet
together, for the
fair city of Asheville.
fourth time, in the
A "decade since our
fiminary education was required. Surgerx-
was narrow and limited compared with
. edge and medical art. It marks the trans-
last meeting in this tiueenly city—the what it is to-day, and consisted chiefly in
Switzerland of North Carolina —far famed ligating for aneurysm, performing tracliefor
her hospitality to the stranger that is otomy, amputation and resection; operawithin
her gates—known the world over ting for empyema, strangulated hernia,
for her beauty and her climate. stone in the bladder; reducing dislocations;
Great changes have come during these setting and dressing fractures; trei^hining
ten years. Many wlio were with us then have for head injuries; caring for wounds; refinished
their work here and have been moving foreign bodies; and extirpating tucalled
to higher service, bequeathing to us mors. A few surgeons were doing ovariexamplesof
lives nobly lived, spent in unsel- otomy. Comparatively few operations
fishs ervice for others. Their lives have not were done, and many ignorant people were
6tr« /c»^/, for as Kuskin has said: "ivvery afraid of hospitals—would go to one only
nol)le life leaves the fibre of it interwo\en in the last extremity, and then went in deadly
forever in the work of the world." terror. In 1877 the great wave of surgical
In casting about for a theme to speak to progress, which is one of the most notable

22 THE CHARLOTTE MEDICAL JOURNAL
events of a notable age, was beginning to The question arises, How shall this eduforni
a moving billow. cation be accomplished? I answer, the
Apjiendicitis was unknown, and was to leaders of the people and prominent men,
remain so until i'ltz, of Boston, published \vho occupy responsible positions, must
his paper in ISWi. Mellin had guessed the first be educated, for through them we can
truth in 1.S27, but he was suppressed by reach the masses. The education of the
authority, and thousands died because of masses must be accomplished through pubit.
In 1S,S7 drugs producing local anes- lie organizations—the press, the legislathesia
had not been discovered. The es- ture, the churches and the schools. To
sential importance of embryology in solving preserve health and prevent disease are the
many problems of disease was beginning objects of modern medicine,
to be appreciated. Pathology, chemistry, Hygiene or preventive medicine has
and physiology were becoming fruitful only arisen in the last 40 years. It has
sources of marvels. lagged farther behind than any other
We have had the Laboratory of Anato- branch in medicine. But this to be brought
my for centuries—we must now have la- up with the other branches must be done
boratories for at least a dozen other sub- by educating the masses, and getting them
jects. Xo hospital is complete at present to understand and cooperate with us. Men
without an up-to-date laboratory. No must be educated for the purpose of teachphysician
can intelligently practice his pro- ing the people and through this channel
fession without the daily use of the micro- we will be able to fight the preventable
scope. diseases.
A few progressive and able men had If it is necessary to show that our knowlgrasped
the full importance of the recent edge of hygiene is still limited, we need
discovery of Pasteur—had realized that in- only look around us in our own cities and
fectious diseases were probably due to bac- towns, and country as well. A startling
teria, and that preventive medicine was ignorance of the laws of health is found in
destined to become one of the highest call- almost every farm-house, cotton factory
ings to which man could devote his brain villages, manufacturing villages, and even
and consecrate his life work. in many of our cities to a large extent.
Antisepsis has wrought marvels as Many diseases coming from these sources,
mighty as were ever conjured by the seal as we know, are recognized as preventable,
of Solomon. It really made possible most if the community was only aroused to the
of the surgery of the brain, the chest, the necessity, and the possibility of their preabdomen,
and the abdominal viscera. It vention. Butthanks be, there are signs of
has practically abolished the so-called blood awakening! We notice that the University
poisoning as a sequel to surgical operations, of Virginia has announced a summer course
It has immensely mitigated postoperative for the training of those interested in subpain
and fever; arrested puerperal septice- jects connected with the prevention and immia
with its destruction to the child bear- provement of public health. This course
ing woman. It has lessened the mortality began on yesterday and will continue until
of major amputations from 50% to .5%; of July 24th. It is especially for health ofBof
compound fractures of the long bones cers, medical inspectors, and similar public
from over 50% to 1%; of ovariotomy from officers. The same Institution will inau-
50% to about 5%, or less. The discovery gurate in September a four years course for
of anesthesia, antisepsis, and the creation the training of sanitary engineers. A course
of the science of bacteriology have been of lectures will also be given on selected
Ihe ///n-e g-real triumphs oi medicine in the topics on public health, some of which are
lytli ceatury. The scientific practice of intended especially for public health stumedicine
is today based on objective patho- dents, while others are open to all students
logical experiments. I believe to-day we in the University.
are on the e\e of still greater discoveries for I hope to see this step taken bv all the
the well being of mankind. Universities and Colleges in this country.
As I have before said, with the light we The Insurance Companies are beginning
have gained it is our solemn duty to our to realize the great need of sanitary laws
fellowman to promote the general welfare and their proper enforcement. To quote
of the communities in which we live, bv Dr. Irvin Fisher, Professor of "Political
nistructnig them. Everything pertaining Economy" of Yale, and president of the
to medicine IS of vital interest to the public, "Committee of One Hundred of National
to every man, woman and child, be they Health," in a recent address before the Asrich
or poor. There is no science or art sociation of Life Insurance Presidents, said:
that has a closer relation to the human race "A fall of the death rate always promptly
than medicine, and none that is so clothed follows sanitation. Colonel Gorgas cut the
m mystery.
jjg^tjj j.^^^ ^f Havana in two, bringing it

OEIGINAI. COMMUNICATIONS. 23
down to 15% or less. The New York death services, not mereh' holding the position
rate responded at once to Col. Warrick's honorarj', but with their shoulder to the
clean streets, and that of Rochester to Dr. wheel, earnest in their endeavor to make
Coler's inilk crusade; and now it is an- North Carolina the most healthful State in
nounced that Xew York's death rate is the Union, with vital statistics, on an accu-
16.5%, the lowest on record. A result in rate basis to prove it, in keeping with other
all human probability due to the hygienic civilized countries. \"ital statistics are the
work of Dr. Darlington, the efficient health very basis and foundation of any attempt
officer; Nathan Strauss, the milk reformer, to better the general health. Public hyand
the i-ublic agitation for health, by the giene is built on it, is controlled and direct-
"New York Times," "The Journal," and ed by, and is everlastingly in debt to vital
other media allied with the health work of statistics, and to it belongs the might and
the "Committeeof One Hundred of National the right to direct the future of preventive
Health," the Tuberculosis Association, and medicine. We need more medical legislacommittees,
and other organizations. These tors. There are golden opportunities for
and other facts, and the mass of detailed fig- some of our medical talent of North Caroureswhicli
they represent, show conclusively lina to distinguish themselves by services
that human life is long or short precisely of eminent value in our legislative halls,
under the hygienic conditions under whicli And, while he may not have an open reit
is lived, that human life can be prolonged ward, he will have a reward which is posas
these hygienic conditions are improved, sibly unknown to him, but he will have,
and that there is still enormous room for best of all, the pure joy of service well renimprovement.
dered. To do things that are worth doing
A report which Dr. Fisher compiled for —to be in the thick of it—Ah, that is to
the Conservation Commission, based on live!
data from American sources, shows that I shall not attempt to suggest a number
human life in America can be prolonged by of new laws to l)e enforced, but urge that
the adoption of hygienic reform already the laws we already have be carried out to
known over one third, or more than fifteen the letter. I would like to make only a few
years. suggestions along this line. There should
Tuberculosis is known to be ijreventable. he a State law requiring every case of tuber-
In Dr. I-"isher's report it is entered as 75 per culosis to be promptly reported by the atcenl.
preventable; Typhoid 85 per cent.: tending physician. Then the patient should
Pneumonia 45 per cent. Many diseases receive treatment at a Sanatorium if possisuch
as cancer are entered per cent, pre- ble, and they should go as soon as a diagventable,
although the best expert would nosis is made, for every tuberculous patient
allow some degree of preventaljility, if pre- is a source of danger to all who come in
vention begi"ns early enough in life. On contact with them. Not only the open air
these premises we find that about two years treatment with rest and forced feeding; but
of the possible lengthening of the human the educational advantages will accomplish
life would be due to the elimination of jire- great good among the people, for they are
ventable tuberculosis; 6 per cent, a year taught to ward off and protect themselves
would be due totlie prevention of Typhoid; and others against the disease. When they
H percent, a year to the Diphtheria; 9 per retuni to their homes they will impart the
cent, a year to the elimination of prevent- information gained to their families and
able accidents. At least 8 years could he neighbors and the result will be that the
added to the average life by securing rea- entire community will be benefitted by it,
sonably pure air, water, and milk. Apply- and tuberculosis will be on the decrease ining
what is actually knowo in hygiene, the stead of increase.
death rate amongst insured peojile could be There should also be a law making it a
reduced nearly one-half during the decades, misdemeanor for any parent or parents to
between thirty and sixty, about one-seventh allow any remediable deformity of their
during the next decades. According to this children to go untreated. If the parents are
plan which the writer had in mind, life in- notsensibleenough to realize that it is forthe
surance money invested in saving life would child's future usefulness as a good citizen
not be in Hospitals, but in tlie education of that it should have a healthy body, then
the public, and particularly their policy the State should make them realize it by
holders, in health matters, and joining in compelling them under penalty to give the
every legitimate way to improve the public child every chance for recovery. One
health offices and services in the muncipali- mother when asked why she did not have
ties. States, and Federal Government. her child's deformity attended to replied:
We need in North Carolina laws to back '
this was a double club-foot in a little girl),
us, then (.onipctent men elected to fill the "Well, God made her so and I will let her
positions created, and they paid for their stay so." Thepoorignorantmother did not

24
THE CHARLOTTE MEDICAL JOURNAL.
know it was a result of transgression of iia- art of healinc;, or curinij the people, whether
ture's laws. thev be Homeopath, Osteopath, Eclectic,
There should be a law demanding that Christian Scientist, Allopath, they should be
Medical Examiners be elected to the schools made by law to pass examinations showing
in North Carolina. Other States and that they are well grounded in the fundamany
towns and cities have real- mental principles of medicine, anatomy,
ized the importance of this and have seen physiology, and pathology, before they are
good results from it. In the United States, allowed to practice. For unto all come the
Boston seems to be entitled to the credit of ill and diseased, and they should know
establishing the first regular system of Medi- enough to diagnose the case before treating
cal Inspection of Schools. This was done it. I hold that no man can diagnose and
in 1894. Forty physicians were elected by treat any case intelligently until he first
the Board of Health to inspect the public knows the anatomy—second, the normal
schools of Boston. In 189.5 nine such in- functions of the body—third, what pathospectors
were ajipointed in Chicago'. In logical changes are to be looked for.
1894 the Board of Health of Xew York A law to compel all practitioners, no matelected
134 Medical Inspectors for the pub- ter whether they give drugs or not, to
lie schools. In 1898 the Bureau of Health pass examination showing that they
of Philadelphia passed a resolution direct- knowledge of the fundamental branches
ing that each of the fifteen Assistant Medi- would protect the people. Then the Osteocal
Inspectors should visit one public school path would know enough to send a case of
in his district each day, inspecting it ac- suppurative appenditicis to a surgeon, and
cording to the methods employed in Boston, not undertake to remove the cause by ma-
Xew York and Chicago. uipulation, and by so doing, in all possibil-
Only four general state laws providing ity, rupture the mass and let the patient die
for or allowing medical inspection of of peritonitis all because of his ignorance,
schools have been passed. In Connecticutt Or the Christian Scientist who suggests to
in 1899 the Legislature passed a law pro- the poor anaemic, who is languid, has little
viding for the testing of eyesight in all the strength for daily tasks, bad digestion, etc.,
public schools of the State. New Jersey that he is not sick, but that he only thinks
has a law authorizing the Board of Educa- so. It is all imagination. When if they
tion to employ medical inspection of schools were examined by an intelligent diaguosand
defining their duties. \'ermont has a tician would probably find early signs of
law since 1904, requiring an annual exam- tuberculosis. Then if he was honest would
ination of eyes, ears and throats of school warn his patient that this was the time to
children. In 1906, Massachusetts passed a make the fight, and by so doing he would
law which is comprehensive in its provis- add years, if not a complete recovery to the
ions, and mandatory throughout the State, patient, instead of chaining hiln by his dethe
only mandatory law of its kind in the ception to await a slow, loathsome disease
country. It requires every town and city that will number the patient among its
to establish and maintain a system of medi- many victims, slowly but surely.
cal inspection by competent phy.sicians for There are signs of awakening in North
the detection of contagious diseases in the Carolina which will cryslalize with efficient
schools. Examinations must be made an- organized efforts under State direction and
nually by the Inspector of all the pupils for control. This is shown in many ways too
physical defects, and their eyesight and numerous for me to deal with in so short a
hearing tested every year. There is, so far time. Suffice it to mention two or three of
as can be ascertained, some form of medi- the most important events in the line of
cal inspection in vogue at present in sev- progress.
enty cities in the United States outside of The Legislature of 1909, this year, ap-
Massachusetts. But the United States is propriated thirty thousand dollars for the
still behind Germany, and a number of for- permanent improvement of the State Sanaeign
countries in this important movement, torium for Tuberculosis, and also increased
The educated physician, let him special- the annual maintainance. This makes in
ize in whatsoever line he may, has it in his all, given to this Institution, in the neighpower
to protect the families, and the people borhood of $.5S,0t)0.00. This Institution is
at large against contact with infectious and located at Aloutrose, Cumberland Co., a
contagious diseases, and has it in his power most beautiful location for an institution of
to place those who may consult him on a its kind.
sound and honest basis. Therefore, i be- This is a small beginning when we couheve
for the good of the people that we sider the great need but shows progress in
should never have but one Medical h:xam- the right direction and will do great good
ining Board in North Carolina, and every to many who enter this Institution for treatman
or woman who propose to practice the ment. Besides the educational feature of

ORIGINAL COMMUNICATIOMS. 25
this Institution will accomplish untold g;ood sick, involving the comfort and material
throughout the country. prosperity of 5,000,000 homes, and 25,000,-
The last Legislature appropriated a suf- 000 people, and that one-third of this was
ficient sum to secure the entire services of directly preventable. On account of inadr
the Secretary to the State Board of Health, equate authority for medical officers during
and require that he give his entire time to the Spanish-American war, we lost sixteen
that office. The State Board of Health has of our soldiers from preventable disease to
elected to this position, as you are aware, every one lost in battle. And 85 out of
Dr. W. S. Rankin, formerly dean of the each 100 of them were inmates of Hospi-
Medical Department of Wake Forest Col- tals during that short struggle from some
lege. In electing Dr. Rankin as Secretary, character of disease. During the Russothe
Board has not only honored Dr. Rankin, Japanese war, with medical officers having
but they have likewise honored themselves, co-equal authority and rank, except on field
and I feel that Dr. Rankin will discharge of battle, Japan lost but one of her men
the important duties of this office with from sickness to every four killed in battle,
fidelity, honor and credit to himself, as well and only fifteen of every one hundred of
as to the State. them ever saw the inside of a Hospital. As
The State and the Medical Profession of an argument for peace, we are told, that
North Carolina owe a lasting debt of grati- two hundred and ten thousand men died as
tude to our honored retiring Secretar\— Dr. the result of battle in both armies during
R. H. Lewis, who filled faithfully thisposi- the Civyl War. As an argument for health
tion for 18 years, and retired at his own laws we are told, that seven hundred and
request. We feel grateful for his work and fifty thousand people died of tuberculosis in
know that his most efficient services made the I'niled States during the last four years,
it possible to secure tlie entire time of a and that at least three (luarlers of a million
Secretar>' to the State Board of Health. are continuously sick of it.
This is a very decided advance since it gives For a moment think of the money annuan
active member to the Board of Health, ally expended by the Department of Agrimaking
it possible for him to devote his en- culture, SIO, 000,000 in the last ten years,
tire time to this office. in investigation and extermination of fever
I trust that the time is not far distant in cattle, cholera in hogs, pests in cotton,
when each County in the State will realize corn, etc., and other profitable things of
the importance of having their County Su- commercial value; then compare with the
perintendentof Health on a salary sufficient assistance we have received from our Legisto
justify him in devoting his entire time to lature in this our unselfish warfare against
that office. There is increased work for him pestilence affecting men, women, and chilto
do with the increase in population. He dren. We have been called a Medical
could be kept busy improving the sanitary 'i'rust.—God forgive, and may such as think
condition of the towns in his County, look- thus see us as we are—the nol)lest of all
ing after the jails, and the schools, and he professions, poorest of all trades!
could easily be appointed the Medical In God direct and give us men of sound
spector of Schools in his respective County, minds and healthy bodies who are earnest
The conservation of health promotes the and eiilliusiaslic over this great work. It
conservation of wealth, and vice versa, has been said that enthusiasm is the motive
therefore it would pay the County to do this force of progress. No really great deeds
from a commercial standpoint, to sav noth- were ever done in arts or arms, in literature
ing of the good done in the way of prevent- or science, that was not the product of ening
disease and saving human life, and thusiasm. It beckoned Columbus across
building upour country wifh strong, healthy the ocean; it struck fire from cold flint; it inmen
and women. vented the alphabet; and it saw in the steam
With our State organized in this way and wreaths from a tea-kettle a force greater
the people educated, with otherStates acting than that of all the men in the world united;
in accord with us, aconuniation which will it tunneled the Hudson; it took signals unnecessarily
come, we will soon have "A Xa- der the ocean; it carried messages through
tional Department of Public Health," all the air; and it harnessed lightning to carry
joining hand in hand— National, State, and the vehicles of man. It discovered the cir-
County. This done we will soon have laws culation of the blood; invented the ligature;
to back us, vital statistics accurate, and pre- it introduced vaccination and anaesthesia;
ventable diseases placed at a minimum, and it laid the gentle hand of healing on the
and more lives, more homes, and more wounds of humanity through antiseptic surmoney
saved, than by any other general gery.
agency in the whole plan of Government. It was with the three noble medical heroes
Think for a moment that during last year who gave their lives to free a large section
ISiiD.ooo persons died and 100,000 were of the country from the annual dread of

26
THE CHARLOTTE MEDICAL JOURNA].
cholera and yellow fever, and made possible bias are among the stigmata of psychasthenia
the building of the Panama Canal. in its emotional form. Among the other
May we feel it! May we be animated by stigmata are the feeling of inadequacy, the
this immortal principle! May we be driven psychological and physiological insufBcienby
this divine fire! And of our work, let us ces, and the alteration of the feeling of
sfee to it thai when the final summons comes, reality; also the episodic forced-agitations,
it can be said of us, "Greater love hath no whether motorial (the tics and crises of agman
than this, that he lay down his life for italion, including the dromomanias and
his friends."
fugues), or emotional (the phobias and an-
. goisse), or intellectual, such as the rumi-
Tlie Essentially Dillerent Treatment Re- nations, indecisions, definite monomanias,
quired lor Some Conditions Often and the complete and typical obsession^.
Mistaken lor Neurasthenic.* The presence of any of these, with the ac-
Ev Tom A. Williams, M. B. M. C. (Ediu.) companying predominance of psychic over
WashiiT'ton, D. C.
physical symptoms especialh' when inquietude
dominates, constitutes a picture indica-
Some neurologists even of our own day ^-^^ ^^^^ ^^^^^ tj^e ^h^.x\^^, aprosexis, inbelieve
that ' psycho-neurosis, that all- somnia of a simple neurasthenia. When
embracing term, is a sufficiently precise g,, ^^^ ^ther hand, a patient suffering from
diagnostic guide to treatment.
nervous prostration is so asthenic as not to
They believe this because they do not be constantlv troubled by futile repetitions,
recognize that any differences in tlw treat- explanations, svmboles, hesitations or atment
of neurotic individuals are suscepti- ^^^^^^ ^^ precision, or when he does not
bleof being classed 1 hey think that the ^,,5 in a day dream, or when he has not
treatment consists of the therapeutists m- g^,gr„.^g|^j„g p^i,,5 orbesetments as
numerable adjustments to an infit.ite variety ^^ ,,j^ ^^^^jy functions or as to his relations
of individuals each quite unlike the other ^^j^j^ ^^-^^^^^ ^^ j^^ ^^ ^^^^^^ 1^^ i^ ^^^^
except 111 so far as one resembles the others ;„ ^ ^^ate of general distress, we may be
in being a psycho-neurotic.
^^^^ ^^^^^^^ ^^^ ^^ 1^^^^ ,^^^ ^^^^
Yox these clinicians, any distinctions with a psychasthenic. Even the feelings of
drawn between hysteria, psj'chasthenia
i„eompleteness mav have adequate grounds
neurasthenia, and hypochondriasis, and
j^^ ^^^ ^^^^ exhaustion of the patient whose
have only an academic value; as the treat-
„eurasthenia,creates (more than a mere senment
of each IS, for them, the same. Ihe
timent), a real incapacity to perceive, deobject
of this paper IS to show the fallacies
.^^^e, to will, to act, to adapt himself to a
of the blunderbuss method entailed by so,
„^^^ situation, to be other than timid, even to
confusing a conception, and that from
forget and lose in intellioence, as well as to
pyscho-neurotic conditions in general can
be really melancholy or^indifferent, and to
be clearly separated, at least three clear
require comfort and direction,
ypes, and tha as regards treatment these
^^^^ ^^^ ,^^^ neurasthenic, hasreal pains,
' types diiter as the poles. . • , ,. ,. ,, .^. ,. ,
' K, J . , ,, ., gastrointestinal trouble, nutritive disorders,
Now-a-daysstrychnme and bromides are
vasomotor and secretorv pertubations and
regarded as physiologically incompatible.
^^^^^ impotence; while the psvchasthenic
Similarly belladcmna IS not prescribed with -^.^^ ^^^J^^ ^„ incapacitv vhich he thus
phvsostigmme, nor calcium with the alka- ', -^ u i- ,. ^,' •
'>=

ORIGINAL OOMJIUXICATION. 27
tro-intestinal auto-intoxication, so called, heightened suggestibility. Moreover, indue
to faulty diet; bacterial modifications toxication by alcohol, haschish, or bacteof
the flora of the digestive tract; chronic rial products in the course of infections
diseases, etc; not forgetting the constitu- maj' affect the psyche in either or both of
tioually born tired individual. these ways. These are the symptomatic
From these considerations a clinician may psychasthenias and hysterias respectively,
know when he is dealing with more than a and are analogous, nosologically speaking,
simple neurasthenia, and thus can avoid to symtomatic hallucinations, disortentawasting
the patient's time and money on a tion and delusions seen in the fevers or exuseless
"rest cure, " which would not onh' haustion.
fail to ameliorate the psychasthenic symp- Another form, psychasthenic in tppe,
toms, but would aggravate the patient's false neurasthenia, unfortunately too corncondition
by isolating him from the stimuli mon, is that induced by the reaction pf the
of daily life, some of which are not inju- patient against some disappointment, disrious
to his mental state and should be util- grace or other psychic trauma. Initsesized
as a fulcrum to uplift his will power, sence this is what psychologists call a defer
which purpose they should be especially fen se reaction, and further analyzed is one
managed or at least arranged by the doctor, of the varieties of what Dupre (4) has
The successful psyc/iol/ierapy of psychas- termed mythomania, though of the types of
thenics is arduous, and often only relative- which he speaks none simulate neurasthely
successful. Any isolation imposed upon nia. The brilliant inventions of the conthese
patients is confined to certain situa- stitutional liar, or those of poetic fancy, do
tions and acts, or is a mere simplification not adapt themselves to so uninteresting a
of their life; and the ])rocedure is quite dif- role as that of a neurasthenic; they tend
ferenl to that used in hysteria to emphasize rather to assert themselves in a more posithe
suggestion, persuasion against, and re- tive manner than the negation of activity
education of the morbid trend. Xor is it entailed by the neurasthenic role. The apthe
isolation required by the neurasthenic, petite for distinction; the dislike of neglect
for whom the deprivation of jjhysiological determined to be fed, and having no means
stimuli is required to give rest to exhausted of satisfaction through exhibition of talent
neurones and induce an anabolic phase, or capacity to perform in some useful way;
Psychasthenics, on the contrary, require or from indolence or cowardice of disposiphysiological
stimuli in order to maintain tion, resorts to the extortion of sympathy
what Janet calls the "'ijsychological ten- by its perseverance in a suffering in which
sion. Of course, stimulation must be short the patient indeed comes to believe,
of exhaustion. One of their characteris- Sympathy or even praise removes deprestics
is to be able to bear themselves well sionor vacuity of mind, titillates the psyche,
during temporary stresses. A physical, .\ child who has learned to lean upon either
mental or moral strain when too long con- is a candidate for false neurasthenia of this
tinned, however, is sure to induce a psy- type when later in life some business or socliasthenic
crisis, a desire for movement, cial project miscarries. When a person is
feeling of unreality, expectant anxiety, or ruined or slighted, or when ambition fails,
obsessive doubt, or any of their numerous neurasthenia is often diagnosed and a rest
modifications. Of course etymologically cure imposed. Psychotherapy pure and
speaking, psychasthenia should be a form simple, is the true indication: for the state
of neurasthenia, but nosologies do not de- was not neurasthenia, but a palsy of will
pend upon etymology, else hysteria would and interest whose jwychogenesis is manibe
in a sad plight. I do not defend the fest in the fixed idea of a determination to
term psychasthenia, but merely accept it as lie down acquire thus the moral comfort to
a now pretty well recognized clinical auto- their vanity the misfortune itself did not
noniy, representing at least a clearly de- bring largely enough to satify it.
fined mode of reaction to environment dis- 'i'he personality of many a woman denied
played by certain individuals, often of neu- a legitimate field eventually shows itself in
ro])athic heredity. As such it is clearly chronic neurasthenia (sic). Her beautiful
differenliable from the picture of neurr>s- resignation at last gives her the eclat she
theuia, of which the dominant feature is has longcraved; she now has an object for
fatigue and easy fatiguability, as well as which she exists, and nurses that as caremany
physical symptoms not so usual in fully as her husband does his business or a
doui)ting madness and the other forms of naturalist his collection,
what we have agreed to term psychasthenia. .V remarkable case ( 5) of this kind has
It must be remembered that a truly neu- just come to the writer's notice. -It was
raslhenic condition may produce in certain that of a naval yeoman, who after rapid
individuals oljsessive manifestations and promotion of which he had reason to be
morbid fears and timidities, as well as a proud, utterly broke down on account of

28
THE CHARLOTTE MEDICAL JOURNAL.
the exactions and irritability of a new com- matograpia, urticaria, oedema, phlyctenulmander
whom he could not please. Mis la, fever and so on. The numerous instate
of heallh eventuated in his desertion, stances where these phenomena have ocalthough
this stigma was later removed curred along- with such systoms as hemiafroni
his record. His symptoms were mo- nesthesia and contracted visual fields in
rosity and and loss of interest and stamina, suggestible patients of mobile humor are
impotence, and overpowering desire to get referable to the intercurrent disease someawaji
from his distressing environment and times at the root of the hysterical state,
to go to his mother. He also seriously But more often they are due to intentional
thought of committing suicide. He become trickery on the part of the patient of mythosuspicious
to the point of believing that the w««/V tendencies (as Dupre has (14) deobject
of his persecution was to promote scribed with his rare clinical insight from
over his head his clerk, who had been long- his large experience at the spscial police
er in the service and was more efficientthan infirmary in Paris), in other words the couhimself,
though too unreliable for the chief stitutional liar, if it takes an evil direction,
post. As soon as he felt that he was in an or the maker of romances if the sphere of
asylum and free from the risk of having to the patient is literature or art. It is merely
return to an environnient he could not the carrying into adult life the child's love
stand, he began to improve, and recovered of phantasy, combined with the desire to
within three months. All the time, he was attract attention or sympathy. If from a
glad even to believe himself insane so as to lack of capacity or opportunity it cannot
get away; and indeed while under the find an outlet in the direction of creative
treatment before going to the asylum had art, the imperative desire to mystify or inrun
away from home with a vague idea of terest takes the vulgar form of the simulafinding
employment. Although well in tion of some bodily defect seen, read, or
other respects, he still interprets his expe- heard of.
rience as an attempt by the commander to I have elsewhere discus.sed the mechansupplant
him. If this is re.illy a delusion ism of the acquisition by imitation of simuof
persecution, its strict limitation to the lated symptoms (15), which is merely a
detail of the mental conflict it concerns form of suggestion, and I have given exwould
place it in the category of Frieduian's amples (16) of cases where a suggestion
first form of restricted paranoia, (6) has lain latent for long periods, such as
which is cured through subsidence of the those of a girl who became paralyzed as
effective state which causes it; and although the result of a slight electric shock she felt
no insight comes, the delusion persists only or imagined on crossing a car line. Though
as an intellectual complex without feeling she had completely forgotten the circunitone.
This type is distinguished from the stance, close questioning revealed the fact
allied form in which the delusions are en- that she had six months before heard some
dogenous, that is to say of hypochrondiacal mechanicians narrating the dangers of electype,
resembling tiierlich's paranoia (7). trie shocks. Of course this hysterical pak.
Botli are episodic affections, and hence dif- was quickly removed by suggestion. An
ficult to distinguish from manic-depressive other example was that of the Hebrew buy
insanity, in which, however, insjght occurs (17) who had retained his evacuations for
on recovery, the patient being astonished three days while hiding in a barrel during
that he could ever have thought and acted the massacre in Russia. It was not until a
as he did. year later that he developed retention of
Of hysteria the treatment markedly dif- urine, quickly cured by suggestion,
fers. I speak of hysteria in the precise Some clinicians, (18) however, believe
sense which we have learned to adopt from that suggestibility occurs outside hys-the
recent work of the followers of Charcot teria properly speaking, by which they
(8). From them we have learned to ex- mean that debiles, desequilibres, and perclude
from the hitherto vague picture of sons in crepuscular states are suggestible.
hysteria every symptom which does not This of course is true; and in so far as they
conform to the definition of Babinski (9): are suggestible, they are hysterics, the fact
"Susceptible of being produced by suggest- that they are something else as well no
ion and of being removed by suggestion- more negativeing the definition than does
persuasion." The recent discussion at the the presence of albumin in a diabetic nega-
Faris neurological society ( 10 ) summarized tive the glvcosuric character of that disease. ;e.|
elsewhere by the writer (11) clearly ex- Equally a'person with organic heart disease, se.
eludes from hysteria alterations of the ten- may acquire phthisis, or a person with
don reflexes, of the pupillary re ictions, scarlet fever may contract diphtheria. Ann
true muscular spasms in the sense in which titoxin will cure onlv the diphtheria: thd
the word is used by Brissaud (12) and de- cure in the open air" will remove onlv the
scribed elsewhere by the writer (l,n der- phthisis, leaving the cardiac disorder." lu
i
,

ORIGIXAL COMMCNICATIONS. 29
the same way, the removal of hysterical perhaps be cailed suggestive-persuasion, as
symptoms by suggestion leaves the patient it combines the characteristics of each as
just as before with regard to his reurastbe- defined by the writer elsewhere. (20) It
nia, mental debility, etc. is these cases which have given rise to so .
The tics, obsessions, feelings of inade- much difficulty in laying down a clear symquacy,
timidities, scruples, ereutophobia, tomatology of the two affections: they are
agraphobia, and other morbid fears, as the hystero-neurasthenics of the older wriwell
as the impulses to steal and to act or ters: and are by some still erroneously callspeak
obscenely and towards meaningless ed neurasthenics. The most coiispicuous
flights, all of these belong to the psychas- recalcitrant in this respect is Dcjerine, (2)
thenic constitution, often called the obes- who refuses to apply the cognomen of hys-"
sive slate or /y.vf de double from its charac- teria to \h& false gasiropaihs whom he cures
teristic symptom of uncertainly. Any of after the method of Dubois of Berne. (22)
these symptoms, however, may be produced This method which both Dubois and Dejein
a non-psychasihenic individual by sug- rine call persuasion, is conclusively shown
gestion. In this case, however, it can be by Levi and Bayot, not to differ from the
as easily removed by the same means, thus suggestion of I^ernheim, and is practiced
distinguishing it from the true obsessive by them with great success, and in this
phenomenon, which is accompanied by country by Taylor of Bcston, and others,
dread of its occurrence and is quite una- The false gastropaths are in reality neurasmenal)le
to suggestion (19). thenic only secondary to the malnutrition
Now none of the preceding symptoms is caused by their fixed idea they cannot diessential
to the neurasthenic state, which is gest. {2i) This fixed idea generally arises
a mere fatigue entirely irremediable by jisy- bv suggestion, that is, is hysterical, and is
cho-lherapeutic measures. It is true that thus curable by suggestion. It is usually
in a fatigued condition the suggesliliility of medical origin, (24) and is the conseof
everyone augments; and a neurasthenic (juence of the temporary dyspepsia for
sometimes from mere tiredness will not re- which a doctor is consulted who does not
sist solicitations to which in his normal recognize the necessity of wiping out the
state he would refuse to respond. It is also suggestion of disease induced by the pretrue
that in his astlienic condition the cautions he advises the patient, and who
easier course is sometimes to allow himself is ignorant of the inhibitory effect of anxto
be cheered up even against his own bet- iety at meals upon the flow of gastric juice,
i ter judgment and to declare that he is bet- 2.t) A smaller proportion of false gaster
from the suggestion that he is belter; tropalhies arise secondarily to the shape of
for example, when soldiers are tired out body ( 26) ocurring in the scrupulous psyby
marching, their fatigue may ajiparently chasthenic who has been imbued by certain
be removed by the pyschic agency of music
or the excitement of approaching battle,
of the doctrines which have attached them,
selves to the Christian religion. A still
But it is only apparent, the reaction is all smaller propartion of ner\o-anorexias are
the greater. Similarly with a neurasthenic, the accompaniments of the modifications
encouragement, so often indiscriminately of the internal sensibility termed cenesihopused
by unskilful physicians, is followed athy, (27) and some are episodes in tlie
by still greater dei)ressioii and inadeciuacy. course of a psychosis, more especially de-
IntDxicaled neurones are no more capat)le mentia precox. None of these are true
ponding without injury to added stress neurasthenics, although of course anorexia
is the heart when compensation has is a prominent symptom of tlie neurasthenic
i. The neurologist sees many wrecks state.
u liicli have resulted from the uncalled for The foregoing considerations should enurging,
so inadvisably applied by the laity able an intelligent clinician to exclude by
of psychotherapeutic jiersuiision. the positive sign of suggestiljilty, any hys-
It is true that many so called cases of terical element in a difficult psychoneurotic
nervous break-down go on the shelf merely case, and enable him to undertake its treatfrom
incapacity, or want of desire to resist ment wilh a much clearer conception of the
the auto-suggestion or hetero-suggestion indications to be met in addition,
that they are not well. These are the Symptomatically speaking, psychotherapy
''Jalse neiirastheuics by suggestion;'" and ,\f hysteria resolves itself into skilful suguntil
their health breaks down from the se- gestion; but this only removes the sympclusion
and confinement to which they are loms as they occur or prevents them indiaometimes
ignoranlly subjected, the\' are vidually. It is anal gous to the procedure
curable merely by the removal of the false of excising the guinea worn or expelling
fixed idea that they are neuraslhenic. The the tape worm while leaving the head. Andestrnction
of this fixed idea may require other analogy would be the removal of the
a considerable time; and the process may neurotic areas due to a general infection.

30
THE CHARLOTTE MEDICAL JOURNAL.
Accordingly, the cause of the patient's sug- future dement.who suddenly' and without I
gestibility must be sought. It is derived external cause, loses his ambition, his i
from faulty education tending to perpetuate
and to' fortify the natural susceptibilpride,
his .dislike, his care for his person,
his fears (he cares for nothing not even
regard and without appar-
I
ity of the child, sometimes in conjunction
with a hereditary tendency or an acquired
himself ) without
ent suffering. He is not irritable to outside
organic disease interfering with neuronic things, small or great, as is the neuras- j
activity. Re-ediicalion (28) is the remedy tlieuic. The latter's egoism is entirely
J
in the first case; and in the last, failing lacking in him.
|
removal of the organic cause, adjustment The physical fatigue in dementia precox |
of the education in conformity with the pa- tends to occur in bursts, like a bolt from
tient's special deficiency. The principle is the blue, having no relation with the
that of converting suggestibility into per- enii)ty stomach, the morning heaviness, or
suadability, (29) that is to say the substi- the influence of mental or physical labor
tution of the habit of dispassionately weigh- like that of the neurasthenic. Psychoing
and comparing impressions for the therypy has no influence on these crises,
childlike immediacy of action by first im- It is in these cases that one sees the first
pulse. This is an art in itself, and would indications of the characteristic signs of the
require many chapters and illustrations for dement, the automatisms, and stereotj'pes
its adequate presentation.
It remains to differentiate the early stages
of nio\'ement, attitude or speech.
When carefully questioned, these patients
of some psychoses; for though these are always reveal hypochondriacal ideas; but
not treated by the practitioner, they are
usually first seen by him; and much injury
these are never accompanied by obsessive
anguish or morbid terror. The memory is
is done patients by confusing them with generally intact, both for facts and calcuconditions
such as the foregoing for ex- lation, while the neurasthenic's memory
ample. while sometimes impaired is so only during
Hebephrenia. (30) In its commencement his crises of inertia after ascertainable
and early evolution the neurasthenic state fatigue.
to the casual observer does not differ at all The foregoing are difiicult of appreciafrom
that characterizing the earlier stages tion; but there are certain others easy to
of the simple forms of dementia precox, in verify the presence of which connotes somethe
early stages of which the intellectual thing more than a mere nerve exhaustion,
deficiency and emotional disorder are con- For example, grimaces and tics unaccomcealed
by the conventional behavior which paniedby imperative besetment or the emothe
patient automatically shows. An apt tion of anguish, sudden impulsions of rage
illustration is that of an intoxicated man or aimless wandering, or even to absurd
who can accomplish quite well any task to acts; the persistent obstinate opposition to
which he is accustomed, but who shows trifles known as negativism, especially
himself quite incompetent in Ihefaceof when it alternates with extreme facility,
something demanding unusual mental con- When unusual peculiarities in behavior are
centration.
Apathy, sluggishness, feeling of exhaustion
and difiiculty of making efforts characadded
they are almost pathognomonic of
the future dement. A most important symp-
tom is the crazy laugh. This is explosive
terize both neurasthenia and hebephrenia,
The friends are very apt to magnify what
and without motive, having no emotional
accompaniment, neither shame nor annoythey
imagine to be the cause of "nervousness,"
which has ni reality occurred, so to
speak spontaneously, The preoccupation
ance being shown by the patient. It very
often terminates with an attack of tears. It
is perhaps the most striking mark of the inof
these patients with the exigences of their congruity between the patient's emotional
life is not the cause of their disease, but is
one of its effects. But there is a fundamental
distinction between the diseases,
Except at the very onset, a certain indifference
shows in the future dements. This
occurs especially with regard to their work,
Careful questioning will often reveal a period
during which work was done more
slowly, with difficulty, a certain stumbling
hesitancy. In the neurasthenic, this hardfeeling
and its manifestation; for the
laugh may interrupt an attitude apparently
denoting great sadness.
It must not be forgotten that physical
symptoms occur in hebephrenia. The se-
vere headaches are characteristic; peculiar
visceral sensations I have found ver\- com-
mou; treatment has little effect on these,
There is nearly alwavs anorexia, dyspep-
sia, constipation, gastro-intestinal intoxi-
ly exists; for fatigue predominates, he has cation, irregular menstruation, i
in women),
not lost interest; moreover, he has not lost heavy sleep and insomnia in alternation,
his affective instincts, they are rather ex- hvperhvdrosis, especially on the palms, diaggerated.
In marked contrast with the lation of the pupils, tremor and einacia-
|

ORIGINAL COMMUNICATIONS. 31
tioii. So that the clinician must not be- teric period should make the physician
lieve that such physical symptoms neces- think very carefully of this condition,
sarily indicate a mere passing intoxication Anxiety is the prominent feature in this
with neurastheniform accompaniments.
Having diagnosed hebephrenia we are
psychosis. In the presenile form there is a
feeling of uncertainty as well, while the
yet unfortunately not in a positiori to pe- form of simple apathy of the aged is the
scribe a remedy; but as there is no evidence most like neurasthenia; for there are not
that the Wier Mitchell treatment is efEca- delusions, and orientation is undisturbed,
cious in these cases, we at least save the The desire to commit suicide is very sigtime,
money and blighted hope of the pa- nificant involutional melancholia. From
tient's friends. Xot that hope need be the .?4'w//

^-> THE CHARLOTTE MEDICAL JOURNAL.
16 Williams, International Clinics, 1908, The author believes that this condition
Vol 111 P- 1-^- produced by the streptococci themselves,
17 Raimist, Revue Xeurologique, Paris, since no other bacilli are found in the exa-
'
^c)Q(^
dation. Treatment consists of the usual
is! Raymond. Dejerine and Dupres. in general measures and lavage of the parts,
their discussion on Hvsteria. with dioxide of hydrogen or antisepti-
19. Raymond et Janet, Loc cit. washes.—La Progres Medical.
20. Williams, Alienist and Neurologist, Electrization ot the Stomach Studied
1909. with Radioscopy.
21. Dejerine, Les Fausse Castropathes, „,,„,, , . ,
^^^ '"^'^'^ ' • ^ ^"•"^'^'
-^5 Dubois La Traitentment Morale des of applications of electricity to the stomach,
watching the picture as it appeared by ra-
Presse Med 1906 ^- ^S°^°
Pv'scho Neuroses, Paris, 1904, Trans. New
diascopic examinations made while the
York 1907
23' Williams, The Most Common Cause electric current was in action. He used
of Nervous Indigestion, Jour. Abnormal faradism galvanism; and static electncty
Psvchologv, Boston, 1909.
and applied them withm the stomach, and
24 Bernheim, Suggestion L'Hypnotism outside on the abdomen. The experiments
etPsvchotherapy, 1903. Williams, Loc cit. were made upon dogs. Of the three forms
25: Pawlow, Functions of the Digestive of electricity used, the faradic current was
'Jiost
Glands, London, 1900.
effective in producing m producmgr
'6 Taiiet I oc
contractions of the stomach walls. Internal'
cit
27.' Dupres et Camus, Cepresthopathes, application gives no greater and even kssj.
effect than the best effect when appliedf I
L'Epcephale, Paris, 1907.
28. Levi, L'Education Rationale de la transvesrely or anteropostenorly. The mo-.;
Volonte, Paris, Pavot, L'Education de la nopolar method is also effective. Contrac--
Volonte Paris
tionsof the abdominal muscles or diaphragm;
29. Williams, Alieiii.st and Neurologist produce no stomach contractions. Static:!
electricity gave no good results. .The gal--
Lqj, (.jf
30. Pascal, La Forme, Pseudo neuras- vanic current is somwhat less effective than;
j
thenique delaDemence Precoce, Congras faradism. Apphcations made directly over: I
de Lille, 1906, L'Encephale, 1907. the stomach are less effective than trans- j
31. Williams, Importance of Pvchometry verse ones. The galvanic current should j
in the Diagnosis of Cerebral Disorders, In- be interrupted or poles changed, in order to
ternational Clinics (to appear). order to get contractions of the stomach.—
32. Williams, Loc. cit. Giornale di Electricita Medica.
33. See Regis Manual of Psychiatry,
Entero—Colitis and Cholera Inlantuivt.
1906, White Outlines of Insanity," 1908.
Necrotic Anginas and Perforations of
the Palate in Scarlatina.
The following advice from the pen of a 1
well known Denver physician, will be found i
to be most seasonable and helpful, in the |
treating of entero-colitis.
P. Lereboullet gives histories of five cases "Cleanse the intestinal tract with calomel
of perforation of the soft palate in scarla- and a saline or with castor oil. Prescribe 1
tina. This is a rare complication of scar- a suitable diet, easily digested and iioii-
let fever. In most cases it has proved fatal, irritating. Irrigate the rectum and colon at ;
but of the author's patients all recovered, suitable intervals with normal salt solulion I
It generally affects children under five years or some mild antiseptic, using for the pui- i
of age. A- false membrane similar to that pose a soft rubber catheter or colon tube, i
present in diphtheria first covers the tonsils "Instead of opiates, which lock up the i
and pillars of the fauces. In this mem- secretions and thereby favor auto-intoxica- ;
braue examination shows no diphtheria tion, relieve the muscular rigiditv and the i
bacilli, but only streptococci. The glands excruciating pain which is such a drain I
are sometimes not infiltrated, but the gen- upon the vital foces by the use of Aiiti- .
eral condition of the patient is bad. The phlogistine as hot as can be borne over the
larynx is not affected, but the nasal fossae entire abdominal walls and covered witli ij
may be involved. F'ever is high. This absorbent cotton. If the patient is not too ,1
lasts for some days, when the appearances far gone, the effect will be astonishing. ';
rapidly change. The tonsils necrose and The little drawn faced patient, who until .1
the palate may be perforated while the now has been suffering severely, will in |i
membrane clears up. There are no diffi- most cases soon quiet down: the agonized (I
culties of deglutition or phonation. If death expression will leave the face and restful ':
does not ensue the repair is rapid, the ti.s- slumber intervene, thus starling the child jf
sues showing little inflammatory reaction, upon the road to recovery."' ^ ]
^'
|
]
:'
''
"

EDITORIAL. 33
rUai'lriiio Lnai JOlie
X'iaA'trnl Iniifnal should arouse the thoughtful consideration
iVieUltdl journal ^^ ^^,^^^ ^-^-^^^^ ^^ ^^^^^ Carolina. The
Publisbed Monthly.
EDWARD C. REGISTER, M. D.,
fii'st ^^^s that the State should pass a law
requiring physicians to report every case of.
EDITOR tuberculosis, and that the cases should be
CHARLOTTE, N. C.
treated in sanitariums, and thus avoid the
danger to the health of others.
The second was that a law should be
passed making it a misdemeanor for any
jKirent or guardian to allow a child who
The fifty-sixth annual convention of the was born defective to go without sufficient
Medical Society of the State of North Caro- medical treatment.
Una was called to order on the morning of The third was that the legislature should
June 15th, 1909, by Dr. T. E. W. Brown, pass a law providing for a sanitary inspector
chairman of the committee on arrange- —a physician—who should visit the schools
ments, in the ball room of the magnificent frequently and thoroughly look after the
Battery Park Hotel in Asheville. Prayer health of the school children. He called
was offered by Rev. R. F. Campbell, D.I)., attention to the advances made by the last
after which Judge Thos. A. Jones, repre- legislature in establishing a sanitarium for
senting the Mayor of the city, delivered a the treatment of tuberculosis, but said that
splendid address of welcome. His speech
abounded in good sound, common sense,
the speaker laying particular emphasis on
this was only a step. The speaker believed
that the State had advanced by appointing
Dr. W.S. Rankin, of Wake Forest, to the new
the need of a better knowledge on the part
of doctors of medical jurisprudence. Judge
Jones said that on the witness stand the
i)osition of Secretary to the State Board of
Health. He paid a great tribute to the
work of Dr. R. 11. Lewis, of Raleigh, who
doctors of North Carolina had alwa\'s ac- has done so much for public health,
quitted themselves courteously and as gentlemen,
but he advised them to study some
Dr. Highsmith always has something to
say and he says it well. It may not be out
law and especially the law of medical juri^- of place to express an opinion which is uniprudence.
In this way, said he, could a versal among members of this Society, viz.,
doctor not only be able to hold his own be- that as president he occupied the chair with
fore any court but be able to protect him- grace and dignity, with fairness and just-
self from being entangled by a lawyer who ness.
had probably made a special study of the The registration at the time of the opensubject
under di.scussion for about a week ing session was estimated at two hundred,
previous to the trial, and was prepared with a figure that scarcely gives a true idea of
all kinds of questions to catch the expert the attendance. The program, while not
doctor. He also suggested that they use as extensive as that of some other meetings,
fewer technical terms in their evidence, as included many papers of very great scienthey
in that way greatly weaken their evi- lific value and profound interest. Thedisdence,
as a jury could not ui.derstand half cussions, engaged in with the greatest ena
doctor said because of the terms he em- ihusiasm, gave evidence of a genuine apployed.
"Speak to tlie jury in plain I'niled jjreciation of what the meeting means to the
Stales," said Judge Jones, "and not in doctors of our State. It would be impossi-
Latin." Ijle to mention all the papers and addresses
Dr. Chas. A. Julian, of Thomasville, in the soace allowed for these comments,
made eloquent response. As is character- nor would it indeed he fair to attempt the
islic his speech was expressed in the choicest task of specially drawing attention to any
language. With eloquent figures he paid certain ones. A number of prominent phyhigh
tribute to ^\sheville, her people, her sicians from other States were guests of the
climate, her beautiful environs, her institu- Society. Contributions from these gentletions
and her doctors. men added considerably to the interest of
The president. Dr. J. I*. Highsmith, in the meeting. Several subjects of special
his address on "Hygiene in Relation to importance werediscussed at length—among
Public Health" sketched the wonderful ad- these we mention especially the Pellagra
vances made in Medical Science and the and Tuberculosis Problems,
achievements in preventive medicine dur- The con-joint session of the State Board
ing the past thirty years. He emphasized of Health and the Medical Society was prethe
importance of educating the laity in sided over by Dr. George C. Thomas, of
order that tliere may be a proper apprecia- Wilmington, President of the State Board
ti>>n of the attitude of the medical man in of Health, and chief surgeon for the Atlantic
his efforts to improve sanitary conditions. Coast Line Railway. In opening the meet-
He made several recommendations which ing Dr. Thomas spoke of the very efiBcient

34
THE CHARLOTTE MEDICAL JOURNAL.
and very effective work of the retiring Sec- present. He likewise in fluent portrayal
retary of the State Board of Health— Dr. R. forecasted the future of the medical pro-
H. Lewis, of Raleigh, lie said that the fession.
work had been ably carried forward of ad- Essayist Dr. W. L. Dunn spoke of "Senvancing
preventive medicine, and that timental Barriers of Scientific Advancemuch
of tins advance was due to the untir- ment," among those being named antiing
zeal of Dr. Lewis. Others made many vivisection and opposition to post-mortems,
feeling and appropriate tributes to his He pointed out how the most notable disservices.
The report of the Secretary of coveries in medicine had been attained
the Board of Health dealt with the very through vivisection and maintained that
considerable advances made in this depart- while there might be rare, very rare cases
ment in our State in particular and in pre- of unnecessary vivisection the cause of
veutive medicine in general. He mentioned humanity demanded some suffering from
the recognition on the part of the legisla- the lower animals, pointing out that untold
ture of the value of the department by the suffering to countless thousands of human
increased appropriation. Reference was beings had been avoided through the realso
made to the laws enacted which require suits of experiments made on a few aniproper
analysis of mineral waters that are mals. Vaster progress could be made in
offered for sale, to the act making registra- medicine, he said, if physicians were pertion
of deaths obligatory and to the provision
for the free distribution of diphtheria
mitted to hold post-mortems on patients,
He made no suggestion, but simply pointed
antitoxin. out the loss to humanity which result from
The North Carolina Society for the Pre- prejudice.
vention of Tuberculosis held a session for The election of officers resulted as folthe
election of officers, those chosen being: "lows:
President, Dr. \V. L. Dunn, of Asheville.
Vice-president, Dr. Paul Ringer, of Asheville.
Secretary and treasurer, Dr. C. A. Julian.
President— Dr. J. A. Burroughs, of Asheville.
First vice-president— Dr. E. J. Wood, of
Wilmington.
of Thomasville.
Chairman committee on arrangements,
Second vice-president—Dr. John O. Myers,
of Charlotte.
Dr. Roy Williams, of Greensboro. Third vice-president— Dr. L. D. Whar- •;
The association is determined to make a ton, of Smithfield.
great campaign along educational lines Secretan,— Dr. D. A. Stanton, of High i
looking to the prevention of the spread of Point, re-elected.
tuberculosis. This work will be taken up Orator— Dr. Cyrus Thompson, of Jack- !
vigorously within the next year and the son ville, N. C. I
association is determined to push it. Essayist— Dr. R. \'. Brawley. of Salis- 1
An act of great significance was the elec- bury. !
tionof Dr. Julian, the secretary of the Soci- Leader of Debate— Dr. D. A. Garrison, i
ety for the Prevention of Tuberculosis, as of Gastonia. I
assistant secretary of the State Board of Treasurer— Dr. H. D. Walker, of Eli.a- ]
Health, the latter thus giving full of- beth City. 1
ficial recognition of the excellent work of Delegate to the American Medical Assothe
Society for the Prevention of Tubercu- ciation— Dr. T. 11. W. Brown, of Asheville. -.
losis. This election of Dr. Julian means Alternate—Dr. J. B. McGoughan, of ]
that the State Board of Health will shortly Favetteville. ^
begin a very active campaign against the Wrightsville was selected as the place of '
spread of tuberculosis. meeting, on the third Tuesday in next June, ij
Under the report of the Obituarv Com- Dr. George G. Thomas, of Wilmington, j;
miltee the eulogy of Dr. P. E. Hines by Dr. was chosen as chairman of the committee j
A. W. knox, of Raleigh, was a beautiful on arrangements for the meeting next vear.
|j
tribute to one of North Carolina's famous Committees were appointed as follows: (,
doctors. It IS one of the finest bits of lilera- On public policy and legislation— Dr. R. I
ture the State Society has ever heard. We H. Lewis, of Raleigh, Dr. Albert Ander- ||
call special attention to it. son, of Raleigh, Dr. George G. Thomas, of i
1 he annual oration by Dr. Moseley, of Wilmington.
Ckeensboro had for its text, "The Evolu- On publication— Dr. H. A. Rovster, of
tionot Medical Science, a Symposium of Raleigh, Dr. R. L. (^,ibbon, of Charlotte.
Its 1 ast and Its Manifest Destiny." The Scientific work— Dr. T. S. McMullan, of
paper manifested much brilliant research Hertford, Dr. R. II. Bellamy, of Wilmingand
dealt with the development of medicine ton.
from the earliest ages, from the time of the Finance— Dr. G. T. Svkes, of Grissom,
Iharaohs, through the dark ages, up to the Dr. I. Fearing, of Elizabeth City, Dr. Wil-
'J

EDITORIAL. oD
Ham Jones, of High Point. ciety, having joined in 1889, he has persist-
Obituary—Dr. C. A. Julian, of Thomas- eiitly declined to permit his name to be
ville, Dr. R. P. McFaj-den, of Randleman, offered for election to high office. The
Ur. J. W. McGhee. of Raleigh. innate modesty and unselfishness of the
Delegates to the Mississippi Association— man led him ever to prefer honor for his
Dr. C. J. O. Laughinghouse, of Greenville, friends rather than for himself. Aside from
Dr. J. S. Rhodes, of Williamston, Dr. J. W. having been made vice-president in 1896, he
Hooper, of Wilmington, Dr. C. S. Jordan, has received but one other office at the hands
of Asheville, Dr. J. R. McCracken, of of the society—that position he still holds.
Waynesville, Dr. \V. H. Cobb, Jr., of We refer to his having been made a mem-
Goldsboro. ber of the North Carolina State Board of
Delegates to the Virginia Association— Health, an office which he accepted most
Dr. M. Bolton, of Rich'Square, Dr. F. R. reluctantly and indeed unwillingly. Dr.
Harris, of Henderson, Dr. R. E. Lee, of Burroughs has been a most faithful attend-
Goldsboro, Dr, S. M. Mann, of Moyock, ant upon society meetings, and a prolific
Dr. D. O. Dees, of Greensboro. contributor of numerous valuable papers on
Delegates to the South Carolina Associa- a great variety of medical subjects. Untiou—Dr.
C. A. Patterson, of Mitchell failingly answering the roll call, he is and
county. Dr. W. H. Ward, of Plymouth, Dr, has always been ready to engage enthusi-
J. E. Ashcraft, of Monroe, Dr. J. D. Wal- astically in the discussions—business and
drop, of Ileiulersonville. scientific—whicb go to make up the round
A committee was appointed to represent of society duties. Open-hearted and honest
North Carolina in the revision of the United he is one of the most genial gentlemen in the
States Pharmacopoeia, which will be revised world, a pleasant companion and a friend
next year. The committee appointed con- worth having. A student of men and things
sists of Dr. W. L. Dunn, of Asheville, Dr. he is unerring in his estimates, and to his in-
Wiiliam DeB. MacNider of the University fluence and aid have been due the successful
of North Carolina medical faculty and Dr. launching of many younger men on useful
]•'..
J. Wood, of Wilmington. careers. A highly successful practitioner,
To sav that the visiting doctors were well !'« '« at the same time a man who has- pretaken
care of is to tell onlv half a truth, served the attitude of the investigator. A
Thev were royally entertained as onlv Ashe- close observer, his studies have resulted in
villeknowshowloentertain. Evervth'ingwas l'»e contribution of a large number of genudone
that could be to insure a pleasant '"«!>'
stav.
scientific articles which show a most
A good old-time barbecue was given at comprehensive knowledgeofthingsmedical.
Overlook Park. A reception and dance at '-""S familiar with society affairs, he will
IJatter^' Park Hotel, a reception and niusi- prove himself a thoroughly capable presidcale
at tiie splendid home of Dr. R. S. Car- '"K officer; his honesty will render him fair
roll, drives, luncheons, &c., afforded a andimpartial in hisrulingsand hisunfailing
never-ending series of pleasures. The visit- courtesy and geniality will recommend him
ors were frank in their expressions of ap- ^° all. We would offer him our congratupreciation
of the manner in which their
lations. our best wishes, and our support
unstintedly.
every comfort and desire was considered.
The next meeting will be held at Wrightsville,
beginning on the third Tuesday of human ftwo boviine tubercuuosis.
June, 191(J. The time honored controversy concerning
the identity of human and bovine tubercu-
THE PRBSiOBrnr or tub mbdic/xu so- losis continues to afford a fruitful field for
ciBrv OF rue s*rArB-or NOMrri theorizing and experiment. The eminent
ortROBiNA.
discoverer of the tubercle bacillus, Robt.
It is with many pleasurable sensations Koch, stands almost alone in his belief that
that the Journal thus indulges in favor- the human and bovine bacillus respectively
able emendations concerning him who are essentially distinct. He maintains that
now occupies tlie highest seat of honor the bovine bacillus cannot, except on the
in the gift of the Medical Society of the rarest occasions, produce the disease in
State of North Carolina. Dr. James A. man, and that, even when it does so, the
Burroughs, of Asheville, N. C, needs no disease is local and not progressive; the
introduction to the medical profession of same being true of the human bacillus in
this Slate, or indeed of the whole country,
He is widely known and favorably known.
That he will wear the honor conferred upon
him worthily and dignify and grace the
office he now occupies no one can deny,
For many years a member of the State Soits
relation to the ox. Arrayed against
Koch is practically the whole scientific
world, yet such is the weight of authority
which any pronouncement of Koch's carries
with it, that, even after several years of
searching investigation, the question seems

36
THE CHARLOTTE MEDICAL JOURNAL.
as unsettled as before. At the last great same, and that man and animals caJi be
Congress on Tuberculosis which met at reciprocall}' affected with it. The third and j
Washington, D. C, in 1908, the debate most recent interim report of the commisraged
hotly, and after numerous attempts sion is concerned with some important \
and a conference i?i camera a solution of aspects of the third question—that, namely, I
the problem still remains a great way ofT. which deals with the conditions under which j
Following the meeting of the Interna- transmission from animals to man takes '
tional Congress on Tuberculosis in London place, and the circumstances which are "
,
,
j
i
]
;
;
in 1900, at which time Koch announced favorable to such transmission. Tubercuhis
famous dictum, the British Government losis of the udder is fairly common in cows,
\
appointed a Koyal Commission to inquire and the milk of such cows always contains
and report (one) whether the disease in animals
and man is one and the same; (two)
whether animals and man can be reciprotubercle
bacilli. But it was undecided
whether tuberculous cows gave tuberculous
milk in the absence of manifest lesions of
\
\
cally infected with it; (three) under what the udder. Six cows were dealt with, five
conditions, if at all, the transmission of the of which had normal udders, while that of
disease from animals to man takes place, the sixth was affected, but so slightly that
and what are the circumstances favorable the lesion could not be detected during life. '
or unfavorable to such transmission. This Three of the cows were apparently healthy,
commission has issued three interim reports
—one very recently, and their findings are
the fact that they were tuberculous being
demonstrated only by their reaction to
succinctly stated by Zy/^" //o.9;!>//a/ of Feb. 9. tuberculin; while the other three showed
According to the reports, the bacilli associ- definite clinical signs of the disease. The
ated with human tuberculosis fall into two milk of those apparently healthy failed to
categories. Of these, one—called the causetuberculosiswheninjectedintoguinea-
"human" type, because it occurs in the pigs, while that of the three which showed
majority of human examples of the disease clinical evidences of the disease produced
—produces limited non-progressive lesions tuberculosis, though not invariably. Thus
in oxen, rabbits, pigs, and goats. But in infection of the udder is not a necessary
guinea-pigs, monkeys, and anthropoid apes element in the production of tuberculous
it results in a generalized tuberculosis. To milk by tuberculous cows. Moreover, the '
this "human" type therefore Koch's dictum faces of five out of the six animals were |
applies. But in a large group of cases, in- found to contain living and virulent tubereluding
particularly the primary tubercu- cle bacilli capable of producing tuberculosis
lous lesions of cervical and abdominal in guinea-pigs and swine. The bearing of
glands, the causal bacillus is absolutely this item is of the highest significance, in
indibliuguishable, both culturally and mor- view of the indifferent cleansing to which
phologically, from that habitually associ- the udders and adjoining parts of milchated
with bovine tuberculosis. This, there- cows are commonly subjected, and the ease ;
fore, is called the "bovine" type. Injected with which milk may become contaminated i
into bovines it produces a generalized tuber- by fsecal products unless the greatest care '
culosis identical, both clinically and patho- is observed. Further, sinct pigs may be '
logically, with that produced by the injec- made tuberculous by being fed with tubertion
into these animals of bacilli of known culous milk, the practice of feeding pigs '
bovine origin. In anthropoid apes bacilli with the milk from ailing cows ceases to be !
of the "bovine" type, whether of human justifiable, both from the hygienic and the j
or of bovine origin, alike give rise to gener- economical point of view. Altogether, the \
alized, progressive, and rapidly fatal tuber- Royal Commission has already earned the "
culosis. thanks of the public, and it is not likely (
l^rom this It is apparent that the first two that future protestations by the eminent i
of the questions set to the commission are discoverer of the tubercle bacillus will alter ,
conclusively answered. Although it ispos- the general opinion that in this particular '
sible to distinguish a "bovine" and a business he has been seriously mistaken. !
"human" type among bacilli respon.sible
for human tuberculosis, these two must be
anti-typmoid iNOGUUftTiON.
considered mere variants, l-or in cultures Inoculation against typhoid infection was !
all gradations are met with between the two first advocated and begun during the Boer
types while the less virulent "human" type war by Sir A. K. Wright, the famous pro- !
'
can, by passage through a series of calves, niulgalor of the Opsonic Theory. One of
be converted into a strain capable of pro- the most widespread of all diseases, it is not \
ducing in bovines a generalized tuberculosis strange that typhoid fever should occupy
such as characterizes the "bovine" bacillus so prominent a place in the minds of those {
proper. J hus one must say *
that the dis- who are hoping for such great things to
ea.se m man and animals is one and the come from anti-inoculations. Dr. J. F. '

EDITORIAL. 37
Siler, of the U. S. Army, in an instructive in what way the immunity is produced,
article published in the Post Graduate be- Very interesting theories have recently been
lieves that antityphoid inoculations are advanced concerning the true nature of lybeneficial
in that immunity is conferred phoid fever but our knowledge is still in-,
which greatly diminishes the liability to
infection. The vaccine used in the U. S.
Army is the same as that recommended by
complete and far from exact. However the
facts stand out for themselves. Those who
have employed the method and observed
Wright: a broth culture of the bacillus ty- the results are confident that not only is the
phosus which has been sterilized by heat, incidence of typhoid fever reduced by in-
At present it seems to be considered best to oculation, but that the mortality rate in
use an old strain of the bacillus that has a those who, after inoculation, do become
low degree of virulence. This old strain is infected, is distinctly lowered,
transferred to broth, and after 24 to 48
hours' growth, the culture is sterilized by the PREsiOBNr's ft>MJftu rVDDRESS
heating for one hour at a temperature of
.S,i° C. Experience has shown that
I'^'sewhere
this de-
m this issue we publish the
gree of heat is the death point of the
annual address of the president of the
iv- Medphoid
bacillus, and cultures
'cal
sterilized
Society of the State of North
at
Carolina,
this temperature rather than at 6(»° C. give I^""- J- I^- Highsmith, and it is only proper
much better protective results. It is prob-
^"^t ^^'^ ^'"ct the attention of our readers
able thst the action of the protective sub- ^^ >t- ^^^^^ f*" ^'^ distinguished abilily
stance present in the culture, is impaired ^'^ ^ presiding officer— a position which he
by the higher tenifierature. After the cul-
R^'^^^d and honored in every way, Ur.
ture has been heated for one hour, Miglismigh has given yet another evidence
it is
tested to see that the bacilli are dead. After °^ ^^^ eminent qualillcatioiis and has enithis,
a small amount of antiseptic solution
Piiasized his right to a place among the
is added, a 0.2.5 per cent, solution of
leaders
Ivsol
of his professien. The president's
having been found sufficient to preserve the
address shows a most comprehensive knowlvaccine
and prevent its becoming contain- ""^^^ °^ *e theme which was certainly most
inated. The vaccine is then
fittingly
standardized and appropriately chosen. Just
by ascertaining the number of bacilli in a
^^ t'"'* time our State—and indeed the engiven
quantity t're country—is of vaccine. The dosage awakening to a realization
is:
.SO(),0()(i,(K)U for the first inoculation. The of the importance of improved hygiefiic
standardization is so carried out that each
conditions and the fact that prevention of
1 c.c. contains 1,(JUO,()00.0(»() dead tl'sease is
germs,
the keynote of modern progress.
The first injection would therefore
Already
consist we are witnessing the effects of
of ..S c.c. of the vaccine. t'^^
This is followed
awakening in the campaign against
in ten days bv the second injection
certain diseases, nnd in legislation
consistregarding
ing of 1 c
public
c.
health affairs. And in many other
o*'^^'' "'=»>'«
Tliere is both a local and "^^ "'^
general reaction,
perceive a proper realizatbe
local reaction consisting
t>on
in a reddened,
of what Ur. Highsmith so eloquently
tender spot around the point of
emphasizes in his address.
infection, That our hon-
^''ed which is u.suallv not larger than I'lesident is
the palm a student of health conof
the hand. The general reaction
ditions could scarcely be denied after one
varies,
but the most severe form is manifested bv ^'^^ '"^^^'^ the pages to which we refer.
headache, loss of
articular
appetite,
stress is laid and occasionally
bv the writer
herpes labialis, nausea, vomiting and «" tl'e necessity of educating the public
trailsient
albuminuria. It is the general opin-
"'°"- the hues of hygienic and sanitary
ion tliat the amount of
prol'lems.
protection acquired
Medicine has made most woii-
clerful may be gauged by the
strides amount
during
of reaction:
the past few decades
—the more marked the reaction,
'"
the greater
every field. Great progress has likewise
the protection. Two ^^een
injections should be made in preventive medicine, but tins
given at an interval of ten
particular
davs and if the
branch has lagged behind, doubt-
less
reaction first and second injections is not
because of the seeming mystery which
noticeable, a third inoculation should be
envelopes the medical profession and begiven
after an interval of ten days. The cause of the neglect of any systematic alsyraptoms
all disappear,
tempts to instruct laymen concerning the
as a rule, within
12 hours, and for this reason
essential
the inoculareasons
for fighting disease and
tion is best given about four o'clock
disease-breeding conditions. I he special
in the
afternoon. The points of injection are over P^^^ "^ ^^'- Highsmith is for just this-eduthe
pectoral
^^tion
muscles or at the
Education of individuals with the
insertion of
the deltoid.
special view of fitting them to instruct the
Nothing definite is known as yet as to the multitude. Instruct the people through
duration of the immunity nor is it known every possible channel—the children in the

38
schools as well as the parents in the home.
The importance of this is evident to the
most casual observer when he looks about
him and sees the utter disregard of the simplest
and most fundamental rules of health
in every class and condition of our people.
It is all however a neglect which has its
origin in ignorance for which doctors are
largely responsible, at least they must be
the first to attempt a remedy.
Laws are also essential. Public opinion
must first be aroused in order that the laws
may become possible. The two are mutually
interdependent—the one being ineffective
without the otl;er. We would call attention
especially to the excellent saggesttions
made by the president regarding the
enactmet of certain laws. These, we believe,
deserve the thoughtful consideration
of every citizen in our State. The Journal
is thoroughly in accord with Dr. Highsmith
in believing that such laws are badly
needed and that their enforcement would
go a great way toward bringing preventive
medicine to that plane of development to
which it must be and will be brought within
the next few decades.
Dr. Highsmith has delivered a message
which is pregnant with good, and we believe
that his words will bear fruit.
Editorial News Items.
Examination Questions Asked by the
Board of Medical Examiners at
Asbeville, N. C, June, I»09.
MATERIA MEDICA.
By Dr. Benj. K. Hays, Oxford, X. C.
1. Name the organs influenced by (a) a
cholagogue; (b) a sialogogue; (c) an
oxytoxic; (d) a diaphoretic; (e) a mydri-
atic.
2. t'.ive the oiScial name, using the correct
Latin terminations, of (a) Epsom
salts, (b) Dover's powder; ( c) Calomel;
(d) Salol; (e) Fowler's solution; (f)
MofTman's anodyne: (g) Cod liver oil.
(h) Sulphonal; (i) Aristol; (j) Spirit of
Nitroglycerine.
3. Define a tincture. Name four of the
most important official tinctures and state
percent strength of each.
4. Give the dose of a { a ) pomorphinae hydrochloridum;
(b) Arseni trioxidum; (c)
Chloralum hydratum; (d) Atropinae sulphas;
(e) Ilydrargyri chloridum corrosivum;
(f) Slrychninae sulphas; (g) Hexamethylenamia;
{h) Tinctura aconiti;
(i) Tinctura gelsemii; (j) Glandulae
suprarenalis sicca.
5. Give specific treatment for diphtheria,
THE CHARLOTTE MEDICAL JOURNAL
and state (very briefly) how the remedy
is obtained.
6. Give specific remedy for myxedema.
7. Write a prescription for dysentery.
8. Name four drugs which might be use-
ful as local applications in tonsilitis.
(Official remedies onl}'.)
9. Name five agents (not official drugs)
which frequently cause poisoning.
10. Give specific antidote for poisoning by
(a) Bichloride of .Mercury; (b) Arsenic;
(c) Iodine; (d) Opium; (emetics, stomach
pump, etc., being taken for granted).
CHEMISTRY AND DISEASES OF CHILDREN.
By Dr. John Rodman, Washington, N. C.
1. A patient is found with a temperature
of 104 degrees Fahrenheit. Express this
in Centigrade.
(b) Express the equivalent of one grain
' (decimally) in grams,
2. Metlij'l alcohol, give (a i common
name,
(d) uses (e) dangers.
3. Define combustion, and state what takes
place when coal is burned.
4. What is fractional distillation?
5. Name four mineral acids used in medicine
and give formula of each.
1. Ophthalmia neonatorum, (a) Etiology
and symptoms.; (b ) Crede method of prophylaxis;
(c ) Treatment, general, medicinal.
2. Describe Kernig's symptoms of cerebrospinal
meningitis.
3. Give diagnosis and treatment of acute
intussusception.
4. Describe the eruptions in (a) chicken
pox; (b) small pox; (cj measles; (d)
scarlet fever.
5. Give most common complication in
scarlet fever and treatment of same.
OBSTETRICS AND GYNAECOLOGY.
Bv John Bvnum, M. D., Winston-Salem.
N. C.
1. Describe the uterus, its normal position
its relationship to other organs, and
means by which it is held in place.
2. Give symptoms and treatment of placenta
previa.
3. What is plegmasia alba dolens? At what
time does it occur? What is the treatment?
4. What are the danger signals of impending
eclampsia? Give treatment of eclampsia
at Sth month of pregnancy.
5. Define abortion, miscarriage, and premature
labor. Give treatment of an incomplete
abortion.
6. Give the etiology and treatment of an
acute general cystitis.
7. Define plastic operations as applied to
gynaecology.

8. What is the differential diagnosis between
ascites and ovarian cyst.
I'R.VCTICE OF MEDICIXE.
r,v !I. 11. Dodson. M. D., Greensboro, X.C.
: ',i\ e differential diagnosis between
'\[\c ricer and Carcinoma of stomach.
*ii\e pliNsical signs in Croupous Pneumonia—in
the stage of solidification and
differentiate from Pleurisy with effusion.
,>. In Aortic and Mitral InsufBciency,
where is the murmur heard most distinctly
and its direction of transmission?
4. (Jive lUiology of Cerebro-Spinal Meningitis,
(epidemic) and characteristic
symptoms.
r>. Define Arterio-Sclerosis, and give chief
causes producing it.
(). Ciive symptoms of hemorrhage in Typhoid
I'ever and treatment.
7. What is the chief cause of Locomotor
Ataxia? (".ive symptoms briefly in initial
and ataxic stages.
5. Wliat conditions are found in examination
of urine, and circulation in chronic
Interstitial Nephritis?
istering chloroform?
6. Describe method of preparing hands for
a surgical operation or obstetrical exam-
ination.
7. Why do we have abscess of tlie liver
following purulent appendicitis?
•S. What is the rule as to fixation of joints
above and below a fracture?
9. Mow do you differentiate between chan-
cre and chancroid? What is period of in-
cubation for each treatment?
10. Describe operation for talipes equino-
1 1
.
varus.
I'"or the diagnosis of what disease is the
Wasserman reaction used?
' ^'ou are exjiected to answer only in
questions.)
EDITORIAL. 39
PHY.SIOLOGY AXD HYGIENE.
By J. L. XichoLson, M. D,, Richland, X.C.
1. What evidence is there that the secretion
of urine is not a simple process of
filtration from the blood? State the probable
nature of the stimulation controlling
the secretion of urine.
2. Explain the structure and use of each
of the three coats of blood vessels.
3. Name the principle centers of organic
function situated in the medulla oblongata.
4. Give the teachings as to the (a) origin
(b) functions (c) variations in number of
leucocytes.
.T. Five the functions of carbohydrate
foods.
(>. Discuss Enzymes: Giving (a) Their
general character, (b' six principle ones,
where chiefly found, and their respective
actions in the process of digestion.
7. What is the significance of (a) nitrates
and (b) nitrites found in drinking water?
5. Give the prophylaxis of uncinariasis.
9, Give briefly treatment
ticular Rlieumalism.
10. Write one prescription
ment of I%rysipelas.
SURGERY.
for Acute .\r-
for local treat-
9. Discuss municipal supervision of a city's
milk supply.
10. Discuss the contamination of air in
dwellings, consequent upon improper
lighting, heating, and ventilation.
ANATOMY.
By W. W. McKenzie, M. D.
By L. H. McBrayer. M. I).. Asheville. 1. Name the bones of the head, and de-
1 . What is pathology and treatment of
paronychia?
J. What is pathology and treatment of
scribe the frontal bone.
2. Where does abdominal aorta commence
and where does it terminate? Name its
o.steomyelitis of tibia?
.3. Describe operation for radical cure of
branches.
3. Name the principal lobes of the brain
oblifiue inguinal hernia.
and the fissures dividing them.
4. Describe ojieration for acute catarrhal
appendicitis.
.5. How would you treat a patient who had
suddenly ceased to breathe while admin-
4. Give the origin and function of the
trigeminus (5th cranial) nerve, and name
the divisions of the same.
.T. With what bones does the astragulus
articulate.
6. Describe the stomach, give its average
size, attachments, regional location, gross
structure, blood and nerve supply.
7. Give origin, insertion, and action and
nerve supply of the following muscles;
Deltoid, Soleus, and Quadratus Lumborum.
5. Give the surgical anatomy of femoral
hernia.
'). Locate and describe the ovaries.
ID. Give a histologic description of an
artery.
11. Describe the rectum.
12. Describe the Iris, give its blood and
nerve supply.
(Answer only 10 questions.)
A. G. U. SURGEONS MBBT.
The annual meeting of the Association of
Atlantic Coast Line Railway Surgeons was

held at Wrightsville, N. C, bes;iniiing June
8th, conlinuing through the 9th. Half a
hundred members were in attendance and
the sessions were characterized by great enthusiasm.
The membership of this bod)' is
composed of those who stand highest in the
ranks of the profession throughout the territory
covered by this great railway system.
The meeting was opened with prayer by
Bishop Robert Strange, after which the
address of welcome was delivered by Mayor
Walter G. MacRae, response being made
by the president, Dr. J. H. Mcintosh, of
Columbia, S. C. A large number of highly
interesting scientific papers were presented
and discussed. Mr. Geo. B. Elliott, assistant
general counsel of the Atlantic Coast
Line, spoke on the relation between the relief
(Surgical ) and legal departments of the
railroad. His address was heard with the
closest attention. The Tidewater Power
Company entertained the visitors at Lumina,
the spectular amusement pavilion at
Wrightsville. At this place also Mrs. Geo.
G. Thomas, wife of the Chief Surgeon of
the System, entertained the visiting surgeons
and their wives at an informal recep-
tion.
The Chattanooga and Hamilton County
(Tenn. ) Medical Society, on June 4, held a
most • interesting
meeting. Dr. E. G. Ballenger,
of Atlanta, tlie guest of the Society,
read a valuable paper which was enthusiastically
received. A number of unique cases
were reported. Several new members were
elected, as follows; Dr. H. L. Fancher,
Dr. II. C. Smith, Jr., Dr. E. Bunbar Newell,
all of Chattanooga.
After the meeting adjourned the members
went to the residence of Dr. James Atlee on
Oak street, where an informal reception
was held for Dr. Ballenger.
Nortb Carolina Medical Examiners.
The State Board of Medical Examiners
which met in Asheville, June 9, completed
its work and announced the successful candidates^
before the State Medical Society
June l3. There were a total of 120 applicants
of whom 96 were granted
license. Included in this number were one
woman and eight negroes. The class was
led by Branch Craig, of Salisbury, who
made an average grade of 95 6-7, with Hul)ert
P,enberry Haywood, Jr., of Raleigh,
only one-seventh of a point below him,
making a grade of 9.5 5-7. Hubert Gudger,
of Asheville, came third with a grade of
9.5 5-7. The successful applicants were:
William A. Johnson, Reidsville.
Vernon L. Andrews, Mount Gilead.
Joseph Collier Ray, Raleigh.
THE CHATLGTTE MEDICAL JOURNAL
David Russel Dixon, Rocky Mount.
Fred G. Sigmon, Spencer. |
Thomas W. Long, Garysburg.
N. D. Morton, Jr., Bullock.
O. E. Underwood, Ernest.
Julian B. Sutton, Elk Park. ]
J. Frank Cranford, Davidson College. ;
C. M. Lentz, Albemarle.
H. P. Harris, Wake Forest.
Charles R. Rullel, Granite FaUs.
Thomos J. Tudor, Mount Gilead.
K. C. Moore, Wilson.
G. D. Moose, Mt. Pleasant,
]
Edward C. Register, Jr., Georgetown, S. i
C. i
J. C. Knight, Clarksville, Ga.
;
!
i
I
]
'
E. B. Alford, Greensboro.
R. W.Crawford, Rocky Mount.
R. A. Vaughu, \'aughn.
W. B. Chapin, Pittsboro.
B. B. Lloyd, Chapel Hill.
W. A. Whitfield (colored), Stokes.
P. W. Miles, Milton.
R. G. Rosser, Broadway.
J. M. McMillan, Star.
J. X. Hill, :\Iurphy. I
W. C. Morrow, Andrews.
C. A. Shore, Raleigh. ;
T. D. Crouch, Taylorsville.
N. B. Adams, Murphy.
Bessie Violet Puett, Dallas.
H. B. Haywood, Jr., Raleigh. I
C. F. Shafer, Boonesville.
j
W. F. Cole, Rockingham. |
Thos. O. Coppedge, Castalia.
W^m. C. Tale, Saginaw.
Julian C. Davis. Clvde. I
D. C. Absher, Obids.
Fred B. Spencer, Swan

Edgar M. Long, Hamilton.
Ben F. Royal, .Morehead City.
Hugh \V. McCain, Waxhaw.
J. E. Dowdv, Winston-Salem.
Benj. F. Cliff, Asheville.
James A. Battle, Wilson.
John T. Wortham (colored), Raleigh.
W. P. Carter (colored), Reidsville.
William J. H. Booker (colored), Oxford.
H.irold II. Cauble, Salisbury.
I). Humphrey, I.umberton.
James W. \'ernon. Busby Fork.
O. W. Shelleni, Raleigh.
At the annual meeting of the faculty of
the University College of Medicine, {Richmond,
Va., held June Isl, several imij'>rtant
changes in the faculty were announced.
After a service of several years. Dr. Paulus
A. Irving declined re-election as dean of
the dei)artnient of medicine, and Dr. A. L.
Gray, professor of physiology, was chosen
to succeed him. In the department of dentistry
there was a change of similar char-
acter. Dr. L. M. Cowardin, who has filled
the post for some time, retired, and his
place as dean will be taken bv Dr. W, II.
O. McGehee.
Other changes and additions that appear
in the faculty list for next year are as follows:
Lecturer on Materia Medica and Therapeutics,
Dr. Paul W. Ilowle.
Lecturer on Clinical Diagnosis, Dr. U. G.
Hopkins.
Instructor in Obstetrics, Dr. R. T. I'er-
gusoii.
Instructor in
mons.
Pediatrics, Dr. !•". G. Sim-
Instructor in Clinical Diagnosis, Dr.
Cliarles M. Edwards.
.\ssistant to Chair of Clinical Medicine,
Dr. C. H. Lewis.
Bedside Instructor in Surgery, Dr. Paul
EDITORIAL. 41
W. Howie.
Clinical Assistant to the Chair of Division
of the Ear, Throat and Xose, Dr. W.
B. Hopkins.
Clinical Assistant to the Chair of Diseases
of the Eye, Dr. W. W. Gill.
There were no changes in the im] orlant
chairs. Dr. Roshier W. Miller was reelected
dean of the department of pharmacy.
Doctor Sold Cocaine.
Dr. J. li. W. Haile, a practicing physi-
C. v. Orr. Judson.
cian of 'Rock Hill, S. C, who was recently
J. D. Weatherly, Kernersville.
indicted for selling cocaine, plead guilty
B. W. Page, Tencheys.
to the charge and was sentenced to pay a
Iv. F. Long. Tohaccoville.
fine of S50.
M. S. Gilliam (colored). Rocky Mour.t. The witness was a Lancaster negro, who
l-"red Wharton Kankin, Mooresville. had ordered the cocaine by mail. Dr. Haile
Arthur Edward Riggsbee, Durham.
filling the order. The cocaine sent the ne-
J. M. Buckner, Dem< crat.
gro was found on his person when taken
Br.inch Craige, Salisbury.
in custody by the officer at Lancaster.
Iul\v:;rd T. Gordon (colored), Raleigh. Dr. Haile moved to Rock Hill from Ker-
A. W. Choate, Sparta.
shaw about a year ago.
Hubert Gudger, Asheville.
W. 1'. Coleman (colored), Kalei

Name of College Passed Rejected
Columbus University 1
I'niv. Col. of Medicine
Richmond 14
Tennessee Med. 1 1
.\tlanta School' of Med. r,
fniv. of N. C. 12 1
Leonard Med. College 9 3
Jefferson
^
Xorth Carolina Medical 14
I'niv. of Nashville 2
Johns Hopkins 2
Chat. -Med. 3
P. ^c S., Baltimore 1
Gate City Med. Tex. 1
Geo. Washington Univ. 1
I'niv. of Tenn. 4
I'niv. of Md. 12 1 (1904)
Meharry 1
Cniv. of Pa. 4
Baltimore Med. 1
I'niv. of I^ouisville 1
t'niversity of Cieorgia 1 1
I'niversity of South 2 2
Womans Med., Baltimore 1
Med. College of Virginia 3
Univ. of Michigan 1
P. & S. Atlanta 2
Knoxville Med. 2
MINUTES FOR THE MEETING OF 1909.
The Board of Medical Examiners of the
State of Xorth Carolina met in regular session
at the Battery Park Hotel in Asheville
on the night of June Sth, 1909, with the
following members present: Dr. L. B. Mc-
Brayer, Asheville; Dr. W. W. McKenzie,
Salisbury; Dr. H. H. Dodson, Greensboro;
Dr. John Bynum, Winston-Salem; Dr. E.
L. Nicholson, Richlands; and Dr. Benj. K.
Hays, vSec. and Treas., Oxford. Dr. Jno.
C. Rodman, President, was detained at
home on account of sickness. Dr. J, I,.
Nicholson was elected President of the
Hoard, pro tern., and served throughout the
entire meeting.
Dr. L. B. McBrayer made a short talk of
welcome, extending to the Board the courtesies
of the city, and inviting the members
to take a drive through Biltmore (at a time
to be appointed).
It was decided to devote Wednesday
morning to registration of applicants; \\'ednesday
afternoon to a consideration of the
claims of the applicants for limited license;
and Wednesday night to the applicants for
reciprocity. It was decided that Dr. Dodman's
examination on Diseases of Children
and Chemistry should be divided between
Drs. Hays and Dodson, the former taking
Chemistry and the latter Children. The
lullowing order of examinations was agreed
upon, all examinations to be written except
THE CHARLOTTE MEDICAL JODRNAl.
the practical part of Dr. Bynum's examination
upon Obstetrics.
Anatomy, Thursday a. m.
Surgery, " p. m.
Gynecology, Friday a. m.
Materia Medica and Chemistry, I'riday
p. m.
Physiology, Saturday a. m.
Practice of Med. and Diseases of Children,
Saturday p. m.
This was later modified by putting up
Materia Medica, Chemistry and Diseases of
Children together on I'riday p. ni.
Applicants for limited license were granted
an oral examination. Reciprocity was
granted in one case on the ground of having
done five years successful practice in a
State whose requirements are the same as
ours. In every other case reciprocity was
granted upon individual merit. The rules
of the Board in regard to reciprocity were
changed, and will be published feter.
Dr. J. L. Nicholson was elected President
of the Board for the coming year.
There was a feeling on the part of the
Bi.ard that the applicants were of a high
order of serious minded men who will
become a valuable acquisition to the medical
profession of North Carolina.
The Chattahoochee Valley !VIedical Association
to Meet in Lafayette, Ala.,
July 13th and 14th.
The following program has been arranged
for the sixth semi-annual meeting
of the Chattahoochee Valley Medical and
Surgical Association, which is to be held
in the Knights of Pythias Hall, in Lafayette,
Ala., July 13 and 14.
FIR.ST DAY—MORNING SESSION.
Association called to order at 10 a. m.
Invocation by Dr. W. C. Bledsoe.
.Address of welcome on behalf of the city
of Lafayette, by Hon. J. Hines.
APdress of welcome on behalf of Chambers
County Medical by Dr. G. A. Pate,
Milltown.
Respogse on behalf of Chattahoochee
Valley Medical and Surgical Association,
by Dr. J. G. Palmer, Opelika.
AFTERNON SESSION, 2 P. M.
"Appendicitis," by H. T. Hamner,
M. D., Camp Hill. Leaders in discussion,
J. A. Goggans, W. L. Cooke and R. S.
Hill.
Diabetes," by C. S. Yarbrough, M. D.
Auburn. Leaders in discus.sion, A'elpean
Langley, II. B. Disharoom and W. B.
Gaines.
"Insects as Conveyors of Disease," by
B. R. Rea, I\I. D,, Lafayette. Leaders in
discussion, C. A. Carey, J. II. McDuifie

and H. A. Slack.
"Infection and Immunity," by \'elpean
Langley, M. D., Camp Hill. Leaders in
discussion, Martin Crook, L. L. Mill and
II. S. Bruce.
"Intersusseplion, with report of a Case."
by W. C. Cooke, M. D., Columbus, Ga.
Leaders in discussion, Gaston Touance,
J. M. Poer and L. L. Hill.
"Surgical Treatment of Diseases of Gall
and Bladder and Ducts," by Gaston Torrence,
M. D., Birmingham. Leaders in
discussion, H. T. Hamner, W. J. Love
and J. A. Gogjjans.
"Diagnosis of Pneumonia," by J. K.
Jarrell M. D.. Xotasulga. Leaders in
discussion, A. B. Bennett, J. P. Motlev
and J. II. McDuffie.
"'I'hirty Years Observation of Therapeutic
Kffects of Ceralrum Veride," by Thomas
Xorl'iern, M. D., Liiieville. Leaders in
discussion, J. S. Ilorsley, J. J. Ilorsely, J.
J. Winn and C. L. Williams.
"Thfrapeutic Suggestions," by ti. A.
Cr>-er, M. D , Ecletic. Leaders in discus
sion, J. G. Palmer and O. S. Justice.
"The Mangenieiit of Smallpox from a
Rural Health Officer's Standpoint." by O.
S. Justice, M. 1)., Central. Leaders in discussion,
Martin Crook, W. II. Moon and
A. H. Read.
"The Importance of Home Sanitation,"
byDr. C. A. Carey, Professor of X'eterinary
"Diagnosis of Breast Tumors," by J. P.
Watkins, M. D., Opelika. Leaders in 2iscussion,
W. D. Gains, Gaeton Torrance,
H.S. Bruce and R. S. Hill.
"Reverse Peristalsis," by T II. Haralson,
M. D., Cusselta. Leaders in discussion,
A. B. Bennett, J. P. Watkins and W.
L. Cooke.
"Abortion," by J. S. Hor.^^ely, M. D.,
West Point, Ga. Leaders in discussion. J.
H. McDuffie, J. G. Palmer and W. P.
Dickinson.
"Pellagra," by H. !•. Harris, M. 1).,
Atlanta. Leaders in discussion, J. M.
Poer, J. II. McDuffie and II. R. Slack.
"The Duties of the Obstetrician to his
Patient," by J. II. McDuffie, M. D., Columbus.
Ga. Leaders in discussion, J. S.
Ilorsley, J. G, Palmer and A. B. Bennett.
"f.al)or and its Proper Management,"
by A. 15. Bennett, M. I)., 0|)elika. Leaders
in discussion, C. S. Varbrough, G. T.
.
EDITORIAL 43
Grady and J. M. Poer.
"Renal Caculi," by H. B. Disharoom,
M. D.' Roanoke. Leaders in discussion,
H. R. Slack and J. S. Horseley.
"intrar Capsular Fracture of Hip Joint,
by A. D. McClain, M. D., Salem. Leaders
in discussion, W. L. Cooke. J. G. Coggans
and W. D. Ciaines.
'Anesthesia," by P.. T. Green, M. D.,
Hickory Flat. Leaders in discussion, H.
S. Bruce and J. M. Anderson.
"Surgical Assistance," by H, A. Milford,
M. D., Five Points. Leaders in discussion,
W. D. Gaines, H, S. Ilaninerand
^^'. T. Langley.
Dr. J. A. listopinal, .secretary of the State
Board of Health of Louisiana, has resigned
bis position as secretary, and has accepted
the position recently created by that board,
as special medical inspector in HavEua,
Cuba
Dr. Kdwa'rd S. Kelly of Xevv Orleans,
and a graduate of Tulane University, was
appointed to succeed Dr. P^stopinal as secretary
of the board. He took charge of his
new work June the 1st.
At a called meeting of the Wake County
Medical Society on May 27th, Dr. W. A.
Goodwin of Raleigh, N. C., was suspended
from the society for a period of six months
Science, Auburn. Leaders in discussion, for malpractice. From this action Dr.
J. II. McDufBe, A. B. Bennett and O. V. Goodwin has the privilege of appeal to the
Langley.
State Medical Society.
"The Duty of the Doctor to the Public,"
by J. G. Palmer, M. D., Opelika. Lead- Gov. Xoel of Louisiana has appointed
ers in discussion, T. Iv Mitchell, J. J. Winn Dr. I. W. Coojjcr of Newton, La., member
and II. B. Disharoom.
of the State Board of Health from the Fifth
District to succeed Dr. W. W. Hickman,
SKCOND D.W, .S .\. M.
who has resigned.
The twenty-fifth session of the Sonthside
\'irginia Medical Association was held in
Petersburg, Va., June Sth, in the Chamber
(if Commerce Hall.
This association comprises the counties of
Sussex, Surry, Southampton, Prince Cieorge,
Brunswick, Greenville, Dinwiddie and the
city of Petersburg. Among the speakers
were Dr. R. A. Martin, Petersburg; Dr. T.
W. Murrell, Richmond: Dr. R. L. Raiford,
Conley; Dr. K. L. McCiill, Petersburg; Dr.
.\. J. Osborne, Lawrenceville; Dr. J. W.
Baird, Carsley; Dr. C, M. Hazel, Bon Air;
Dr. Lucius Lofton, ICmporia; Dr. Robert C.
Bryan, Richmond; Dr. A. R. Shands, Washington,
D. C; Dr. J. Boiling Jones, Petersburg;
Dr. I

44
THE CHARLOTTE MEDICAL JOURNAL.
terian Hospital of Charlotte. X. C, was »>• »ewcy Honored.
held in the auditorium of the Presbyterian At the meeting of the American Medico-
College on the evening of June 1st. Dr. A. Psychological Society held, June 2nd, at
A. McGeachy, pastor of the Second Pres- Atlantic City, Dr. William F. Dewey of Pe- j
byterian church, delivered the address of tersburg, Va., was chosen president for the ;
the evening, which was enjoyed by a large ensuing year. This is an honor that is well
and representative audience of Charlotte deserved by one of the most distinguished
people. alienists in the country. Dr. Dewey is sti
The members of the graduating class a young man, but his reputation is by no
were: Misses Julia Ann Jennings, Harriet means local.
Louise Cornelius, Ina Saunders, Adelle .
Jones I emmoml, Ada Beatrice Gray, Mabel ^^^^ ^^ ^^^ ^^^^ successful meetings of ,
r,eon Mcintosh and Francis Royall.
the Or.nigeburg County Medical Associa-
r . tion, since its organization, was held in St.
After twenty-three years of service as a ^^^^^^ g. C, on June 1.5th. Excellent
member o the visiting staff of the City
^^^^ ^^^^ ^^, ^^^ ,p j^ ^^^^ j^_
"ome,atRichmond, \a.,Dr.J.G. Trevil-
^ ^^^^^^ ^.^^ ^ jj Svmmes, each of
lan resi
'
Tt^rr,^/K!'!l?.lflo?/i°" which uere thoroughly discussed by the
June 19th. Dr. Trevilian has made arrange
ments for a trip to Europe, and will sail
some time in July.
Physician Wanted.
We understand that there is a good location
for a young physician at Roaring River,
X. C. We also understand that the people
Dr. and Mrs. Robert W. Gibbesleft their
home ill Columbia, S. C, on June 29th, for
New York, whence they will sail shortly for
Europe. They will be away all summer
in that locality are very anxious to have
some good physician locate there. In the Superior Court at Wadesboro,
^ X. C, June r2th, the jury brought in
verdict for the defendants in the suit in
Xineteen candidates applied for license
under the reciprocitv rule. Of these twelve which Mrs. Reddie B. Kirker asked damwere
granted license to practice medicine ages of ten thousand dollars from Drs. R.
in Xorth Carolina. They are as follows: Armfield and H. M. Brooks, of Union
Dr. J. A. Anderson, of McAdensville; Dr. county, X. C. Mrs. Kirker charged mal-
M. J. Costello, of Philadelphia; Dr. A. F. practice on the part of the physic. ans. The
Reeves, of Asheville: Dr. M. W. Maer, of trial occupied the entire week.
Dorchester, Mass.; Dr. L. C. Lowder, of Drs. Armfield and Brooks are two of the
Asheville: Dr. J. R. Elv, of Trvou; Dr. E. best known and capable physicians of that
Iv Stewart, of Wake Forest: Dr. Jno. D. section of the county, consequently we are
Nichols, of Etowah, Tenn.; Dr. James not surprised at the verdict. i
Washington, of Boardman; Dr. R. A. Powell,
of Caroleen: Dr. D. W. Colby, of Dills-
boro.
Mai«Mao-o

EDITORIAI,. 45
Dr. Claude N. Smith of Clinton, N. C,
and Miss Dora H. Tew also of North Caroloosa,
Ala., were married at the home of
the bride on June 14th.
lina were married in Richmond, Va., June
1'*''xhe
groom is a son of Dr. and Mrs. Jos.
Farrior, of Chipley, Fla. He was educated.
Dr. J, P. Young, a prominent physician of
Richburg, S. C, was married to Miss Constance
Witherspoon of Lancaster, S. C, on
June 2.3rd. The wedding took place at the
home of the bride's brother, Mr. Marion
at the Southern University at Greensboro,
'^^^' ^"^ ^°°^ "'s medical degree at Tulane
t'niversily of Louisiana. He is a gentle-
"^^i" °^ ^""ch worth and has many friends.
„ , j #- - .- i ,t- t-v n
,,r-., r . c> r »v. Dr. Leonard Cripliver and Miss Dell
Wilherspooii, in Lancaster. Soon after the . ,, , ^, c r ^
^ ^r ^
.
., , , , 1 c» r (jrimes, both of Lexington, X. C., were
ceremony the bride and groom left for an •
i » »i ^, ,i i- f i t .,
. • • J 1 1 1 1 ,
Ti X- .1 I- married at the Methodist church there on
extended bridal tour in the North. I pon , „., , >• . , c^ ,-,
., . . ^, .„ •
, .1 r , June 9th. Immediately after the ceremony
their return thev will make their future •'
,. . li , i , . ^.
,.,,.,, a reception was given the bridal party at
home in Richbur'^. .i i c .i i j ta j ^t a
Dr. Young graduated from the Univer- ^^ ^°'",« °l ^'jf '^"^^- Dr. and Mrs Cnp-
^.
j-verj^eft^after the reception for an extended
sity of Maryland School of Medicine in
Dr. Robert Ormond Apple and Miss
Dr. Mortimer Jordan and Miss Lucile b:velyn Courtney Owens, both of Winston-
Gaston, both of Birmingham, Ala., were Salem, X. C, were married June 17th. The
married June ')th, at the Highland Meth- ceremony was performed in St. Paul's Episodist
Church in Hirmingham. copal church of that city. Dr. Apple is one
Dr. Jordan graduated in medicine from of the most popular young men of that city,
Tulane University of Louisiana in 1907 and and has succeeded in building for himself
is now practicing his profession in Birming- an extensive practice there,
ham.
Dr. J. H. T. McPherson of Athens, Ga.,
Dr. John Cooper, of Oakdale, Tenn., and Miss Margaret Claudius Bonney of Norwas
married to Miss Bertha Moore, of Kings- folk, \'a., were married June 22nd, at the
ton, Tenn., on Friday, June 8th. They home of the bride's sister, Mrs. W. \'. Davis
will make their home in Oakdale, where in Savannah, Ga.
Dr. Cooper enjoys a large practice, and
where he is surgeon for the o. & C. Rail- »>•- A. Hodge Newell and Miss Janet
r(,-,(]
Dr. James Percy Freeman.—The mar-
Elizabeth Hayes, both of Louisburg, N. C,
were married in the l^piscopal Church
there, on June .^rd.
riage of Dr. James I'ercv I'Veeman to Miss
Clara Lee, both of Bridgeport, Ala., was
celebrated on the evening of June 17th, at
six o'clock, at the home os the bride's pa-
Dr. N. C. Hunter and Miss Carrie Jones,
both of Rockingham, X. C, were married
i" the .Methodist Church in Rockingham,
rents. Dr. and Mrs. F,. L. Lee. on June the 9th.
Dr. Joseph Davis Eby and Miss Julia
Dr. Hunter was originally from Halifax
county, N. C but went to Rockingham
Connally k.isser, Ijoih of Atlanta, Ga., were several years ago to practice medicine,
married at the home of the bride's parents where he has met with great success, and
on June the 2.>rd. The ceremony was jier- is now one of the best doctors in that secformed
by Rev. J. A. Rosser, the bride's
grandfather, assisted by Bishop W. A.
tion of the State,
Candler, and Dr. Jno. F*. Purser. n^^ A, ^,. Marchant, of Fredericksburg,
„ , .. „ .. 1 >r- D ,1 Va., and .Miss Marv Ruth Shackelfoid. of
Dr. Lewellyn Powell and Miss Ruth \ • j .
Ashton, both of Alexandria, Va., were
married at Clirist Ivpiscopal Church in that
Mathews county, \ a., were married in
Central chuch at Mathews court house, on
city on June l.oth. June 21st.
Dr. Powell graduated from the Medical ,
Department of the Columbian University, Or. James E. Norman of I rentoii, Tex.,
Washington, I). C , in 1904, and since that and .Miss Stevie Countiss of Tuscaloosa
time has been practicing his profession in county, Ala., were married June 8th, at the
Alexandria.
l^o^^e of ,!,£ bride's parents. Th-y will
_ , . _ ^ , in ,

46
Dr. Alexander B. Moore, of Fauquier
couutv, \'a., a giadjate of the Medical
School of t'le University of Virginia, and
Miss Carolyn Bell Watson of Falls Church,
Va., a recent gra lua'ed from the University
Traitiing School for Nurses were married
on Saturday afternoon, June 19th.
Dr. K, N. Lee and Miss Cordelia Thomas,
both of Chattanooga, Tenn., were married
June 22nd at the Church of Christ in South
Chattanooga.
Dr. Lee is a graduate of the University
of Chattanooga, and is well known in Chattanooga,
both in business and social circles.
Dr. Arthur Grayson Vaden of Mathews,
Va., and xMiss Mabel Lee Anderton of Saluda,
Va., were married at the bride's home
on June 2nd.
The groom is a graduate of the University
College of Medicine, Richmond, Va., class
of 1895.
Dr. Thomas L. James, who is surgeon at
the Battle Creek Coal iS: Coke Co., at Orme,
Tenn., and Miss Elizabeth Mulcke of that
cit)', were married at the home of the bride's
parents on June 24th.
Dr. Percy Wade Olive, a prominent
young physician of Wake County, X. C,
and Miss Sallie McDonald Williams of
Wade, N. C, were married at the Presbyterian
Church in Wade on June ISth.
Dr. Harry Clay Willis and Miss Alma
Hverine Lewis, both of Rome, Ga., were
married at the home of the bride's parents
on Tuesday, June 22nd.
Deaths.
Dr. E. J. Setz, who at one time was one
of the most popular physicians of Georgia,
died at his home in Marietta May .31. Dr.
Setz was in his seventy-ninth year, and had
been very feeble some time.
He graduated from the Medical College
of Georgia in 1882.
Dr. Albert T. Ryall, an aged physician,
died at his home near Shelby ville, Tenn.,
on June 19th. He was in the 70th year of
his age, and had been unusually successful
as a practitioner.
Dr. W. A. Reynolds, aged 52 years, a
very prominent physician of Union Springs,
Ala., died at Margaret's Hospital in Montgomery,
Ala., on June, 19.
He was a graduate of the Medical Department
of the University of Alabama, and
had been very successful in the practice of
his profession since he received his diploma
from that institution in 1885.
THE CHARLOTTE MEDICAL JOURNAL.
Dr. William H. Whitehead of Rocky
Mount. X. C, died in Raleigh June 25tli,
aged 5') years, his death Ijeing caused by
paresis. The State has lost one of her best
citizens and the medical profession an honored
member. Dr. Whitehead has held
many places of honor and trust as the following
will show. He was at the time of
his death, an honorary fellow of the State
Medical Society. From 1890 to 1896 he
was a member and president of the State
Board of Medical Examiners, member State
Board of Health 1901—1905 and vice president
of the Medical Society of the State of
Xorth Carolina 1885, and also a member o'
the Board of Directors of the Central Hospital
for the Insane at Raleigh.
Dr. Whitehead was a graduate of the
University of Maryland and passed the
Examination for license before the Board
of Examiners in 1885 since which time he
had been engaged actively in the practice
of his profession. During the early part of
his professional life he lived in Baltimore.
In 1892 he came to Rocky Mount where for
years he was division surgeon and adjuster
of damages for the Atlantic Coast Line Railway.
He enjoyed a large and lucrative
practice, was greatly loved by all with whom
he came in contact and stood high in the
esteem of his fellows.
Dr. Q., Kohnke of Covington, La., died
June 21 of apoplexy while visiting a patient.
Dr. Kohnke graduated from the medical
department of Tulane University in 1890.
He was prominent in the public affairs of
New Orleans, where he resided and practiced
after his graduation, serving as a
member of the city council and subsequently
as chief health officer of the city. He was
one of the first to recognize the truth of the
mosquito theory of the transmission of yellow
fever, and his efforts to have the Council
pass an ordinance requiring measures to
eradicate the mosquito finally culminated
in success.
During the prevalence of the fever his
energy and zeal, though at the time not
received in the proper spirit by the ignorant
of the city, won for him a name as one of
the foremost sanitarians of the Ignited
States, and he received calls to address
assemblies in many parts of the country.
Dr. Kohnke held the position of chairman
of the City Board of Health until 1006.
Upon his retirement from office he
moved to Covington and resided there until
the time of his death. He had built up
quite a large practice in that city. He was
a member of the Progressive Union, the
Board of Trade and of the Chess, Checkers
and Whist Club; for many years he was a
member of the Press Club, the Artists'

I C.
EDITORIAL.
Association, the American Medical Association,
the Louisiana State and Orleans
Parish Medical Societies and recently he
became a member of the Knights of Columbus.
Dr. Kohnke cared more for his profession,
his pet theories, to the proving of
which he devoted the best part of his life,
and his schemes for the betterment of the
welfare of the health of his fellow-cicizens
than he did for financial gain: devotion to
his practice would have increased 'his increased
his income much, I)ut he preferred
the welfare of his city to any pecuniary
benefit to liini.^elf.
Dr. W. J. Jones died, June 27, at his home
in Goldsboro, X. C, after many weeks of
lingering illness. It is with great sorrow
that we clironicle the passing of yet anotlier
honored member of the medical profession.
Dr. Jones was a man who had served his
country with distinguished ability both as
citizen and physician. Graduating in medicine
in liS.5S from the University of Xew
York he was among the oldest physicians in
North Carolina. He became a member ot
the State Medical Society in 1860 and was
at the time of his death an honorary fellow
of that body. While he only once held high
office in the Society, having been vice-president
in 18.S9, yet he was considered a man
of the very highest abilities, an accomplished
physician, a genial, popular gentleman,
a fluent conversationalist and brilliant
speaker.
Dr. A. M. Newman, of Meadville, Miss.,
was shot and instantly killed in a feud battle,
June 14. His son. Dr. Lenox Xewman,
also received fatal wounds from which death
resulted within a few hours. The difficulty
grew out of i)olilical differences as a result
of which Dr. A. M. Xewman in April killed
15. I'ritchard. Trial resulted in the
acquittal of Dr. Xewman. Three other
persons beside those above mentioned were
victims at the same time.
Or. BeniaminLawton Wiggins vice chan-
> cellor of the University of the South, died
June 11th.
Dr. Wm. D. Hali of Montgomery, Ala.,
an alumnus, and until a year ago, a member
of the medical faculty of that institution,
has been appointed acting vice chancellor
of the University of the South, temporarily
filling the vacancy caused by the
death of Dr. Wiggins. Dr. Wiggins' permanent
successor will be chosen later by
the trustees of the University.
Dr. Ricliard Benburg Crcecy Lamb died
in lUpaso, Tex., on June 2_'iid. Dr. I.amb
had been suffering with an attack of typhoid
'
pneumonia, but was believed to be improving
and was expected at his home in Elizabeth
City, N. C., in a few days. He was
26 years old, and had been practicing medicine
only a few years.
Dr. J. M Cunningltam, who had been in
ill health for several months, and had subsequently
been compelled to give up his
practice, died at his home in Shelbyville,
Tenn., on June 5th. Dr. Cunningham was
a man who was widely known throughout
his state, and his many friends will regret
to learn of his death.
He graduated from the Medical Department
of the Lhiiversitv of Tennessee in
IS.SS.
Dr. H. V. Westmoreland, one of the best
known physicians of Greer, South Caroliua,
died on June 4ih at Jefferson Medical Hospital,
Philadelphia, where he went to be
treated. Brighfs disease was the cause of
his death.
Dr. Westmoreland was the oldest practicing
physician in that section of the counirv,
and was not only an eminent physician,
hut a good citizen, and did much in the
building up of tlie town in which he lived.
He graduated from the Atlanta Medical
College in 1869. after which he located in
Greer for the practice of his profession, and
where he made great success as a practitioner.
Review of Southern Medical Literature
iWri' Orleans Medical and Surgical Journal,
May, 1909.
Headache as a Symptom of Pregnancy
and Pelvic Disorders. —Dr. C. II. Chavigny
says that the dysmenorrhea, so often
accompanying the earlier days of menstruation,
is frequently associated with severe
lieadache, as well as backache. Change
of environment, with judicious use of tonics,
proper diet and purgation, cold hip
bath and putting the patient to bed at the
menstrual period, is very beneficial. It is
very rarely necessary to subject this class
of ijatients to a vaginal examination, which
would serve very little purpose and probal)ly
make our patient worse. The menopause,
be it artificial or natural, is one of
the most distressing disturbances that we
are called upon to treat. The hot flushes,
palpitations of the heart and severe headaches,
are symptoms which are very difficult
to arrest, and ven,- often run their course
to be relieved only hv time. Proper dieting,
exercise, attention to the excretion,
with the use of sulphate of strychnin in
1 .^0 grain doses every four hours. Extremely
nervous and restless patients should

THE CHARLOTTE MEDICAL JOURNAL.
^g
.. • wt. The solu- the discovery of some reflex from eye, nose
be given bromide m some form. The soiu i
^^^^^ ^^ ^^ ^^.^^ ^^^^ ^^^^.^ ^
tion of bromide of strontmm in 3 ..dose or pe
-^^^^^ „,,,e. Renal headevery
four hours. The use of ovarian ex covere p
.^^^^ .^ ^^^^^^^^ ^^,^y,.
tract in 3-grain doses three tunes a da> is ac^ies m y P^^
^^^ ^^^^ ^^^.^ ^^^.^_
one of the few remedies that seems to bene The> a P
.^^ y ^^^^^^^ ^^^ ^^ ^^ ^^.^.
fit this condition. Whatever be our treat na
products. They often ocment,
avoid as much as possib e tbe use of matio
^^ ^^J ^^^^^ symptoms and conopiates
aud the coal-tar Pyo

REVIEW OF SOUTHERN MEDICAL LITERATURE. 49
good. Such a clinical picture with the
physical signs of a central attachment
pulse that is weak.
In chronic conditions a pulse rate of more
should by all means receive this form of than 120 should contra-iudicate operative
form of treatment. Under all other condi- work, but in acute conditions, where the
tions the author would prefer to empty the operation is little more than opening an
uterus per vias naturales. To accomplish abscess, a patient may be a good risk with
this the cervix and lower segment must be a pulse of more than that rate. Patients
dilated or incised according to the method with a normally slow pulse of say forty to
of Duhrssen. fifty, if regular, make good risk.
AH conditions of the heart that show in-
The American Practitioner and Ne-ccs, May, competency should contra-indicate operal()i>9.
tion.
Gun-Shot Wounds ol the Abdomen witb
Special Rclcren ce to Injuries to the Ali I'irginia Medical Semi-Monthly, May 7t/i,
mentary Tract.— Dr. F. W. Sammuel points 190'^.
out that perforation of the intestine by gunpej^sonal
Experiences in Prostatic Surshot
missiles are followed by extrusion of
^3, I^ e. Brvan calls attention to a
the mucus membranes, rosette-hke ,n approstatectomv
as a radical cure
-
pearance. Th.s effect is caused by the re-
^ ^
.
,^„i^,^i
dundance of the mucus membrane and by J ^
»
^^^ ^^^^.
spasm of the circular fibres. n some pergonorrhea
ten years a^go. Since
forations . ,s no so noticeable Wounds "
innumerable outbursts
mace by the bullet passing tl^rough |e
.Uaracterized bv severe discharge, frequent
walls of the gut parallel to Its long axis he
urination and relapsing epimucus
membrane IS earned away and his
jidymitis or epididvmoorchitis. The proseffect
does not occur It is also absent 111
moderatelv enlarged, boggy and
wounds of he stomach and large 11 est ne.
'expressed on each oc-
Uounds of the intestine do not bleed so P
,gonococci
and brokenfreely.
likewise the solid viscera, he most
,i„,,„ p.^^ucts. Sitz tubs and rectal irrigamsignificant
artery when severed, under
^ religiously carried out at each
the innuence of intra-abdominal pressure
untif wearied with the frequency
will bleed continuously, and the shock
^f ^^ attacks and understanding that the
which IS significant 11. a 1 peritoneal wounds
^^^^^^ ^^ .^^^^^^.^^^ ^^,^^ ^,^^ ^^^^^^^ ^1^^^ j^
brings about the wel -known fact o vis-
.^aHzing the severitv of the operation, he
ceral engorgement, which consequently en-
^^.-^y {I. subjected " himself to any radical
courages hemorrhages.
procedure which he thought stood a fair
The Conditions which Modify Opera- chance of bettering, probably curing, his
live Work.-Dr. A. D. Wilhuoth says that
trouble. (Jii March 1st, by perineal section
lesion of the mitral valve with a moderate
(1,^ prostate was most satisfactorily removmyocarditis
take anesthetics well, other
^j The patient left the hospital at the end
things being equal, while aortic lesions with
of the fifth week; the wound had entirely
advanced myocarditis should be looked on
],eaied. Daily irrigations of a mild soluseriously.
The surgeon should withhold ^^^^^ ^f permanganate of potassium have
his opinion until the kidneys have been
,,gg„ earried out and, at present, there is
carefully examined and the blood pressure
;ii,solutely no discharge, the patient retains
taken, for in the first instance those with
j,jg y^ine throughout the night and from
marked lesions that can be heard easily
f^ur to five hours during the day, and has
with little or no kidney complications make already gained much in weight and spirits.
a good risk, and in those of more advanced 'j-he focus of the infection having been rekidney
complications, if it is shown that moved, the writer believes this patient to be
the cardiac action and the volume of the
,m,ch better off than it would have been
pulse at the wrist are in direct relation to
possible ever to have accomplished by medieach
other, we are safe in saying that the
^..jtion, instrumentation or washings,
patient has a sufficient cardiac force to ,.„... ^
stand the extra strain that will be placed Intestinal Perforation in Typhoid
upon it in doing an operation of ordinary Fever. -Dr. C. C. Teniiant believes that
severity. If the heart's action is tumul- the diaggosis should be based mainly upon
tuous and the pulse weak at the wrist such the sudden sharp pain, followed by tenderpatients
should be regarded as bad risk and ness and rigidity, the latter being the most
operated on onlv as life-saving measures, important, and seldom absent. Besides
The heart should be examined for regu- these, we may have more or less shock, fall
larity. Irregular pulse is far more serious, of temperature, an increase in the pulse
even though it be strong, than a regular rate, or the patient may perspire, shiver, or

Sq the charlotte medical journal
complain of feeling chilly, and pass liis As the disease progresses, the dog becomes
urine involuntarily. more furious. Finally, he leaves home and
Should we have a typhoid patient who may run for miles, biting anything that
begins more or less suddenly to complain comes in his path, thus distributing the inof
pain or of an uneasy feeling in the lower fection over a wide area, .\fter a day or
abdomen, and before long, whose abdomen two, the animal returns home exhausted
becomes tender and rigid over the lower and covered with dirt and blood from his
right quadrant, we would be justifiable in numerous encounters. He shows no fear
making the diagnosis of perforation, for, as of water in any stage of the disease, and
Osier says, we must operate when we have drinks readily so long as he is able to swala
probable diagnosis; to wait till all the low, but the progressive paralysis of the
symptoms of perforation are established pharyngeal muscles soon make drinking
means to rob the patient of his chances for impossible. The jaws droop open, the tonrecovery,
gue hangs out and saliva exudes from the
Typhoid patients stand a laparotomy re- mouth. The dog may paw at his mouth,
markably well, provided too much time is and this, together ^^ith his inability to swalnot
taken, and in the few cases reported in low, may lead the owner to introduce his
which there were no perforations found, the hand into the mouth in search of a bone in
patient has usually recovered. the throat. In a short time paralysis of the
hind legs sets in. which soon becomes geu-
Alabama Medical Journal, May, 1909. eral and the animal dies paralytic. The
The Sanatorium in
^ourse of the disease
its Application
from
to
the onset of the
Tuberculosis.-Ur.S.G. ^""^^ Bonnevsavsthat
symptoms ,s usually from two to five
indigent patients with advanced
days, never more than ten days. It is
disease
exundoubtedly
represent the
tremely doubtful if recovery
chief source
ever takes
of
further bacillary distribution, and above all P'^^e.
others should be subjected to rigid discip- '-The paralytic type of rabies occurs in
linary supervision. They not only constitute
an oppressive burden to their families,
about 15 per cent, of dogs infected with
street virus. The onset is similar to that of
but through their inability to observe hy- the furious type, but the paralytic sympgienic
precautions become a constant men- toms follow the premonitory without the
ace to society. They are almost always intervening period of excitement, and the
denied admission to municipal hospitals, progress of the disease is more rapid. The
Tuberculosis sanatoria possessing facilities animal shows no disposition to bite, andrefor
their care are exceedingly few. Ade- mains quiet. Paralysis occurs first in the
quale accommodations should be provided throat and jaws, soon extending to the rest
in the form of segregation establishments of the body. Death occurs in two or three
where all possible comforts may be admin- days. This is the usual type of infection in
istered through judicious nursing and medi- laboratory animals and after inoculation
cal attehtion. Aside from humanitarian with fixed virus.
grounds it is precisely by virtue of their In man alone is the disease properly callignorance,
destitution and occasional ob- ed hydrophobia, for it is only in man that
stinacy that some form of institutional care fear of water develops. This dread is not
is demanded. As to its practical berefi- confined to water, but extends to anything
cence for this group of patients there can that might cause an effort to swallow, and
surely be no room for difference of opinion, hence brings on a convulsion.
Babies and the Pasteur Treatment.- xbe Value o! the Von Perqaet Test for,
^^' ^^^''°" thus describes the symp- Tubereulosis.-Dr. J. S. Davis says as a'
toms^'
T ' ,, 1 , ., 1 . diagnostic measure, its , greatest usefulness
n the dog, at the end of the period of in- is seen in children, since almost all adults
cubation, the animal shows a change of dis- have latent foci, which would be thus reposition.
He becomes morose, ill at ease, vealed
i.rritable and snappish. Often he seems to -, ',..,... .. ^ .,, . ,.
ill mdi-
be in distress, and unable to remain quiet -Y ''}'''}''^\ ^^^^"^'>' °' "'" """'J
foranv length of time. He is easilv ex- ^"J^^^^ /^^ absence excludes tuberculosis,
cited, but recognizes '^ ^^^^''^
his
'" ^"'"'^und and
master
advanced]
obeys his
command, and mav even seem more afTec- ''^^^^- ^^ promptness and course are of :
tionatethan usual. '
P-^"ostic value.
The appetite fails, and
soon the animal becomes more Positive
restless. He reactions are of three kinds:
is constantly in motion, worries his chain, 1- The "norma," which reaches its maxibedding,
or anything else that mav be in "lum in twenty-four hours and pales in two
the kennel, and his bark changes in tone, or three days,
acquiring a peculiar high pitched quality'. This indicates early and favorably pro-

REVIEW OF SOUTHERN- MEDICAL LITERATUI 51
giessiiig tuberculosis, if the reaction is
strong:.
2. There is a very early and ephemeral
reaction, which is often missed, as it fades
quickly. This is very unfavorable.
3. There is the strong- late reaction which
appears in thirty-six hours, reaches a maximum
blovv ly in two or three days and many
persist several weeks.
This is often seen in cases clinically nontuberculous
and indicates in any case an
ability of the body to resist. A battle is
being fought and the victory may be in
doubt. The stage of the disease offers few
indications as to its progress. A mere incipient
apicial catarrh may be more serious
than an advanced case, which often this
reaction may show.
The reactive capacity may be increased
by favorable surroundings or decreased by
unfavorable and thus indications as to the
efficiency of treatment may be obtained.
Tbe Etiology of Renal Sclerosis.— Dr.
R. T. Styll says that as the arteries and
arterioles in the brain are thin walled and
deficient in elastic fibres, they are not very
contractile, and on account of the stress
and strain to which they are freciuenlly
subjected they are among the earliest of
yield to atheromatous and calcareous degeneration.
Hence the frequency of miliary
aneurysms. The toxins of infectious diseases
and other poisons find easy ingress to
the nerve centres and, by their irritating
properties, readily excite action therein
which is transmitted in every direction, producing
among other results both contraction
and dilatation of the arterioles, which,
if continued, will result in general arterio-
sclerosis.
The arterioles of the kidneys are very
muscular and well supplied with vasomotor
nerves; consequently they are conspicuously
under the control of nervous influences
affecting both the vaso-motor conh;trictor
and the vaso-dilator fibres, and are
necessarily as a consequence of any al)normal
condition in the centres presiding
over these nerves in a constant slate of alternate
spasm and dilatation, which is
obliged to eventuate in degeneration of the
arteries and the organ dependent upon them
for nutrition.
Brlei Review of Alcohol.— Dr. U. C.
Keister concludes by quoting the following:
I'irst, we have now in the United States
3,640,000 hard drinkers of alcoholic beverages,
12.S,()00 of whom die annually from
the direct effects of alcohol; over .S,(»(Ki of
these lake their own lives.
Second, during the past four years alcohol
killed more people in the United States
than were killed by bullets during the four
years of our Civil War. In 1907 there were
10,782 suicides in the United States.
Third, the use of alcohol as a beverage
costs the United States annually $1,200,^
000,000.
Fourth, Seventy-four per cent, of crime,
7.5 per cent, of the pauperism and 5 per
cent, of the insanity of the United States
are caused by alcohol.
Fifth, seventy-five per cent, of the diseases
of fashionable life are caused by alcoholic
beverages.
Sixth, forty per cent, of all diseases of the
liver and kidneys are caused by alcoholic
drinks.
Seventh, sixty per cent, of the inmates of
all reformatory schools are the descendants
of parents or grandparents who were addicted
to the use of alcohol.
lughth, sixty percent, of all the imbeciles
and epileptics of the United States is caused
by the hereditary effects of alcohol.
Ninth, in 1905 the amount of alcoholic
beverages consumed in the I'nited States
was 1,694,392,765 gallons; 1,494,191,325
gallons were lager beer.
Tenth, in the year lS9t) the liquor traffic
paid the United States treasury $157,485,-
9S2. Itcosl the people of the United States,
directly and indirectly, $1,884,0^7,982.
The late Mr. Gladstone made the emphatic
statement that alcohol was a greater
curse to any nation than war, famine and
l^stilence combined.
Notwithstanding this array of scientific
facts and figures, our Federal and Slate
governments continue lo issue licenses for
the sale of a poisonous beverage that is
slowly, but surely, destroying our nation. "
Medical Organization and its Benefits.
— Dr. V. \'. Anderson sums upas follows:
15y urging the great importance of the county
medical society. As the family is recognized
as a unit in its jjolitical, moral and
social organization by society throughout
the world; as the family is the foundation
of the whole structure upon which modern
civilization is built, so in our great scheme
of medical organization, the home society
is the unit upon which its super-structure
rests. If tile home or county organizations
are weak, doing no practical work, filled
with dissensions and jealousies, opposed to
all plans for the more thorough organization
of our profession, the elevation of its
standards, and the noble purpose of the
more perfect performance of its duty to the
human race, then little can be expected
from the district and State organizations.
The Soulhern Clinic, May, 1909.
Guaicol in Orcbitis and Epididymitis.
-Dr. John Meriweather says that guaicol

52 THE CHARLOTTE MEDICAL JOURNAL.
three or four drachms, menthol one drachm, or milk, yolk of egg, salt, flour. They
glycerine two onnces makes a mixture that should not be given oftener than every
will be of great benefit in orchitis and epi- eight hours. Ice bags should be applied to
didymitis. the epigastrium. Drugs that often prove
It relieves the pain, tenderness, and beneficial are ergot, adrenalin and chloride
swelling in eight to twelve hours, and will of calcium.
do it better than opium or its derivatives. Second Week— Rest in bed; hot poultices
The swelling will gradually subside, and to the epigastrium; warm milk; beef tea;
by the next day the patient will be feeling liquid peptonoids; albumen.
much better. Third Week—Morning and evening, while
Treatment is commenced by an active in the recumbent position, the patient should
cathartic to thoroughly clean out the bowels take a glass of alkaline mineral water: hot
and rectum and the weight of the scrotum poultices should be applied" to the stomach,
relieved by a suspensory bag. Hot fomen- The diet is the same as in the second week.
tations are applied to the scrotum. The If there is no tenderness or discomfort over
guaicol mixture is applied by saturating a the stomach the patient may sit up in bed
piece of absorbent cotton with it and the at the end of the thirh week,
whole scrotum lightly anointed every four Fourth Week—The patient mav be up in
hours until pain and tenderness subsides.
^^^ ^^^^ ^^^^ ^^^^^ ^^^ ^^^^^ "
.^.^^ ^.^^
Texas Medical founial, Mav 1909.
should be bland, such as mashed potataes,
'^.. The ..->.< .. m -
Anti-TubercuIosis
^ J. Crasade J purees '^ of vegetables, tender, rare meats.
and "
_l
PhlWsophobia.—Dr. T. Y. Hull believes ,,, , , ,„ , ,/j-- -/
., . r .1 » r 1 r Atlanta ' ournal-Kecoid ot Medicine, jfa\'
. -»
that one of the most powerful agencies for
the prevention of tuberculosis is compulsory
1909.
registration. In cities where it has been Wbooping Cough.—Dr. S. A. Visouska
carried out for some time it has proven a
beiie^.gs t,,^t attention to diet is very impowerful
agent in awakening the public ....
mind, and of giving aid and instruction P"-"*^"^' ^^ vomiting is often a persistent
where it is- needed. It is not intended to and at times an alarming condition. Nutriannoy
and harass the sick, nor to make tious, easily digested food should be given
their burden more unbearable. It is not often and in small quantities, the best time
intended to hold the unfortunate victim up
to administer it being just before a parox-
before the public, and does not. It is simply
intended to give the Board of Health,
and the Board of Health only, the knowl-
^ , . ^^ „, ^ ^^.,
y^m. For the vomiting Dr. W. T. I^ilmer
of New York has advocated the use of an
edge of the existence of the disease, that in abdominal belt made of linen with a strip
case the attending physician does not as- of elastic webbing under each arm and fastsume
the responsibility of instructing his
^^^^^^ ^^, jaciug ^up the back. Besides the
patient m preventive measures, it may do ^ ; , , , ,
""el'sf
so. The results in other cities have
of the
been
vomiting he claims that the
most beneficial. In these Southwestern number of paroxysms are reduced and corn-
cities to which so many tubercular people plications rendered less frequent bv this
flook, and in which the mortality from belt. An objection has been raised to the
tuberculosis is so appalling, some active , w ^i a t -^ •
i
.„=„.,,,-•, • -,,-0 ;,„„„, J T »i 1 c belt on the ground ot its causing hernia,
measures are imperative. In this work of
^"^ '^ doubtful, however, if this is true. In
popularizing registration, the nurses and
their association can render valunble assist- connection with this the author states that
*"'^^- last year he was called on to treat not less
than six cases of umbilical hernia within a
Gaillard's Southern Medicine, May, 1909. week, each case being the result of Pertussis.
Gastric Ulcer.—Dr. M. O. Burke says Some cases were already wearing different
that a patient who has hemorrhage should
^^^^^^ „f apparatus, but he used the Z. O.
be kept absolutely quiet for several davs— „ .
'
. ,
,
at least one week.' The bedpan
adhesive strips and all made good recov-
should be
used for evacuations of the bowels and eries. The thought then occurred to him
urine, h'or twenty- four hours no food should that this ver\' troublesome complication
be administered by the mouth, not even ice might be prevented by the application of
water, hor twentv-four or forty-eieht hours

Book Notices.
The Popes and Science. By James J . Walsh,
M. D., Professor of the Historj' of Medicine
and of Xervous Diseases at Pordham
University School of Medicine. Cloth,
423 pages. New York: Fordham University
Press, 1908.
The writer wants to prove that the Roman
Catholic Church, in the person of its Popes,
has been misjudged by the general consensus
of historical opinion, that the Romish
Church has fostered Science as well as Art,
and the Science of Medicine in particular.
Dr. Walsh rather rashly takes issue with
"The Warfare of Science with Theologv,"
by Andrew D. White. Dr. Walsh's work
is not without a certain interest but it somehow
fails to carry conviction, as for instance
in his first argument concerning Pope
Boniface X'lH's prohibition of dissection in
1300. He does not succeed in weakening
Dr. White's position in favor of papal prohibition.
It is significant also that he finds
it necessary to go to such elaborate pains
to discredit M. Daunou's contribution to
the Benedictine "Ilistoire Litteraire de la
Prance," a standard authority from which
Dr. White quotes. The final quotation
from Pope Benedict XFV (1740-17.S8) to
prove that the decretal of Boniface V'lII
was not intended to forbid dissections seems
too much like ex parte testimony to have
much weiglit, though why a man living
some four hundred years later should be
authority does not appear.
Even the authorities he approves of do
not come to the same conclusions that he
does. Robert von Toply, in Puschmann's
"Oeschicte der Medizin." p. 214. \'ol. II,
says that, "Das klassische ( )biekt der mittelalterlichen
Anatomie, das Schwein"
played identically the same role in practical
instruction from the beginning of the eleventh
century until tlie end of the fourteenth
and even into the sixteenth.
The book is strongly partisan, unnecessarily
so. It has few resereuces to authori-
ties, aside from those it seeks to discredit.
Writing the Short-Story. A practical handbook
on the rise, structure, writing and
sale of the modern short story. Bv J.
Berg lisenwein, A. M., Lit. D., Editor of
Lippincott's Monthly Magazine. Hinds,
Noble cS: lildredge, Publishers, 31-.>.S
West Fifteenth St., New York City. Cloth.
I'rice, SI. On postpaid.
The author has made a most critical study
of the short-story which, as he says, is now
the most popular literary form. After a
historical introduction, the nature of the
short-story and its structure are most carefully
detailed. This part, which consti-
BOOK NOTICES 53
tutes the bulk of the work, is abundantly
illustrated with quotations from short-stories
by the best authors. Part three deals with
the preparation for authorship, including
the methods of acquiring a vocabulary and
the laboratory method of study of shortstories.
Part four deals with the marketing
of manuscripts, and several useful appendices
coaclude the volume. The writer
is eminenth- cjualified to give advice upon
this subject since his experience in passing
upon the quality of manuscripts submitted
to his publication has been very extensive.
To any of our readers who contemplate an
excursion into this literary field his treatise
can be heartily recommended as an eminently
satisfactory guide.
/V\iscellancou;
Rare Observation ol Acute Primary Latent
Dipbtberia ol the Middle Ear.
(Jlimpio Cozzolino records a somewhat
rare observation of primary diphtheria of
the middle ear. There was no evidence of
primary diphtheria of the nasopharynx,
although the child had adenoid vegetation
and hypertrophied tonsils during the course
of the disease. It began with an acute otitis
media which rendered paracentisis necessary.
Through the opening of the drumhead
was to be seen a grayish white membrane
covering the structures of the middle
ear. When removed with forceps this disclosed
a bleeding base. Aiititoxin was administered
and relieved the general symptoms,
but did not cause the disappearance
of the membrane. The serum was then
used by instillation into the middle ear, and
the membrane promptly disappeared. The
exudation from the throat showed no diphtheria
bacilli: neither did the membrane
removed from the middle ear. Still, the
author considered that there were enough
characteristic symptoms to show a true
primary diphtheria of the middle ear.—La
Pediatrica.
Experimental General Infection witb
Hepatic Localization.
Le Play reports the results of experiments
relative to general infection by a vine parasite,
called stearophora radicicola. The
spores, when injected into the circulation,
select the level of the liver, to the exclusion
of other organs. Innding in this gland a
hydro-carbonous medium, particularly favorable
for development, one can see them
appear, at the end of a few weeks, under
the form of mycelium or in the state of
selerols. This parasite gives rise to the

54 THE CHARLOTTE MEDICAL JOURNAL.
formation of acid and alcohol, and inflicts out the loop, the presence of circulatory
harm by its secretions to the hepatic paren- disturbance: above the hernial aperture. If
chyma; both mechanically and chemically, the symptoms of ileus persist more than
These experiments place in evidence the twenty-four hours after the operation and reprimordial
importance of the soil in the ductionof an apparentlystrangulatedhernia,
evolution of pathological processes. It is there is reason to suspect a mechanical or
thus that we can conceive how these pro- paralytic obstruction of the bowel. The
cesses can vary, not only from species to writer has seen ten of such cases and has
species, but, in the same animal, from organ
to organ.—La Presse Medicale.
collated ninety-five from the literature,
which show that there may be a diversi
of causes for the obstruction, such as incar-
Diagnostic Importance ol Examination ceration of an internal hernia, strangula-
*•' ''"'
l^ints wTth'^Purrona^rr"" '"
^^^ ^^ '"^^^'-^ ^.'^ ^\^' ''^' f "^'^ 'T''
Tuberculosis nitestine, compression by bands, volvulus,
i»vagination, benign or malignant stenosis
Nicolo Serio-Basile notes the.difEculty of
foreign bodies, or parab^s.s of the bowel
early diagnosis of tuberculosis, especiallv
in children who do not cough and
from peritonitis, appendicitis or acute pan-
expect-
^reatitis.
orate. The author has attempted
The proposis m all these cases
to examine
for the tubercle bacillus in the faeces '1 very unfavorable, the mortality being
of such infants in the hope of obtaining
about /O per cent.
evidence of their presence in the lungs. He clean Out, Clean Up and Keep Clean!
finds that in spite of the technical difficul- ^, . , , . , t r
ties of such examination, important evi- ^}'^ «1"-^"' '^^.^°.''^ ^1^^ profession for sev-
eral
dence of the presence
years
of tuberculosis may and originating with the Abbott
be obtained from the feces. The
Alkaloidal Lompany in connection with the
bacilli
may pass all the wav through
promotion of their specialties, has found its
the intestinal
canal without being altered morphologically w^v ">to the hearts and practice or more
or pathogenicallv. Thev appear ,1'^'^, ^^'""e^
in greater ,"^ medicine than anything
^^''^ numbers when there is a lesion of the ^^^ ever been put before them,
intestinal
mScous membrane, and With the clean out" goes their inimit-
in smaller ,
numbers when the
so-called Abbott s Saline Laxative'
lesion is in the respira- J^^^
torv apparatus. The (granular effervescentmagnesium sulphate)
tubercle bacilli mav
be absent in the faces of infants who swaf-
^'^Pl^' P^''^ ^"^ t^' efficient and nonlow
the sputum from irritating: said, pnlmonarv facetiously, to do the busilesions,
This method of examination is of diagnostic
"^^^ ^"^ "^^^'' ?ripe". It removes, envalue
in positive cases, but as negative ^^^^' "itestmal toxins, debris from indi-
evi
dence against tuberculosis
gestion, etc.,
it is valueless.—
leaving the way clean for the
La Pediatria.
direct action of their pure sulphocarbolates
to do the "clean up" act.
Intestinal Obstruction Simulating The Abbott Alkaloidal Company are the
Strangulated Hernia.— Clairinont(Archiy. largest producers of the sulphocarbolates in
f. Klin. Chir. ) mentions certain cases of America, if not in the world. In quality
intestinal obstruction, in which owing to their products stand second to none and as
the simultaneous presence of an inguinal, adjusted in their "Sulphocarbolates Comfemoral
or umbilical hernia the condition pound", a mixture of the sulphocarbolates
may be mistaken for a strangulated rup- of lime, soda and zinc I, commonly known
ture. In these cases the hernia may be- as the W- A Intestinal Antiseptic ) we have
come painful tense or irreducible, although the most desirable preparation for use, while
this condition is really secondary to the ob- the continuation of the use of these two exstruction
of the bowel. Hence, in such a pedients assure a state of health, inordinary
case the surgeon contents himself with conditions, not otherwise obtainable,
henotomy and fails to recognize the real When tonics are required nothing excells
cause of the trouble, the ileus will persist their Triple Arsenates with Xuclein. Saraand
lead to a fatal termination. That we pies of these preparations are offered to the
have not to deal simply with a strangulated interested profession on request. Thev may
hernia is shown by the slight tension and be obtained of all first class pharmacists or
tenderness of the hernial tumor in the early through jobbers and will be supplied to any
stages. Later, when the hernia appears to physician direct who is not able to supply
be incarcerated and an operation is per- himself otherwise. Therapeutic nrice list
formed, there may be other signs which for the asking.
point to intraabdominal complication, such The management of this journal is fainilasthe
absence of distinct strangulation, the iar with Abbot goods and Abbott methods
distention of the afferent segment of gut, and takes pleasure in recommending this
the impossibility of reduction or of drawing firm as first-class in every particular.

ADBVRTISEMENTS.

THE CHARLOTTE MEDICAL JOURNAL.
In Summer Complaints
ALKARHEIN
THI THINK. OI
OF USE
IN INDIGESTION.
We do not claim that it will cure all cases of dyspepsia, but it will be sur-
prising bow useful it will prove in very many derangements of the gastro-intesti-
COMPOSITION-- -With Physiological Action,
Rhubarb a superior laxative because it does not impair but
2 1-2 Grains improves the digestion—Is a tonic, also astringent.
Golden Seal (With the acrid resin removed)—The great tonic
I 1-4 Grams and corrector of the mucous surfaces.
Potassium Bicarbonate
2 1-2 Grains
Antacid. Increases Alkalinity of the blood and the
oxidation and excretion of effete matters.
Pancrcatin Promotes intestinal digestion, converts starch into
I Grain sugar and dextrose; proteids into peptones; emulsi-
fies fats, digests the casein of milk.
Ceylon Cinnamon valuable in atonic conditions of the intestinal mu-
I 1-4 Grains
cous membranes, with flatulence and diarrln
Spirit of Peppermint and a minimum of Simple Elixir is a menstruum that
will commend itself to physicians.
Think of Alkarhein in acid dyspepsias, flatulent colic, infantile colic, cholera
infantum, cholera morbus, diarrhea and all abnormal acid conditions of the ali-
mentary tract. Think of Alkarhein in these cases and prescribe it as thousands
of physicians have been doing for many years with the confidence bom of ex-
perience.
ORIGINAL WITH AND PREPARIiD BY
The Wm. S. Merrill Chemical Company
Manufacturing Chemists.
C;lI^dINP^I/\TI

INDEX FOR JULY,
Table of Contents for July, 1909.
Original Commanicationa.
Keport of Two Cases of
Hemophilia, by Parks M.
Kingr, M. D., Charlotte.
N. C
Urethral Stricture, by W.
L. Champion, M. D., Atlanta,
Ga.,
Report of a Case of Pulmonary
Edema Complicating
Pregnancy, by Dr. William
L. Kirkpalrick,
Pacolet. S. ('.
Personal ICxpHrience in
Prostatic Surgery, by R.
C. Bryan, M. D^ Richmond,
Va :
A Case of Abdominal Gun-
Shot Wound with Intestinal
Perforations, with
Spcci:>l Reference to th>i
Afler-Treatment with
"Saline Urip," by Theodore
Maddox, M. D.,
Union, S. C,
Gastric Ulcer,by MaitOtey
Burke, M. D., Richmond.
Virginia.
Typhoid Fever. Importance
of Early Diagnosis
— Fasting—Special Diet
—Surgical Rest of Bowel
—and Simplicity of Treat-
Tuberculosis In Children. Slieiiuau, in
the London Medical Lancet, has reviewed
l.OS.T cases in the Royal ICdinburjjh Hospital
for Sick Children of which 41."? died
from tuberculosis. These cases were examined
in two series, the first containin;^
105 and the second containing 30S cases.
The ages of the cases varied from three
months to thirteen years, approximately hS
per cent, being under five years of age.
The lymphatic glands were tuberculous in
97 cases (92.4 percent.) in the first series
and in 24. i cases (7.S.,S per cent. > in the second
series. The mediastinal glands were
more frequently affected than the abdominal
glands, and dissemination took place
more freciuently, apparently, from the former
group. Tuberculosis of the mediastinal
glands was commonly unaccompanied
by primary tuberculosis of the lungs, but
was freciuently accompanied by recent tuberculosis
c)f these organs, in many cases
evidently .secondary to the gland tuberculosis.
In nearly half of the cases of tabes
mesenterica there was no ulceration of the
intestines and in one-third of the cases there
was no excavation of the lungs, although
in some of them the lungs showed early
manifestion of tuberculosis. In a number
of cases excavation of the lungs was not
followed by ulceration of the intestines,
although in about half such cases tabes
mesenterica had resulted, the excavation
being of some standing. Primary ulceration
of the intestines, in absence of any
previous excavation of the lungs, was frequently
found. It was usually accompanied
by caseation of lymphatic glands, me-
12 Editorial.
Meeting of the Medical So-
14
ciety of IheStateof Xorth
Carolina, 33
The President of 1 he Medical
Society of the Stale
of North Carolina, 35
Human and Bovine Tuberculosis
35
ment, by A. .7. Burkholder,
M. D , Richmond, Va
The Value of Employment
in Cases of Dementia Praecoxby
PaulV. Anderson,
.\I. D., Morganton, N. C,
President's Address, by J.
17 Anti-Tvphoid Inoculation,
The President's Annual
Add^es^
Editorial News Items
19 Marriages
Deaths
36
37
38
44
46
F. Highsmith. M. D.,
FayetteviUe, N. C ...... .jj Review of Southern Medico! Lit-
The Essentially Different
erature, 47
Treatment Required for
Some Conditions often
Mistaken for Xeurasthenic.
By Tom A. Wil-
Book NoticeB.
The Popes and .Sciences, by
James J, Walsh. M. D., 53
liams. M.B., M.C..(Edin.)
Washington, D. C,
Writing the Short-Story.
26 by J. Perg Esenwein 53
diastinal or abdominal, or both simultaneously.
In a large proportion of these
cases the immediate cause of death was
tuberculous meningitis. Death was due to
tuberculous meningitis in 44. .S i^er cent, of
the cases. Apparently the dissemination
had taken place in the majority of the cases
from caseous lymphatic glands, and more
often from the mediastinal than from the
abdominal groups. In twenty- four cases
of tuberculous meningitis caseous nodules
were found in some part of the encephalon,
but these had not given rise to the meningeal
condition in every instance. These
children were of the poorer classes, who
form the great bulk of the patients treated
in the Royal Edinburgh Hospital for Sick
Children. In view of the wide divergencies
which appear in statistics emanating
from different countries the only rational
conclusion to be arrived at is that these dif-
ferences depend not on the manner of treat-
ing the material but upon the material
itself. Statistics, therefore, representing
the conditions prevailing in any one coun-
try should not be considered as applicable
to the conditions prevailing in any other
country, seeing that the circumstances and
environment, h^-gienic and social, under
which the inhabitants of that country live
may differ widely in many important res-
pects.

58
THE CHARLOTTE MEDICAL JOURNAL.
When ordinary cow's milk is acted upon tional disorder of the blood-forming organs,
by human gastric juice it forms a firm curd depeuding chiefly on a debility of these
which is broken up and digested with great hemopoietic tissues, a debility perhaps indifficulty;
human milk, however, forms a herited, but depending (in common with
finely divided curd, which is readily acted other tissues) for its production chiefly on
upon by the digestive juices. such faults as lack of suitable food and
These facts, in part at least, explain why fresh air, but at times determined by the I
it is that cow's milk is not easily assimila- toxins of measles, syphylis, and other in- f;i
ted by infants and by adults affected with fectious. If a number of children are ill- '
digestive disorders. fed, all their tissues suffer more or less, but
|
The clotting of milk in the infant's stom- usually one tissue more than another, the
ach may be overcome to a great extent by tissue most affected varying in different .
the use of Chyiuogen, a rennet preparation, children. Hence with some children the
wdiich, under proper conditions, acts upon debility affects chiefly the blood-forming i
casein and precipitates paracasein in a form organs. With some insufiBcient food or
which is easily broken up, and thus prepar- fresh air at once determines anemia. That
j
ed for rapid digestion. The particles of these infantile anemias are of this nature is |
curd are so small that the infant can take shown by the results of treatment. Give |
its food in the usual way from a nursing the infant suitable food and plenty of fresh
bottle. air and, provided no complication such as ]
As Chymogen contains sugar of milk, its pneumonia occurs, a cure may be confi- j
use renders cow's milk more nearly of the dently looked for in time. ;
same composition of human milk. .
Milk treated with Chymogen is not pep- Trcalment by Nurses. i
tonized, nor is it made into buttermilk. It
is merely sweet milk that will not curdle in Chicago has her difficulties, as well as !
large and indigestible clots. other sections, with nurses. The Medical ]
Chymogen is packed in 4 oz bottles at Review of Reviews (April) speaks of it
S2.0dperlb. thusly: ',
There is some danger that the school
A New Book. inspection and school nursing may be per- i
mitted to exceed the proper limits of such 1
Dr. Robert Gray, of Pichucalco, Mexico, activity. It is noticeable in Commissioner i
has written a most interesting book to which Evans report, for example, that school i
he has given the appropriate title. Specific ^^rses treated 863 cases of ringworm and i
Medication." The boo^ is full of facts 2,357 cases of impetigo during the quarter i
that are of inestimable value to every phy- ending March 31, 1909, which indicates a I
sician. Dr. Gray is one of the oldest phy- <
,,,iiii„^ness, if not a desire, to treat the
sicians in ^lexico, and he has won the res- :
g^hool children, to the neglect of the fampect
of the medical profession everywhere jiy physician. Thirty-six cases of favus ;
by his valuable contributions to medical were also treated by nurses, and, as every ,
literature._ Dr. Gray gives in the most open dermatologist knows, it is one of the most
manner his experience with many drugs,
difficult of all skin diseases to cure. We
About one remedy, with which many phy- .
are confident that school inspection and
sicians are acquainted, Anasarciii, Dr. i^irsing under the charge of the health .1
Gray is very emphatic He says: Ana- ,,oard is of the greatest value, hut compe- !
sarcin.-lhis has cured for me some of the tent supervision is essential by the medical ,i
most fearful cases of dropsy that I ever officer of health, and the family physician i
saw in all my long experience not having i^as a ri^ht to demand all due consideration. , (
failed me once. These words, strong as -ph^s far we sympathize with the members
I
they are wil strike a responsive chord m i
^f ^1,^ Chicago Medical Society. Adequate I
the hearts of many physicians who have qualifications on «
the part of both physicians
had similar ex^periences.
^„d ^^^1^1^ ^^^^^^ ^,,^ thorough co-opera- |
Dr. Gray s book ,s sent out as a message tj^n will not only advance the general wel-. \
of truth to the profession with no apologies, '«
fare, but will insure a negative answer to
and It will find many appreciative readers, '.'>
all fear for the future of the — medical pro-
I herapeutic Record, April, 1909.
fpssioti " '
Inlanllle Splenic Anemia.- Hunter (in
^ Scientific Priest on tlie Dangers of i
The London Medical Journal ) records ten ""'^ Water. ,
cases of this affection. The writer's re- The sanitary dangers lurking in "holy
marks leads to the conclusion that the con- water have often been referred to by medi-'
dition is not a primary, but rather a second- cal men. Thev have recently been scien- i
ary anemia, and in the main duelo a func- tifically studied by a monk, Fr. Augustin I
'
j
|
j
j

ABSTRACTS
Genielli, who is himself a highly qualified
medical man. He publishes his results in
the Sciiola Caltolica. Each cubic centimeter
of holy water in the basins in the church
of Santa Croce, Turin, taken from the surface
contained 150,000 microbes, while a
culiic centimeter taken from the bottom
contained no less than 6,000,000 microbes.
He injected this water into animals and
alwavs found that it killed them, the causes
of death being; tuberculosis, colitis, or
dipththeria. He does not think a daily
cleansing with corrosive sublimate sufTi
cieut, but recommends a new form of hol\
water receptacle so constructed that ])er
sons instead of dippino; their fingers into il
can obtain three drops of water by pressing
a button. A vessel of this nature has bee;i
placet in the church of Vergiate, Milan.
Fr. (".emelli turned his atte:ition to the
grilles i.i the confessional Ijoxes. Water
which hid been used for washing these
only contained 2.S microbes per cubic centimeter
and when injected into animals only
proved fatal to In per cent of them.—London
!,ancet.
Res» Treatmeut In Chorea.— K u b r a h
(British Journal of Cliildren's I)eseases>
says lliat a modified Weir- Mitchell treatment
gives cfuicker, better, and more lasting
results than any otiier method. Ivvery child
should be kept in bed until the movements
have ceased entirely, and the patient lias
gained in weight. In the average case no
medicine is required. Iron is indicated if
there is anjemia. Kubrah does not use
arsenic. With one or two exceptions all
the cases so treated improved rajjidly. In
the mild cases the movements ceased in two
or three days, and in the moderate in a
week or ten days, and in the severer in from
two to three weeks. The shortest stav in
hospital was ten days, the longest 7J, and
the average M-, days. Recurrences under
this treatment were exceiitional.
Operative Indications in Fibroma Uteri.
—Faure (
Presse Med. ) states _that the evolution
of fibroma uteri makes of it a unitpie
growth, no other pathological tissue increasing
and then siwntaneously undergoing
regression at tlie moment of the menopause.
It is a tumor that for an indefinite
period causes no symptoms and then may
undergo regression without having been
recognized. There is no reason for operating
on every fibroid as soon as it is diagnosticated
without waiting to see whether it
causes symptoms, At the same time, we
should recognize that this growth is a serious
affection, and one that should be
watched from time to time to see if it is
producing any of the serious symptoms:
Met jmnicJallD teue. Tytet'!
10 healthy gro%vlh aod aicU qiiici healii
It is endorsed by feeding hospital pts
given it careful elinica! tests and by leading tr
America and Europe, as the best construct
>V^2k.aslxirvg l:oiv<
Pine Kid^e Sanitoriiiui.
Treatimiit of Luryngeal
antl rulmonary Tuberculosis.
Dear Doctor: It you
are Roing send your
TutHTCuIar Patients to
the best climate in the
world, "The Sunny
South,'* we offer yoti
advantae^^s you c.intiot
afford to overlook. Proper
altitude, no malnina.
luxuries of a city with
advantnires of country
air. Ttiberculine and
Vaccine treatment wit.'n
ncpessnry. hyslenic rnoklnii. Rates reasonalile. Address
DR. CEOROE BROW.V. Pres.; DR. LOUIS ROUGLIN.
Sec'y, AUanU, Ga.
hemorrhage, pressure, and disorganization
of the kidneys from obstruction of the ureters.
When any of these occur we should
not hesitate to operate. When these tumors
grow rapidly it is generally because they
are undergoing sarcomatous degeneration
and taking on a malignant character.
Whenever the general condition of such a.
patient grows rapidly worse it is time to
operate. When pain, weight in the abdomen,
and hemorrhage are making the life
of the patient miserable and the woman is
of the working class and must be on her
feet and cannot rest, we should disembarrass
her of her burden. These symptoms
are gradually aggravated, and a time will

60
THE CHARLOTTE MEDICAL JOURNAL.
come when the patient can bear no more with still greater probability for tuherculowithout
becoming an invalid. The time of sis. He thinks that the combined Calmette
life of the individual has an important bear- and Pirquet tests may completely replace
ing on the conduct of the case. In a young the diagnostic injections.
woman it is necessary to operate, But in .
a woman who is near the menopause it is ,„,,,,., ^ . ,
, ,
best to wait and see if atrophy will not re- 'Hie Medical profession has not only
move the necessitv of an operation. Es- made its advances in the Ime o appliances
pecially at the menopause will any sign of ni the treatment of diseases but it is equaldegeneration
of the tumor call for immedi- l.v as well represented with the improveate
operation
ments that have been made in the line of a
general antiseptic. There are so few anti-
Radium and X-Rays iu Gynecology.— geptics offered to the medical profession
Foveau de Corrmelles (Gaz, de Gyn.) cites tij^t can be relied upon in all cases where
his previous publication of results obtained j,j antiseptic is indicated that when one is
in the treatment of uterine fibroids and the offered to the profession, it is not surprising
artificial menopause, by means of small that it receives such a reception. One of T
doses of X-rays, used with an aluminum ^jjg j^ggj antiseptics thaV is now offered to r
j
shield. The author now brings forward the tijg medical profession and one that can be .
^
rays as an efiicieut and safe method •
xxszA with success in the treatment of minor
of production of artificial abortion and major surgery good under the name of
in cases where pregnancy is jeopard- Campho-Phenique. It has been on the I
izing the life of the mother. It was used market for the past twenty -five years and i
in a young woman who was tuberculous, ti^gre are few physicians of any prominence '
and in whom uncontrollable vomiting was to-day who have not used this remarkable i
dangerously reducing her strength. After
r^tjo^.
twenty-five sittings delivery of the placenta
and fetus occurred normally. The rays polyneuritis During Pregnancy —Krivwere
used for five minutes at a time over
^^^^^^^ ^^ ^^^^ ^^ d'Obst.) savs that
the abdomen for four davs: then one day
over the thyroid; then returning to the ab-
. ninety-two cases ot neuritis during pregnan- |
I
'
domen. They are also useful in the treat- cy have been detailed in literature, of which
,
meiit of hemorrhages. In the form of a thirty-six appeared before labor and fiftypaint
combined with inert substances radium
has been successfully used in skin
six afterward. There were forty-six cases
^f o„e^ritis, of which nine were fatal. |
lesions. But its use m ttiis manner for the ^ *^^
',....'
uterus in cases of fibroids involves the dan-
'
. .
., . .
,
, ,
Sometimes incoercible vomiting and poly- ger of burns. It is therefore used in tubes neuritis are coincident in the same case,
>
i
for treatment of uterine fibroids. Applied The cause is said by some to be hepatotox- I
to the mammary gland it has the effect of g^iia. The causative agent of tlie two con- \
drying; up the secretion causing regression ^.^.^^^ .^ probably the same. He mentions ;
when It has been established, and prevent- „ , ,r ,, ,. ,r I
ing the formation of milk during preg- a fatai case obferved by himself, ma woman I
nancy. of twenty-six in her second pregnancy. She j
. was anemic, having had scarlet fever and :
Ilammerschmidt (Med. Klin.,) advises marked constipation; her neuritic troubles 1
tha both Calmette's reaction and Pirquet's began some six weeks before labor, when ]
test of inoculation by scarification of the she was in comparatively good health, with |
skin should be used coincidentallv in order ,, , r»i i „ ,*„f^„ \
., ^ , 1 .1 » 'i I iU a sudden weakness of the lower extremities, i
that one mav neutralize the mistakes of the
other. For Calmette's reaction one drop of
which increased to entire paralysis, and ex-
not more than i per cent, of tuberculin dis- tended to the muscles of the upper extremi- :
solved in .S per cent, phenol solution was ties, the throat, and the pneumogastric
instilled into one eye. For Pirquet's test
^g^ve. It became impossible for her to
the arm, after being rubbed with 60 per ,, j,j.j- .*ir swallow,
a
cent, alcohol, was
and she died in an attack of suffotouched
with a drop of
20 per cent, of tuberculin and then on the cation from paralysis of the nerve. Some
same place a cross was scratched with a hours before her death labor had begun, and
new boiled steel pen. When Calmette's an attempt to deliver bv artificial dilatation:
lest was positive, Pirquet's test was also was made successfullv, but the patient died.,
always oositive, but the reverse was not „„ ,
,
, ' . •,.^. • , i
i always the case. He he only remedy for this condition is to pro
thinks that a negative
result speaks with great probability against voke premature labor with the hope of stopj
tuberculosis, while a postive result speaks ping the source of the poisoning.
j
'
|

ADVERTISEMENTS.
St. Luke's Hospital
1000 WEST GRACE STREET,
=^=^ RICHMOND, VA.
H|Kr^

^Xii
THE CHARLOTTE MEDICAL JOURNAL.
Gastric Digestion In Inlants.-Clarke secting forceps. The patient must be pre- ;
(Dublin Med. journal I savsthat many and Pared by a preliminary visit to the dentist, !
contradictory results have been obtained; so that no operation in the oral cav, y is
;
a few facts, however, seem to be pretty de- performed until all carious teeth have been ,
finitely proved. In the first place, it may stopped or removed The patient is placed ,
be said that all the factors present in the m a recumbent position with a sandbag beadult
are found in a weaker form in the "^.^\\^^^
shoulders, with the head falling
young infant. In the newborn child on shghtly backward, so that the nasopharynx
breasUnilk the stomach usually empties slopes backward and dowmvard thus en- ,
abhng the small quantity of blood which ,s ;
in from an hour to an hour and a half; as
the child grows older this time becomes s >ed to trickle toward the nosrils rather
longer. The few drops of gastric juice tl'^n toward the larynx, whilst the slope is -
found in the empty stomach are the re- »ot so great as to cause engorgement of the ;
mains of that secreted during the last meal, pliaryngeal venous plexus A loop of silk .
and are not due to a secretion into the is passed through the top of the tongue for i
empty stomach. The motility is more rap- the purpose of retraction, and a gag ,sin- |
sorted between the last molar teeth. The i
id inbreast fed children than in those on
cows' milk or artificial food, and more rapid tonsil is then seized in the ring forceps and
in the healthy than in the ill child. The gently dra^yn toward the middle line, so
acidity immediatelv after a meal is nil, but that the imbedded part of the gland bulges ,
steadily increases during digestion, and is beneath its normal coxering of the anterior j
lessinthe verv young than in the older.
piUar of the fauces. Immediately external
On a barley water diet free hvdrocloric to the internal margin oi the anterior pillar,
acid appears in the stomach in a'few min- J^^st where it blends with the surface of the ^
utes, but on a milk diet it does not show it- tonsil, an incision is made with the finely .
selfforanhourormore, due to the fact that toothed forceps, parallel to and extending ,
the casein absorbs it or combines with it in ^°^ the whole length of the tree margin of ;
someway, and the free acid does not apthe
anterior pillar. Ihis incision reveals
pear until the casein has taken up all re- the capsule of the tonsil which now ap- .
iiuiredforits complete digestion. The free pears as a glistening smooth bluish white ;
acid appears later in disease than in health, surface. Ihe ease and success of the op- j
due to the increased amount of food in the oration depend upon this incision display- |
stomach and to the slower secretion of the "^^^ the capsule of the tonsil and not enter- ,
acid; in cases of pvlorospasm the acidity is "'"-'ts substance. This mistake is easily ,
increased. Opinions differ as to the oc- "^^^^ ^^y keeping too near to the free sur- I
currence of lactic and volatile fatty acids. ^^^^ °^ the tonsil, and it is the common
but these probably do not occur in healthy
cause of difficulty and .sailure for begmbreast
fed infants, "^""S- while in those ill or on T^i^ ""^ forceps is then readjusted
cows' milk they are fairly common. Part ''^ ^^ ^^ -^t a firm hold upon the tonsil and I
of the acidity is probably due to a fat ^^^ anterior pillar is drawn outward by ,
splitting enzyme in the infant's stomach, means of the fine toothed forceps. The jl
Pepsin is present at all ages
t°"sil is and then practically dislocated from its h
in all
kinds of health, and acts in the infant
^^^' ^"'^ ^''^ separation of the rest of the ,
stomach though to a less degree than in the ^^^^^ °^ ^"^ cellular tissue, intervening be- ,!
adult. The pepsin digestion goes on to the tween the capsule of the tonsil and the (
stage of peptones, but not beyond muscular wall of the pharynx, is easily ef- '|
that,
fected either by the finely toothed forceps »!
The fact that the stomach contents will no
not fibrin in thermostat is due to the fact ^^^^ ^ ^^'^^^^^ P^''' °^ curved blunt ended ';
that all the hydrochloric acid is combined scissors which fit in behind the whole of 1
with the casein, and while the protein with the tonsil and push the pharyngeal wall I
,
which it is combined will be acted upon by ^^^^^ ^"^ ''• ^'"'^^ the tonsillar vessels I
;
the pepsin, a foreign protein without the ^^^ thereby torn across and are able to re- :
addition of more acid will resist the enzyme ^^^'^^ within the muscular wall of the I
i
Rennin occurs in the stomach after the first Pharynx, there is practically no bleeding— i
few weeks of life; whether during the first '" ^^^^' *^^ absence of bleeding forms a |
week is a question. striking contrast to the sharp hemorrhage i
^
which ensues after the tonsil has been cut
Removal ol the Tonsils.—Waugh, in the across by a guillotine. The time occupied
j j
(ilasgow .Medical '
Journal reports nine hun- in the complete removal of both tonsils and |
dred cases of complete removal of the ton- adenoids is, on an average, three minutes. ;
j
sils. The instruments required are two A brief, deep anjesthesia ' with chloroform I
Martman's ring conchotomes, a useful se- is necessary, and the coughing reflex i
i
cretion to the margin of the lower, one pair should be abolished. I'or the after treat- j
of curved scissors, and a finely toothed dis- ment a simple mouth wash is provided and
1
I
,

ADVERTISEMENTS.
a mixture containing sodium salicylate and
potassium chlorate, administered every feuhours.
The patients are kept lin bed for
about forty-eight hours and are allowed
solid food when they feel inclined for it.
With children this is frequently on the day
after the operation.
Eczema In Infants.— Mendelsson ( M unch
Med. Woch.,) states that according to
iMukelstein, the eczema of infants is due to
disturbed assimilation of the salts in milk;
its treatment therefore is not local, but must
consist of dietetic measures, 'i'he best

PHE CHARLOTTE MHDICAI. JOURNAL.
eczema 1)ul other iiheiioiiiena of "exudative
diathesis.' 'JMiey stand the withdrawal
of salt very well if it is not continued too
Ions after the curative effect upon the ecezenia
has been noted.
The Treatment ot Eczema ol Infants
and Young Children by Thyroid.— liason
(Scottish Medical and Surgical Journal)
reports a series of consecutive cases of eczema
in voung children successfully treated
bv thyroid. In the first case, fourteen
months old, the baby had suffered from eczema
of the face for nearly a year. This
had been entirely resistant to the usual ap-
plications and internal treatment, nor was
hospital treatment more efhcacious. Two
and a half grains of a thyroid tablet was
given daily. In a little more than one
month the child was entirely well. His
cure persisted for nearly a month, when the
disease showed a tendency to recur. The
second course of thyroid was followed by a
permanent cure.
similar results.
The other cases gave
Researches into the Haemoglobin Content
ol Tubercular Children.— Lorenzi
('La Tediat. ) says that (1) the number of
red corpuscles diminishes in proportion to
the gravity of the illness and rises when an
improvement in the general condition occurs.
Alteration in form is shown by more
or less marked frequency of microcytes with
or without poikilocytosis. (.2) The haemoglobin
content is relatively below the number
of red corpuscles. OligochroniEemia
becomes more marked with the advance of
the disease, and is usually more marked in
the marasmus of chronic forms. It improves
with the general condition. (3)
The relative amount of iron remains always
below the correfponding amount of lieemoglobin.
This inferiority is more marked
when the disease is progressing, and tends
to disappear, on the other hand, when the
acuteness of the disease diminishes. (4)
The globular value, calculated with respect
to iron, is always inferior to that of
the haemoglobin, but their variability is not
always proportionate, although they are
both in relation with the course of the disease
and the general state of the patient.
(.5) His researches in a general way lend
support to the theory of Bard with regard
to variations in the quality of the haemoglobin,
and he is of opinion that in infan-
tile tuberculosis the alterations in the rela-
tion of iron and haemoglobin are chiefly referable
to a condition of hypohfematopoie-
The Sequelae of Scairlet Fever.—Schick
(Jahrb. f. 'Kinderheilk.') discusses the
following sequelae. (1) Post-scarlatiual fe
ver: In the period comprised between the
twelfth day and the seventh week, most
frequently in the third and fourth weeks, a
rise of temperature, usually without constitional
disturbance, occurs, for which neither
at the onset nor later is any abnormal
condition of the organs to be found: il)
Rheumatism: As a rule this occurs towards
the end of the first week or in the
course of the second, and may be associated
with endocarditis, the onset of which
is often insidious. The fever accompanying
endocarditis is usually remittent, and
ends by lysis. In all his cases of endocarditis
the initial attack had been mild.
Rliematism occurring later than the second
week is rare. He had seen only four such
cases— three in the third and one in the
fourth week. (3) Secondary adenitis:
This may occur as an herald or as an accompaniment
of nephritis and also as an
indeijendent sequela. It subsides long before
and is more frequent than nephritis.
Nephritis and secondary adenitis do not
occur before the twelfth day or laler than
the sivth week, most cases being found in
the third or fourth week, (4) Relapses:
Schick has collected 72 cases, including l.i
personal ones. Like the other sequelae of
scarlet fever they occur most frequently in
the third or fourth week. It is doubtful
whether the initial attach find the relapse
are to be attributed to the same infection,
or whether the relapse owes its origin to a
fresh infection from without. He, like
Hekoch, thinks that the scarlatinal virus
has not been completely eliminated by the
primary attack. In discussing the cause
of the interval between the primary symptoms
of scarlet fever and the appearance of
the above sequelae, he suggests that at the
usual time for the onset of sequelae the organism
has a diminished power of resistance
or else is super-sensitive. This period
of diminished resistance or of super-.sensitation
lasts from the end of the second
week till the seventh week, and is most
marked during the third and fourth weeks,
after which the tendency rapidly diminishes.
The hypothesis of a specific sensitiveness
of the organism after scarlet fever has
an analogy in other morbid processes, c. g
in typhoid fever and in the serum disease.
Prolonged Prlapism.-Terrier and Dujaries
( Revue de Chirurgie) describe this
rare affection, and collect in the medical
literature of the world 4S cases. This form
of priapism is an erection which is not accompanied
by sexual desire or by voluptuous
sensation; on the contrary, it is frequently
painful. It is never followed by
ejaculation. In the greater number of cases
the erection involves only the corpora cav-
.

ADVERTISEMENTS.
SOUTHERN MEDICAL SOCIETIES.
^s«-5*;$SSr$SS5;$S5Sssss-
MISSISSIPPI VALLEY MED. ASSOCIATION. KENTUCKY STATE MEDICAL ASSOCIATION.
Pres., J. A. Witherspoon, M.D., Nashville,
Teini. \'ice Pres. Louis Frank, M. D.,
Louisville, Kv. Second Vice Pres.,
A. I"-. Sterne, ^L D., Indianapolis, Ind.
Secy., Henry Enos Tulley, M. U.,
Louisville, Ky.
Annual meeting at Winchester, K^^, Oct.
1909.
A. T. McCormack, M. D., Sec,
Bowling Green,^ Ky.
Jonn G. Cecil, M. D., Pres.,
Louisville, Ky.
Treas. S. C. Stanton, M. D. Chicago, 111.
Next Meetinji St. Louis, Mo,. Oct. \2,
and 14th 1909.
l.i,
SOUTIIKKN SURGICAL and GYNECOLOGICAL
ASSOCIATION.
Annual meeting at Hot Springs, Va., Oct.
.S-6, 1909.
W. 1). Haggard, M. D., Sec,
N'asliville, Tenn.
Stuart McC.uire, M. 1)., Pres.,
Richmond. \'a.
SOITHKRN MEDICAL ASSOCIATION.
Annual meeting at New Orleans, La. Nov.
9-10-11-12, '09.
OscarDouiing, ^L I)., Sec. Shreveport, La.
C'.ilcs C. Savage, M. I)., Pres.
Nashville, Tenn.
MEDICAL ASSOCIATION OF THE SOUTHWEST.
Annual meeting at San Antonio, Texas,
October, 19(19.
1-. 11. Clark, M. D., Sec, Kl Reno, Okla.
Jabez N. Jackson, M. D. Pres.,
Kansas City, Mo.
Tkl STATE MEDICAL ASSOCIATION OF THE
CAKOLINAS AND VIRGINIA.
Annual meeting at Richmond, \a.. I'eb. S,
1910.
J
Howell Way, M. D.. Sec,
Waynesville, X. C.
LeC.rand Cuerry, .\I. I)., Pres.,
Columbia, S. C.
MEDICAL ASSOCIATION OF THE STATE OF
ALABAMA.
.Annual meeting at Hirmingham, Ala.. 1'mi"».
J. X. Baker, .\I. I)., Sec,
Montgomery, Ala.
H. L. Wyman, .M. D., Pres.
i'lirmiugham, Ala.
FLORIDA MEDICAL ASSOCIATION.
.\iiiiual meeting at Pensacola, I-'la., April
7-9, 1909.
J.
1). I''ernandez, I). D., Sec,
Jacksonville, I"la.
!•.
J. .McKinstry, Jr., M. D., Pres.,
Gainesville, I'la.
MEDICAL ASSOCIATION OF GEORGIA.
Annual meeting at Macon, da., April 21,
19((9.
Claude A. Smith, M. I)., Sec. .\tlanta, Ga.
Thos. I). Coleman. M. D., Pres.,
Augusta, Ga.
'
LOUISANA STATE MEDICAL SOCIETY.
Annual meeting at New Orleans, La., May,
4-6, 1909.
E. M. Hummel, M. D., Sec,
141 Elk Place, New Orleans, La.
E. Denegre Martin, M. I)., Pres.,
New Orleans, La.
MISSISSIPPI STATE MEDICAL ASSOCIATION.
.\nnual meeting at Jackson, Miss., April
13, 1909,
H.E.Howard, M. I)., Sec,
Vicksburg, Miss.
J. W. Gray, M. U., Pres.,
Clarksdale, Miss.
MEDICAL SOCIETY OF THE STATE OF NORTH
CAROLIN.V.
Annual meeting at Ashevilie, N. C,
June 15 and IS, 190''.
1). A. Stanton, M. I)., Sec,
High Point, N. C.
J. E. Highsmith, M. D., Pres.,
Eayetteville, N. C.
NEW MEXICO MEDICAL SOCIi:TY.
Dr. G. K. Angle, Silver City, N. 11. Pres.
Dr. G.S. McLandress, Albuciuerque, N. M.
Secretary.
Dr. C. G. Duncan, Socorro, N. M. Treas.
Xext meeting at Roswell, N. M., in the
fall of 190'>, the date to be announce later.
SOUTH CAROLINA MEDICAL ASSOCIATION.
,\nnual meeting at Summerville, S. C,
April 21, 19CW.
Walter Cheyne, M. D., Sec,
Sumter, S. C.
S. C. Baker, M. 1)., Pres.
Sumter, S. C.
TENNESSEE STATE MEDICAL ASSOCIATION.
.\nnual meeting at Nashville, Tenn.,
April. 13-l.S 1909.
Geo. II. Price, M. 1)., Sec,
146 8th. Ave., N., Nashville, Teun.
B. D. Bosworth, M. 1)., Pres.,
Knoxville, Tenn.
MEDICAL SOCIETY OF VIRGINIA.
Annual meeting at Roanoke, \'a., fall of
1909.
Landon B. Edwards, M. D., Sec,
Richmond, \'a.
Stuart McC.uire, M D., Pres.,
Richmond. Va.

XXVI
.
THE CHARLOTTE MEDICAL JOURNAL.
ernosa. They are distended and hard, toralis major, latissimus dorsi, serratus
The glatis and corpus spongfiosum are magnus, etc. He could not support himself
scmetimes increased in volume, but soft on being placed on his feet. Both knees
and of a totally different consiftency from were partially flexed from contracture of the
that of the corpora cavernosa. One can hamstring muscles, and could not be exfeel
the!r hardened points through the tended. Both feet were in the position of
glaus. The pain generally begins some talipes equinus from contracture of the calf
hours after the beginning of the erection, muscles. There was such weakness of the
and can at times he very severe. In severe extraordinary muscles of respiration that
cases the patient is in a perpetual agitation, the child could not easily by coughing clear
with the face moist with sweat, and anx- his bronchial tubes of mucus. The life of
ious. He rolls himself about and cries the patient in this advanced state depended
lustily. The pain does not continue with on the progress of the increasing muscular
such intensity, but abates and then returns weakness and the chance occurrence of some
in attacks, The weight of the bedclothes pulmonary complication. Complete rest for
is unbearable, and the patient particularly any time was considered a mistake, as the
dreads any attempt to lower down the penis, muscles rapidly waste and the patient be-
As a general rule micturition is normal; comes gradually more and more helpless.
in some cases retention follows, and the . .w ^ - .> .
r ,, .1 . A Alleged Dangers of the Coniunctlval
use of the catheter is required. » »
This affection ends generally in gradual ReacHon.-Teichmann (Mediz. Klniik),
recovery, sometimes at the end of a few bases the following conclusions on his obweeks;
other times at the end of two or servation of l.SOi) cases, and on a comparithree
months. Of the 4S cases collected, son with the results obtained by others:
31 recovered spontaneously, 5 died later on (1) That the harm alleged to have been
from leukemia, 10 were operated and re- caused by the conjunctival reaction depends
covered, 2 died in full priapism. without exception on the choice of unsuitable
tuberculin preparations or
Owingtothe difficulty of following up
on the neg-
of important contramdications
those cases, it is impossible to say what the (2)
^f^
after results have been, but in many cases
^^^ installation, in diseased and espe-
^^f}
'
^lally in
permanent impotence
tuberculous eyes, in the scrofulous.
followed.
^, r .1 1- 11 particularly in those of vouthtul age, and a
The cause of this disease is not well as-
^^^^^^^^ ^-^^ j,, the same eve, especially with
certamed. Leukam.a seems to be the most
^ solutions, is not' permissible. (3)
frequent cause. As regards treatment the
That the conjunctival reaction-undertaken
^" ^^""^y incision in
..-ith freshly-prepared solution-is absolutebotir'''rrr°'''°'^
1 corpora.
j^ j.^^^ from danger, and is at present the
Pseudo Hypertrophic Paralysis in an simplest means of diagnosing a tuberculous
AdvanccdStage.—R. Barclay Ness, in The focus, not recognizable by other clinical
Glasgow Medical Journal, mentions the case methods of examination,
of a boy, aged l.i years, and was one of a The cases observed by Teichmaiin were
family of six. None of these were affected all treated with one per cent old tuberculin,
in the same way as the patient. Between and the majority showed only a mild conthree
and four years of age he was recog- junctivitis lasting three or four days. Isonized
as being in an early stage of the dis- lated cases, however, occuired in which
ease. He then had large calves, wadling chemosis, follicular enlargement, purulent
gait, lordosis, and the characteristic way of secretion, and subjective sensations of presarising
from the supine to the erect position, sure and burning were present. These were
The succeeding years had been marked by limited to the conjectiva, and disappeared
a gradually increasing failure of muscular in four to eight days, leaving no trace, and
power and by wasting of muscles. At the the eyes after some further months of obserage
of thirteen years the boy showed great vation still gave no sign of conjunctival ir
emaciation and general helplessness. Lying ritation. Reactions which threaten to be
on his back he could only to a slight extent severe are readily checked hy the instillation
pull up and extend his legs. He could move of cocaine 2 per cent and adrenalin 1 in
his arms slightly, but they were quite flail- 1000. These marked reactions occur almost
like. He could not raise himself into the solely in cases in which tuberculosis is clin-
sitting posture. Placed in this position his ically manifest, so that the test will not in
back became markedly curved (kyphosis) future be used in such cases, but if it is used.
Any attemi)t with hands in the armpits to a transient ophthalmia is better than the
raise him by the shoulders only elevated the general disturbances which, in these same
scapuliu and brought them together on the cases, would probably occur from the injecback,
all support having been evidently lost tion of tuberculin. Severe conjunctivitis of
by the wasting of such muscles as the pec- long duration, corneal ulcers, iritis, etc.,

»»<
ADVERTISEMENTS.
To obtain the best results ults in t
Anaemia, Neurasthenia,
Bronchitis, Influenza, Pulmonary
Tuberculosis, t
and during Convalescence after
exhausting diseases employ t
fellows' Syrup!
of
l)ypopbo$pbite$
Contains—Hypopbosphites of Iron, I
Quinine, Strychnine, Lime, J
Manganese, Potash.
Each fluid drachm contains the I
equivalent of I -64th g'rain of 1
pure strychnine.
Special Note.—
Fellows' Hypophosphites
is Never Sold in Bulk, i
Medical letters may he addressed to T
The Fellows Company of New York,
26 Christopher St., New York. X
t

XXVIII
.
ADVERTISEMENTS.
described as having been occasioned by the suria it is desirable that the mode of life,
conjuctival reaction, were in no case ob- diet, etc., should be carefully considered
served. and regulated, with the object of prevent-
M Calmette's and Hochst's tuberculin f.re
inconstaut and much too strong. The author
advises the use of Koch's old tubercuing,
if possible, the affection from develop-
ing into a severe form of diabetes. Many
cases of slight or temporary olycosuria delin
in one-per-ceiit or at most two-percent velop, in course of time, into severe diabetes;
solution. Any irritant condition of the cor- but it is important to remember that this is
nea is an absolute contraindication. Sim- nor always the case, and, both in the young
pie chronic conjunctivitis was never made and the old, a slight glycosuria may disapworse,
nor did any complication arise, but pear or remain slight or intermittent, with-
|
j
the tost is difficult to determine in such
cases. In the literature, harm resulted in
no case (with a single unexplained exception)
from any other cause than the omisout
progressing into severe diabetes.
When a consideration of the family history
or life history of any individual leads
us to think that there is a special risk of
j
J
f
sion of one or other of the above mentioned
precautions, which have been experimentally
learned to be necessary.—British Medidiabetes
developing, the following precau- l
tions as to the mode of life appear to be ad- !
visable, in view of what is known regarding I
cal Journal.
The Possibility ol Preventing Diabetes
or of Postponing its Onset.— Williamson,
The London Practitioner, states that precautions
for preventing or postponing the onset
of diabetes may be considered in the following
cases:
the etiology of the disease:
|
Sugar, sweets, chocolate, very sweet fruit, I
^^^^ ^^ ^^^-^^^^ ^^ ^^-^^ ^^ ^^-^^^^ containing ^
much sugar should be avoided. It is easy i
for most individuals to acquire the habit of
|
taking food without sugar; but if there 1
should be difficulty in this respect, saxin or
]
saccharin may be used. j
1 In the case of individuals who have a Unless actual glycosuria has been detected i
family history of the disease, and especially there is no reason whv an average amount |
if a brother or sister has suffered. of starchv food should not be taken: but of \
2. In the case of Jews, whose profession course great excess of starchv food would .
or business cause great mental oxerstrain, „ot be desirable. As alreadv mentioned, i
'
especially those who are very ambitious, observations on ailmentarv glvcosuria show
those who are very stout, who eat an excess that sugar is much more powerful than v
of food, and who take little exercise. starch in producing glycosuria. 'i,
r-,. In the case of women whose urine has The total amount of food should not be* ;:
contained a considerable amount of grape excessive, especially after the age of forty.
sugar during pregnancy, which has disap- strict moderation as regards all forms of '
peared after parturition. alcoholic beverage is important, and sweet
4. In cases of gout, acromegaly, and ^ines (especiallv port, Tokav, and cham- J
great obesity, especially if the obesity, pagne) and liquors should not be taken, i]
should have developed at an early period Beer should only be taken in very moderate }
Oi ^iiS. quantities. All beverages containing much j
•5. The possibility of diabetes is worthy sugar should be avoided. J
of a thought in the case of men who have A sufficient amount of outdoor exercise
reached the age of forty or fifty, who have is very desirable, and this particularly im- i
had great mental strain in their profession portant if the occupation should be a sed- '
or business, who have been very ambitious, entary one. Dyspepsia and constipation I
worked ver\- hard, and taken little exercise, should be treated, since severe dyspepsia is i
if such individuals have taken an excess of occasionally an antecedent of diabetes. As j
food and alcohol, and have become stout, mental worry, mental overstrain, and over- |
there is a greater risk. work are so often exciting causes of the '
6. In very stout women just after the disease, it is advisable that those who are
climacteric period, and after au operation considered to be predisposed to diabetes j
on the uterus or ovaries, the risk of diabetes siiould, if possible, choose an occupation in i
is worth bearing in mind, especially when which there is not a special risk of these ;
there is a family history of the disease. injurious influences, or that the work should j
7. When the urine
]
has been found to be so arranged, or modified, as to diminish
contain a trace of sugar temporarily after this risk to the minimum.
an acute illness,, an injury, an excess of The possibility of diabetes developing is
sweet food, etc. or at the examination for worthy of a thought in the case of successlife
insurance, the ciuestion of the prevention
of permanent glycosuria, or true diaful
barristers, solicitors, and medical men,
who are working at high pressure, and have
betes, requires consideration. little tune for exercise or holidays, and also
•s. In all cases of permanent slight glyco- in the case of publicans, who are taking al-

—
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(WHAT A DOCTOR PRESCRIBES.
m liatcliechuhbee. .\l;i ,
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XXX
.
THE CHARLOTTE MEDICAL JOURNAL.
coholic beverages in liberal quantities. The most striking feature concerning the
The physical and mental overstrain con- circulation is the acceleration of the pulse,
nected with the nursing of a sick relative or which is out of all proportion to the
friend through a long illness should be height of the fever, and is particularlyavoided
by those who are thought to have marked in children in whom it is apt to
any predisposition to diabetes. persist long after the fever and other sympin
the case of married couples, if one toms have subsided. It is probably due to
should suffer from diabetes, it is probable some disturbance of the nervous niechan-
tliat the liability to diabetes in the other is ism of the heart by the toxins of the disvery
slightly increased, whatever may be ease.
the explanation. In diphtheria the changes produced in
In cases in which a temporary or slight the heart consist mainly of granular and
glycosuria has been detected, in addition to fatty degeneration of the muscle fil)ers and
the precautions already mentioned, the of the muscular coats of the blood vessels.
starchy articles of food should also be re- But these changes do not satisfactorilv exstricted,
because it is most important to pre- plain the attacks of cardiac syncope which
vent, or postpone, the development of true at times occur in diphtheria. Degenerative
severe diabetes in such cases: and it is im- changes in the pneumogastric nerve probaportant
to remember that, if the develop- bly account for the tendencv to cardiac
ment of true diabetes can be postponed syncope, which is all the more apt to take
until the individual is past middle life, the place because of the degeneration in the
disease will probably be of a less severe heart muscle. As to treatment, prolonged
form
md absolute rest in bed is essential when
When a considerable amount of grape there are disturbances of the rhvthm, rapid
sugar has been present m the urine during heart action or shortening and weakening
pregnancy, and especially if there have of the first sound. The Bnul dc Galop\s 2.
been thirst and diuresis, it is most desirable grave danger signal. Small, easilv digesthat
pregnancy should not occur in the tible meals with the use of strychnin hypofuture,
dermically are recommended.
Pulmonary Tuberculosis in Children.—
Williams ( British Medical Journal ) says
'^«"« Vulgaris and its Treatment by
that phthisis is one of the most common Vaccincs.-Meming, m the Edinburgh
diseases of childhood, and, among I^Iedical
those
Journal, describes the acne bacilwho
die of it at the ages when it causes the '"^' ^^ seen 111 smears of comedones and
highest mortalitv, the majority have con-
Pustules, as a small Gram staining bacillus
tracted and suffered from the disease in
varying in length from under 1 in. to.Mn:
childhood. This view o'"'"is
supported by death
+ and about ]2 in. wide. Theyounger
and morbidity statistics.
^o'^'^s stain evenly and darkly, but com-
In the immense majority of cases monly the
tuberolder
forms show one or more
culosis is not contracted bv inhalation, but
deeply stained dots in their interior. These
bv the ingestion of bacilli or bacilliferous ^°^^ ^"^y ^^ situated at the poles or they
products by way of the intestinal mucosa ^y ^^ present along the whole length, re-
The tendency of the disease in these cases
sembling a chain of small cocci. The
is to cure. tenacity with which these bacilli retain
Important earlv svmptoms are

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XXXU
THE CHARLOTTE MKDICAL JOURNAL.
and stouter, and stain evenly, while in the
jjustule longer forms are seen with very
irregular staining. The author thinks that
it is definitely proved now that in localized
who were under treatment simply for uter-
ine displacements. The serum was derived
from the blood taken with the patient under
scopalimin-morphin anesthesia just prior to
infection, when one innoculates the patient operation.
with appropriate doses of a carefully pre- The writer's results were very gratifying.
pared vaccine derived fron the infecting All the patients were benefited and in some
organism, one obtains a beneficial effect, the hemorrhage ceased entirely after one or
\'ery fretjuetly in treating, a case of acne two days. There was no return of the
with staphylococcus vaccine it is found symptoms in the patients kept under obserthat
there is a definite improvement for a vation and menstruation returned to normal,
time, then the condition remains stationary
in spite of any modification in the do.se or Erysipelas In the New-Born.— Herrgott
character of the styphylococcic vaccine. ( Annales de Gynecologie et d'Obstetrique )
This is exactly what would be expected describes er\sipelas in the new-born infant
from a consideration of the bacteriology, as a very serious and generally fatal disas
it is only in a certain number of cases ease. The fatality depends on the absence
that the staphvlococcus is present, and even of reaction against the germs, due to the
when present it is not responsible for the absence of phagocytosis in the new-born
whole condition. We can, therefore, divide child. After the age of three months the
cases of acne vulgaris for therapeutical pur- prognosis is quite otherwise because here
poses into three classes. The first uill con- i)hagocytosis goes on normally. Starling
sist of those cases in which the comedo is from the solution of continuity at the umthe
dominant feature, with, also, some of bilicus the germs enter the tissues and are
those which have progressed further to the not opposed by the lymphatic glands. They
indurated and postular stages. In this class enter the lymphatics of the subcutaneous
of case the acne bacillus is the offending tissues, where they are found in great numagent
and the staphylococcus if present at bers, as also in the outer coats of the blood
all is playing a subordinate role. This vessels. A rapidly fatal peritonitis closes
class, therefore, may be treated with a vac- the scene. The external redness and swellcine
of acne bacillus alone. The second ing are slight, the symptoms of peritonitis
class consists of a large number of the in- being the first seen. Treatment has no efdurated
and pustular varieties where both feet,
staphylococcus and the acne bacillus ap-
year to be playing an active part in the Oiphtheria.—Mackay and O'Brien ( In-
tercolonial Medical Journal of Australasia )
causationof the inflammatorv process. The
therapeutic requirements of ' this class are
best met with a mixed vaccine of staphyloreports
404 cases. The conclusions arrived
at by the authors from this series of cases
coccus and acne bacillus. The third class are:
consists of those less common cases where Provided no complications are present,
there is more acute inflammation, tending the best control for the administration of
almost toward a furuncular form. Here diphtheria antitoxin in faucial cases is the
microscopical examination will show that patient's temperature. They gave antitoxin
the staphylococcus is the chief offender and in such dosage, repeated at eight to twelve
treatment should be directed at first against hours' interval where necessary, that a fall
this factor, not forgetting, however, that at in temperature to the normal line was prothe
basis of the condition there is an acne duced. Practically none of their charts,
bacillus infection. except those few cases in which complications
existed, show a temperature range
The Treatment of Uterine Hemorrhage above normal after the second dav. Their
with Serum.- Busse (Zentralblatt fur Gy- average dose of antitoxin was high, but
nakologie) reports his results in the treat- their results were most satisfactory, as evinient
of ten cases. All were cases in which dencedbv the comparatively low death-rate,
there was apparently no anatomical cause earlv resolution of the membrane, and low
for hemorrhage, and in which the hemor- percentage of resulting albuminuria,
rliage was not controlled by other meas- Qeiitle swabbing, douching, and gargures
Curettage had not been successful, ling of the throat with simple saline solu-
In all he cases the aiiemia from the hemor- tion, accompanied by mild oral antisepsis,
rhage had become sufficient to have a seri- js more efficient and much less distressing
"''°" ^'^"'"'''^
''atienfs''"''"^
^'^''^^^' °^ ^'^^ ^^^'' vigorous swabbing and gargling witii
'
\^
strong antiseptic solutions, whose tendency
The treatment consisted in the injection is to abrade the mucous membrane, and so
of 10 c.c. of human serum suljcutaueouslv. produce a fresh raw surface for the spread
The serum was taken from healthy subjects of the diphtheric membrane.

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XXXIV
THE CHARLOTTE MEDICAL JOURNAL.
Their experience has led tliem to .strongly will develop eclampsia and which not, alfavor
inlul)ation as the routine hospital op- though probably the one most subject to
eration in cases of laryngeal diphtheria,
Their procedure has been first to try an inheadache
and nervous recklessness is more
liable to do so. Althoush the amont of albuitial
dose of antitoxin, say 2(t,0()n units, min in the urine before the onset of the conaccompanied
by external applications of vulsions may be very slight, in most cases
heat to the throat; if that failed, them to the urine becomes solid with albumin afterintubate,
probably giving more antitoxin; ward. He does not deal with the many
and finally, if failure again, to do trache- theories as to the causation of eclampsia,
otomy as a last resort, the child getting
40,000 to 50,000 units of antitoxin.
beyond saying that most authorities agree
that it is a toxemia. The onset is always
Paralysis Agitans.—Taylor, in the Lonsudden,
and in most cases probably the
medical attendant called in has not seen
don Lancet, states the well-known fact that
paralysis agitans is one of the most disthe
patient defore. The main principles of
treatment to be followed are: (1) To con
tressing diseases of degenerative type with trol the convulsions; (2) to empty the uterwhich
we have to deal. The most trouble- us, if the attack be antepartum; (.i) to ensome
symptom is the shaking, but besides deavor to insure the eliminative action of
this the patient frequently complains of the the bowels, the kidneys, and the skin. The
feeling of constant heat, of free and trou- two chief methods of checking the fits are
blesome perspirations, and not infrec(uently (a) the administration of chloroform, and
of sleeplessness. It is idle to hope that we (f, ) the hypodermic injection of morphine,
shall ever be able to cure such a disease. He has an objection to keeping a patient
But it would be something to be able to re- under chloroform for a long time in this
lieve .some of the troublesome symptoms, condition, as it tends to increase conges- i
and Dr. Taylor has been greatly imiiressed tion of the kidneys. For many years he |
with the efficacy of hypocine in modifying has trusted almost entirely to morphine to i
—one might almost say, in some cases, in control the fits, giving at first half a grain, I
controlling—the tremors. The writer gives and repeating a quarter of a grain every J
the hydrobromide, and he gives it with a three or four hours if necessary. In cases '•
small dose of strychnine in an acid mix- of eclampsia the os general! dilates very [
ture. The dose he usually begins with is rapidly, as if nature was making an effort r
1-200 of a grain three times a day, and this to empty the uterus, so that on making a j'
can sometimes be increased up to even vaginal examination the os is found dilated '
1-100, but sometimes is efficacious even if to the size of a half-crown, or a crown piece. :
only given 1-200 twice daily. The draw- If the patient is not comatose a little chlo- ,!
back to its use in this and in other diseases reform should be administered, and thecer- I
with tremor is the excessive dryness of the vix dilated either manually or with a Hos- i
throat which it produces, and it also in si's or other dilator. As soon as the os is ',
some people very readily apparently pro- dilated to the size of the closed fist, the 1
duces, and paralysis of accommotion and child should be delivered either with forceps 1
pupil dilatation, so that these two incon- or podalic version. The placenta should I
veniences have to be borne in mind, as it be quickly peeled off and the uterine cavitv
is often necessary to reassure the patient douched '
with hot saline solution. The j
who complains of them. Of course, one I
bowels are acted upon bv enemata or bv
meets with certain cases—perhaps it is that placing a drop or two of croton oil on the |
ui these the disease has reached a certain tongue in butter. The skin and kidneys are I
stage—in whicli no benefit is experienced stimulated to action bv wrapping the pafrom
the drug. Vet in many cases, as tient in a blanket wrung out of very hot
above slated, it is useful m controlling, or water. A pint of normal saline solution
at least in modifying, the severity of the should be run in under each breast. When i
tremor.
^jje patient is able to swallow, water or i
„ . ^ . . , barley water may be given freelv. He bled ,
;
Puerperal EC amps.a.-Lrago Austra- ( three out of four of his earlier' cases over
lasian Medical (.azette) says that fortunt^,„t^
Thev all recovered, but
ately a bumiiuina in a pregnant woman ^^^ symptom remained' for a long time in
does not always spell eclampsia. During .,. r r, r ,
the writer's connection with
evidence, viz., a forgetfulness of
a maternity
everything
hospital, as well as in private practice, he that had occurred before the illness,
has seen very many cases of albuminuria
in pregnant women (in some the urine was ^^i^'V »«» '^c Semilunar Cartilages ol
almost solid on boiling) who did not de- •*** Knee.— JMorrisoii, in The London f^anvelop
eclampsia. The author knows of no cet, has had occasion to see a large number
means of deciding beforehand which patient of the above cases. He has operated on 75
-

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mstructive and interesting: jioint. The experienced teacher, the skilled
;;i-nitour()I

XXXVI
.
)
THE CHARLOTTE MEDICAL JOURNA].
in all. The prevailing assumption that the and without the necessity of a communicapathology
of injury to the semilunar carti- tion between the two regions. In conclulage
is a displacement, the author has found sion, he condemns the therapeutic test by
to be entirely wrong. In all of his cases the administration of iodine, which should j
the lesion was found to be a fracture; the never be used unless the microscopic examdislocation
is merely secondary. The writer ination proves very uncertain. It should j
says that displacement, without fracture, if then be pushed rapidly and its effects watch- j
it occurs at all, must be a very rare event, ed for only a limited time, Early diagnosis
Of 100 cases, in 98 the internal cartilage and operation is the only hope.
was fractured and in two the external. The .
j
j
diagnosis is made by the typical history of
,,,^j„ ,„ surgical Tuberculosis.
sudden locking, the inability to extend the
•
ti ^r . t. . , „ „ , , u , "
c „
, ,
r ., • t f 11 Dr. \V. A. Tatchell saya that tuberculosis of the
knee, and swelling of the joint following
^^j^^^^ ^^^^^^ g,^,,^^ ^^^ 3^i„ j^ the most comthe
attack. In a fair percentage of the mon disease in China and highly recommends the
cases, osteo-arthritic changes may occur, application of iodin liniment after operative treati
>
(
i
•
l
resulting in more or less permanent dis- "'''"' A/*^'' i-i-, »TM i 1 1 r 1
ability. The treatmen of recent cases con-
°P,^,'''>V"g. ?^s'^/.^PJ."8. the cavity is
thoroughly swabbed With lortm liniment. .-V piece
^j ^b.sorbent cotton twisted around the end of a
i
ii
"
SlStS in first reducing the dislocated cartl- probe forms a good swab, and can be graduate^ i
lage. This can usually be done by flexing according to the size of the sinus. The liniment is |
the joint to its fullest extent and then sud- aPpHed every day. The application does not cause i
li ^j. . Tc . , . pain, except a momentary sensation when applied t
denly extending it. If not rotatory move- P,
^„;„^ J,i^^^^, neither does it destrov tisstles, as ,
ments should be made in the fully flexed does pure carbolic acid. Granulations do not be- i
position before extension is performed. If come excessive. At the first application he inserts i
this also fails, these movements should be a thin piece of gauze or packs lightly, but never at ;|
repeated under anesteesia. After reduction, t^^^:^1::^J^ t^:^:::^ 'Cr \
splints are applied for SIX weeks. If dls- many chronic sinuses. From the first he gives a
placement rectirs, the case may be treated mixture internally, containing syrup of iodid of i
bv the aid of a support or by operation. For 'n. ' ^rani, and potassium iodid, 5 grains, three )
persons whose livelihood depends on a times a day.-British Medical Journal. •
strong knee, the support is useless and a
radical operation is advised. This opera-
*
Treatment ol Children Suifering from 1
tion consists in a hockey-shaped vertical Rheumatism or Chorea.
,
incision on the inner side of the knee, open- Dr. D- B. Lees states that every case of chorea in
ing of the joint and removal of the anterior
childhood should be considered as presumably
t„. tv.v^ f .1 fl- t 1 .-1 r\c 11 rheumatic, and ought to have the benefit of this
two-thirds of the affected cartilage. Of 41
probability. Every such patient should be at once
operated patients in whom the subsequent sent to bed, and treated vigorously for rheumatism.
i
J
history could be traced, 38 reported them- He claims that almost the whole of the heart dis- j
selves able to work, while three were cases which exist in patients under thirty years of
still
a: ui I '1^1 »• 1 r 1 age, as well as a very considerable proportion of the
disabled. I he average tune before work ^Lk disease of later life, is the result of rheumatic
was commenced was about 1 2 weeks. infection of childhood that was either unrecognized
or ineffectively treated. The author emphasizes
Operative Treatment ol Inlra-Oral the point that every child who complains of sore
Cancer.— Childe ( British Medical Journal throat or of pains in the joints, muscles or tendinmeiltions
the two principals of operative ous structures, every child who suffers from malaise
treatment of oral cancer. The neck should '^::^7^J^:^:;^:^J::Z^
always be operated on first, then followed nodules on his tendons or round his joints, or subat
once or later by the excision of the pri- periosteal nodules on his bones, every child who
mary growth. By ligation of the lingual '^^^ P^'" '" ^^'^ chest, or shortness'of breath, or
°'arked pallor,
and
and everv child exhibiting even
facial arteries on the alTected -.--i^v-va side luc the Liic
.
•
, ,
, ,.
gjjgjjt choreic movements or merely weakness and
severe hemorrhage is obliterated if the sec- incoordination of muscular action or emotional inond
stage of the operation is undertaken at stability should at once be put to bed and his heart
once, and, if delayed, tends to starve the should be promptly and carefully examined. The
^""'°"' •"''" cancer cells and diminish
P?y"ton and Paine's demonstration of
their activity ' in
a diplococcus in rheumatism and chorea which is
. . ,, 1

ADVERTISEMENTS.
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WIXH
REPRESENTS THE MOST
VALUABLE COMBINATION
OF TONIC AND RESTORATIVE
KNOWN TO MEDICINE
EISNER,- MENDELSON CO., NewYork
should not be Kiveii. The neck should be packed
externally with ice bags in order to relieve the pain.
The author uses a douche of warm water which has
been rendered faintly alkaline with sodium bicarbonate
in order to diminish absoriHion of the toxines
from the fauces. The object of this procedure
is flushing and not disinfection. The patient should
lie on bis stomach with the head projecting over
the edge of the bed. the forehead supported by one
hand of the nurse. At least two pints should be
used for each irrigation. C.entle swabbing with a
solution of borax is sometimes u.seful in adults, but
the application of germicidal solutions should not
be used, and neither the spray nor the paint brush
has any legitiuiale place in the treatment of the
throat A separate nozzle should be used for each
patient. In toxic cases he discusses the use of
serum, which should be polyvalent, sterile, and not
more than six months old. From. 50 to kkj c.c.
should be given, and he has never seen any harmful
result therefrom. In septic cases, germicides
should be used in as concentrated a form as possible,
in small quantity and should be applied with a
swab. The doUche also should be constantly used
as before recommended. It is not advisable to incise
enlarged and tender cervical glands unless
definite evidence of fluctuation is obtained, so long
as the skin over them is not affected. In septic, as
distinguished from toxic cases, streptococcus serum
should be avoided, .\lcohol in Dr. Gordon's experience
is usually both unnecessary and harmful
in septic cases.—The London Practitioner.
Tbe Home Treatmenl ol Scarlet Fever.
The line of prophylaxis indicated by the pathology
of scarlet fever is for clinical purposes the same
a.s ill a series of fatal diseases such as diphtheria
measles, and whooping-cough, and of less serio
affections such as influenza, mumps, and others,
writes Wm. Ewart, of London. It is admitted that
in all of them the upper respiratory tract is the
headquarters of infection ; yet are we ever taught
that the entire stress of our efforts at disinfection
should be concentrated upon that region?
Whether we are dealing with scarlet fever or with
any of the other diseases mentioned, we should
bear in mind that cleanliness is the simplest and
most efficient of our antiseptics, and that our patient's
disease is unwashed until the entire upper
mucous tract is systematically and frequently
cleansed. The author gives as a simple and painless
method, which he has long advocated and
practiced in all these conditions, frequent instillations
of jasmin oil through the nostrils, to spread
above and behind to regions iiiacce.ssible to sprays,
douches, and gargles, to be continued from the
onset through the entire duration of the period of
observation. —British Med. Jour.
Treatment ol Severe Arlbrilis.
Schawlow, physician at one of the prominent
watering-places for rheumatism and allied joint
affections, speaks highly of the beneficial effects of
sulphur waters, in combination with massage, gymnastics,
stasis, and electricity, in the treatment of
the chronic forms. Acute articular rheumatism is
usually' cured by thirty baths, though the same
number of baths and more taken at home may
have no effect. In arthritis deformans and chronic
articular rheumatism the treatment is naturally
extended over a longer period, though the good effects
do not admit of dispute.
The third group includes chronic progressive
arthritis, a much more serious disease, which is not

XXXVIII
THE CHARLOTTE MEDICAL JOURNAL.
influenced by the salicylates and which progress- of Bordeaux (in the Medical Annual), as originatively
affects all the joints and is often fatal. In ing this treatment, E. Manuel Sympson, of I.uicertain
respects it resembles the gonorrhoic form, coin, Eng., has frequently employed it, and has
but no specific germs have yet been discovered. been greatly pleased by its almost unvarying success.
His plan is for the patient to bathe the af-
The gouty pint affections are included by the ^^^J^^^'^^ ^ri^^^J^l^
^troy;slJ°Sct1o^'- especially in the more ^^ ^'^'^^ -^'^^ :^' }^^Zll:^ ^^
chronic progressive type, have been found a most utes, twice daily. This treatnient has the addi- |
valurbi; adju4it in th; treatment, and have t.onal advantage of being capable of being carried
brought abit remarkable results when all the
"^''^Tl^'^'^'' u l''"\^!'!^j:^^X^^^^^^^^^
other measures failed. As a rule, ,o injections of though it is well to dun nish the strength of the
2 3 Cc. each were given, one dailv, into the gluteal Peroxide ,f much pain and irritation is produced
muscles. Improvement was generally noticed onlv by the application. A continuation of thi.s treatafter
the twentieth injection:' No aftlr-effects were "'ent for two or three days m most cases will effect
observed, except in a few cases a slight diarrhea. ^ cure. -British Med. Jour.
Even patients with valvular disease and lung trou- ,
ble stood the injections remarkably well. The Splenectomy.
swelling of the joints disappears, the active and , ^ .
passive mobilitv returns, and a most marked change Fisher (Prcceedings of the Royal Society of
J
in the general condition can be noticed. Fibro- Medicine) reports the case of a woman 47 years (
lysin acts as a lymphagogue, increases the hvper- old. who entered the hospital complaining of a
emia, and stimulates chemotaxis. As a cbnse- severe pain in the left hypochondrium, which t
quence, the firm connective tissue will be softened, came on suddenly four days before she was seen. 1
—Deutsch. med. Woch. This for two days was not entirely crippling in in- •:,
^ tensity, but thereafter had confined her to bed. -j
..„ .•._,. M« Pulse, temperature, and respiration were about

^/^
ADVERTISEMENTS
Aseptinol Manufacturing Company.
'Baltimore^J^d.
iJdERAL ::^MrLF TO PHYS/C/ANS AND NURSES.
Treatment oi Intestinal Allectlons.
Ill the latest edition of his Practical Therapeutics,
Professor Hare says that salol "renders
the intestinal canal antiseptic, and so
removes the cause of the disorder, instead
of locking the putrid material in the bowel,
as does opium." He regards salol as "one
of the most valued drugs in the treatment of
intestinal affections." When we add the
antiin-retic and anodyne effects of aiitikamnia,
we have a happy blending of two valuable
remedies, and these cannot be given
in a better or more convenient form than is
offered in "Antikamnia & Salol Tablets,"
each tablet containing 2]^ grains aiitikamniaand2'j
grainssalol. The average adult
dose is two tablets. Therefor*, we conclude
that to invaluable reniedv in solol; while to
remove accompanying i)ain, to (juiet the
nervous system, and to reduce any fever
which may be i)resent, we haxe a remedv
equally efficacious in antikamnia; an ideal
combination for the treatment of this class
of diseases.
Prickly Heat
Prickly Heat can be relieved and prevented
by the use of 'I'yree's .\ntiseptic Powder.
Dr. W. M. Chartier, of the I'aculte de Paris.
France, after using it successfully, says thai
it possesses curative and preventative prf)perties
to a high degree. This is the general
opinion of all physicians who have tried
Tyree's Antiseptic Powder in abrasions,
burns, ulcers, and infected conditions of the
skin and mucous membranes. Its high
antiseptic properties make it one of the most
jjowerful remedies at the command of the
physicians for combating the effects of pathogenic
micro-organisms after they have become
active, and preventing the further
growth and activity of pyogenic bacteria.
It is not an expensive preparation, and
therefore, even long treatment can be carried
out with comi)aratively small cost to the
l)atient. The doctor recommends in these
cases a sponge bath made of one ounce of
Tvree's Powder in one gall"" "f water applied
freelv three times a dav. Sample with
SAL HEPATICA
For preparint^ an
EFFERVESCING ARTIFICIAL
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Superior to the Natural,
Containing the Tonic, Alter-it
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the addition of Lithia and Sodiun
Phosphate.
BRISTOL - MYERS CO
277-279 Greene Avenue.
BROOKLYN - NEW YORK

XL
THE CHARLOTTE MEDICAL JOURNAL.
chemical formula, bacteriological and clinical
reports free upon application. It will The nervous system in every case of St.
not irritate the most sensitive skin. 25c. Vitus' dance shows a more or less marked
per box. J. S. Tyree, Chemist, Washing- depreciation of functional vitality. Valur
ton, D. C, able as nearly always will be found some
preparation of arsenic—Fowler's solution
Watch HIII, Rhode Island. usualh—many practitioners have grown
The most delightful spot in New England place great reliance^ on the preliminary or
to spend the'summer, free from mosquitoes' coincideivtal use of Cray s Glycerine Tonic
malaria and tvphoid fever. Just the place, Comp. The tonic restorative effect of this
Doctor to send vour clientile who need a eligible preparation is promptly manifested
cool delightful climate to spend the sum- by a substantial improvement of all vital
mer Children suffering from "summer functions and a very pronouuced augmencomplaints"
do well here. The ideal loca- tation of so-called nervous stability. Ths
tion of Watch Hill for a summer resort and following prescription with suitable rer
the many attractions—boating, sailing, fish- diet and regulation of the hygiene, is wit
ing, driving, automobiling, 18-hole golf out a peer:
course, splendid tennis courts, still-water » I^iq- Potass Arsenitis 3iss
and surf bathing, are so well known as to Gray's Glycerine Tonic Comp. Sviii
need little more than mere mention. For ( P. F. & Co.)
many vears Watch Hill has been the chosen ^M- et Sig: A teaspoonful in water three
summer home of many people of fastidious times a day for a child eight years old.
tastes and exclusive habits, whose charming
cottages add distinction to the place.
During the winter and spring months The
The Second Summer.
There is no denying that the second
Watch Hill House has been enlarged, reno- "teething summer" is usually a hard one
vated and refurnished. A new and up-to- for the babies. Digestive disturbances are
date laundry has been installed. A number common and the "wear and tear" on a litof
new rooms, with private baths, has been tie one's nervous system is often severe,
added. A sun parlor, or enclosed piazza. The systematic use of Gray's Glycerine
also for the comfort of the guests, has been
built. Many other improvements to both
hotel and its cottages have been added.
The New Watch Hill House occupies the
Tonic Comp., however, in doses of twenty
to thirty drops, three times a day will ob-
viate many if not all of the distressing complications
that make the second summer
finest position on the elevated peninsula, such a bugbear. The baby's digestion ir
Raised above the surrounding buildings, it proves, its assimilation of nutriment is aided
commands a view of both ocean and sound, and its whole vitality is so materially elevaso
that each room has an ocean view. From ted that the teething process becomes a negits
spacious port cocheres can be seen the ligible factor, at least so far as the general
entire sweep of the neighboring islands and health is concerned,
promontories, bays and inlets. Long Island The formula of Gray's Glycerine Tonic
sound, the mouth of Pawtucket river and Comp. adapts it particularly to the needs of!
Little Narragansett bay, and just to the growing infants that show the slightest diwest
of the elevation on which it stands the gestive or other weakness. Clinical expe"
road dips down to the beautiful bathing perience is a dependable guide, and count^
beach. Col. A. E. Dick, a host of inter- less infants have been carried over critical
national reputation, has leased the New periods by the judicious use of this effectiv
Watch Hill House and will be pleased to remedy. At such times it has proven time
serve his friends this summer. See an- and again a true therapeutic friend to zealnouncement
in advertising pages. ous, painstaking practitioners.
The Gastric Neuroses.
Movable Kidney, with Details of an <
,,,.,, , eration for Fixing the Kidney.—Chevne,
,
In all functional derangements of the
j„ ^j^^ j^^,,^^^^ lancet, savs that movable
nervous mechanism of the stomach, Gray's
^^^ ^^^^^^^ ^^ discussed from the stand-
Glycenne Tome Comp. will be found of
^^-^^^^ ^^ symptomatology, indications fori
extraordinary therapeutic value. Its action operation and the causes of failure of operais
manifold, manifested by an immediate tions.
influence on the gastric -"^ tissues and a sub- "ew fixation operation is described:,
stantial promotion of the general
^^'^ patient lies on the back with a small;
nutrition.
,, ,, , T \ c pillow under the loin, projecting it slightlvi
As the secretory and motor functions are
^^^.^^^d; it is not necessary to push the!
improved, the patient's whole condition is iuml)ar region very far forward. An iiicis-,
correspondingly benefitted. ion is then made along the edge of the ribs

ADVERTISEMENTS.
The State Examining Board Statistics
For Graduates of 1908, Published by American Medical Association, Show
Virginia leads adjoining States— North, South and West, . ReCOrd,
94. 5 '^
Richmond leads the State of Virginia Record, 96.4".
University College of Medicine leads Richmond. Record, Sl.T'c
Also leads all medical schools mVirgmia, on the combined record
o( medical graduates for the entire period of her existence, ReCOrd, 91.8'V>
SIMILAR RESCLTS I\ DEPARTMESTS OF DENTISTRY AND PHARMACY.
Students Limited to Fifty in each class. Send for Catalogue and Bulletin 30 Z
University College of Medicine, Richmond, Va
I College of Rhysioians and Surgeons |
J
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^
A 38 Annual Session Begins October Isl.
^
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$ hydrophobia and many hospitals for clinical work present to the medical students ^
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• GH«F?I_ES l=. BEVrtIN, IW. O., DErtIN, $
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and an inch below them, beginning abuot
the edge of the latissimus dorsi, or practi
cally just where, lookinij down on the patient,
the anterior surface of the abdomen
ends, and from this standpoint it is carrie
forward parallel to the edge of the
from three to four inches. It is
make the incision short in the first instanc-e
it can be subsequently lengthened if neces:
sary. The skin and fascia are divided and
also the external obli(|ue muscle; the internal
oblique and transvalis muscles can be
partly separated and partly divided. The\- X
only require a little division here and there, *
and any nerves that are crossing can be •
pulled out of the way. One then comes
down on transversalis fascia. The fascia
is not divided but is pushed towards the
%
J
*
middle of the line, the peritoneum, , fasc-- fascia,
and kidney being thus carried forwvard
lo-
A-
f
gether. In this way there is less risk of «
tearing the peritoneum, and we also get at
once to the posterior surface of the kidney,
which can be easily felt. The edges of the
wound being well retracted and the fascia
and peritoneum being held well towards the
middle line, and the kidney being fixed by
[the assistant's hand placed in front of the
abdomen, the outline of the kidiiev can be
A simple and cflectivc trea
for the various affections c
bronchi. Especially useful for very
young children. Avoids internal
medication or may be used with any
other treatment.
Indicated in Whooping Cou|s:b,
Croup, Bronchitis, Diphtheria,
and the hn.nchial c .niplicatiuns incident
to Measles and Scarlet
Fever.
Vaporized Cresolene relieves
Asthmatics.
Laboratory tests have proven
the destructive effect of vap(jri/.ed
Cresolene on Diphtheria bacilli.
I^lterature on reqtiest.
Vapo-Cresolene Co. %
180 Fulton St., New York.
|
288 St. James St., Montreal, Can. S

XLII THE CHARLOTTE MEDICAL JOURNAL.
readily ])alpated. A hole is now made in external obli(iue is closely united by two or
the perirenal fascia over the posterior part three mattress sutures and subsequently by
of the kidney, and the renal fat will at once a continuous catgut suture,
protrude. This hole can now be enlarged Apart from the case with which one can
vertically over the posterior surface of the fix the kidney in its j)roper position by this
kidney, and the fat being pushed outwards operation, there is another great advantage
or reniox'ed the posterior surface of the kid- in this incision. liveryone is familiar in
ney isexposed. The renal fat is then partly cases of movable kidney with the ditEcuUy
removed and partly pulled forwards with of being certain that all the symptoms are
the perirenal fascia and the kidney is grad- entirely due to that mobility. With the orually
shelled out and can be readily brought dinary lumbar incision one cannot as a rule
out of the wound. The posterior part of the make any investigation of the condition of
wound is then thoroughly cleared from fat these other parts but with the incision detill
the diaphragm, the psoas, and the quad- scribed it is quite easy to do so. By makratus
lumborum muscles are fully exposed, ing an incision into the peritoneal cavity
The faty capsule and the posterior part of after having exposed the kidney, one can
the renal capsule are thoroughly turned ascertain the condition of the various parts,
aside (it is well to take away a good deal of And not only can these conditions be diagthe
fat in case it should get in between the nosed, but some of them can also be remekidney
and the muscles and prevent firm died without making a further incision. For
adhesion). The kidney is then turned for- example, it is, of course, quite easy to stitch
wards and incisions are made through the the liver up to the edge of the ribs so as to
capsule on the posterior surface, as follows: obtain adhesion between that organ and the
A vertical incision running upwards near diaphragm. And also, the colon can be
the inner side of the posterior surface and fixed up to the under surface of the liver at
curving outwards at the upper part towards the same time. And then the various conthe
upper and inner part of the posterior ditions in connection with the gall-bladder
surface, and then a transverse incision run- are quite accessible by extending the incisning
across the kidney at the lower end of ion.
this vertical incision. The capsule can be jj
I
stripped off as far as the convex border of Johann
the kidney. From each end of the lower
Hofl's Malt with Iron
Digested.
Easily .
J
transverse incision a small vertical incision
is made through the capsule, and then this "' pharmacological action.
i
portion can be pulled down so as to hang Powers of three different kinds are condownwards
from the lower pole of the kid-
^eyed to the body by Iron. First. Are
ney. The fatty capsule and loose fascia
t^°s^ derived from its presence in all the
being prevented from getting
tissues.
in between Second. Those of appetite, digesthe
kidney and the posterior muscles t>0",
the
strength, derived from its action or
kidney can now be turned back and placed
nutrition. Thi>d. Those which arise from
exactly in ''^s the position which is desired;
formation of heemoglobin, without which
it
can be put up as far as one wishes, and "either the blood nor life itself
also would be
at the proper distance from the spine. By possible.
;|
means of strong catgut or
'^^^
silk stitches the
importance of Iron is obvious; but it ,•
vertical piece of capsule is now stitched ^^^^ ^^ S^^'^" '" ^ digestible form.
~
^
down to the muscles behind, taking care not _ .":
..
^^ . „, . T
Pruritus Remedies tbal
to stitch it too Work.
tightly, because the natural
tendency of the kidney is for the outer bor- Pruritus of the skin, anus or vulva, espeder
not to be so closely in contact with the cially when attended by scaling of the skin
the posterior wall of the abdomen as the of the hands or feet, may be invariably set
inner border is. The piece of capsule which down as due to autotoxemia from fecal abis
hanging down from the lower pole is then sorption. This condition is admirably met
stitched to the muscles below the kidney, by the following combination:
and in this way the raw surface of the kid- Juglandin gr. 1-6 to stimulate secretion, f
ney is kept in contact with the surface of relieves costiveness, and favors the loosenthe
muscles behind and acquires firm adhe- ing of fecal matter adherent to the coats
sion to them. The capsule at the lower of the bowels; physostigmine gr. 2-250, to
part is strengthened by stitching down the stimulate peristalsis and the ejection of
detached portion of the renal capsule so as fecal matter; berberine gr. 1-6, to induce |;
to form a sort of ledge on which the kidnev contraction of the relaxed and dilated ti
rests. The kidney having been fixed, the bowel. This dose should be given from L
peritoneum is then allowed to fall back into three to seven timet a day (with the morn- T
position and a few stitches will generally ing salithia flush ) and continued as long as j
bring the deeper muscles together while the the necessity exists. fl

Much better results will be obtained from
such application of exact remedies to meet
the conditions they exactly remedy than
from the ignorant combination of cathartics
without regard to the specific action of each
and the adminstration of such remedies in
very large doses which soon exhaust the
irritabiliiy of the intestines and require con-
stantly decreasing effects.
In persistent ana! pruritus, usually dependent
upon internal "piles" the Ilybisco
Ointment (Abbott) will be found an excellent
thing.
All these remedies may be obtained of
The Abbott Alkaloidal Company, Chicago.
Gasiro lutestinal Irritations and Their
Treatment.
Brose S. Home, M. D., Kx-Physician Indiana
State Pri.son, Marion, Indiana.
luiteritis is only a clinical expression and
the disease is due to many causes. The
most fruitful cause is drinking water con
laminated bv the discharges from diseased
patients, lixposure to cold, bad food,
through nervous influence and direct irritation
of the mucous membrane, may produce
individual cases of the catarrhal forn-s. hi
army life this disease is cjuite freciuent and
is described under the name of dysenter\
In crowded places, as in the army or in
prison, epidemics will arise and fre(|uently
the whole mass of humanity will be taken
down with this dreadful disease.
There are many micro-organisms found
in the discharges from these patients. ( )nc
is the amct'ba dysenteriae, claimed by some
to be the main cause, but it is doubtful if
any one organism can be pointed out as the
sjjecilic cause of the trouble. It is a settled
question now that some poison introduced
into the system produces these gastro-intes
tinal troubles such as gastro-interitis,
I eiitero-colitis, epidemic dysentery, etc.
We need not dwell on either particubu
nosological classification as the treatment
is about the same in either one of the enli
The common symptoms met with in
ties. I
I these disorders are about the same. Tlie>
commence with a light form of gaslro-
will ;
intestinal catarrh. After the stage of incu-
j
I bation
! a
' diarrhoea
\
j-
which may last from a few hours !<
few days, symptoms of dyspepsia and
set in. There is anorexia, heartburn,
nausea, vomiting, borborygmus, often
pain in the abdomen and copious fluid dis
( charges. In some cases there is violent
*
; of
1' is
griping and collicky pains with a sensation
depression. The patient in some cases
unable to leave the stool. The tenesmus
; is frightful, making the i)alient not only a
- misery to himself but to his friends as well.
I
Often the patient will sit at stool hours at a
time until he becomes so faint and weak
, .
ADBVRTISHMBNTS.
FORMULA:
Benzo-Salicyl. Sod. 3:i-i3; Hucalyptol
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ionis -16; Glycerine and solvents q. 8. 480,

XLiV
THE CHARLOTTE MEDICAL JOURNAL
that he cannot leave it without assistance, ences. After a review of the symptoms
There is great depression in these cases, which occur as the different organs are
The constant nausea, with occasional vom- most affected, he considers the electrical
itiuo- and tenesmus causes great prostra- therapy. The author states that we must
'
ji^^j,']'
admit that the means hitherto at our dis-
Uuring the winter of of 1901-1902 an epi- posal have been of little use in the treatdemic
started in Michigan City, Indiana, ment of this disease. Nor is the method he
At that time the writer was physician of the advocates applicable to advanced cases,
Indiana State Prison. Hundreds of cases where the treatment can only be palliative,
developed; the inmates of the prison were His treatment rests on the use of the highinfected
as well as some of the officers of frequency current. Its beneficial effect dethe
institution. The general suffering was pends on its great tension, its great intensgreat
indeed. In these cases all of the ity, its great penetration, its periodicity,
symptoms were those of a case of poison- and its great inductive power. He argues
ing. The skin is hot and dry, the tongue that the body cells must be greatly affected
is heavily coated, the face soon wears an by such a current. It has a double action,
anxious expression, the abdomen becomes Firstly, directly on the cells; secondly, on
distended; there are constant discharges of the vaso-constrictor and vaso-dilator nerves,
mucus, blood and pus, some cases would The writer compares these electrical waves
go to stool as high as two hundred times in to certain forms of sound and light waves
twenty- four hours. In the worst cases the which affect us, but are not apparent to our
patient would sit or lie upon the bed most senses.
of the day not caring apparently whether The author mentions the physiological
he lived or not. The first discharges, as a experiments showing greater chemical acrule,
in these cases were like the white of tivity of the blood under the influence of
an egg; later on they would be tinged with the current. The amount of COj is more
blood. The general symptoms were alarm- than doubled, and animals under the infiuing.
At times a person would be tempted ence lose weight rapidly. The urine shows
to call the case cholera. In some cases a better oxidation of its contents, together
there would be fever and in others there with an increase of the latter,
would be none. To give some idea of the Clinically, the author says, one cannot
cases I will cite one: deny the great general improvement pro-
John S., age 32, white was taken sick duced by the current—as evidenced by imwith
a discharge of mucus from the bowels, provement in the appetite and digestion and
He had tenesmus, griping pains, went to by the improvement in rheumatic condisiool
one hundred and twenty times the tions. The writer states that it has now
first twenty-four hours. He was given the long been recognized how easily articular
ordinary treatment without any relief what- nodules, arthralgias, rheumatoid arthritis
ever. After the first forty-eight hours his and gouty deposits can be fa\orably influbowels
were washed out wi h a solution of enced by this current properly applied,
hot water and Glyco-Thymoline two ounces The writer mentions several cases cured
to each pint of water. He was given a few by the treatment. A case of chronic eczema I
doses of Dover's powder and a half a tablespoonful
of Glyco-Thymoline in a little
with asthma, treated otherwise without suc-
cess for years, was promptly cured. A like
water every two hours. In forty-eight hours result has been obtained in chronic rhinitis
from the beginning of this treatment he was and catarrh of the Eustachian tube, hibothe
up and around. The constant vomiting he says that the current has a special effect on
had disappeared after the third dose of the vaso-motor nerves. The fact is incon-
Glyco-Thymoline. testable that it combats vaso-constriction,
Electrical Therapy in Arteriosclerosis,
— Libothe (Journal de Neurologic) says by
and so diminishes the arterial tension,
cept where renal sclerosis is marked.
ex-
He
the term arteriosclerosis he understands a is sure that even in advanced cases the
fibrous transformation of the arteries, with lessening of the contraction
the other vessels at times affected. It may vasorum has a good effect.
of the vasa
be local or general. The thickening of the
vascular coats may be patchy or diffuse. The Lo«ver Segment of the Uterus.
In the large arteries Xh.^ three coats are af- Cyrille Jeannin distinguishes the inferior
fected, but especially the middle coat. In segment of the uterus as the isthmus, or
the visceral arterioles it is especially the lower third of the fundus. It is of great
intima which undergoes change. The importance pathologically and normall>' in
causes are microbic, tcxic and mechanical,
Libothe believesthat continued hypertension
pregnancy. Its walls are much thinner
than those of other portions of the uterus,
determines the arteriosclerosis, such hyper- In front it is thinner than behind. Its lower
tension being due mostly to toxic influ- limit is the internal os. Its thinness pre-

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disposes to rupture of the uterus. Its form
varies with the presentation of tlie fetus.
During pregnancy it lends itself to the development
of the fetus by stretching. By
some it is supposed to be the cause of the
beginning of labor. Its dilatation by a
rubber balloon is a most efficient means of
inducing labor, in tiie early part of labor
it contracts, but later remains inert. During
pregnancy the implantation of the ovum
on this segment is a frequent cause of abortion
and of hemorrhage in placenta previa.
During labor the adhesion of the ovum to
this segment is a cause of very slow dilatation
of the cervix.— La Presse Medicale.
Pericardial Adhesions of Tuberculous
Nature and Cirrhosis of the Liver in
Children.
Hutinel descri'ues a somewhat rare condition
in which a tuberculosis of the bronchial
and mediastinal glands is communicated
to the pericardium, producing adhesive
pericarditis. Later cirrhosis of the liver
follows, accompanied by ascites, and a fatal
issue from heart failure ends the case. He
calls it caidio-tuberculous cirrhosis. It begins
sometimes insiduously with bronchitis
and wasting. At other times it is more
acute, and begins with a pleurisy. Hypertrophy
of the liver follows, the consistency
of the organ being firm. Then appear circulatory
troubles. The lips become cyanotic
and the face violet, as in congenital
heart trouble. There is dyspncea, but no
cardiac signs can be elicited. The urine is
abundant and albuminous. The tuberculous
condition has remained latent, and it
is the liver signs that attract all attention.
The pleura and pericardium are adherent,
and the heart apex does not move with the
beat. Treatment has so far failed to prevent
a fatal issue.—Le Bulletin Medical.
Primary Cancer of the Urethra tn
Women.
Andre Boursier gives two cases of primary
cancer of the urethra, a somewhat
rare disease. These cancers are usually of
pavement epithelium, which may be tubular.
It is accompanied by pain, difficult urination,
pollakiuria, and final retention of
urine. In some cases incontinence and
liain in coitus have been observed. The
treatment varies with the depth to which
the disease has invaded the tissues along
the urethra. When it has involved onlv
the tissues below the symphysis, that is
from ten to twelve millimeters in length, it
may be removed by the bistoury, an inciscision
being made wide of the growth, and
the mucous membrane of the urethra sutured
to the vaginal wall to reconstitute its
THE CHARLOTTE MEDICAL JOURNAL
orifice. When the whole urethra is involved
the growth may be still removed, but
the operation is much more difiicult. When
the growth has involved the neck of the
bladder operation becomes impossible. In
any case the results are that incontinence
remains to a greater or less degree.— journal
de Medecine de Bordeaux.
Method for the Prompt and Easy Demonstration
of the Reticular Structure
of Nerve Cells.
C. Golgi states that the internal reticular
structure of the nerve cells described by
him has been little studied hitherto on account
of the difficulty of demonstrating it
by staining agents. He describes a new
method of staining that is easy of execution
and gives excellent results, and that has
been made use of for a year in his laboratories.
It consists of a modification of the
^ilver reduction method. It includes fixation
for from six to twenty four hours iu
arsenious acid, 1 per cent, solution, using
.50 parts of the solution, 40 parts of distilled
water, 0..5 to 20 parts of alcohol, and 21
parts of formalin. Next the tissue is placed
in 1 percent, silver nitrate solution for some
hours. The third step is to develop it in
hydrochinone. Sections are made after embedding
in celloidin or parafin. Fixation
of the sections in chloride of gold and hyposulphite
of soda follows, and the sections
are bleached by \'eratti's method: successive
coloration of the nuclei ends the process.
La Riforma Medica.
Prolapsus Uteri in Nulliparae.
Paul Reclus saj's that prolapsus uteri in
young nullipara who are unmarried is generally
of congenital origin. It is seen in
girls of infantile aspect, with irregular menstruation,
ill-developed muscles, and ptoses
of the abdominal organs. Here the peritoneum
is not at fault and its repair or suture
is of no value as a therapeutic measure.
The origin of the trouble is due to a bad
development and weakness of the uterine
ligaments, especially the round ligament.
This allows the uterus to descend and the
Alexander operation is found to give no
benefit because the ligament is found to be
weak and to stretch easily. The only operation
that is of benefit is that of ventrofixa-
tion, one that is not generally advisable in
women who may marry and become pregnant.—Gazette
des Hopitaux.
Hematic Cysts of the Breasts.
Pons describes an interesting case of cyst
of the mammary gland that required enucleation.
These cysts occasion no inflammatory
reaction, but when the fluid is
—

ADVERTISKEMTS
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THE THERMAL BELT SANITARIUM, TRYON, N. C.

XLVIII
—
THE CHARLOTTE MEDICAL JOURNAL.
d.aiiied they rapidly occur. They are lined four weeks more to my indisposition, my
with pavement epithelium. The contents liver and kidneys got into a very bad conconsist
of a fluid that is serous, mixed with dition.
blood, sero-mucous, or oleagenous. The I commenced the use of the Cystogen
I)athogenesis is uncertain. Most authors Lithia with some doubt as to its efficiency,
refer them to an obliteration of the milk but the results have been most satisfactory,
ducts, at their excretorv extremity. The Instead of being awakened every hour of
l)lood contained seems to be the result of the night by an accumulation of irritating
injury to the mammary gland. Or it may urine, I seldom awake for the entire night,
be extravasated as a result of the congestive and never more than once. I find my liver
condition that arises in the breasts at men- and kidneys working jierfectly, which is
struation. Another more modern theory remarkable for an old chap of 72, since the
refers them to an inflammatory lesion of the greatest nuisance that a man meets with
gland. The wall of the cyst removed by after his three-score years and ten is an illthe
author consisted of layers of fibrous behaved bladder.
tissue, the cavitv being lined with cubical I am more than satisfied with the action
and plorostratified epithelium. The surface of the Cystogen Lithia tablets, and they
of the cystic membrane was covered with dissolve perfectly, leaving actually no sedivillosites,
each one containing a dilated ment.
vessel. These vessels freeiuently had under- You are at liberty to use this endorsegone
extravasation of blood into the villo- ment in any form or manner you please,
sities. The structure resembled a fibroade- Sincerely yours,
nomatous tumor. This would show that
extirpation was necessary on account of
(Signed)
May S, 1909.
Dr. Jas. R. Phelps,
Dorchester, Mass.
the danger of cancerous
Ciazette de Gynecologic.
degeneration.
The Therapeutic Action of Prunoids.
• Prunoids produce their excellent thera-
Histology and Pathogenesis ol Condy- peutic results by stimulating secretions, inloma
Acuminate. creasing the fluid content of the feces and
,,. •
, e^ n- I.
1 only gently increasing peristalsis. They
Pietro Stancanelli has examnied many \ i i ^ i i -i ^ i \
.r 1 , . 1 1 ., . are extremelv palatable, easily taken by
specific condyloma a and compared their
^^^^^ children, and when brought in
histology with that of condyloma acumi-
^^^^^>^^ ^^^^^ the secretions rapidly dlintenata,
and as a resu t gives us the following » , , ^, . •
-c j- i
'
. • TM .1 • 1 .
'^ grate and produce their specific medicinal
conclusions; This growth is a product of a . -n i •
ui c .-t ^ .-c
, . ... ,. 1- . .
, I ,, effect. Probably one of the most gratifving
chronic proliferation which begins *^
m the r, .„ -j- u ^ c fi'c
, r,ti.i. 1. features or Prunoids is what tor lack or a
mucous coriniscles of Malpighi, resulting u ... ^ u n i ^u
. £,. ^.' , i.r ? r .. better term may be called their remote
in inn tration and proliferation or the pa- a- ^ ,,n •, ^ i j -j j ^i
.,, , \\. r effect. While prompt and decided catharsis
1 1
pillae; a new tormed tissue of embrvonal r ,, ..\ j .. .. .
i ..
'
. 1.1^1, ~_. . follows their administration in six or eight
type arises, which tends to organization , -u j i ^ ^ ^- a
T -L- ^ 1 1 j-«- .• *• ?> .1 . hours, a mild and Salutarv laxative mfluand
histological differentiation. From their . , j c '^ a c» ^u
jr.. . • J 1 1 ^ ence is observed tor several davs alter ,
the
mode ot origin and tendency '
to necrobiosis £ i i r r> -a /~>,i ^u .
'
., u .u
1 J. T^i final dosa of Prunoids. Other cathartic
the beginning is in the mucous bodies. The .^ . ^ .^t j r^
~^
,. . .^a ^ , , / ^ measures act just the reverse, and after
tissue IS an miiammatory-hvperplastic type ., . ^i i i .111
\^^'' ""'^ the bowels invariably show greater
which tends to organiza ion. It is furnihed
^^'^^'^^ ^"'^ sluggishness.
with a peripheral nervous reticulum
fibrillar and ganglionic. Bacteriological Nervous Excitement.
and bacterioscopic researches indicate that t ^.t ^ .-• 1 ^1
. • . A ^ ^ . • 'iM. In these strenuous times, when the menit
IS not caused bv bacteria. The cause is

VDVERTISEMEXTS
ERUPTION^
Inflammation and irritation of the skin, of any kind and from
any cause, will i>roni]itI\ rt-si^nd inulerthe local aiiplication of
RE5INOL OINTMENT
Alone or conjoined with systemic treatment as may be indicated, the efllciency
of RESIXOL has been demonstrated in thousands of cases of skin affections
by many physicians, and their reports of the excellent results obtained
furnish unquestionable proof of the value of this remedy. RESIXOL has
earned the reputation of beino; the best remedy for Eczema, Herpes, ICrythema,
Erysipelas, Seborrhea, Psoriasis, Eruptions of Poison Oak, Burns, Scalds,
etc. It is equally valuable for inflamed raucous surfaces and very effective
in all local inflammatory conditions. It is being pressribed daily for these
affections in almost everv counrtv of the world.
RE^yiNOL SOAP
Also contains the kI-:SlXoI. .MlvlJlL ATIOX, audit is the only Soap that
should be used in bathing by persons affected by any skin trouble whatever
for it not only assists in the cure, but also prevents the recurrence and development
of many skin atTections. l"or bathing chafed and raw surfaces, and
to cure and prevent Acne (Comedones and Pimples) it is unexcelled. It also
prevents Dandruff and overcomes the tendency to profuse and offensive Perspiration.
The tonic glow of health the daily use of this Soap produces is
simply delightful.
RESINOL CHEiMICAL CO.,
BALTIMORE, lUD.
r.REAT BRITAIN BRANCH: AUSTRALASIAN BRANCH
97 New Oxford Sireel London W.C Chas. Ma.rkell -^4 Ho8^i>itol
DRS. FULXILOVE AND PROCTOR'S
ATHENS. OA.
For the treatment of Medical, Surgical, ynecological and Obstetrical Cases. No contagious diseases
or insane patients admitted. Capacity :-T\venty-one beds. Thoroughly equipped with all modern
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Training .School for nurses, affording skilled attendants for all patients. Nnurses furnished for the
treatment of patients in private homes.
Ambuance service day or night for tho.se who are too ill to be moved otherwise.
Terms:-Kor Hed, Hoard and eneral nursing, Double rooms, I12.50 to |2o.oo per week. Privates
Rooms j;25.rocee

I,
THE CHARLOTTE MEDICAL JOURNAL.
base of the skull. The point is then gently to the needle, and from I.t to 20 minims of
loweredby raising the handle, and the edge SO per cent, alcohol injected slowly, a few
of the foramen ovale is felt for at a depth drops at a time. If no general ane.sthetic
of from l,'i' lo 1;'4 inches, according to the has been given, as is the practice of the
size of the individual. Continental and American workers, the
Harris's results have shown him that in patient will cry out with pain as soon as the
practically every case the needle can be point of the needle reaches the nerve, and
made to pass through the foramen into the the further injection of the alcohol causes
Gasserian ganglion if necessary. a sharp burning pain over the area of dis-
When attempting to inject the inferior tribution of the nerve, a pain which is
maxillary nerve at the foramen ovale, if the repeated with each push of the syringe,
needle is passed straight in and too horizon- The writer prefers to have a general anestally
the wall of the pharynx will be pierced thetic given before puncturing the skin, and
at a depth of 2 to 2,'4 inches. If the point when his needle is approximately in the
be directed too far backward the middle correct position for making the injection he
meningeal artery may be injured, w'hite if allows the patient to come partially round
the needle be passed too far through the from the anesthetic. Moving the point of
foramen ovale, to the depth of 2'4 inches the needle then against the nerve will proor
more, the cavernous sinus and the inter- voke a reflex spasm of that side of the face,
nal carotid artery within the skull may be as though pain w'ere felt, and the injection
damaged. can then be made safely, without the patient
For the second division of the fifth nerve remembering anything of the pain afterthe
injection is made below the orbit into ward.
the infraorbital foramen, taking care to use There are other foramina which can be
no force when inserting the needle, or the injected with the greatest advantage, nameantrum
may be pierced. The direction of ly, the supraorbital notch or foramen, infrathe
needle must be upward and outward, orbital foramen, mental foramen, inferior
Besides injecting the infraorbital nerve, the dental foramen, and the palatine foramina,
superior maxillary nerve is also injected both anterior and posterior. The inferior
deeply at the point of its emergence from dental foramen on the inside of the ramus
the foramen rotundum in the sphenomaxil- of the lower jaw may be injected with adlary
fossa. To reach this point the needle vantage in cases in which the attacks of
is pushen through the cheek in front of the pain are limised to the lower jaw, without
coronoid process and below the malar bone, affecting the territory of the lingual nerve,
a little in front of the line of the posterior thus avoiding the numbness and loss of senborder
of the orbital process of the malar sation in the tongue which would result
bone. The needle is pushed upward and from injection of the inferior maxillary
inward until the front edge of the external nerve at the foramen ovale. There are two
pterygoid plate is reached. The point of routes to the inferior dental foramen, either
the needle is then passed in front of this inside the mouth or outside the cheek, round
bone so as to enter the pterygomaxillary the ramus of the mandible. In either case a
fissure, through which it is pushed, always stout curved needle is necessary; Schlosser
at the same angle upward, until the nerve is practices the external route, though there is
reached. This will vary in depth from 1 -'4 a real danger with this method of producing
to 2'8 inches, according to the size of the facial palsy from the alcohol running backskull,
Besides a certain degree of risk of vascuward
along the needle.
A successful injection, besides producing
lar injury there are two most serious dan- a sensation of numbness and burning for
gers to beware of after the point of the some hours over the area of the nerve deneedle
enters the splienomaxillary fossa,
namely, the danger of piercing the optic
stroyed, always causes a certain amount of
edema and a sensation of stiffness of the
nerve or of injecting it with alcohol; and parts. The burning sensation passes off
sfecondly, of passing the needle into the after a few hours, the edema disappears
sphenoidal fissure and there damaging the after two or three days, whilst there is left
oculomotor nerve. The optic foramen lies behind a sensation of numbness; and there
not more than three-eighths of an inch be- is anesthesia to touch and pin-prick on the
yond the orifice of the foramen rotundum skin and mucous membrane, corresponding
in the same straight line, and it is therefore to the anatomical distribution of the nerve,
imperative never to sink the needle to a This will last for weeks or months, accordgreater
depth than 2 inches, or even 1 ->4 ing to the amount of destruction of the
inches, in the case of a small skull, as of a nerve, but will generallv begin to diminish
woman .=; feet 2 inches in height. When after three to four months. Theattacksof
the nerve is reached the syringe, ready filled pain cease immediatelv after injection, and
with SO per cent, alcohol, is fitted tightly on the delight of the patients on finding they

ADVERTISEMENTS.
The Success of Listerine is based upon Merit
The manufacturers of Listerine are proud of Listerine—because
it has proved one of the most successful formulae of modern
pharmacy.
This measure of success has been largely due to the happy
thought of securing a two-fold antiseptic effect in the one preparation,
I. e., the antiseptic effect of the ozoniferous oils and ethers,
and that of the mild, non-irritating boric acid radical of Listerine.
Pharmacal elegance, strict uniformity in constituents and
methods of manufacture, together with a certain superiority in the
production of the most important volatile components, enable
Listerine to easily excel all that legion of preparations said to be
"something like Listerine."
"The Inhibitory Action of Listerine," a 208-page book, descriptive of the
antiseptic and indicating its utility in medical, surgical and dental
practice, may be had upon application to the manufacturers,
Lambert Pharmacal Company, Saint Louis, Missouri,
but the best advertisement of Listerine is
USTERINE
can talk, eat, use their false teeth, or rub cal incision if necessary, and from the low-
the face, is proof that the nerve has been er end of this a curved incision is made
successfully reached. An accident that upward and outward to the lowest part of
will occasionally happen is a hematoma
from ])uncture of the artery issuing with
the nerve out of the sui)raorbital, infraorbital,
or mental foramina.—(ilasyow
the costal margin. This divides skin and
superficial fascia only. The muscle with
the skin and anterior sheath is now raised
up with the left hand, and the whole cut
.Medical lournal.
straight outward through the middle of the
fibrous intersection till the whole thickness
Incisions lor Operations on the Upper of the rectus is divided. The deep epigas-
I
Abdominal Organs.— Don ( Brit. Med.
Jour. states that incision through the rectric,
or a branch, may bleed and re

Ill
THE CHARLOTTE MEDICAL JODRNA].
'
moved, and the veilical peritoneum, togeth- a calculus no time should be lost with coner
with the posterior sheath, is closed first, servative methods, but the ureter exposed
Efficient drainage may be secured through by abdominal incision, opened longitudithe
upper end of the lateral wound before nally, and the calculus gently expressed,
the peritoneum and vnnsversalis fascia are A sound is then introduced to detect any
brought together. \\ h:ii the inner end is other calculi or strictures and the ureteral
reached the rectus is suiu -ed at the fibrous wound closed by a few fine silk sutures. It
intersection where the St'tuie holds well, is better not to imbed it or fix it in the sur-
The anterior sheath is ma le to overlap a rounding tissues, since kinks and cicatricial
little, and the fibres of the external and in- induration may result. If the ureter is obternal
oblique and transversalis muscles are structed low down it may be exposed
gently approximated. The skin is closed through the vagina or by perineal or periby
celluloid thread or Meckel's clips. sacral, incision, though the latter is not to
be recommended. If the calculus is sit-
Treatmenl ol Ulcerative Colitis.-Dunn ^ated near the bladder cystotomy is indiin
the Medical Lancet reports that m the cated. In cases of injuries of the ureter
Berkshire Asylum, Wallingford, they have garlv operation is necessary, although the
for some years past been so convinced of diagnosis is often uncertain. The retrothe
superiority of the treatment of ulcera- peritoneal route should be selected so as to
five colitis by creosote and ol. morrhuse avoid urinary infiltration. In gynecological
that it is now exclusively made use of. He operations if the meter is injured the
has no hesitation in saying that it relieves wound should be closed at once by two fine
the symptoms more quickly and shortens silk sutures, or if torn across, the sutures
the course of the disease more effectually are preferably to be applied in an oblique
than u.se other, and there has been less mor- circular rather than a transverse direction,
tality since adopting this method. The '
Anastomosis may give rise to obstruction
dose used is as follows: Creosot., W iii; ol.
j^ t^e urinary flow, and it is better to j
morrh., 3i, is given three times daily on the i„vaginate the proximal end into the vesi- /
first day of the disease, castor oil having ^al end of the ureter. From 3 to 5 cm. of ij
been previously administered. This is in- the ureter can be resected, this being com- 5
crea.sed by 3i daily until on the fourth day pensated for by the descent of the kidney. {:
the patient is taking creosot., "^xiii: ol. Suture of the divided ureter low down near 1,
morrh., 3ss. This is continued until the the bladder is technically impracticable \
termination of the disorder. and is commonly replaced by intraperito- '_
Eczema in InIants.-Menddssonl Munch,
Med. Woch.) states that, according Finkel-
"eal implantation of the ureteral stump into .:
the bladder. Apart from injury, implan- ',
stein, the eczema of infants is due to disturb- Nation is also indicated m cases of prolapse, '
tumors of the bladder, ectopia ,'
vesicse, etc.
ed assimilation of the salts in milk; its
treatment therefore is not local, but must
^^ contraindicated for technical reasons it .|
consist of dietetic measures. The best diet ^^^ ^e replaced by (I extirpation of the ) j!
ispoorin salt but rich in proteid andfat,
co^'^^esponding kidney, if the other is
j
and is prepared by removing the salts of liealty; (2) anastomosis of both ureters; I
milk washing the casein in water and then '^^ nephrostomy or implantation into the <
abdominal wall; (4) implantation into the "I
mixing it with diluted whey. Mendelsson
obtained very good results with Finkelstein's "'testme; and (5 '
artificial replacement of
)
diet, the eczematous conditions disappearing of the ureter by tubes. In regard to these !
more quickly and surely than with the older procedures Garre remarks that anastomosis '
local treatment. The loss of weight noted °^ "'l^'^h ureters is very difficult and fail- j
on this diet should not .stop its use, as it is ^^^ ^^o^l*^^ imperil both kidneys and cause caused bv the rapid loss of water with the
\
'ieath. In intestinal implantation of the ;
ureter, to avoid the risk of pyelonephritis, j
removal of salts in the tissues. The diet,
however, .should be tried only in such chil- ^^^ ureter has been implanted into an ex- )
drenwhocan bear fat well; such infants are eluded segment of the sigmoid,
usually large for their age, have a pasty „ . . , , , „ * r„ t-aoLv
, ,,
„.•„ J . T .
Pepsin IS undoubtedly one of the most valuable
Skin and are prone to manifest not only ec- digestive agents of our Materia Medica, provided a
zema but other phenomena of "exudative good article is used. Robinson's Lime Juice and
diathesis." They stand the withdrawal of I'epsin, (see page xvi this number) we can recorasalt
very well if it is not
me"^l as po.ssessing
continued
merit of high order.
too long
after the curative effect upon the eczema "^^^ ^^'^^ '^'''' '''"^ manufacturers of this palatable
has
been noted. preparation u.se the purest and best Pepsia, and
that every lot made by them is carefully tested, be-
Ureleral Surgery.—Garre ( Deutsche fore offering for sale, is a guarantee to tire physic-
Med. Wochensch) believes that in cases in ian that he will certainly obtain the socd results he
which the ureter is completely blocked by expects from Pepsin.

Jlnnomicemeiit
to the
medical Profcssioif
During the past year we
presented to. you fairly
and frankly the actual
facts regarding
We have offered every possible opportunity to members
of the medical profession to inform themselves as to the
analysis of this beverage. We are led to believe that
physicians as a whole now appreciate the wholesome-
ness of Coca-Cola and its freedom from injurious in-
gredients.
We are eoing to ulk with you every month this
Summer about Coca-Cola—by the way, can't
we demonstrate its goodness by sending you a
supply of coupons, each good for a glass of
Coca-Cola at any soda fountain serving the genuine?
Send us your name and address— we will
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with our compliments.
(Sit (tor(i-(SolQ (Somponi^
—

Dropper=Ampoules of Chloroform.
ximately 30 grammes of Parke, Davis & Co.'s Pore Chloroform.
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The Dropper-Ampoule provides for each operation an ample supply of
chloroform of full strength and purity.
It is hermetically sealed, assuring freedom from deterioration and contamination.
It is quickly prepared for use—break off the capillary point of the long
tube, also the capillary point, on the shoulder of the ampoule (with thumbnail,
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It is conveniently carried in the emergency bag.
Specify Parke, Davis & Co.'s Dropper-Ampoules. Get the purest chloroform
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Descriptive Clrcn4ar on Request.
MERCURETTES
An Improved Form of Mercary for Inunction.
Many syphilographers regard inunction as the best method of administering
mercury to syphilitics.
But the mercury ointment commonly used is unsightly. It has an unpleasant
odor. It becomes rancid with age. The dose is inaccurate.
Mercurettes overcome all of these objections.
Mercurettes are small oblong blocks, each block containing 30 grains of
metallic mercury, incorporated in a cacao-butter base, agreeably perfumed.
Mercurettes have been thoroughly tested clinically, reports indicating
that they are superior in every way to mercury ointment— more effective,
more readily and fully absorbed, more cleanly, more convenient. We suggest
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Boxes of 6, each Mercurette wrapped in wax tissue-paper and tin-foil.
Write lor Descriptive Literature.
PARKB, OAVI3 c& OOiVlRAINV
Laboratories: Detroit. Mich., U.S.A.: Walkerville. Ont.: Hounslow. Eng.
Branches: New York. Chicago. St. Louis. Boston, Baltimore, New Orleans, Kansas City, Minneapolis,
U.S. A.; London. Eng.; Montreal, Que; Sydney, N.S.W.:St. Petersburg. Russia;
Bombay, India; Tokio. Japan; Buenos Aires. Argentina.

ttiiALIH AFFAiRS LIBRARY
Charlotte Medical Journal.
A SOUTHERN JOURNAL OF MEDICINE AND SURGERY.
^^: Charlotte, N. C, August, 1909, ~J^.
THE
Table of Contents. Page 127.
clotting of milk in the stomach
may be overcome to a great
extent by the use o "
Chymogen, ivhich under proper
conditions acts upon casein,
and precipitates paracasei:
in a form which is easily
broken up and then pre«
pared for rapid digestion.^^^
The particles of curd ^^^^4^
are so small that the ^^ ^^^A
infant can take i^^^^^/"^
food in the usual ^^ ^ J ^^ A
way from a ^^^ ^^^^r
nursing ^^ fW^ ^F
MILK.
bottle M^X^M CURDLING
AGENT
o
REMOVES THE PRINCIPAL
OBJECTION TO THE BEST AND
HEAPEST OF INFANT FOODS
As Chymogen contains
sugar of milk, its use renders
cow's milk more like human milk
ARM!DURiA>
*— COMPANY
Literature
to Phytieiana ChicagO
[entered at the Posl-Oflice at Charlotte, as tecond-clas* matter.]
^

Chattanooga Medical
College.
MEDICAL DEPARTMENT OF UNIVERSITY OF CHATTANOOGA
Session of 1909—1910.
Twenty-first Annual Session Begins Sept. 22rd.
New buildings. Large patronage. Every facility. A full teaching corps.
Laboratories with latest equipment and salaried teachers. Modern methods
of instruction. Excellent hospital. Minimum living expenses. Requirements
those of the Southern Medical College Association, of which this institution
is a member. A most desirable school for patrons from the frigid North or the
extreme South—equable climate, favorable to effective study. City one of the
most beautiful in America, both by nature and art. National Military Park,
National Cemetery, and miles of splendid Government Boulevards. Scenic
surroundings unexcelled on this continent. Population (including suburbs)
about 75,000. .^
Rates Reasonable. For particulars address,
—
J. R. RatHmeli, M. D., Dean.
CHATTANOOGA, TENN.
EMERGENCY SURGERY
A Practical Guide in Time of Stress of Uncertainty for Treatment of Accidents and
Acute Conditions
By JOHN W. SLUSS, A. M., M. D,
Professor of Anatomy. Indiana University School of Medicine: formerly Professor of
Anatomy a7id Clinical Surgery, Medical College of Indiana; Surgeon to the
Ijidianafiolis City Hospital; Surgeoti to the City Dispensary; Mem-
ber of the Nationaal Assocation of Military Surrgeojis.
PRESS OPINION
"This is a haudy volume bound in flexible leather aud small enough to go into an overcoa
pocket. It is meant for the general practitioner who does not refuse his services in surgical capacity
though he has not made a specialty of that branch of practice. Accordingly the book is intensely
practical; it tells the methods of administering anesthetics, of stopping hemorrhagss, of preparing
material, and finally of operating that the author has fonnd most serviceable in his own practice.
The dogmatic character of some directions is fully made up for by the clearness gained; references
to literature are omitted because of the very aim of the book to give one or at most two methods
of operating and no more. Most of the commoner operations are included in the scope of the book
from tracheotomy and a circumcision to an operation for hernia or laparotomj' for appendicitis. The
treatment of fractures and dislocations is allotted sufficient space. The illustrations arc good. We
recommend the book as fulfilling the purpose of the writer, to furnish a manual of ready assistance in
preparing for an emergency operation. The Medical Record. New York.
With 384 illustrations, some of which are printed in Colors, 12mo., 692 pages. Full Limp
Leather. Gilt Edges. Rounded Corners, $3.50 net.
P. BLAKISTON'S SON & CO.,
Publishers 1012 Walnut Street Philadelphia

ADVERTISEMENTS.
F>OST -TTPHOI
RECONSTRUCTIOl
// is a fact that
Angier's Petroleum Emulsion
is indicated and is effective in all forms of Summer Diarrhoea
of both adults and infants. Because —
1. Petroleum itself is sterile— germs cannot grow in it.
2. It is sedative, soothing and inffammation-allaying to
the entire intestinal tract.
3. Intestinal antiseptics and astringents are useful, when
given alone, only in vhe uf.per part of the intestines. Suspend
them in Angier's Petroleum Emulsion and they are
carried to the lower part of the ileum and colon — just
where the trouble is located and just where they are needed.
Samplea oniy upon re()i):st AMGIER CHEMICAL CO.MPANY, BOSTON, MASS.

THE CHARLOTTE MEDICAL JOURNAL.
^ SAN IVl El T GENITOURINARY DISEASES
A Scientific Blending of True Santal and Saw Palmetto with Soothing Demulcents
in a Pleasant Aromatic Vehicle
A Vitalizing Tonic to the Reproductive System.
SPECIALLY VALUAL E IN
PROSTATIC TROUBLES OF OLD MEN-IRRITABLE BLADDER-
CYSTITIS-URETHRITIS- IE-SENILITY.
f OOSE^-One Teatpoonful Four Tlmei a Day. OD CKEIVI. CO., NEW YORK
CAMPHO-PHENIQUE |

C
ADVERTISEMENTS.
BOVININE
Reconstructive Food
and Tonic
BOVININE represents the most valuable combination of
Food and Tonic elements known to the medical prolession.
BOVININE enables the nerve cell to assimilate its specific
elements, which it fully supplies.
BOVININE promotes the' metabolism 'of fat and albumin
in muscle and blood, thereby restoring the bodily
health, strength and normal powers of resistance.
BOVININEJ supplies full and complete nutrition through
its Food and Tonic properties.
THE BOVININE COMPANY
73 V/gst Houston St . New YorK City
The Standard of Therapeutic Efficiency.
NOT ONLY FDR THE LAST YEAR BUT FOR THE LAST QUARTER
nl- A CFXTURY HAS HAYDEX'S VIBURNUM COMPOUND OIVEN
niaM'XDABLI- KI-:sri,TS IX Till'. TRIvXTMENT OF
Dysmenorrhea, Amenorrhea, Menorrhagia, Metrorrhagia
and other diseases ol the Uterus and its appendages.
There has been no necessity for any change in the formula of H. V. C. because
its therapeutic efficiency has made it "Standard" and so recognized by the most
painstaking therapeutists and gynecologists from the time of Sims.
Unscrupulous manufacturers and druggists trade upon the reputation of Hayden's
Viburnum Compound, and to assure of therapeutic results insist that the genuine
H. V. C. only is dispensed to your patients.
SAMPLES AND LITERATURE UPON REQUEST
NEW YORK PHARMACEUTICAL CO. H^ZV^f'^t
HAYDENS URIC SOLVENT ol incsljmabic valus in Rhcumalism, Gout and other conditions indicatinj an excess of Uric Acid.
3

HAY
THE CHARLOTTE MEDICAL JOURNAL.
fe:ve:r
Write Globe Manufacturing Co.,
Battle Creek MicHigan.
I WHAT A DOCTOR PRESCRIBES
Hatchechubbee, Ala.,
April 30, 1908.
The Rock Hill Buggy Co,
Rock Hill, S. C,
Gentlemen :
—
The wheels to my buggy
reached here about the same time as your
letter, and I waited long enough to take
several rides before replying to your letter.
Am delighted with the job in every respect,
and shall be glad to advise anyone who
is looking for style, comfort, and perfection
in workmanship, to invest in a "Rock Hill"
buggy.
Yours truly,
R. A. White, M. D.
.
No 17 Doctor's Buggy
Further comment on the above letter is hardly necessary for
Dr. White has evidently used enough bnggies in his practice to
make his opinion worth something.
We are willing to guarantee that you will be just as well pleased
as Dr. White, if you will use a No. 17 Doctor's Buggy.
|
Rock Hill Buggy Co., Rock Hill, S, C. I
••A Little Higher in Price, But—" I
^PRICKLY HEAT
PONDS EXTRACT'
C
Pruritus and prickly heat with their often=
times intolerable itching and smarting are im=
mediately relieved by free applications of
Pond's Extract.
POND'S EXTRACT CO., New York and London.
'

ADVERTISEMENTS.
Successfully Prescribed
for Twenty Five Years
Rh eum a. tJsm '^ '~
f/e uralgia
Scia-tlca
Lumbago
Ma/aria
Gr/ppe
Mea'\^y^ Co/cfs
Gout
Excess of Ur/c Acicf
Relieves Pain
Allays Fever
Eliminates Poisons
Stimulates Recuperatiori^
Samples by Express prepaid- Mellier Drug CompanyTrBt.Loui&
ANTIKAMNIA & SALOL TABLETS
Hare says " Salol renders the intestinal canal antiseptic and is the most
valued drug in intestinal affections." The anodyne properties of antikamnia in
connection with salol render this tablet very useful in dysentery, indigestion,
cholera morbus, diarrhoea, colic, and all conditions due to intestinal fermentation.
ANTIKAMNIA & CODEINE TABLETS
Especially useful in dysmenorrhoca, utero-ovarian pain, and pain in general
caused by suppressed or irregular menses. This tablet controls the pains
of these disorders in the shortest time and hy the most natural and economic
method. The synergelic action of these druj^s is ideal, for not only are their
sedative and analgesic properties unsurpassed, but they are followed by no unpleasant
effects.
The efficacy of this tablet io all neuroses of the larynx is also well known.
In coughs and colds, coryza and la grippe they will always be found of inestimable
value.
THE ANTIKAMNIA CHEMICAL COMPANY
ST. LOUIS. U. S. A.

In Summer Sickness
THE CHARLOTTE MEDICAL JOURNAL.
of both children and aduhs, there is no eliminant to compare with Abbott's Effervescent Saline
Lcixative (granular effervescent magnesium sulphate). Saline Laxative for general use, Salithia
(the same with colchicine and lithium added) for "rheumatism"—where the deeper eliminant
action of colchicine and lithium are indicated.
They never gripe, never nauseate, never weaken; are not unpleasant; are cooling, promptly
effervescent, perfectly soluble and uniformly efficient.
You are urged to give these preparations a triad, to specify them on your prescriptions.
Samples to interested physicians on request.
1( your druggist cannot supply you, send direct. Per dozen, in not less than half dozen lots, either
kind or assorted; small, $2 00; medium, $4.00; large, $8.00. Cash with order, delivery prepaid.
THE ABBOTT ALKALOIDAL COMPANY
MANUFACTURING CHEMISTS
CHICAGO
New York, 251 5th Aveoae. San Francisco. 371 Phelan Bldg. Seattle, 225 Central Bldgr.
LIFE SAVERS FOR PHYSICIANS
How many lives might be saved, how much
pain made unnecessary if the Phyician would use an
Emblem
^ Motorcycle
in making his calls. SWIFT, PLEASANT, IN-
EXPENSIVE. The IDEAL transportation for a
Physician. Saves time, and time may save LIFE
as well as Money. Think it over.
Emblem Mfg. Co.
Catalogue Free Angola, N. Yh
i

ADVERTISEMENTS
^--«*»i^ui4 >Ji^Woi^
,
Unlike milk or other ordinary food-stuffs which require
digestion, vary in composition and often irritate or produce
fermentation and flatulence, Liquid Peptonoids is predi-
gested, uniform and aseptic.
Its nutrient content comprises the essential Protein and
Carbohydrate elements of Beef, Milk and Wheat in
physiological ratio, extractive-free, and palatable form.
It is peptogenic, restorative and mildly stimulating.
It is, therefore, eminently suitable as an Emergency Nutrient
or Auxiliary Food Tonic.
THE ARLINGTON CHEMICAL COMPANY,
YONKERS, NY.
Samples
on requci,
H^'o^\jilA\JiJ^WoOfeLy
"KELENE"
PURE CHLORIDE OF ETHYL
Put up in Glass Automatic Spraying Tubes
USE ROR
LOCAL ANAESTHESIA
Also as an adjuvant to Ether in
GENERAL ANAESTHESIA
Sole Manufacturers
FRIES BROS., 92 READE STREET. NEW YORK

VIII
THE CHARLOTTE MEDICAL JOURNAL
J^^oirth Oarolina JMedioal
OLDEST MEDICAL COLLEGE IN THE STATE
SESSION OF 1908-1909 BEOIXS Sl'l'TRMUl-R 15, 1 Q(
\V. O. NISBET, M. D.
Professor of Diseases of
the Digestive System and
Dean of the Faculty.
JOHN P. MUNROE, M. D.
Professor of Neurology and
Practice of Medicine.
I. \V. FAISON, M. D.
Professor of Pediatrics and
Clinical Medicine.
E. C. REGISTER, M. D.
Professor of the Principles
and Practice of Medicine.
B. C. NALLE, M. D.
Professor of Physical Diagnosis
aud Clinical Medicine.
R. h. GIBBON. M. D.
Professor of Practice of
Surgery.
G. W. PRESSLY, M. D.
Professor of Principles of
Surgery.
A. J. CROWELL, M. D.
Professor of Rectal Diseases
and Genito-Urinary Surgery
and Secretary and Treasurer
of Faculty
E. R. RUSSELL, M. D.
Professor of Diseases of the
E}'e, Ear, Nose, and Throat
W. D. WITHERBEE, M.D.
Professor of Dermatology,
and Materia Medica.
C. M. STRONG, M. D.
Professor of Gynaecology.
C. H. C. MILLS, M.D.
Professor of Obstetrics and
Clinical Gynaecology.
C. N. PEELER, M. D.
Professor of Anatomy and
Superintendent of Dispensary.
R. H. LAFFERTY, M. D.'
Registrar and Professor of
Chemistry and Physiology.
. ;
L. B. NEWELL, M. D.
Professor of Patholoey.
WM. ALLEN, M. D,
Professor of Bacteriology
and Assistant in Pediatrics.
C A. MISENHEIMER,M.D.
Clinical Professor of Surgery
J. P. M.\THESON, M. D.
Clinical Professor of Diseases
of the Eye, Ear, Nose and
Throat and Professor of
Yygiene.
Oollege
DR. PARKS KING
Assistant in Surgery.
DR. WM. STRONG
Assistant in Gynaecology.
DR. C. S. MCLAUGHLIN
Assistant in Anatomy.
DR. MYERS HUNTER
Assistant in Obstetrics and
Clinical Gyanacology.
HAMILTON McKAY, A.B.
Assistant in Anatomy.
BENJAMIN TEAM, A. B.
Assistant in Chemistry.
S. A. HARDING
Assistant in Bacteriology.
C. M. LENTZ.
Assistant in Genito-Urinary
Diseases.
CALDWELL WOODRUFF.
Assistant in Histology.
H. B. MALONE
Assistant in Clinical Microscopy
and Pathology.
For Catalogue address
A. J. CROWELL, M. D.. Charlotte. N. C.
|N. Y. ROSX GRADUATE
/VVedical Scl-iool and Hospital
Second /\\
ieth Street, Neui/ York City.
Oldest an
ituniers. Teachintr wboU
al and personal, or in small
groups Etci-j-
2J.T Beds in the Hospitol
-jjatient.s dail.v. Continuous
courses for the
ihers adapted to Ibe specialist
department. Special
aud comparative courses iu surgery, carryinfr the students with individual instruction from the cadaver
trainnifr through the clinics, the wards and the operating room. Similar courses iu each of the specialties,
liiMi;iKti.>ii lu x-ray li^ht, and electro-therapeutics, tropical medicine. Public Health aud Sanitation Inclnilint;
Sthool Inspection, opsonin therapy, etc. Unusual and advanced work readily arranged for. The
sessions continue throughout the year and may be entered at any time. For full information address
George Gray Ward. Jr., M. D. Secretary ol the Faculty.
V

\
ADVERTISEMENTS.
Significant Requirement
In Victoria, Australia, it is required of infauls' foods that they "shall
contain no woody fibre, tio preservative substance, and no chemical substance insoluble
in -water, and, unless described or sold specially as food suitable only for infants
over the age of seven months, shall , when prepared as directed by the accompanying
label, contain no starch, and shall contain the essential ingredients and conform
approximately in their composition to normal mothers'' milk. "*'•'*
Milk Prepared with Peptogenic Milk Powder, in the nursing bottle, ready for
feeding', conforms to these legally constituted retiuirements for a food for in-
fants seven mouths of age.
Milk jjrepared with Peptogenic Milk Powder contains no woody fibre
(cellulose); no preservative substance: no starch. It meets the requirements
fully in containing the essential ingredients of normal mother' milk, and pecu-
liarly so in "conforming apijroximately in compcsition, " because of the fact
that its proteids are in the minutely coagulable, soluble and diffusible form
characteristic of the albuminoids of mothers' milk.
Fairchild Bros. & Foster New York
*From the Fhui-niacetUical Journul and riiurmacist,
London, England, March 6, '09, page S^H.
STAFFORD WATER
Noted for Ito Kcmarkuble Remedial Properties In
PARENCHYMATOUS NEPHRITIS,
ACUTE NEPHRITIS, ALBUMINURIA,
and Its Therapeutic Value and U(flcl«ncy in
Diabetis. Chronic Interstitial
Nephritis and Cystitis.
For Sale: THKO. F. KLUTZ & Co., Salisbury, N. C.
•'or Litoraluro
S. iM. riTRCELL, Salisbury, N. C.
HI'RWIOLL & DUNN CO., Charlotte, N. C.
I). P. FUIICR-^OX, CharleHton, S. C.
P,\TUICK McINTVRE, AsheviUe, N. C.
MURRAY DRUG CO., Columbia, 3. C.
COLBURN, MORCAN 6l CO.
VOSSBLRG. ------ MISS.

THE CHARLOTTE MEDICAL JOURNAL.
COCO-EnULSION, LILLY
A New Depart-are in
Cod Liver Oil E,in\i lsions.
^ Most Palatable and Assimilable.
q STRENGTH —Same as the official emulsion—contains 50 per
cent, finest Norwegian Cod Liver Oil.
q PALATABIUTY—Coco-Emukion, Lilly, is flavored with choc-
olate and modified by the addition of aromatic adjuvants, whereby
the fishy odor and taite of the oil is more satisfactorily disguised
than by previous methods. It will be found very acceptable to
the patient.
^ DIGESTIBILITY—Inaead of the benzoates and salicylates
which are liable to disturb digestion, 5 per cent, alcohol is used to
prevent rancidity and mould. To avoid inte^al fermentation,
the sugar content is kept low— just sufficient for palatability.
^ Supplied by the drug trade.
fl
Address request for sample to Indianapolis.
ELI LILLY & COMPANY
PRUNOIDS
AN IDEAL PURGATIVE MINUS CATHARTIC INIQUITIES
A scientifically prepared edible tablet to produce purBation that positively will not be
followed by after-constipation. Pmnoids will never occasion g-riping or other discomforting
symptoms. A safe and pleasant evaeuant in either toxic or non-toxic conditions
of the intestines. It can not create irritation of the gastro-intestinal mucous
membrane.
AN INNOVATION FOR THE PERMANENT REMOVAL OF CONSTIPATION
cactina
THE MOST DEPENDABLE
FORM OF CACTUS
Taken from carefully selected Mexican
Cereus Grandifloms, Cactina is obtained
by a method original with us. It positively
presents the therapeutic principles
of the true drn^ in a proximate form.
Cactina PiUets has proved its value as a
heart tonic in functional, cardiac and
circtdatory disturbance, and in general
muscular relaxation with impaired nerve
energy. Excellent in Tobacco Heart.
""Itir„,^jlrsl7'^ SULTAN DRUG CO.,'^cT.S'r' St. Louis, Mo.
SENG
A VALUABLE DIGESTIVE
SECERNENT
To a remarkable extent, Panax (Ginseng),
as embodied in SENG, has the peculiar
action of stimulating the secretory glands
of the digestive tract. It is an excellent
remedy in stomachal atonicity and Its
value is evidenced by increased nutrition.
Used alone, or as a vehicle in other
treatment, it will assist in keeping the
alimentary tract phyaiologicaL

Peak's
Supporter
ADVERTISEMENTS.
For after operations of
APPENDICITIS,
Wocher's Surgeons
Operating Oiitiil No. 25
Set of Three Pieces.
$28.50.
HERNIA, Etc.
Net to Physicians - - 5i.'^>-
No. 1004 Combination Nebulizin*;
and \toMiizing Ontlit, Oxidized Steel
Tank, 3 Bottle Nebulizer, Atomizers
and Lever I'linip, complete.
Special price, - - - $50,00
FAULBEE'S LATEST OPERATING SCISSORS, don't pinch, 8 inches
i>ng, made in straight-sharp, curved-sharp, or curved-blunt, each
2.60; set of 3 J6.00.
('incinnali Heat Ray Therapeutic Lamp,
with special 'jo c, p. heat generatiug lamp
and removable condensing liood J7.50: new
100 c. p. Therapeutic Lamp. fi.S-oo.
1V401A/ Hospital EcitilptT
THE CINCINNATI OPERATING ROOM.
We Make All Kinds of Hospital Furniture.
It List Sent OponlReQuest.
Surgical In.striiment Makers. Orthopedic Apparatus, Trusses, Elastic Slochlna »
19-21-23 W. Sixth St. Cincinnati, Ohio

THE CHARLOTTE MEDICAL JOURNAL.
NEURILLA roR NERVE DISORDERS NEURILLA
If Patient suffers fromTHE BLUES (Nerve Exhaustion),
Nervous Insomnia, Nervous Headache, Irritability or
General Nervousness, pive four times a day one
tesspoonfui NEURILLA r-^
Prepared from Scutellaria Lateriflora,
Fassi flora Incamata and AromatlcS.
DAD CHEMICAL COMPANY, NEWYORK and PARIS
Just Published
GENITOURINARY DISEASES
AND SYPHILIS
By EDGAR G. BALLENGER, M. D.
KCTUKER ON GEXITO -URINARY DISEASES, SYPHILIS AND URINALYSIS, ATLANTA SCHOOL OF
MEDICINE ; EDITOR JOURNAL-RECORD OF MEDICINE ; GENITO-URINARY SURGEON
• TO PRESBYTERIAN HOSPITAL, ATLANTA, GA.
"Barely a page of this work can be read without finding at least one
instructive and interesting point. The experienced teacher, the skilled
genitourologist, and the learned syphilographer, is revealed in every line."
Medical Record, New York.
With 86 Illustrations. 276 Pages.
F*raotical, Corioise
F»rlce S3.00, CarrV""8: Charges F'repaici
E. W. Allen & Co., Publishers
ATLANTA, GA.
THE ATLANTA SCHOOL OF MEDICINE
Luckie, Bartow and Main Streets
/\TL/\IN-r/\, GEORGIA
"In order to properly teach medicine. Medical Colleges must have hospitals either owned by them
or entirely under their control so far as ihe clinical material is concerned. This is now one of the
greatest needs of medical teaching."— Extract from Report of Council on Medical Education of
the American Medical Association, adopted June, 1909.
The Atlanta School of Medicine is the ONLY medical college in the Southeast which owns
and OPER.vTES its OWN HOSPITAL. Wards of the Grady (city) Hospital also used for bed-
side teaching.
"The uncleanliness of the buildings and laboratories of some of our medical colleges makes one
question the possibility of their teaching asepsis, or even ordinary cleanliness. ' '—Extract from Report of
Council of Medical Education of the American Medical Association, adopted June, 1909,
No effort is spared by this institution to teach practical Sanitation. For information write
The /\tlanta Sohool of AYedioine
Box ^57 ....... rtTLAINTrt,
Ga.

ADVERTISEMENTS.
P0ST=0PERAT1VE
CONVALESCENCE
is usually prolonged when Suppuration, Sepsis or
T'rn irrhage has preceded surgical interference.
'pepfo•/\5I\^^^ ((jiide)
is distinctly helpful as an aid to recuperation, as
it eligibly supplies the urgently needed material
for corpuscular reconstruction and hematogeaesis. 57
Samples and
Literature upon
Application.
M. J. BREITENBACH CO.
NEW YORK, U. S. A.
Our Bacterlologflcal Wall Chart or our Differential Diagnostic Chart
will be sent to any Physician upon application.
THE ONLY WORK OF ITS KIND IN AMERICA.
STUDIES OF THE HUMAN FORM
ROBERT W. SHUFELDT, M. D.
Major and Surgeon f. S. Army (
< Retired
BeautUuIly Dluslrated with over 425 half-tone Reproductions of Photographs from Life.
A Unique. Valuable. Trutbful Guide in Studying the Human Form AS IT rkally IS,
not a single negative having been retouched or imi'ROVEO upon.
"This book is much more than a set of pictures illustrating the nude in Art. It is
a close study, with the p'ictures as illustrations of the subjects treated in the text.— Medical
Council, June, 1909.
Restricted in its sale to Physicians, Artists, Scientists, Decorators,
Sculptors, Educators, Photographers. Architects,
Clergymen, Anthropologists, Designers, Attorneys.
Art Collectors.
Additional information may be obtained by persons of good standing in any of the
above professions by addressing—ART DEPARTMENT.
F. A. DAVIS COMPANY, Publishers.
1914-16 Cherry Street. - . - - Philadelphia, Pa.

THE CHARLOTTE MEDICAL JOURNAL.
Atlanta College of Physicians and Surgeons.
(Consolidati'
A. W. Calhoun, M. D., LL.D. President
J. S. Todd, M. D,, Emeritus,
Wm. Perrin Nicholson, M. D., V.P.
\Vm. Simpson Elkin, A. B., M. D, Dean
W, F.Westmoreland, M. D.,
Floyd W. McRae, M. D.,
Clarence Johnson, M. D.,
J.
Mtlanta Georgia
1S9S of the Atlanta Medical and the Southern Medical Colleges.)
F=-aciJlty :
A. L. Fowler, M. D.,
T. C. Davison, M. D.,
Dunbar Roy, A. B., M. D.,
John G. Earnest, I\I. D.,
Bernard Wolff, U: D.,
Michael Hoke, M. D.,
Chas. E. Boynton, A. B., ^
John C. Olmsted, M. D.,
Cyrus VV. Strickler, M. D.,
H. F. Harris, ISI. D.,
Wm. S. (Goldsmith, M. D.,
Jas. B. Baird, M. D.,
S. T. Barnett, A. B., M. D.
E. Bates Block, M. D.,
Marion McH. Hull, M. D., F. Phinizy , Calhoun, A. B., ... M. D.,
The fifty-fifth annual session of the .Mlanta College of Physicians and Surgeons begins Wednesday,
vSeptember 22nd, 1909.
With a group of five college buildings, arranged upon the university plan, and a corps of fifty-ihree
profes.sors and instructors, this Institution stands second to no medical school in the country. The
laboratory facilities are unsurpassed.
The main college building contains the Chemical, Physiological and Materia Medica I^aboratories,
and the Carnegie Pathological Institute contains three large laboratories, each equipped with an
ample number of microscopes and all neces.sary apparatus and appliances for teaching Histology, Bacteriology
and Pathology. A separate aud distinct building is used for practical anatomy.
.A. four years graded course of seven months each is required, the last year of which is devoted
largely to clinical and practical work. Our students have access to the Grady Hospital, across the
street from the college, and all the principal infirmaries and hospitals in the city. A large out-docr
clinic, where more than 25,000 patients are treated a year; affords other valuable clinical instruction.
The buildings are new and commodious, and one attractive feature in the new building is the Gymnasium
with shower baths. Here the student is taught the u.se and application of exercises for various
di,seases. For catalogue or other information, address WM. SIMPSON ELKIN, M. D., Dean.
Atlanta College of Physicians and Surgeons, Atlanta, Ga.
A PRIVATE^ HOME EXCLUSIVELY FOR
Alcoholic, IVIorphine and Drug Ha^bitues and
Air Forms of Neurasthenia
GREENSBORO, N.C.
JACKSON SPRINGS SANITORIUM.
A new and modernly arranged building including modern diagnostic
apparatuses and various electrical appliances for the treatment of noncontagious
diseases. Special attention given to renal, hepatic, digestive
and nervous diseases.
Patients have free access to the celebrated Jackson Springs mineral
water which took second prize at the St. Louis World's Fair. This
water is especially indicated in above named diseases.
Centrally located in Moore County, N. C, amid the sand hills and
long leaf pines. Elevation 700 feet above sea level. Rates reasonable.
For further information, address
J\. A. WVcDONALD, TVV. D.
JacU.son Springes, N, C
I

%
ADVERTISEMNTS.
PROFESSIONAL CARDS
DR. GEORGE W, PRESSLY
Charlotte, N. C.
Practice Limited to Suugeuy.
DR. W. O. NISBET
Diseases ol Digestion
Offices: 9 North Try on Street
Phones: Office, 21. Residence, 1196.
yffice Hours: 8:00 to 10:00 a. m., 11:00 a, m.
to 1:00 p. m.\ 3:00 to 5:00.
Special Hours by Appointment.
DR. JOHN R. IRWIN.
Charlotte, X. C
JOHN P. MUNROE, M. D,
SPECIALIST IN NERVOUS DISEASES.
(iffices Charlotte Sanatorium, Charlotte, N". C
CONSULTATION PRACTICE.
Will meet physicians in adjacent towns and
country for consultation in general medical
cases.
W. D, WITHERBEE, M. D.,
CHARLOTTE, N. C.
Practice limited to treatment of Cane
Skin Diseases.
Office, Charlotte S.\xaT()kiu>
CHARLES M. STRONG, M. D
Diseases oi Women and Surgery.
Special attention driven to Abdominal Office Charlotte Sanatorium, Phone .S21
Residence 609 S. Tryon Street.
Surgery and Diseases of Women.
Phone 144.
ANDREW J. CROWELL. .W. D
Chaklottk, .\. C.
Practice Limited To (ienito I'rinarv and
DR, CHARLES H. G. MILLS
Realty Bulldlnq, Cbarlotte N C.
Rectal Diseases.
Hours: .S.,30 A.^L to 12. M.
i'ractice limited to G\iiecol()ij;v and
4 to 6 I'M. Sunday by appointitient
DR. A. M. WHISNANT.
Obstetrics.
DR. GEO. \A/. PRESSLY
18 S. Tr>-on St., Charlotte .\,C.
Office Hours;
8:30 a.m. to 1 p. m., and ,> to 6 ]).m.
Sundays by appointment. Practice
limited tf) P,ye. F.ar, Xoseand Throat.
E. R. RUSSELL. M D.
J. P. MATHESON, M. D.
22\ S. Tryon Street, C ..klottk. .\ C.
Hours: 9 a. m. to i p. m., and 4 to 5 p "i
Sundays 9 to 10 a. m.
Special hours by appointment. Practice limiteil
to the Eye, Ear, Nose and Throat
Phone 418—687
OR. GEO. y\. NILES.
Diseases of Dig>estion.
408-9 Candler Building,
Atlanta. Ga.
Xow has his office at the Charlotte
Sanatorium and does all his work there.
I'KACTICE LIMITED TOSUK(;iCAl. CASES.
DR. ED\A/IIN CUADA^OIN.
SPECIALIST
TrHi.;Kcri.osis
Southern RInes, rs, CZ.
Tlir. JorRXAL keeps, l

HE CHARLOTTE MEDICAL JOURNAL
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after eating. Children one-half to one teaspoonfnl.
according to age.
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16 oz. Bottles. $1 00

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BATTLE & COMPANY
PARIS ST. LOUIS LONDON

I
THE CHARLOTTE MEDICAL JOURNAL. I
1
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IN
ADVERTISEMENTS
ALBUMINURIA OF BRIQHTS DISEASE
PREGNANCY AND SCARLET FEVER
A
LITHI
SPRINGS
WATER
DR. JOS. HOLT, of A'ar Oi leans E.r-Presidcii! of the Slafe Board of Health of Louisiana,
says; '[ haw- preprescribed BUFFALO IJTmA \VATI-:r in affections of the
kidneys and urinary passages, particularly in OTOUty subjects, in Albuminuria, and in
irritable condition of the Bladder and I'relhra in females. The results satisfy me of its
extraordinarx- value in a large class of cases most difHcult to treat."
DR. QEORQE BEN JOHNSTON, Richmond, la. Ex-President Southern Surgical and
Gynecological Association, F.x- President Medical Society of Virginia, and Professor of
Gynecology and Abdominal Surgery, Medical College of Virginia: "it is an agent of great
value in the treatment of the .Mbuniinuria of Pregnancy."
DR. J. T. DAVJDSON. M.D.. Neir Orleans, f.a, Ex-President, New Orleans Surgical
. and Afedical Issociation, says:" I have for several years prescribed BUFFALO LITHIA
W'a ter in all cases of Scarlet l"e\er, directing it to be drunk ad libitum, viWh the effect of
relievingall traces of .Albumin in tlie urine, and liave found it equally efficacious in
enial diseases requiring the use of alkaline water."
HUGH M. TAYLOR, M. D.. Professor of Practice or Surgery and Clinical Surgery,
University College of Medicine, Richmond, Va: "l have used, with good results BUF-
FALO lITIII.\ \VAT1-:R in L'ric Acid Diathesis, Gout, Rheumatism, Albuminuria of
Pregnancy. Scarlet I"ever, diseases of Women, Renal and \'esical Calculi, and Cystitis,
ad in many instances with .v/]^//*?/ benefit."
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BUFFALO LITHIA SPRINGS WATER CO.. BUFFALO LITHIA SPRINGS, VIRGINIA.
PEACOCK'S
BROMIDES
In Epilepsy and all ca.

X
THH CHARLOTTE MEDICAL JOURNAL.
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weeks, sent by mail to any PHYSICIAN upon direct request to
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Manulacturing Chemists § ^^
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^
ESSENTIAL FACTS ABOUT
Cystogen
1st. It causes the urine to become a dilute solution of formaldehyde ,with antiseptic properties.
2d. Prevents intra-vesical decomposition of the urine.
3d. Renders fetid, ammoniacal and turbid urine clear, inodorous and uiiirritating.
4th. auses urates, phosphates and oxalates to be held in solution by the modified urine, and
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Sample* n r.qu.M CYSTOGEN CHEMICAL CO., ST. LOUIS, U. S. A

The Charlotte Medical Journal
Some Recent Views Concerning the
Nature of Typbold Fever.*
By L. v.. Xcwell, A.I!., M.L)., Charlotte, N. C.
We are approaching the Utopian threshold
of accurate knowledge with unprecedented
rapidity; whether it shall ever be
reached we do not know; certainly it is little
to be desired that man will ever have
come to dwell in those Elysian Fields where
there need be no more work or effort.
Would life be worth the living if we knew
all and there were no new "worlds to conquer?"
Relatively speaking it has not been
long since typhoid fever, as a distinct disease,
emerged from the obscurity of confusion
with a number of other fevers which
bear a more or less close resemblance. Only
a few decades ago Ivberth isolated the />ua7lus
typhosus and described it so accurately
that succeeding investigators have been able
to add but little to his observations concerning
the active cause of the disease. However,
little by little, our knowledge has extended
until modern conceptions of the
disease differ in many ways from those
which obtained when even some of the
younger members of the profession entered
the ranks as practitioners. Some will be
perfectly familiar with what I shall say in
this paper; others perhaps will not agree
with the views advanced: but in any case it
can do no harm if I attemiit to present
imperfectly enough perhaps—some thoughts
along the line of the more recent developments
in the study of typhoid fever.
Perhaps, indeed, wUjt i shall have to say
is not all true: at least, however, it is a
fascinating theory upon which we may account
for some phases of what may be
called the pathological physiology of one
of the commonest of all diseases. Hy contrasting
some of the older ideas with the
new it will doubtless be the easier to make
the latter clearer.
I"or a long time it was lielieved that the
bacillus, after having been taken into the
intestine, multiplied and developed its poisons
chiefly in the lumen of the gut and in
the lymphatic tissues of the bowel wall,
and that the poisons absorbed into the body
itself caused the constitutional symptoms.
It was later discovered that the germs could
be found in other organs and tissues in
practically all cases. This established the
fact that the blood must convey the bacilli
•Read by title before the Medical Society of the
SUte of North Carolina, A.sheville, N. C, June
15-18, 1909.
—
CHARLOTTE, N. C, AUGUST, 1909.
from the intestine to the various parts inside
the body, for we may consider that the
gastro-intestinal tract, including gall-bladder,
as well as the urinary bladder, ureter
and pelvis of the kidney are not within the
body but really outside. It was believed
that the micro-organisms did not pass into
the blood in any considerable numbers, and
that it was only late in the course of the disease
that this happened. Within the past
few years, however, we have come to realize
that typhoid fever is not a local disease
in the sense that specific micro-organisms
develop in portions of the body as is the
case in diphtheria, but that it is really a bac-
tercemia— a general infection of the blood
—
and that the intestinal and mesenteric lesions
are merely local manifestations of the infec-
tion. The lymphoid elements of the intestines,
carrying out the function of the
lymphatic tissues, acting simply as outposts,
take up the bacteria and, in their efforts to
destroy them, become inflamed just as any
lymphatic gland does into which an infected
area drains.
It is not necessary to repeat what many
of us know already: that the presence of
typhoid bacilli in the intestine does not
necessarily mean that the patient has typhoid
fever, for there are many individuals
who are apparently healthy, but who nevertheless
are carrying constantly millions of
typhoid bacilli within their bowels. For a
person to manifest the symptoms of typhoid
fever it is necessary for the bacilli to enter
the blood. And indeed something more is
necessary, for it appears that so long as
these micro-organisms are alive, i.e., so
long as they are not attacked and destroyed
by the cells of the body, no symptoms are
manifest. In proof of this one might cite
the fact that typhoid bacilli have actually
been isolated from the blood of individuals
who gave absolutely no evidence of any
infection at the time, but who subsequently
come down with the disease. In other
words bacilli were found to be present in
the blood during the period of incubation
— a period which, in the light of such evidence,
might be counted by days or weeks
or months or years. It can readily be seen,
however, that this could be demonstrated
relatively infrequently because of the few
opportunities for such investigation.
Now, with these ideas before us let us ask
and answer the query: what is the essential
nature of typhoid fever? Instead of being
an intoxication resulting from the absorption
of toxins produced by the bacilli in the

,_>
THE CHARLOTTE MEDICAL JOURNAL.
iutesUue, typhoid fever is an intoxication been spoken of as the "latent" developproduced
during the struggle between the ment of the bacilli, and it is what goes on
typhoid bacillus on the one hand, and the very probably for several days previous to
body cells and juices on the other. The the occurrence of a relapse as well as at the
typhoid bacilli produce a poison which is
retained within the micro-organism, i.e., it
is an f?idoloxiii, and it is only by the death
beginning of the disease,
It can now be seen what we meant when
it was said that a rapidly and energetically
of the bacillus that it can do harm, for with
the destruction or breaking down and disintegration
of the bacteria the toxin is liberacting
immunity might be actually inimical
to its own proper purpose, because it set
free too much intracellular poison (Endoated
and then can exert its inimical effects toxin ) within too short a space of time,
on the body cells. In this respect the ty- The powers of elimination are limited and
phoid bacillus differs fundamentally from are furthermore crippled by the action of
the organisms of diphtheria and tetanus, the poison so that excessive toxin produc-
And in typhoid fever we do not have there- tion means rapid accumulation within the
fore an antitoxic immunity but one directed body. On the other hand, if, with the same
against the bacillus itself. In other words eliminative powers, the toxin production be
the juices and cells of the body attack and spread out over a period of several weeks
kill the bacteria and in so doing actually instead of one week then the intoxication
do something which is harmful to the body, will be comparatively mild and not perhaps
"It is a little disconcerting to be told that dangerous to life.
the more quickly the body kills and disinte- The opsonic theory, of which lately we
grates the bacteria the more severe may be have heard so much, teaches that in the
the symptoms of the disease; this seems, majority of bacterial diseases the power of
however, to be a necessary assumption the blood to destroy the germs is below
when all the facts are considered, though normal. In typhoid fever the opsonic inuntil
we learn how to utilize or control a dex is above normal. Patients do not die,
high bactericidal power of the blood the
physician may not be able to gather many
apparently, because this protective function
is diminished, but possibly because there is
grains of comfort from the reflection that
the blood of his sickest patient may have
too great a bactericidal power in the body,
In these days when we are hoping for such
the greatest bactericidal power" (Barker), great things in the way of artificially pro-
On this theory let us now attempt a few duced immunity, typhoid fever introduces
inferences as to what may happen when the problem not of increasing but of detyphoid
bacilli have entered the blood of an creasing the physiological immunizing
individual, and in considering the toxic power of the blood. Perhaps we might aceffects
of any substance which acts as a count for the good effects of the cold bath
poison to the tissues we must not forget in typhoid fever on this idea. It may be
that the body possesses to a greater or less that the destruction of the invading germ,
extent the power of eliminating these undesirable
products by way of the bowel, the
whether it be through bacteriolysis or phago-
cytosis, is accomplished largely through
kidneys, the skin and the lungs. Those digestive ferments,' whose action becomes
which can be gotten rid of rapidly enough much impaired in the presence of lowered
will necessarily cause little disturbance,
The severity of an intoxication will theretemperatures.
The cold bath, then, inhibits
the action of the destructive ferments over
fore depend upon several factors, viz: The the large area of the skin, thus diminishing
rapidity of the intoxication, the size of the toixn liberation, the temperature drops, the
dose, the virulence of the poison and the patient feels better and the tissues have a
ability of the eliminative functions to throw few hours' respite from hyper-intoxication,
it off. In the case of typhoid infection let For the same reason drugs which would
us suppose that the bacillus is neither de- lower cellular activity might well be indistroyed
nor eliminated, but continues to cated. Quinine is such a drug and its use
multiply. What happens? The immediate might possibly be justified by such reasoneffect
may be ;///, for, according to our ing.
theory, there is no intoxication until there Prof. Vaughan, of the University of
is bacterial destruction. It is, therefore, Michigan, has employed, in a series of cases
conceivable that the body should contain of typhoid fever, a non-toxic residue of
bacilli in large numbers and still show no bacilli grovvu outside the body. By inocusigns
of^ disease. The individual remains lating patients with these substances it apwell.
That this assumption is true is proven peared that the cases were not so severe,
by the fact already mentioned, that bacilli although thev ran a somewhat longer course,
have been cultivated from the blood of per- Richardson, of Boston, has confirmed these
sons who had been exposed to the disease, observations. Probably by introducing this
but had as yet shown no signs. This has non-toxic residue with its specific affinity

for typhoid anti-bodies the destructive action
was diverted from the typhoid bacilli
themselves, less endotoxin was liberated
and the intoxication was therefore milder.
This picture of the essential nature of
typhoid fever makes a number of phenomena
often observed in the disease more
rapidl\- comprehensible. Sometimes one
observes a curious drop in the temperature
which, under routine treatment, occurs without
apparent cause. This might mean that
a period of over-activity on the part of the
tissues is followed by a resting stage in
which no bacilli are destroyed, no toxin set
free, and so the temperature must fall. A
chill, though rare, may represent a sudden
destruction of bacilli as contrasted with the
more evenly distributed production of toxin
which occurs in the majority of cases. A
sudden onset is often associated with a chill,
the coarse of such cases is commonly very
severe and the mortality is high. As we
have already said it seems probable that,
in such instances, the protective mechanism
acts too well and that the victim is overwhelmed
as a result of his own zeal. We
have been in the habit of thinking of relapse
as a re-infeelion; but it is possible that
during the afebrile period the bacilli are
still present, perhaps increasing in numbers
in the absence of resistance, and that it is
only when the body takes up the work of
destruction that symptoms reappear. It
may be that in this connection the hyper
susceptibility produced by a primary attack
has much to do with notably quick rise of
temperature often seen in relapses as contrasted
with the typically gradual onset of
the first attack.
Lastly, we may explain the characteristic
temperature curve of typical cases by employing
our theory. At first there is a steplike
rise. At this time more endotoxin is
being set free than is eliminated; it collects
in the body, the degree of intoxication receding
slightly each morning, because of
the natural tendency to lowered function
during this part of the twenty-four hours,
only to go still higher as a result of the day's
increased activities: consequently the effect
is cumulative.
Having reached a high level—the fastigium—the
intoxication is so intense that
the comparatively small amount of poison
excreted has no appreciable effect on the
general condition. In the latter weeks,
however, when there are comparatively few
bacilli left in the body, then, although the
daily toxin production (liberation) is sufficient
to carry the temperature up to a high
figure, the degree of intoxication is really
small and is more than counterbalanced by
the toxin excretion. As a result the receding
morning temperature is seen. Gradually
ORIGINAL COMMUNICATIONS. 63
the elimination exceeds the production of
poisons until finally the emunctories have
entirely freed the body of them. Convalescence
is then established.
In these views I make no claim to originality—they
are merely the results of study
of some of the more recent contributions on
the ever fruitful subject of a disease which
is universal, and therefore a never-ending
source of serious thought and study.
Bibliography.
Richardson, Boston Medical and Surgical
Journal, May 7, 1908.
Barker, Charlotte Medical Journal, May,
1908.
Adami, Prin. of Path.
McCrae, Osier's Modern Medicine.
McFarland, Pathogenic Bacteria.
Mabee, Boston Med. and Surg. Journal,
June 8, 1908.
Pringle, Dublin Medical Journal.
Conradi, Klin. Jarb., 1907.
Conradi, Deutsche Med. Wchnschr, Oct.,
1907.
Clark, J. A. M. A.. Dec. 26, 1906.
Vaughan and Moag, Cellular-Toxins,
1908.
Busse, Munch. Med. Woch.
Clark and Simmons, Jour. Infec. Dis.,
January, 1908.
Clinical Notes on Sanatorium Work.
Hy J. C. Walton, M.D., Richmond, \'a., Physicianin-Charge
of the Hydro-Electro-Therapeutic
Sanatorium.
Xo explanations or apologies are necessary
for presenting a clinical paper illustrating
therapeutic progress before an audience
that has a national reputation for
scientific and practical work. One great
advantage of physiotherapy is the absolute
impossibility of producing any effects which
would interfere with the administration of
any other therapeutic procedure, and they
should always be accompanied by appropriate
hygienic, dietetic and medicinal
measures.
High Frequency Currents.
Careful clinical studies, embracing not
only my own work, but the opportunity of
seeing the work of many eminent clinicians,
have thoroughly convinced the writer that
for the relief and treatment of hypertension,
anteriosclerosis, tuberculosis, obesity,
chronic nephritis, neuritis, neurasthenia,
and other disorders of metabolism, that the
high frequency currents come nearer meeting
the therapeutic indications than any
other methods of treatment.
The high frequency apparatus giving the
currents D'Arsonval, Tesla andOudin, can
be excited from a coil or a large static ma-

f,4 THE CHARLOTTE MEDICAL JOURNAL ,|
chine of U) to 20 plates. The majority of Mix. This mixture penetrates the tissues,
clinicians prefer the static machine, as they and a gas (carvacol) is generated that is
consider the qualitv of the current gener- very destructive to germ life. The peculiar
ated much superior to that obtained from taste is detected by the patient in coughing
the coil; and this is in accordance with my for hours after the operation. The current j
own experience. I use in my work a 20 probably acts also from its chemical effects j
plate static machine running at full speed, —that is, from the deposit of ozone and j
and ordinarily administer a current of 200 nitrous acid in or on the treated surface,
to .500 millimeters, for twenty minutes, the and from the ultra violet light produced in
patient lying on an auto-condensation couch or on the tissues by these discharges. Phys-
;
.
\
'
,
I
;
with a large metal plate over the abdomen, ical results are secured from the expansion
The patient receives millions of oscillations and contraction of the cell itself, and in the
per second, which produce a feeling of well stimulation of the natural galvanic currents
being, and without pain or discomfort. The of the body which accompany every chtmiblood'pressure
is reduced from five to twenty cal reaction and muscular effort. In addimillimeters,
the temperature is rais-ed, the tion to the above, the open air treatment,
secretions are augmented, the system is nutritious food, hydrotherapy, and the adenergized,
the functional activity is stimu- ministering of mercury succinimide, onelated,
and the proper relation between waste fifth grain, subcutaneously, every other
and repair is better maintained. The elim- day.
ination of effete material takes place more The Morton wave current induces tissue
rapidly, the nutrition is improved, and na- vibration and contraction, thereby re-estab-
I
\
ture is gradually
normal functions.
enabled to resume her
I have record of many
lishing normal circulatory drainage. It has
a most remarkable tonic effect on local and
1
rather advanced cases of arteriosclerosis general metabolism, stimulating the circusuccessfully
treated by the D'Arsonval lation apd the secretions, increasing elim- .'
;
j
current.
High frequency can be relied upon to reination,
relieving pain and congestion, and .
absorbing inflammatory exudates and gouty '
]
,
duce arterial tension, and also to increase and rheumatic deposits. "
the elimination of the urinary solids, thus Chronic Nephritis.
i
I
'
opening up a great sphere of usefulness in Mrs. R., age 30 years. New Jersey. Ad- ,^
arteriosclerosis, and in all conditions of mitted to my Sanatorium on April 12, 1909.
nephritis and kidney incompetency. A Remained until April 29, 1909. An Edepersistent
low specific gravity of the urine bolhs operation, decapsulation, was peris
of far more serious import than the pres- formed on both kidneys four years ago. •
ence of albumen and casts. Nothing ap- The patient gradually grew worse, and has 1'j
proaches the results obtained from the since then spent most of her time in the '^
D'Arsonval current in the above conditions.
In tuberculosis, by use of the catapho-
Dansville, N. Y., Sanatorium. She was \j
',
pale, weak and anaemic; eyelids puffy and
resis obtained from the high frequency cur- (Edematous; tension 220; occasional attacks vj
rents (Oudin current), you not only get of severe chest pains with dyspnoea; obstijj
your drug applied right on the spot, thus nate insomnia; headache; tube casts; albu- W
coming into direct contact with the diseased men; with a large quantity of low specific fi
tissues with the resulting hyperemia and gravity urine, 1002. Treatment: D ' Arson - a|
improved blood supply, but you get in ad- val currents, auto-condensation daily, fol- W
dition to this a most powerful effect on local lowed by the static head breeze and the 4
positive to forehead and J
and general metabolism. The high fre- galvanic currents, (
quency current increases metabolism, re- negative to nape of neck ) and hydro- .jj
lieves congestion, stimulates the vasomotor therapy. Marked improvement in every '^
system, and promotes nutrition and vital way. Urine contains much less albumen *|
resistance. and the specific gravity increased to 1010. '"
'
;
The results of high frequency in tubercu- Tension reduced to 1.^5. Sleeping well, j,
losis have been most gratifying and encour- Headaches and insomnia relieved and thej;
aging. Dr. Goss, of Adams, N. Y. ; Dr.
McPharlan and Dr. Craft, of New York
patient
ing.
was able to go driving and walk- ^.^
City; Dr. Cannon, of Baltimore, Md., and
many other observers report several hundred
cases of all stages of the disease with
She was so much elated over her im- >,
provement that upon returning home she \
had her physician install an electric outfit i
apparent cures of from eighty to ninety-five so that she could continue he treatment,
per cent. I have only treated a few cases, All previous attempts to reduce her tension
but the results were most encouraging. The were unavailing.
formula I use is metallic iodine. Gum Cam- My experience
phor, 1 oz.; oil of turpentine, 2 oz.; sulis
that many chronic kidney
lesions, including Bright's disease and I
phuric acid, C. P., 20 drops. diabetes, which are due to faulty metabol- j
j:
j
{
j
j
|
j

ORIGINIAI. COMMfNICATIONS. h.'l
isui, can be restored to health by a judicious age 26 years, was a healthy child except
combination of hydrotherapy aud electric- some congenital urethral malformation, for
ity; with careful supervision of the daily which he was operated upon twenty times
life, especially as regards diet, bathing, in four years, chloroform being the aujesclothing,
etc. In prostatitis, seminal vesi- thetic used. Referred by Dr. Thomas W.
culitis, enlarged prostate, senile and spe- Murrell, of Richmond, \'a. Epilepsy
cific, no treatment has given me such satis- i
Grand
Mai ) came
on ten years ago.
factory results as the Morton wave and Severe attacks occurring every two weeks,
high frequency currents, administered with
the prostatic electrode in the rectum—the
Under X-ray treatments by Dr. Murrell the
attacks were limited to every three weeks,
metal electrode for contraction, and the Under the continued use of the X-ray and
glass vacuum electrode for chemical or hydrotherapy, with 30 grains daily of
bactericidal effects. Nitrous acid and ozone sodium bromide, he has been entirely free
are freely given off and penetrate to a con- from any epileptic manifestations for a
siderable depth into the surrounding tis- period of more than six months. There
sues. has also been a marked improvement in his
Of the many cases of senile prostatic mentality and general health. All of the
hypertrophv successfully treated during the orthodox remedies had been faithfully triedpast
six years, there has been only one re- ^V many of the leading clinicians; and this
lapse. Mr. II., age 73 years, of Richmond, patient was sent to me as a test case.
Va., was treated at the Mecklenburg Sana- P^f. Morton, of New York, claims most
torium four years ago, for an enlarged pros- excellent results in epilepsy from the use of
tate with retention cystitis, and a septic the X-ray and the milk diet, or a diet closecondition,
with chills and fevers. Six •>' approximating it.
treatments with the metallic electrode per .
rectum effected a complete cure, with no Healltalul Children.
return until a month ago. He was then hv J. Steven Brown, W.D., Hender.sonville. N. C.
agani troubled with frequent micturition.
There was very little enlargement of the Cienuine joy is the rare and rich blessing
prostate, but there was a relaxed atonic that rests upon those who have charge of
condition of the parts. All of his symp- healthful children. Little other human
toius subsided after a few applications of happine.ss is quite so profound as that elic-
ited by the possession of children morally,
the wave current ( metallic electrode for
rectum). The treatments produced a marked
improvement in his general health. In
those cases of enlarged prostate due to
gonorrhea, the results ha\ e been equally
satisfactory. This is not surprising when
we know that the i>rostate and the seminal
mentally and physically healthful. It is
surely in the physician's province to teach
mankind the proper modes of preserving
physical health. Nor is it out of his sphere
to instruct them that healthful minds and
morals should be in harmony with physical
vesicles are the culture fields aud nesting health.
places of the gonococci, and this is the only Men look to physicians as to those in
direct and tangible way of attacking them authority and competent to teach the great
in their strongholds. fundamental truths involved in the evolution
of healthful children. It would fill a
Chronic Rheumalism.
cyclojjedia to write out all the details.
Practically all of these cases should
. , ,. . , . • r While every child should be a law unto it-
cover under a judicious combination of
gglf and the medical advisor should indihydrotherapy,
electricity aud careful atten-
..jdualize his advice to suit each subject, it
tion to the diet and elimination.
^^^, ^^ ^^.^n j^ ^^^^^^ ^ f^,^, fundamental
Anthiitis Deformans. facts.
These cases will recover if treated early 1st. The healthy child should be well
and special attention is given to nutrition
and elimination. In neurasthenia, neuritis,
born. The parents should be sound aud of
good lineage. Let the youth know before
epilepsy, and the various neuroses, one they sow wild oats that their children and
should study carefully the various etiologi- grand-children and great grand children
cal factors, correct faulty metabolism, and must help in the harvest. Reference is
see that all the eliminating organs are prop- made not merely to so-called specific trouerly
performing their functions. bles, but to all that chain of ills arising
I have records of many interesting cases from improper modes of living. The unof
the various psychoses and neuroses sue- strung society woman and the drug habitue,
cessfully treated by physical therapeutic the idolater who worships the dollar so deagents;
but I will not tax your patience by voutly that he has but four or five hours a
reporting them. In closing, a brief allusiou
to one case may be of interest. Mr. B.,
day for sleep, little time for nourishment
and none for diversion, aud eveu the pro-

66 THE CHARLOTTE MRDICAL JOURNAL.
fessional man who works at such a high water may be added. Gradually the child
tension that he has no time to maintain the is prepared to be independent of temporary
proper equilibrium between mind and body
—these and their like have little more right
changes that are apt to occur in the mother's
milk and that are apt to itiflu^nce the
to expect healthful children than those who child's health. It is also better prepared
break the laws of health in more immoral for the not infrequent emergency of necesways.
sary premature weaning. By the twelfth
"Like parent like child." The child of month the child should be independent of
a dyspeptic father or mother is easier prey the mother's milk. One year's lactation is
for the digestive disturbances of early child- long enough drain on most mothers, and
hood. The child of tubercular parents is most year-old children thrive better on a
an easier victim of respiratory troubles, carefully regulated diet exclusive of the
Hence we should teach parents how to mother's milk now quite uncertain and
counteract as far as possible any evil heredi- irregular in both quality and quantity,
tary tendency.
Xo matter how perfect the heredity, in
Parents should know the limitations of the
child's digestive system. They should be
order to maintain a healthful child its habits strenuously informed of the folly of allowin
regard to sleep, exercise, fresh air and ing the child to partake promiscuously of
feeding should he regular and correct,
Baby should have a quiet sleeping place,
whatever ma^' appear on the table. Even
one mouthful of an unsuitable food may be
removed from all likely noises and disturb- suiBcient to usher in a fatal dysentery or
ances. The peaceful sleeper should never cholera infantum.
be disturbed to gratify the curiosity of ad- Such contagious diseases as diphtheria,
miring friends and relatives, nor to satisfy scarlet fever, pertussis and tuberculosis
the whims of an over-attentive mother.
In this era of emphasis on fresh air and
should be carefully avoided. People should
know the dangers of dirt eating or even of
exercise the mere mention of these matters eating soiled fruit and berries and vegewill
sufBce. Of course the baby needs an tables without very careful cleansing,
equable temperature, but this should be The sooner we Americans can be edusecured
by regulation of clothing and arti- cated up to the safe and sane Chinese pracficial
heat rather than by smothering in a
close stuffy room. A child can hardly have
tice of preserving the health of our patients,
the sooner we recognize the full force of
the same degree of health and vigor in a heredity and hygiene as factors in the
low, hot, malarial climate that the same health of the nation far superior to potions,
child would enjoy in a more bracing atmos- pills and scalpels, the more credit will be
pliere. Nor does penetrating dampness or due to our usually good practical common
excessive cold of severe winter climates sense and the more liberal will be our conprove
conduci\e to the child's welfare, tribution to our nation's happiness and
While all cannot live in suitable climates prosperity; for we well know that the near
all the time they should have the benefit of future of the nation depends on the chilan
invigorating climate during special seasons,
as far as possible.
dreu of today,
Perhaps the most important and the most
difficult factor in child-life is proper feed- ^^ Suracon and Gynaecoloaist-Not an
ing. It needs no emphasis
Entity.
in this audience
—each of you doubtless make it clear to ^7 *-" J^^- Strong, M.D., Charlotte .Sanatorium,
every mother that,
Charlotte,
barring
N. C.
hereditary dangers,
it is her most solemn duty and should The history of medicine is of unbounded
be her greatest pleasure to nourish her off- interest to the student. Its evolution has
spring at her own breast. It is the rarest kept pace with the world's advancement
occurrence that a mother's milk is not the along all lines. Its early history was
safest diet for her infant. If it seems to shrouded in ignorance and superstition
disagree, try faithfully to correct it by regu- until disenthralled bv the spirit of freedom,
lating the mother's habits and diet before It has only been within the last half cen-
\-ou try the more dangerous experiment of tury that freedom of medical speech was
modified cow's milk or of the usually in- permitted. It evolved from the cant of the
excusable foods. Circumstances should Barbarous Age and the bigotry and intolergovern
the beginning of mixed feeding. I ance of the Middle Ages, to that of the
believe it is better to begin this cautiously scientific light of the Twentieth Century,
at an earlier period than is usually advised, until there is danger of evolving too far. I
The first addition to mother's milk should mean specialism.
be suitable cow's milk properly modified. I believe that specialists are a necessity.
This IS generally admissible by the fourth but the danger now seems to be that specmonth;
a little later rice-water or barley- ialism will divorce itself from general medi-

ORIGINAL COMMUNICATION. 6/
cine. I am a specialist myself. My plea possible almost anywhere. This composite,
is for the doctor plus the specialist. In institutional work does not in any way rob
other words, he should practice general the surgeon of his individuality ; for has not
medicine before he becomes a specialist. St. Mary's its Mayos, Johns Hopknis its
This would not be true were the human Kellys, Finneys, etc?
body not such an interdependent constitu- In order to emphasize my contentions,
tionality. The physician, like the astrono- bear with me in the citation of a few conmer,
is constantly discovering new stars crete cases, which have come under my
and constellations of disease, and there are observation, proving the benefit of wise and
yet others undiscovered. People die yet of interested counsel.
diseases not catalogued. Case 1.—Mrs. \'. was brought to hospital
Therefore my contention is that the sur- for cancer of stomach, all syrnptoms presgeon
and gynEccologist are only a part of a ent with the exception of a diarrhoea, which
great means to accomplish certain ends, proved to be, by aid of pathologist and inviz.,
to prevent, to alleviate, and to cure ternist, amoebic dysentery. Appendicosdisease.
Surgery takes away obstruction tomy helped, but too late to cure patient,
to functions, poisonous areas, leconstructs Case 2.—R. was presented for gall bladbroken
connections, and may in a general der disease, having most of cardinal sympway
increase reaclionarv life, but in itself toms. Operation done. Normal gall bladhas
no occult power. In its field it has der found. Then passing through differmany
marvelous triumphs, but alone, un- ent hands, myxoedema diagnosed, from
guided, simple mechanical surgery is often which she shortly died, too late for treatuseless
and dangerous. The degree of Sur- ment. Thorough, competent prior examgeon,
etc., should be added to that of M. D. ination would have prevented needless
as is done in some older countries. operation, and at same time valuable time
Surgery, robbed of its stage play, is was lost for specific treatment,
brain-dexterity and conscience, and the Case 3.—Two cases of supposed appengreatest
of these is surgical conscience. It dicitis were operated upon, and both proved
required me about ten years to cultivate it, to be typhoid fever, and both died. t)pera-
—that is, to know when not to operate. .\ tion successful, but inadvisedly done. These
great row of mounds on certain hills around were not my cases.
our city are mute but impressive evidences Case -/.—Mr. C. presented all symptoms
of my educated surgical conscience. of recurrent appendicitis. Operation per-
Tlie surgeon should be surrounded by formed: while still in bed a more violent
the best means science can give, and the attack occurred, and after able consullamedical
science is so broad no one man can tion X-Ray photo proved it to be stone in
cover it. Hence 1 believe the one man sur- ureter, requiring another operation, which
geon has passed, and his l)est work of the cured him. This was my case. Here I
future must be institutional. Of course, would state that satisfactory X-Kay work
this applies to selective surgery principally, can not be done by the tyro or surgeon. He
because from tlie nature of the case emer- must be expert.
gency surgery must be done at once, but Case 5.— Mrs. P. presented every evieven
where it is possible, the first aid should dence of grave abdominal disease. Was
be given and then carried to the nearest sent in for operation. After passing through
institution. hands of competent specialist, dreaded pel-
The best surgery must be composite. The lagra was diagnosed, and she shortly died,
internist, the alienist, the microscopist, the saved from needless suffering and expense,
pathologist and the surgeon -should all act Case 6.— Mrs. U. sent in for fibroid of
in cases of obscure disease, and I don't be- uterus which she had, but after thorough
lieve the best work can be dtme by hired examination cancer of pancreas was diagassistants,
who too often do their work in a nosed, which was confirmed by an autopsy,
perfunctory manner, but a collection of Case 7.—General adenitis of neck and
specialists thoroughly in accord and with marked antemia. Of course, T. B. was the
united ideas can best evolve the highest de- diagnosis at first, but after thorough examgree
of efficiency. ination by nose specialist, polypus and
I do not mean to depreciate in any way sinusitis were found, and first treated, folthe
isolated surgeon, who has done and is lowed by excision of glands, which gave
doing such noble work. Are we not reap- complete cure. Here I must remark that a
ing today what they have sown? Times jiathologist must be of the best,
and conditions are changing. The luxury One objection 1 might surmise,— can't
of today becomes a necessity tomorrow, afford it, from money point of view, and
Enlightened humanity demands of the would answer that my field is North Caromedical
profession its best. Rapid and lina, one of the poorest and stingiest States
comfortable transit makes my contentions in the Union, they say, and yet I find no

hS THE CHARLOTTE MEDICAL JOURNAL.
difficulty in collecting a reasonable fee for epsum salts increases materially the draintheseconsultationsinmost
cases, and where age of the lymphatics by osmosis. If the
they are unable to pay, my colleagues have granulations adhere to the mesh of the
responded as cheerfully as in the first in- gauze, a piece of perforated gutta percha
stance, and I find a constantly increasing tissue may be placed over the wound before
demand by the patient for this collective the gauze and adhesive plaster are applied,
examination. The indications for such a dressing are
Brother physicians, let us make it a per- chiefly if not entirely in those cases where
sonal equation. Vou are sick. Operation it is essential to reverse the current of lymph
advised. Would you rather go to one skilled in the local tissues and obtain drainage insurgeon
and leave it all to him, or would stead of absorption of both the toxines and
3'ou rather have four or five different spec- bacteria. The usual method of treating ;
i
',
ialists go over you, and then refer you to infected wounds at the present time is by ,ti
surgeon? means of a moist antiseptic dressing. In i
Operations in grave diseases at best are the more virulent infections corrosive suboften
worse than useless. My experience limate solution of various strengths is used.
with surgeons is that they show cold feet Corrosive sublimate, as its name implies, is
sooner than the ignorant laity. Why is a caustic, and even if used in dilute soluj
'.
j
.
j
this? The Golden Rule eminently fits the
surgeon.
tion acts as an astringent by coagulating
the albumen and thus tends, in spite of the
f,
Co)iciii>:ions capillary drainage, (if the dressing is kept ;
Ist.-The surgeon and the gvn«.cologist
^° ^^^^ the wound and interfere with .
;
'
'^'''f
^^f drainage of the local lymphatics In |
are a part of general medicine.
2nd.-General medicine is too broad for °^^^' "O';'^^'
'| '« ^^^.^ important to dram .
one man, hence the necessity of specialists, the local ymphatics of their bacteria and .
|
ord.-The specialist, unguarded and un- toxines than ,t is to simply destroy those ^
advised, is inefficient and often dangerous. Present m the superficial layers of the ,|
4th.-Surgery is brain-dexterity and con- ^^^""'^ ^^>' ^^^"^ of an antiseptic which !
coagulates albumen.
science
3th.-The highest type of surgerv is con- ^" 'he treatment of cancer we are con- j
"
.^^antly
sultative and
reminded of the evil effects of local j
institutional.
'"'tation
6th.—The
causing
consultative must
an increased blood sup-
be efBcient
and cover the whole field.
P'y t° the part which ni turn increases ma-
7th.-Inadvised and promiscuous surgery Penally the virulence of the mahgnant cells !
\
present. This is too often well illustrated
should be discouraged.
8th.-Surgical conscience must be culti- ^M the results obtained following the use j
.^^j-gjj
of caustics or partial removal by the knife.
9th'.-The surgeon and gynaecologist are „'^|^^ ?,^'''1*"^1 principles of the Open |
not entities, but integral parts of a whole.
lOtli.— It is time for me to close.
Method freatment of Cancer, which I first
described in a paper read before this Society
in Charlotte in 1906, are: 1st. Enuclea-
An Antiseptic Leech.
tion. 2nd. Drainage. 3rd. X-Ray. Even
By \V. D. Witherbee, M. D., Professor of Sk
Diseases and Materia Medica in the North Care
if the enucleation is carried out according
to the dictum "cut 011I3' in normal tissues"
,. ,. ,. , „ „ ^. , ^. ,, ^ that is wide of the diseased area there can
hna Medical College, Charlotte, N. C. , , , , »i . .1 c .1
be no doubt that even then some of the
Another name for this dressing, quite as malignant cells still remain. The inflamappropriate
as the title, would be a lymph- matory reaction or congestion of blood
atic leech. In fact this might better imply which always takes place about every
the function for which it is designed. wound causes the embryonic cell or cells
The antiseptic leech consists of a piece of which still remain in these tissues to take
sterile gauze dipped in a solution of mag- on more life and virulence and eventually
nesium sulphate. The surface to be directly produce a recurrence which is invariably
applied to the- wound is sprinkled with a more malignant than the original condition,
little powdered boracic acid. The gauze is The method used to overcome this inflamthen
applied to the granulating surface and matory reaction, as well as to promote more
over this a piece of adhesive plaster is thorough drainage about a wound foUowplaced
in such a manner as to completely ing operation in a case of epitheleoma of
cover the moist gauze and at the same time the skin, is by the application of the antiseal
it from the air to prevent evaporation, septic leach as well as the daily application
The reason for preventing evaporation is of the X-Ray. If the case is one of mucothat
capillary or lampvvick drainage is cutaneous surface it is impossible to apply
maintained just so long as the gauze re- this dressing. After the removal of the dismains
moist. Besides capillary drainage eased area a cut is made in the mucous
,

ORIGINAL COMMUNICATIONS. 69
membrane just be^-ond the wound down to It is gratifying to know that the disease
the basement membranes in order that the is being generally recognized, and there is
reaction may take place well beyond the hardly a physician in the South today who
tissues that may contain a stray cancer is not on the look-out for pellagra. In typicell;
this is also treated daily with the cal cases, the condition is so easily recog-
X-Ray. In cancer of the breast after the nized that very often the diagnosis is made
operation Bier's hyperemic apparatus should by the laity, in sections where the disease
be applied daily as well as the antiseptic is being studied.
leech and X-Ray to facilitate drainage, The idea of the relationship of corn to
overcome the inflammatory reaction and pellagra is so firmly fixed, that we can
either drain away or destroy the cells that hardly get away from it long enough to
remain, thus preventing recurrence. look at the question of the etiology from
At the Out Door Clinic in Svirgery of the an impartial point of view. There are
North Carolina Medical College this dress- many, however, who question the relationing
has been used with the most satisfactory ship of corn, and there are still others who
results in the following conditions'. 1st. consider corn merely as a culture medium
Ulcers with hypertrophic granulations, on which the disease germ flourishes. Many
2nd. Inflammatory infillralion about joints ideas have been advanced, having for their
due to trauma. 3rd. \'arious local infec- chief point a specific micro-organism,
tions as well as streptococcus infection after Among the best known observers who have
scarification. 4th. lipididymo-orch i t i s. described an organism which they consider
5th. As a vaginal tampon in the place of to be the specific cause, we have Cuboni,
ichlhyol or boroglyceride. Majocchi, Peltauf and Ileider. More rec-
enllv, Tizzoni, in Rome, and the writer,
Present Status ol the PeUcgra Problem > By Edward Jenner Wood, S.B.,M. I.., W.lnnngton.
N. C.
A year ago, at the meeting of this Society
again called attention to the proba-
^^;^
bililv of their beuig a specific cause. It is
altogether probable that the organism de-
.
•
.^ 1 1 .1
t
scribed by these various observers is one
and the same, and a review of the work of
in Winston-Salem, the ((uestion of pellagra
was brought up, in three papers, and the
each of them would convince anyone that
they were not altogether in the dark in their
discussion of these papers elicited the fact
that the disease was very generally distribciinclusions.
It is very easy to fit in the
idea of a specific germ and still not to conuted
throughout the State, regardless of
section. Since that symposium, through
the co-operation of many of the physicians
iradict any of the conclusions which were
arrived at by Lombroso many years ago.
The work of Tizzoni is of the greatest
of the State, the disease has been diagnosed importance, and his monogram, which is
and notes of the cases furnished me, and in just out of the press, is a master-piece of
this way, ray studies have been materially modern bacteriological research. Tizzoni's
aided. observations extend over something more
It is gratifying to us to have the hearty
co-operation and encouragement of the
than ten years, and during that time he has
produced the disease experimentally hun-
United States Public Health and Marine dreds of times and has studied the life his-
Hospital Service in the study of this prob- t

THE CHARLOTTE MEDICAL JOCRNA].
which pellagra naturally enters the body, nor has it been determined whether or not
Guinea-pigs which were fed on the ordi- there is some other source of infection than
nary food, with the exception of corn, were by way of the mouth. There are still those
able to take enormous doses of the germ by who hold that pellagra occurs commonly
the mouth without any ill results. On the in sections where corn is never eaten, and
other hand, when the germ was given with in my own experience I have seen patients
corn meal, although this meal was most who gave a history of eating not near as
carefully selected as to its purity and free- much corn as is eaten in my own family,
dom from contamination, the animal read- It is hard to conceive that in a section
ily succumbed to typical pellagra. Whether where corn is almost invariably the chief
or not this organism requires a medium con- article of diet, and where the source of the
taining corn meal for its growth and devel- corn is the same for the rich and .the poor,
opment is a question. There still remains that the disease does not abound more
some doubt whether any carbohydrate food generally.
would not furnish the same favorable me- Experimentally, there can be no doubtf
dium, and Tizzoni has suggested that there that the bacillus of pellagra forms an anti-* i
may be an explanation, in that, in the toxin and that this antitoxin is curative. I
cooking of corn meal, as it is usually done Tizzoni was able, by inoculating guinea .
by the Italian peasantry, in the preparation pigs that had pellagra, with blood from a \
of pollenta, the balling of the meal protects healed pellagrin, to cure every case. Asa i
the organism contained in its center from the control, he found that guinea pigs experihigh
degrees of heat to which the surfaces mentally inoculated with the pellagra baof
these balls are exposed. Wheat flour, cillus at the same time with the above men- ;
cooked in the same manner, forms a homo- tioned, died in every instance, unless given
genous suspension without lumps, thereby a dose of the blood of a healed pellagrin. |
allowing the heat to reach every part. One H. P. Cole, of Mobile, Alabama, had two 1
of the most significant discoveries of Tiz- patients in extremis with acute pellagra,
j
zoni was the fact that this organism may He had, also, under his care, a healed pel- I
'
i
be heated to ')!• degrees C. for one hour, lagrin. By using the method of Crile,
and still not be destroyed. It is easy to see transfusing the blood from the healed pel-
hovv' a germ contained in the center of a lagrin to the other patient, he had the sat- \
pollenta ball could withstand the ordinary isfaction of seeing the dying patient not. j
cooking process. only recover temporarily, but of securing a
Occasionally, a bad sample of corn is permanent cure, without recurrence. The j
found to contain the same organism which second patient died before he finished the i
Tizzoni isolated from the blood, feces, operation ou the first. This experiment
j
cerebrospinal fluid, and organs of pel- seems to prove conclusively that there can 1
lagrins. A small amount of corn is beaten be no doubt that pellagra is a disease curable I
up in a sterile mortar and a culture tube of with an antitoxin
bouillon is inoculated with one-fourth its It was Bellamy, of Wilmington, and i
bulk of this crushed corn. The tube is then later. Powers, of Clemson College,
|
i
i
placed in the incubator, at 37 degrees C. S. C, who first suggested the probfor
24 hours. At the end of that time, it is ability that epizootic meningitis of i
placed at a temperature of ')0 degrees C, horses, or "blind staggers," is nothing more :;
and kept there for one hour. This heating nor less than pellagra. While this point
kills practically all of the non-spore bearers, has not been proven, it is very necouroging ,!
but the bacillus of pellagra remains un- to think'that the horse is susceptible to
harmed, and from this tube, other tubes pellagra, because we must have an animal i
may be inoculated with the specific germ for the manufacture of an antitoxin that is i
in pure culture. This is a most important large enough to be bled large quantities of ;
point, because it offers an easy way for blood at one time, in order to make the i
laboratory workers to rapidly examine any manufacture of any antitoxin an econom- ;:
suspicious sample of corn in a relatively ic possibility. When we remember that \
short time. The method is so simple that tlus organism grows readily in the labora- j
it may be done by anyone who has had any tory on all the ordinary culture media, that >.
laboratory training. The same experi- it is easily isolated by the heat method 'i
raents were performed with this organism above described, and that an antitoxin i
isolated from corn as was done with the would be effective, regardless of the rela- '\
organism isolated from the pellagrin, and tionship of any particular food, it seems a ;i
the results showed that in both instances simple matter for the manufacturers to soon !|
the germ was identical. supply us with a curative serum. il
Experiments have not yet been made to While a typical case of pella.gra is as '^
determine whether or not this organism is easy to diagnose as measles, yet there are i;
found in other food stuffs, besides in corn, many cases varying from the normal that ;i:
.
I
'
'
'

ORIGINAL COMMUNICATIONS. 71
^ive US difficulty. When we first see the ery- form of the disease. In tlie discussion of
thema of the exposed part definitely demar- a paper presented by the writer to the Colcated
by the clothing from the sound skin lege of Physicians of Philadelphia, last
and without any other symptom, we are November, Dr. H. A. Cotton. Ruperintenoften
at a loss to know whether we have an dent of the State Hospital for the Insane,
outbreak of pellagra or a simble sunburn, at Trenton, X. J ., mentioned a class of cases
It is never wise to make the diagnosis with- recently described by Adolph Meyer under
out the presence, or the history of the past the term "central neuritis," in which the
occurrence, of a simple stomatitis, or a mental symptoms were quite similar to
diarrhea, or both, but when we have the those of "pellagra-sine-pellagra." Assotriad
of symptotLs; symmetrical erythenia ciated with the stupor or anxious delirium
of the exposed parts, diarrhoea, and sto- he mentioned rigidity, peculiar muscular
matitis, we need not hesitate to make a de- spasms or jactitations, and ob.^tinate diar-
finile diagnosis. We frequently see cases rhoea. All these cases terminated fatally,
without stomatitis atid without a history of The etiology of central neuritis is obscure,
having had it, but it is very infrequent not but the process is probably due to an intoxto
find diarrhoea or some other very defin- ication, and as Dr. Cotton sakl, the histoite
digestive disturbances which are usually pathology has been definitely described and
numerous and varied. A burning sensation can easily be diagnosed by a compein
tlie epigastrium and a pain just below tent neuro-pathologist. While the two disthe
left scapula are common symptoms, eases cannot be counted altogether similar,
"Pel1agra-sine-i)ellagra" was mentioned still, they probably arose from the same
at the meeting last year, but at that time we pathological process. It was my good forfeit
that our experience was insufficient to tune to secure the brain and spinal cord
warrant any reliability in attempting to from one of my cases of "pellagrasinemake
this difficult diagnosis. Since that pellagra," which I submitted to Dr. Cotton,
time, we have extended our experience He writes me as follows:
along this line and we feel justified in con- "My suspicioTis regarding the similarity
eluding that not only does such a condition of this process with that of central neuritis
exist, but that it may be diagnosed. It is is well borne out in this case. The large
is a well known fact that tlie severity of motor cells and a great many cells in other
the attack of pellagra is in no way indi- regions show 'axonal reaction' to a very
cated by the extent or severity of the skin marked degree.
lesion. We have seen many cases with a "The condition has been somewhat delarge
amount of the skin surface affected, scribed by Maranesco and other Italians as
and yet the patient recover, while again, 'chromatolysis' but none of them have rein
other cases where the area of affected cognized that it is an "axonal reaction'. In
skin was small, the patients have succumb- other words, it is a parenchymatous degened.
In most of our cases of "pellagra sine- eration of the central nervous system. "
pellagra" we have found that a careful in- The case above referred to was unquesvestigation
of the previous medical history tionably one of pellagra, and the pathologic
was very suggestive of one or more pre- finding as reported by Dr. Cotton, is most
viousoutbreaksof definite pellagra. Again, important, because, as Dr. Cotton says, it
we found, on careful examination of the is altogether probable that this condition,
skin, in most of these cases, a faint line which has been described as central neuritis
representing the limit of what must have is probably prevalent in the insane institubeen
a skin lesion of mild degree. We are tions of New York and Massachusetts. It
rather disjjosed to conclude that "pellagra- is certainly worthy of further investigation
sine-pellagra" is a misnomer, and that in to determine the question of the possible
all these cases, at one time or another, identity of central neuritis with this atypical
there have been definite skin lesions form of pellagra. It is also probable that
of pellagra, though they may have many of the cases diagnosed dementia-parbeen
very insignificant. Our cases of alytica, in which have occurred peculiar
"pellagra-sine-pallagra were chararter- skin lesions, are really pellagra.
ized by stomatitis, diarrhoea, and well In the fourth Annual Report of the State
marked nervous and mental symptoms. In Hoard of Health of the Commonwealth of
all cases the patients were melancholy. In C.eorgia, 1908, Dr. H. I'. Harris reported
two cases the patients were markedly ema- the occurrence of sprue. I'rom Dr. Harris'
ciated and the reflexes were very much ex- description, it would be extremely difficult
aggerated. Blood cultures taken from to diagnose this condition from "pellagrathese
patients were negative, but this was sine-pellagra", owing to the fact that the
expected, as we have learned by experience characteristic symptoms of sprue are stomathat
the organism can only be isolated from titis, diarrhea, emaciation, and mental disthe
blood of those suffering the acute turbauces very similar to pellagra. In my

72 THE CHARLOTTE MEDICAL JOURNAL
casesof "pellagra-sine-pellagra," I havenot case of acute pellagra in a child eleven
noticed the peculiar ulceration which forms years of age by the hypodermic injection
from time to time on the buccal mucous of four grains of atoxyl, repeated every j
membrane on the roof of the mouth and be- fourth day. The drug in no way altered
tvveen the last molar teeth on both lower the course of the disease. I doubt very,
and upper jaws. The stomatitis of pellagra much whether this arsenic treatment which
is usually a simple redness, w!th salivation was successful in the milder European
but without definite ulcerated patches. I form of the disease, would affect our very
am disposed to question the correctness of severe and rapidly fatal cases. It is interthe
diagnosis of these cases, or to cpiestion esting, however, to note in. this connection
the correctness of the diagnosis of our cases that the disease as we see it today is very
of "pellagra-sine-pellagra," because, in much more attenuated than our first cases
both conditions, the symptoms and course three years ago. Three years ago our
were practically identical. It is far more cases always died while at the present time
likely that the diagnosis of pellagra is cor- the disease is assuming tlie more characterrect,
and that the diagnosis of sprue was istic chronic form which is very much
made through an imperfect knowledge of milder. It is to be hoped that in these
pellagra. I think that if Dr. Harris should cases the arsenic treatment may give usjfsee
some of our cases of pellagra, and also some encouragement.
some of our cases of "pellagra-sine-pella- After all, we must look to serum therapy^
gra" that he would be disposed to accept for relief. As mentioned above, we hav<
our view. It is to be hoped that, with the every reason to expect the early preparatiou|
discovery- of a specific organism of pellagra, of a curative serum.
4
we may be able to resort to a definite ag- In concluding this paper, Iwouldlike^'
glutination test similar to the Widal test in again to entreat the medical profession in
typhoid fever. We have some grounds for North Carolina for their support and co- I
thinking that this test will be perfected operation in the study of a disease that bids '
shortly. fair to be second only to tuberculosis in its I
The treatment of pellagra has been one of importance. We are already deeply inthe
most disappointing in medicine. There debted to many members of this Society for.
is no specific, and first one remedy after an- their assistance during the past year, and I
other has been extolled, only to be thrust take this opportunity to assure them that
aside after the demonstration of its useless- any information or report of cases, or ideas
ness. In our experience, from the begin- as to the etiological factors in this disease !
ning, we are able to predict with a fair de- will be highly appreciated. We are ready ,
gree of certainty, those cases that will re- to" give our time and our means, as far as i
cover and those that will succumi) after a we are able, to the study of pellagra, and '\
few weeks, or possibly a few months, of we feel that we will not plead in vain for
untold physical and mental suffering. In the assistance of our brother practitioners,
the Berliner Klinische Wochenschrift for who should be just as deeply concerned in i
February 8th, 1909, there is a notable arti- the outcome of our studies as we are our- :
'
cle by Babes, \'asiliu and Gheorghus, in selves.
which they advocate the treatment of these . T
patients by
Introductory.
arsenic, ,
given in three wa.N's,
simultaneously. They inject 7 '2 gr. atoxyl Mr. President and Gentlemen:
hypodermically, and in addition to this, I desire to express ray high appreciation
j
|
they have rubbed into the patients skin, 75 of the honor conferred upon me bv the in- /
gr. of an ointment composed of a 1 to ,50 vitation of the Tri-State Medical Associa- \
arsenious acid preparation, Finally, they tion, ccniveved through their secretarv, to I
have the patient take internally, one fiftieth read a paper at its 11th annual session. 1
of a grain of arsenious acid in pill form. This invitation has given me all the more I
three times a day. These observers have pleasure to accept, because the meeting was 1
treated sixty five cases of pellegra in this to be held in Charleston, vS. C. mv beloved !
manner with the loss of only six cases. In native city, where I have not lived for a
the article referred to above, they report a number of vears, but to which I always -
series of fourteen cases, all of which re- return with a sense of coming home,—and .a
sponded readily to from one to three treat- for this opportunity I wish to tender my j
ments as detailed above, :
and have gone for grateful acknowledgment.
a number of months with no sign of any I interpret the invitation, however, as a \
recurrence. In all of these ca.ses there was tribute to the work in which I have been ii
a marked gam in weight. At the present so long engaged, rather than as any per- \
time, 1 am giving this treatment a trial, but sonal compliment to myself, and I : have, i
am not yet prepared ;o report my experi- therefore, regarded it somewhat in the light . \
ence with it. Last summer I treated a of a command that I should select for the i
'
I

ORIGINAL COMMUNICATIONS
subject of this address the consideration of
some branch of medicine relative to this
particular line of work. Hut after scanning
the wide field of material, which is now included
under Sanitary Science, I found so
many interesting and profitable subjects
for discussion, demanding eciu

74
THE CHARLOTTE MEDICAL JOURNAL.
shown to produce disease in man,—in the certain diseases were not apt to have them
lower animals the number of pathogenic again, at least not within a comparatively
forms is slightly larger,—but the study of short time. But the reasons for this immunthese
micro-organisms offers an interesting ity, natural or acquired, are still but parfield
for further investigation,
tially known.
Pathogenic micro-organisms may be con- Whenever the power of resistance is lost
sidered to cause disease either by their me- or diminished, however,—and anything
chanical presence in the tissues, by the poi- which lowers the general or local vitality of
sons produced by tkeir growth, by the with- the tissues, such as hunger or poor food,
drawal from the body of necessary food bad hygienic surroundings, exhaustion from
substances, or possibly by other ways as yet over-exertion, mental depression, exposure
unknown. Although injury is probably to cold, the deleterious effects of poisons,
caused by all these different means, it is bacterial or chemical, acute and chronic
now believed to be chiefly due to the reac- diseases, vicious habits, drunkenness and
tion upon the body cells of the poisons excesses of all kinds, etc., reduces the
elaborated from the tissues by the germs in power of resistance,—whenever this power
their growth. Each variety of germ proba- is lost or diminished, we run a grave risk of
bly produces one or more specific as well as contracting disease.
general poisons, some of which have been i It may be well to state here in parenthepartially
isolated and studied, as in tetanus sis, that in discussing the theories of imand
diphtheria. Bacteria cannot grow and munity and infection it should be rememmultipiy
either in the living body nor out- bered that, however interesting or plausible
side of it without proper nourishment and they may be, they are only theories and
suitable conditions, such as adeciuate mois- may be shown to be untrue. )
ture, light, temperature and air; nor can But granted that somehow or other the
they develop without changing the sub- micro-organisms have gained entrance into
stances upon which they grow. Outside the body and that infection has taken place,
the body this activity gives rise to the pro- let us endeavor to trace briefly and clearly
cesses of fermentation, putrefaction, etc., what is thought to occur. Between the
inside the body to disease. time when the bacteria effect a lodgment
There are many complex factors influenc- and that in which the disease manifests iting
the susceptibility of the body to infec- self the patient simply is troubled with mation
from any germ, only a few of which laise, he feels languid and out of sorts.
are as yet completely understood. The This is the stage of incubation, and it is
most important, however, and perhaps the during this stage that the blood and tissues
all-embracing, one is the condition of the are deeply engaged in the effort to repel the
body at the time of infection, whether it is attacks of the invading germs. These niulfavorable
or unfavorable for the growth of tiply, however, with varying speed throughthe
organism,—whether the soil is suitable out the body generally, or they may be at
or not for the development of the seed. For first localized, or even remain localized, as
without the existence of proper conditions in tetanus, all through the disease. Growno
germ can produce disease. In the living ing in the tissues, they generate in increasbody
the conditions are naturally unfavor- ing amounts their poisons or toxins, which
able for the growth of bacteria, even after soon cause profound changes in the body;
they have penetrated the epithelial invest- the patient becomes really ill and shows
ments of the skin and mucous membranes, signs of unmistakable infection,
wliich so long as they remain intact protect What then happens? Does the body give
the interior from bacterial invasion. Xor- up the fight entirely? No indeed; the white
mal blood has of itself, to a considerable blood cells, the wandering cells and the
extent, a bactericidal power; and the tissue cells of the tissues most affected still keep
cells of the body in general show a similar up an unequal combat. From the lymaction,
depending upon the different cell phatic glands and spleen, armed hosts of
groups, state of health, robustness, and white blood cells rush to the front and atperiod
of life of the individual attacked, tempt to destroy the foe, but all in vain.
This resistance to or protection against in- perhaps; the disease runs its course, to end
fection varies in different Individ- either in death or recovery. But if the case
uals toward the same bacteria, and in terminates in recovery, how are the microdifferent
degrees in the same individual organism finally overcome? This question
toward different bacteria,—which resistance involves many complicated processes, which
may be either natural or acquired. Long time will not permit us to go into in detail,
before bacteria were discovered a difference but the main principles are as follows;
in individual susceptibility, or refractoriness As has been previouslv noted, once the
to different diseases, was recognized. It was bacteria obtain a firm foothold in the body
also noticed that persons who contracted it is subjected to the action of generated

ORIGINAL COMMUNICATIONS. 75
toxins. These give rise to the well known means which have been successsully emknown
symptoms of loss of appetite, head- ployed for their arrest or prevention.
ache, pains, fever, delirium, etc. In addi- Diphtheria.—Since the discovery of the.
tion to the active warfare of the leucocytes cause of this disease and our knowledge of
(Metchnikoff's theory of phagocytosis), the conditions of its transmission, together
groups of cells throughout the body, after with the use of antitoxin, there has been a
recovering from the first onslaught, as it marked reduction in its prevalence, and an
were, of the toxins, begin to tolerate their equally marked decrease in the mortality,
presence, then effect a change in their It is caused specifically, as is now known,
chemical constitution, and finally elaborate hy bacillus diphihe/ia-, described by Klebs
substances ( Bucliner's theory of Alexins^, and LoefQer in lSS,i-4. Its modes of infecwhich
antagonize the toxins and counter- tion are by inhaling infected air, by drinkact
their action altogether, thus lending aid ing infected milk, and also through clothlo
the warrior cells. Other substances are ing, etc., used by diphtheria patients. Virualso
present in the blood which help the lent bacilli have frequently been found in the
leucocytes by preparing the bacteria for healthy throats of persons who have been
absorption and destruction:' these are the (i/i- brought in direct contact with patients, ini^wzwi)
while, on the other hand, substances fected clothing, etc., without contracting
are given off by the virulent bacteria, — the disease. It is evident, therefore, that
lystm—by means of which they strive to infection requires more than the mere presneutralize
the protective substances of the ence of the specific germs in the throat, and
tissue cells, the anti-lysins. Ultimately, that individual susceptibility in this, as in
however, possibly after a desperate struggle, all infections, plays an important part,
during which the life of the patient may This susceptibility may be natural or achang
in the balance, the invading micro- quired.
organisms are overthrown and recovery is Rehring's discovery of antitoxin (1S92)
brought about, a more or less permanent in the treatment of diphtheria may be comdegree
of immunity being produced against ])ared in practical importance with Jenner's
the specific disease. discovery of vaccine in the prevention of
Besides the substances referred to, we smallpox, but there is this remarkable difknow
that aniiloxins also are developed in ference between them; while vaccination
the blood. As to the nature of the action was discovered by accident and empericof
the toxin and antitoxin upon each other ally proved to be of value by use in the
there has been mucli curious speculation. Imman subject, antitoxin was discovered
Among others, Ivhrlich's "side-chain" l)y an organized plan worked out in the
theories are interesting, whether they have laboratory and demonstrated to be true by
a foundation in fact or not, but their chief experiments on animals, before it was tried
value has been in establishing that the pro- on man. This method of investigation,
tection afforded by antoxic and bactericidal instituted by Pasteur as the pioneer, and
serums, used practically in the preventive adopted by Koch and his followers, which
treatment of certain infections, is due, for Hehring employed, was radically new, and
the most part, to purely chemical action, marks a great epoch in the history of medithe
antitoxins neutralizing the toxins after cine. Tliat anything so entirely different
the manner of chemical reagents and the from the old emperical methods should have
bacterial anti-bodies and complimentary met with opposition at first, from the older
bodies combining with the bacterial cells, members of the medical profession, who
Many points, however, are still far from had been taught to abide by clinical expeclear
as to the manner in which both anti- rience and time-honored traditions, is not
toxins and toxins act. Until recently noth- at all surprising. But positive conviction
ing was known about the chemical com- has now replaced misconception and prejuposition
of these substances, only their phy- dice in the minds of the majority of its for
siological properties having been studied, mer opponents.
But it has been shown, at least with regard The preparation of antitoxic serum is
to diphtheria and tetanus, that they are based upon the artificial immunization of
either closely bound to the serum globulins animals (horses), by subcutaneous injecor
are themselves substances of proteid na- tions, in gradually increasing doses, of tlie
tnre allied to the globulins. specific toxin. The antitoxin treatment of
Having thus briefly outlined the theories diphtheria, however, has been so frequently
advanced to explained the principles of in- and so fully described in numerous publifection
and immunity, I would now direct cations. l!i:it only iis practical results, beyour
attention to a review, as concisely cause of their great importance, need be
expressed as possiljle, of the known causes mentioned here.
and modes of infection of some of tlie more The great mass of physicians are now
prevalent infectious diseases, and of the convinced,—First, that diphtheria antitox-

76
THE CHARLOTTE MEDICAL JOURNAL.
in in doses of 500 to 1000 units will confer gans should be removed. Through these
immunity against diphtheria for from 2 to measures the prevalence of the disease may
4 weeks, and that the period can be length- be still further dimished.
ened at will by repeated injections;—Sec- Tetanus.—The tetanus bacillus, discovond,
Behring's claim that, if antitoxin be ered by Nicholaia in 1S84, is now regarded
used early in the disease, i. e., within the as being the cause of all the so-called forms
first 24 hours, in doses of 2000 to 5000 units, of tetanus, such as puerperal tetanus, tetathe
mortality from diphtheria will not ex- nus neonatorum, idiopathic, rheumatic and
ceed 5 per cent., is borne out by experience traumatic tetanus. It is one of the most
all the world over;—Third, that taking violently poisonous of all known bacterias
cases as they occur in practice in their early the dried and purified toxin being fatal to a
and late stages and whether the infection be man weighing 150 lbs. in a dose of 0.23
nearly pure or mixed,—the severity of the milligrams, whereas it would require 4.37
disease is lessened and its clinical course milligrams of dried cobra venom, or 30 to
shortened by the use of antitoxin, and that 100 milligrams of strychnine or anhydrous
thereby many more lives are now saved prussic acid, to produce the same effect,
than formerly. This improvement is most Its mode of infection is through wounds of
conspicuous in the most fatal form, the op- the skin or mucous membrane. In certain
erated cases of laryngeal diphtheria. localities it is frequently found in the soil,
As the result of the use of antitoxin, floors of dwellings, splinters of wood, old
there has been an average reduction of mor- nails, hay, horse and cow dung, and also
tality from diphtheria of not less than 50 in the air.
per cent., and under the most favorable Since the advent of aseptic and antisepcircumstances
a reduction of one-quarter, tic surgery tetanus has become less frequent
or even less, of the previous death-rate, after surgical operation, but it is fairly com-
This has occurred not in one city at one mon after lacerated wounds, and especially
particular time, but in many cities, in dif- after child-birth. In New York City, acferent
countries, at different seasons of the cording to the vital statistics, there are
year, and always in conjunction with the about 15 to 30 cases per year of idiopathic
introduction of antitoxin and proportionate tetanus and 40 per year of tetanus neonato
the extent of its use. In many thou- torum. Its prevention, therefore, is still a
sands of cases treated no dangerous symp- matter of importance. To produce the distoms
have followed its employment, and ease there must always be some wound in
even the disagreeable rashes, which are which the bacillus finds lodgement. In one
sometimes caused by the serum, are now to stage of its development it contains very
a large extent avoidable by the use of the resistent spores, by means of which infecpurified
and concentrated antitoxin. So tion is brought about. The spores re-
fully is the value of the preventive treat- quire favorable conditions to grow, and if
ment recognized that antitoxin is at pres- these conditions are removed the germs are
eiit furnished free of charge by many States rendered harmless. Thus, in regions where
and cities for use, through their official tetanus is prevalent, early and thorough
boards of health, in public institutions, and cleansing and disinfection of all wounds,
also for general distribution through pri- however insignificant, become of more than
vate physicians, for the treatment of diph- usual importance. Such disinfectants must
theria among persons too poor to pay for be used as are not only antiseptic,
the remedy. but also antitoxic in their ac-
Finally it may be said that, with the tion. In some cases where the parts are
moregeneraluseof antitoxin, the more care- extensively lacerated, amputation maybe
ful isolation of the sick, through disinfec- necessary.
tion of the clothing, etc., the rigid scrutiny Tetanus antitoxin, prepared in the same
of the milder cases of throat diseases, a way as diphtheria antitoxin, has been apmore
stringent surveillance in the period of plied on a large scale in immunizing horses
convalescence, and the routine examination against possible infection, especially in
of the throats especially of school children, laboratories where these animals are injectthe
dangers of the disease have been re- ed for the production of commercial antiduced
to a minimum. The chief danger toxins. Similar injections are often given
is now in the mild cases, in which the dis- to man. For immunization 10 c,c. of a
ease is unsuspected, and the child may be serum of medium strength will suffice ungoing
about. Such patients are often a less the danger seems great, when the insourceof
widespread infection. The careful jection is repeated at the end of a week,
attention to the mouth and teeth of For treatment, it is well to begin with 30 to
children is also unimportant factor. In .50c. .c, and then, according to the severity
children with recurrent attacks of tonsilitis, of the case, give from 20 to .50 c.c. each
in whom the tonsils are enlarged, the or- day until the symptoms abate. The injec-

ORIGINAL COMMUNICATIONS, 77
tions are given intravenously or through of bacterial products, serums or attenuated
lumbar puncture. In New York City there cultures of the tubercle bacillus, the results
are usually fifteen to thirty cases following so far obtained do not warrant the conevery
Fourth of Juh'. Most of them are elusion that the problem is destined to be
caused by infection through blank-cartridge solved in this way, although this view by
wounds. Recovery sometimes follows from no means lessens the necessity of continued
the ordinary symptomatic treatment or endeavor until every conceivable method
without treatment at all, so that the statistics for the production of protective or curative
of cures of the disease by the injection of substances has been tried,
antitoxic serum must be very carefully Koch's tuberculins, which are doubtless
sifted before they can be accepted the best of these substances as yet prepared,
The power of tetanus antitoxin to neu- have not met generally with the success
tralize the poison Ijefore it has affected the that was hoped for: and notwithstanding
tissue ceils is marvelous and certain, but the fact that in selected cases, and in the
after the cells have been injured it is slight hands of experts, a number of persons have
and uncertain. The curative treatment in been apparently cured or greatly benefited
man, therefore, has not been followed by by several periods of treatment, in private
very satisfactory results, owing to the fact practice the dangers of tuberculin have
that the disease is generally too far advanc- been considered, by most physicians, to be
ed before it is recognized and treatment greater than its benefits. It is also probably
commenced. Still in the less acute cases safe to assert, in spite of much conflicting
of tetanus it seems to have arrested the testimony on the subject, that there are no
progress of the disease. serums at present obtainable which have
Tuberculosis.—In all its various manifes- any decided value. Tuberculin, however,
tations in man and animals this disease is has proved to be of inestimable value as an
now admitted to be caused by (^a«7//« /w/^(V- aid to the diagnosis of obscure cases of
miosis, discovered by Koch in lS,S()-2. Its tuberculosis in man, and particularly in
common modes of infection are through the cattle.
respiratory tract by inhaling the dried and One of the most remarkable features of
powdered sputum of consumptives, and modern preventive medicine is the universal
through the intestines by drinking the milk interest that has been aroused in the cruof
tuberculous cows, less often by eating sade against consumption. The practical
infected meat. Infection may more rarely results already obtained in places where
occur through inoculation by wounds of the active sanitary measures have been adopted,
skin, and still more rarely through the guarantees the belief that in this direction
sexual organs. In a very few instances it the hopes of even the most enthusiastic bid
has been supposed to have been transmitted fair to be realized. A positive decrease in
directly from parent to child. the prevalence as well as in the mortality
Either at the beginning of the infection of the disease has been effected in many of
or at any stage in its progress other micro the larger cities of this country and elseorganisms
may become associated with the where. This has been the case especially
tubercle bacillus in mixed infection, and in Xew York and severallcities of Germany
their deleterious effects may even predomi- and Great Britain, where the mortality from
nate in importance. Tuberculosis of the tuberculosis has apparently been reduced
glands, bones or joints frequently become .50 per cent, during the last twenty years,
spontaneously arrested. The same is prob- In combatting the disease our main vveapably
true also in from ten to twenty per ons are: First, education of the public in
cent, of cases of pulmonary tuberculosis, personal hygiene, particularly the poorer
Natural cure or arrest is, liowever, tlie ex- classes who do not appreciate the chief
ception rather than the rule in the majority dangers of infection, and in school and facuf
cases where the lesions have advanced tory hygiene; secon'd, the compulsory notifar
enough for detection: nor is it likely fication and registration of all cases of
that any permanent immunity is present in tuberculosis, by organized boards of health,
arrested cases. It is well known that many —the importance of this again relates espersons
readily become infected a second pecially to the very poor and improvident
time. At the same time it should l)e noted, from whom, after all, comes the greatest
as Koch believes, that even and perhaps menace to the community, and who should
chiefly in the very worst cases, as in miliary be under constant control in order that the
tuberculosis, a tendency to immunity is danger may be reduced to a minimum; and
often exhibited; but the immunization pro- third, theestablishment in suitable locations,
cess, if it be such, comes too late to prevent by the State or municipality, of Sanatoria
the fatal termination. for the training and treatment of incipient
Regarding the preventive or curative cases, and of special hospitals for the care
treatment of tuberculosis by the injection and isolation of chronic or incurable cases.

78
THE CHARLOTTE MEDICAL JOURNAL.
Leprosy.—This terrible and once much contained only in the catarrhal secretions,
dreaded disease has many points of simi- Sporadic cases, or the sudden eruption of
larity with tuberculosis. It is caused by epidemics in any localities from which the
bacillus leprae, which closely resembles in disease has been absent for a long time, or
form and staining the tubercle bacillus, and where there has been no new importation
was discovered by Hansen in 1879. Infec- of infection, may possibly be explained on
tion takes place, it is generally assumed, the assumption that the bacilli often remain
through abrasions of the skin and the mu- latent in the bronchial tubes for many
cous membranes, but the disease, contrary months, and perhaps for years, and then
to the popular ideas on the subject, is very become active again under favorable confeebly
contagious, being transmitted slowly ditions, when they are transmitted to others,
and with difficulty to persons exposed to Influenza bacilli are often found in asinfection.
sociation with other bacteria in mixed in-
Since the discovery of the cause of leprosy fections, particularly with pneumococci,
systematic efforts have been made to im- streptococci and tubercle bacilli. While in
prove the condition of its victims and to itself not a very fatal disease, influenza
promote the study of the circumstances certainly has increased the mortality from
under which it prevails. The British lep- such diseases as pneumonia and tubercurosy
commission has done good work in losis, not onh' from its presence in these
calling attention to the widespread preva- diseases but also from its well known effects
lence of the disease in India and in the in lowering the general vitality. Unlike
East. In this country it was introduced most other acute infections, its incidence
into San Francisco by the Chinese, and into has not been diminished by sanitary or prethe
Northwestern States by the Norwegians, ventive measures, but its prevalence seems
There are also foci of infection in the South- indeed to have increased. The nature; of
em States, particularly in Louisiana, and the disease, however, being now better
in the Province of New Brunswick. The understood than formerly, other therapeutic
problem has acquired additional interest remedies are employed which strengthen
since the annexation of the Hawaiian and the weakened vitality of the body, rather
Philippine Islands, in both of which places than the enervating coal-tar products, for
leprosy prevails extensively. There is no example, at first so disastrously used in the
known preventive treatment of the disease treatment of this debilitating affection. No
by bacterial products, but it can undoubt- protective serum has been discovered which
edly be curtailed by systematic measures is of any value in protective treatment,
of inspection and the segregation of infect- Diseases Due to the Pneumococcus.—Typied
individuals; nor is there any likelihood cal lobar pneumonia, as well as certain
of its ever increasing among native Ameri- forms of pleuritis, pericarditis, endocarditis,
cans or getting such a foothold again in cerebro-spinal meningitis, abscess, etc., are
the world as it had in Biblical times or in now known to be caused by the pneumothe
Middle Ages. qoccws ox diplococcus pneumoniae, discovered
Influenza.—This disease as a distinct by Sternberg and Pasteur, independently,
entity can be traced back to the 1.5th cen- in 1S70. It is present in the saliva of about
tury and probably existed at a much earlier 20 per cent, of healthy persons, but is not
date. The last great epidemic reached found outside the body except in sputum.
Russia from the liast in 1889 and gradually Pneumonia is another one of the few disspread
o"er liurope and to America, arriv- eases which, despite all sanitary measures
ingin this country at the close of that year, adopted up to the present time, not only
Since then we have had more or less of it holds its own but has increased in prevaalmost
continually, and especially during lence and severity. The mortality from
the winter months. It is now known to be pneumonia is second only to that from
caused by a specific germ, (^a(77//«/«/f«

ORIGINAL COMMUNICATIONS. 79
tion or drenched to death with drugs as pyogenes, which is one of a large group of
formerly, but measures of great value have spherical bacteria uniting in chains, disbeen
introduced for the support and stimulation
of the heart, and especially the imcovered
by Koch and Ogston, independ-
ently in 1882, gives rise in man to a numportance
of a bountiful supply of fresh air ber of inflammatory and suppurative prohas
been recognized, in the modern treat- cesses, varying in kind and severity, accordment
of pneumonia. ing to the degree and quality of its viru-
Tlie srdden cessation of symptoms between
the .5th and Sth day. Which is frequentlv
characteristic of pneumonia, has
been considered by many to be due to the
lence, the region and mode of infection,
and the susceptibility of the tissues invaded,
Thus it is frequently the primary cause of
infection in erysipelas, acute abscess, celludevelopment
of antitoxic or other protective litis, lymphangitis, tonsilitis, sepsis, puer-
substances in the blood; and it has been peral fever, etc. ; less commonly in pleuritis,
assumed, therefore, that this disease should ulcerative endocarditis, pericarditis, arthribe
paiticularlv adapted for the serum treat- tis, osteomyelitis, and the like. Associated
ment. But, in the first place, it is by no with other bacteria, the streptococcus has
means certain that this is the true explana- also been found contributing to mixed intion
of the crisis, for all pneumonias do not fectionsin pulmonary tuberculosis, broncho-
terminate suddenly in this wav; and we pneumonia, scarlet fever, and septic diphknow
also that many cases have added to theria, playing an important part in these
the pneumonic infection a pneumococcic affections in the production of septicaemia
septicaemiaatthevery time when we should and fever. Streptococci are among the
expect the development of protective sub- most widely distributed of bacteria, having
stances. Moreover, experiments on animals heen found outside the body of man and
have shown that it is extremely difficult to animals in the air, soil and water, and in
produce artificial immunity even by repeated tfie air of surgical clinics. They have freinjections
of pneumococcic toxins. quently been observed in healthy persons
An antitoxin, howe\er, has been prepared
the mouth, nasal cavities, etc.
^''^^ in other infective processes, these
from the blood serum of immunized animals
and has been used in a large number "»cro-organ,sms are more likely to invade
of
'^e tissues and produce inflammation and
cases for the treatment of the disease in
man, without, as a rule, anv
suppuration when the standard of health is
striking preventive
or curative effect. Still the subject ^'?^' ^1'-^ '^^"^e- and especially
'^^^^''f
^^'l'"> ''-^ absorption or retention toxic pro-
is one which demands further studv and
^"-e present in excess m the body.
investigation.* f,"^'s
1^°^ example, local streptococcus infections
*ynl,: Reganling the failure to obtain reliable
serums in piitfumococcus, streptococcus and other are more liable to occur as complications
acute infections, the question is often asked, since or sequelae in various specific diseases, in
thediscovery of diphtheria antitoxin, how is it that chronic alcoholism, in constitutional affecone
species of bacteria will pro

so THF. CHARLOTTE MEDICAL JOURNAL.
animals (horses, sheep, etc.) for the treat- encouraging. The mortality-, which withment
of streptococcus infections. But the out serum treatment varied from 50 to 85
results reported from the use of these serums per cent., has in a number of cases where
I'of which Maruiorek's is perliaps the best) the serum was used given a percentage of
have been very variable, and on the whole only 25 to .30. Holt considers that from
unsatisfactory. The protective power of being one of the diseases most to be dreadthe
serum is undoubtedly specific, but it ed, both on account of its high mortality
soon loses this power and often is practi- and its sequelae, often worse than death, it
cally useless six weeks after its preparation, seems probable that cerebro-spinal menin-
The same serum, moreover, does not confer gitis may become, like diphtheria, one most
immunity, apparently, to any other variety certainly controlled by preventive treatment,
of streptococcus than the one fiom which it The injections are administered by lumbar
was derived. This is a great hindrance to puncture, and the diagnosis is confirmed by
its u.se, for in cases where we want most to bacteriological examination of the fluid obuse
the serum, such as puerperal fever, tained from the spinal canal. This operasepticaemia,
ulcerative endocarditis, etc,, tion is easily performed and is attended
it is often difBcult to make a bacteriological with comparatively little danger. The sediagnosis
from the symptoms, and in over rum itself also appears to be harmless,
one-half of the cases even the bacteriologi- Typhoid Fever.—This disease, peculiar to
cal examination, carried out in the most human beings, is caused by i5ar////cj- i'j'///().T«.f,
thorough manner, will fail to detect the discovered independently by Eberth and
special variety of streptococcus causing the Koch in 1880. The mode of its infection
infection. is principally by way of the mouth and
The almost total abolition of child- stomach to the intestines, through the inbed
fever from our maternity hospitals gestion of infected milk and water, and
and from private practice, has been more rarely by eating raw oysters and clams
one of the most remarkable triumphs of or food contaminated by flies ana other inpreventive
medicine. In many institutions sects, or possibly by the inhalation or informerly
the mortality after child-birth was gestion of infected dust.
5 or 6 per cent., and sometimes, indeed, as In this, as in all infectious diseases, indihigh
as 10 per cent. ; today, owing to proper vidual susceptibility plays an important
antiseptic precautions, the mortality has role in the production of infection. There
been reduced to ,3 or 4 per cent., or even must be some disturbance of digestion, exless.
The recognition of the contagious- cesses in drinking, etc., or a general weakness
of puerperal fever was the most brll- ening of the powers of resistance of the inliant
work, perhaps, of Dr. Oliver Wendell dividual, caused by poor food, exposure to
Holmes, in 1843, although Semmelweiss, bad hygienic influences, overcrowding, and
a few years later, further corroborated the the like, as with soldiers and prisoners, for
fact. But the full realization of the causes instance, to bring about the conditions
of this disease was not reached until anti- favorable for the production of typhoid
septic methods had been put into practical fever,
use. After recovery from typhoid fever a con-
Cerebro- Spinal Meningitis.—This fatal siderable degree of immunity is present
epidemic disease is now known to be caused which lasts for years. This is not absolute,
by the meningococcus or diplococcus intra- as about 2 per cent, have a second attack,
cellularis meningitidis, discovered by Weich- but this attack is usually a mild one. Speselbaum
in 1887. The prevalence of the cific immunization against experimental
disease in winter and spring, a time favor- typhoid infection has been produced in
able to influenza and pneumonia, also sug- animals by the usual method of injecting
gests for this the respiratory tract as the at first small quantities of the living or dead
probable mode of infection. It is not bacilli and gradually increasing the dose,
known as yet why meningitis follows in The blood serum of animals thus immutisome
persons and not in others, from infec- ized has been found to possess bactericidal
tion of the mucous membranes. The diplo- and feeble antitoxic properties. These
coccus is often associated with the pneumo- characteristics have also been observed in
coccus and streptococcus pyogenes in mixed the blood serum of persons who are convainfections.
lescent from typhoid fever. An attempt
An antitoxic serum, prepared by Flexner has been made to utilize the tvphoid serum
and Jobling from the blood serum of im- for the cure of the disease in man; but almunized
animals by injections derived from though a number of individual observers
many strains of the meningococcus, has (
Chantemesse, especiallv) have reported
been recently used in the treatment of the good results, most consider that little or no
disease. According to the latest reports, benefit is derived from its use.
the results obtained would seem to be most The employment of vaccines from killed

ORIGINAI, COMMUNICATIONS. 81
typhoid bacilli has been advocated by particularly in the rural districts, there is
Wrig-ht as a protective inoculatioji in per- often an absence of proper sanitation. Many
sons who are likely to be exposed to danger of our country districts have yet to learn
of infection. According to a recent report the A. B. C. of sanitation. With some of
of the board of ofScers of the U. S. Medical the conditions favoring; the persistence of
Reserve Corps, Dec. 7th, 1908, it was found typhoid infection we are not yet familiar,
that the practice had been used to vaccinate but the chief danger results from impure
about 1.5,000 men* in the English and Ger- water supply in the smaller towns, local
man colonial armies, and complete and house epidemics due to infected wells, and
carefully compiled statistics had been col- milk outbreaks due to the infection of dairy
lected, from a consideration of which the farms.
board was convinced that the vaccination The use of boiled water and of ice made
was quite harmless and that it would be of from distilled water, the systematic inspecgreat
service in diminishing the amount of tion of dairies, the scrupulous supervision
typhoid fever among troops, especially in of the sources from which the water is obtime
of war. It therefore recommended tained, an efficient system of sewage rethat
the practice of vaccination be intro- nioval, and, above all, the greatest possible
duced into the regular and volunteer armies care on the part of physicians and nurses
in time of war; and that in time of peace in the disinfection of the discharges of tyall
the men be given an opportunity to be phoid fever patients,—these are the measprolected
against the disease, and that ures necessary to reduce to a minimum the
special efforts be made to vaccinate as prevalence of typhoid fever,
many of the Hospital Corps and Nurse Typhus Fever.—Notwithstanding the fact
Corps and any others especially exposed as that nothing has yet been determined conpossible.
The immunity conferred lasts cerning the micro-organisms exciting this
from one to three years. disease, no one of the acute infections in
Another important practical application man seems to have been more dependent
of our knowledge of the specific substances upon filth and unsanitary conditions, and
developed in the lilood of persons sick with none has been more benefited by modern
typhoid fever, is the Widal or serum reac- hygiene or preventive medicine. Until the
tion as an aid to diagnosis. It is based middle of the last century this disease preupon
the fact that living and actively vailed widely in the larger cities,particularly
motile typhoid bacilli, if placed in the dilut- in luirope, and also in jails, ships, hospied
blood or serum of a patient suffering tals and camps. It was more generally
from typhoid fever, within a very short prevalent even than typhoid fever and much
time lose their motility and l)ecome aggluti- more fatal. With the gradual introduction,
nated into clumps. I-'roni an exi)erience of, however, of drainage and a good water suptwelve
years of this test, it may be said ply, and the relief of overcrowding, the disthat,
though not infallible, when performed ease has almost entirely disappeared, and
with due regard to the avoidance of every is now rarely mentioned in the lists of morpossible
source of error, it is as reliat)le as taiity, except occasionally in a few of the
any other bacteriological test at present in larger and more unsanitary cities or ports.
use, and is of the greatest value as an aid Asiatic Cholera.—This disease, also pecuto
the clinical diagnosis of irregular or ob- liar to man, is still one of the scourges of
scure cases of typhoid infection. the present times, having recently made in-
Although preventive medicine can rightly roads into Europe and America from India,
claim to have successfully controlled this its native home. It is caused by the
disease in certain localities and under proper "comma bacillus" or Spirillum Cholerae
hygienic conditions, especially where there Asiaticae, discovered by Koch in 1883. Its
h«s been a pure water supply and perfect mode of infection is through the mouth by
drainage, still typhoid fever is very preva- drinking contaminated water, also possibly
lent in this country. This depends mainly by eating food infected by flies, etc.
upon two facts: I'irst, )iot only is the ty- Not every one exposed to infection is atphoid
bacillus very resistent, but it may re- tacked by cholera; according to the greater
main for a long time in the body of a per- or less power of vital resistance of the body
son after recovery, and such persons in ap- the same infectious material may give rise
parent good health may act as carriers of to no disturbance whatever, a slight diarinfection
for months or even for years, ex- rhoea, or it may lead to serious results,
ceptionally; second, and doubtless this is I'urthermore, it may be accepted as an esthe
essential factor in the prevalence of tablished fact that recovery from one attack
typhoid fever in our section of country, of cholera produces individual immunity to
a second attack for a considerable length of
"Report.s had been received of about 100,000 men .;,„«
vaccinated, but in only 15,000 cases were statistics •
,,,'.,, • ... , . r 1 1 m
carefully collected. Within the last few years Ilaffkine, lu

S2 THE CHARLOTTE MEDICAL JOURNAL. j
India, has succeeded in producing an arti- variola was one of the most prevalent and \
ficial immunity against cholera infection dreaded of all diseases. Few persons reach- j
by means of subcutaneous injections of ed adult life without an attack. Today, ^
cholera cultures. In several hundred thous- though outbreaks still occur, it is a disease 1
and persons whom he has inoculated the which is thoroughly controllable by vacci- \
results obtained would undoubtedly seem nation. The protective power of the inocu- '
to show a distinct protective influence in lated cowpox is not a fixed and constant '
the prevention of the disease. quantity, as is well known. The protection j
The cause of the disease and the condi- may be for life, or it may last only for a 3
tions under which it is produced being year or two. The all-important point is J
known, cholera is not likely ever again to this; that efficiently vaccinated persons '
obtain a foothold in this country, as it un- may be exposed with impunity, and among i
doubtedly can be controlled by modern pre- large bodies of men (e.g., the German ,
ventive measures. army), in which vaccination and re- vacci- .
Bubonic Plague.—This disease, which in nation is regularly practiced, smallpox is I
the Middle Ages became such a terrible unknown. 1
scourge that it was known as the "Black It seems strange that after more than a I
Death," is also still one of the most dread- hundred years of the beneficent effects of \
ed of the great epidemic infections. It has, vaccination throughout the civilized world, \'
however, been confined principally to the there should be fanatics who still oppose it.
'•
East, Southeastern Europe, Asia and Aus- But within the last few months from Bos- \
tralia. Both in China and India there have ton,the very city from which Waterhousefirst I
been outbreaks of great severity in the last spread the blessings of vaccination over the '
fifteen years, and even in this Hemisphere, United States, there have emanated a series »]
in certain of the ports of South America and of diatribes which, to saj' the least of them, !
the United States I San Francisco and New are truly astonishing. This anti-vaccina- ''
York ) there have been some cases of recent tion delusion has become so strong that
years, especially among the Chinese. Judg- various Medical Societies in Philadelphia
in g from the readiness with which it has andelsewherehavedeemeditnecessary tobebeen
checked and limited wherever it made gin an active campaign against it. In recent
its appearance in this country, there is very papers read on the subject, Doctors Abbott,
little risk that the plague will ever assume Welch, and others, have produced some
again its former devastating power. It is valuable statistical evidence of the efficacy I
caused by a bacillus discovered by Kitasato of vaccination, which are worth repeating. %
and Yersin in 1894. Its mode of infection Since the enactment, in Germany, of the \
is by means of wounds of the skin, and law requiring the compulsory vaccination '.
throughbitesof infected fleas from rats hav-„ and re-vaccination of all persons, in 1874, a
ing the disease, which are thought to be one
of the chief factors in spreading the malady,
there have been no epidemics of smallpox ^
in that country. The disease is frequently "
Haffkine, in India, has recently applied introduced by foreigners, particularly on
his method of preventive inoculation to the frontiers, but it can obtain no foothold. J
bubonic plague, as he previously did with In 1899, among a population of .54,000,000
|
cholera, and apparently with equally good in Germany, there were only 28 deaths from
^
results. Yersin and Calmette have also smallpox, and these occurred in 21 differ- |
prepared a serum by immunizing animals ent districts, the largest number in any one "%
against plague infection by the repeated district being three. In 1897, there were •*'
j
'
'
injection of dead cultures of the bacilli, and but five deaths from smallpox in the entire
this serum has been employed in the treatment
of the disease in man with promising
German Empire. The large German cities,
Berlin, Hamburg, Breslau, ^Munich and
results.
Smallpox.—The question as to the excit-
Dresden, have a perfectly insignificant mortality
from smallpox as compared with
ing factor in smallpox, according to some Loudon, Paris, Vienna, and St. Petersburg,
authorities, is still undecided, while others in all of which the vaccination laws are
maintain that it is now settled beyond dis- relatively lax.
pute. The latter consider that certain In the 28 years before vaccination in
bodies found chiefly in the epithelial cells London there died each year from smallof
the skin and mucous membranes in the pox, per 1,000,000 of population, 2,050
specific lesions of the disease are protozoa persons; during the 40 years following vac- :
and the causeof the infection. Theseminute cination, per 1,000,000 of population, the .
"vaccine bodies" were first ol)served in smallpox deaths annually average 158. i
1892, and have since been studied and con- During the seven years preceding the intro- I
firmed, especially by Councilman. duction of vaccination in Prague, smallpox \
While not a great scourge like cholera caused l-12th of the total number of deaths;
and the plague, during the last century during the 20 years following the introduc-

' first
I in
' more
I
I been
I young
i
[ pulouscareineverycasenotonlythatthedis-
ORIGINAL C0M:\UNICATI0NS. //

S4
THE CHARLOTTE MEDICAL JOURNAL
of flagella, found in the salivan' glands. Frost is invariably fatal to its life. It cau- I
Thus when such an infected mosquito bites not stand drought, but the dry season in |
another individual the lubricating fluid or the countries where the mosquito seems to .
secretion of its puncturing apparatus will abound is never so much prolonged as to i
carry the parasites into the blood and trans- completely dry up the usual breeding places. !
mit the disease. Only the female anopheles Under suitable conditions it is a long-lived \
!
bite; hence, they alone ran be responsible insect: a specimen has been known to live i
for spreading the infection. They fly mostly for 75 days after hatching in the laboratory.
'
at night or in the dusk of the evening, while It has been definitely shown that a period
the common mosquito or at/tw, which can- of at least 12 days, at a temperature of 80
not carry malaria, flies often in the day to 85° P., was necessary before the infected
j
j
i
time; and there are other physical differ- insect could transmit the disease; but a ',
ences between them, which have been thoroughly
studied.
mosquito which had reached the age of 70
days was able to produce a case of yellow I
j
i
:
I
!
The importance of the studies regarding fever 57 days after it became infected. The
malaria cannot be overestimated. Among stegomyia bites principally in the late afterother
hitherto obscure problems, they have noon, though it may be incited to take blood i
explained the relation of the disease to at any time of the day. The insects are
marshy districts, the seasonal incidence, abundant from March to September, and
the nocturnal infection, etc. More import- have been captured even in November.
ant still, these studies have pointed out They are generally believed to be incapable
clearly the way by which malaria may be of long flights unless materially assisted by
'
i
prevented: I'irst, the recognition that any the wind. Their tendency, at any rate,
j
individual with malaria is a source of dan- seems to be to remain restricted within very j
ger in a community, so that he must be limited areas, unless carried afar by other •
thoroughly
the importance
treated
of the
with quinine; second,
draining of marshy
means
observed
than
that
natural
not all
flight.
stegomyia
It
mosquitoes
has been |
;
i
j
districts and ponds in which mosquitoes
breed; and third, that even in the most infected
regions persons may escape the diswhich
bite a yellow fever patient become
infected, but that of several which bite at
the same time some may fail either to get
i
!
ease by living in houses thoroughly pro- the parasite or to allow its later developtected
from mosquitoes by nets in windows ment in the body. How long do infected
and doors. mosquitoes remain dangerous to the non-
Yellozc Fever.—The results of the recent immune community? This is a question
experiments of Reed, Carroll and Agra- that cannot be positively answered at presmonte
make it certain that yellow fever is ent, but there is good presumptive evidence
i
|
(
I
•
transmitted by the bite of a mosquito, that the insects may harbor infection through
stegomyia faciata, in the same way that the winter, under favorable conditions, and
i
<
malaria is transmitted by the anopheles, be ready to transmit it in the spring, or that I
although the specific organism causing yel- once infected they can transmit the disease \
low fever has not yet been discovered. at any time during the balance of their i
'
The following interesting facts are known lives.
regarding the stegomyia: It is spread over The brilliant practical results obtained in t
a wide range of territory, embracing many the prevention of yellow fever, since these .'.
varieties of climate and natural conditions, investigations regarding the cause of the i
It has been found as far North as Charles- disease have been made, which have been
ton, S. C, and as far South as Rio de la demonstrated by the work of the U. S. i
Plata. There is no reason to believe, there- Marine Hospital Service in Havana, New \
fore, that it may not be present at some Orleans and Panama, render it certain that i
time or other in any of the intermediate yellow fever will never again become prevalatitudes.
Brackish water is unsuited for lent in this country. In cities where all .:
the development of the larvae. The stego- infected persons are immediately quaran- ]
myia seems to select any deposit of water tined and efficiently isolated by protective ^
which is comparatively clean. Defect- netting, and all breeding places of the spe- >
ive drains along the eaves of house-roofs, cific mosquito are drained or properly pro- i
open cisterns, and the like, are favortei tected by screening (as open cistern, etc.)
breeding places; indoors they find an excel- from the deposit of larvae, there is no doubt ,
lent medium in the standing water of cups that the disease can be controlled,
and other vessels. Like other ctiHcidae, to Rabies.—Until recently all of the numer- :
'
which family it belongs, it prefers to lay at
night. It is eminently a town insect, seldom
breeding far outside of the city limits,
which explains the well-founded opinion
ous researches regarding the cause of hydrophobia
have given negative results. The
latest studies, however, make it probable
that this disease may be added to the list of
that yellow fever is a domiciliary infection, infectious specifically caused by protozoa.
'

ORIGINAL COMMUNICATIONS.

SC) THE CHARLOTTE MEDICAL JOURNAL.
namely, that of the increasing competition only accepted but generally welcomed by
in the art and science of healing, not alone the American people, despite its exercise of
within the ranks of the regular medical pro- arbitrary jjower, on account of its certainly
fession, including its various adjuncts, the beneficent results, pro ^(vm pi/6//iv, and simhospitals.sanatoria,
dispensaries, and boards
of health, but also in the so-called new disply
because they are democratic,
I am no advocate of centralization in the
pensation treatment of disease, such as abstract, nor special pleader of the health
Divine healing, Christian Science, Faith department system: but may not such a
and mind cures, Emmanuel movement, protective union, or "merger, "—to use the
hypnotism, massage, osteopathy, hydro- commercial parlance of the day,—be a pospathy,
and all the other cults and pathies, sible outcome of the growth and developnot
to speak of the advertising quacks and ment of preventive medicine?
charlatans,—who although not more num- Or, are medical services to be engaged
erous today, perhaps, in proportion to the and contracted for, on the co-operative
population, than in times past, still count plan, by societies and families, and phytheirvotariesby
the thousands,— I say that sicians to receive annual salaries for regain
contemplation of these undeniable facts, larly caring for the sick and preserving the
I should like to know what is to become of health of their patients,—as is now largely
the legitimate practice of medicine or the done in Germany with the so-called
general practitioner in the future, from a "Kranken Cassen" and "Hans Artzt, " and
financial standpoint?
to some extent also in the United States by
Physicians, like others, must live; but corporations, etc.? Or, are they to be paid
even now it is getting harder every day to only, like Chinese doctors, to keep people
make a living in the practice of medicine, well, and not paid when they get sick?
and there is no relief in sight. The pros- But be this as it may, in view of the depects
are rather that the conditions will creasing frequency of sickness, as shown
continue to grow worse. It is true, perhaps, by the records of vital statistics, and the
that as the requirements for graduation and waning private practice of physicians,
license become more exacting and difficult, which needs no demonstration, what is to
while the emoluments of practice get com- be the future, Mr. President, of legitimate
paratively less, fewer men may enter the private practice in this country? Intheevomedical
profession, and an increasing num- lution of the new school of treatment,—not
ber of those who do may devote themselves to mention the rapid advance of progressive
to research
career,
work or to a special official surgery, or the successful operative inter-
ference in many affections hitherto regarded
Butarealllegitimatepractitionersof medi- as incurable—what is to become ofthe oldcine,
with the exception of the specialists, time general practitioner of medicine with
to become ultimately merged into some pro- ^'s drugs and galenical preparations, when
tective system, some system of health pre- perfeced methods of modern sanitary
servation, likelhehealth departmentsystem, science shall have arrested or prevented all
for instance, under legislative regulation and infectious diseases and life shall be procontrol?
This is not so impossible as it might longed to a green old age?
appear. The health department svstem,'''as . . ^ .— 7" • ;t r.^r^r.A,^ ^.1.; .f.. ;„ ., *
It
c ^i alreadj exists in tnany parts of this country,
IS a centralized, autocratic organization,
under State or municipal control, de-
,, ., ,. , ,.
^OTE.—In the compilation of this paper I have
„,ade liberal use of other articles and books written
by others, as well as by myself.
'-—^
signed for the care of the public health."
The word "autocratic, " and the acts which
it involves, would seem to be inimical to
our basic principles as a democracy. But
AlcohoJ.
By Wm. deB. MacNider. M. D., Professor of Phar-
macology in the University of North Carolina.
(From The Laboratory of Pharmacology).
in this republic of ours there is a strong and ( a ) The Pharmacalogical Action of Algrowing
tendency toward centralization cohol.
and concentration of authority,—as is seen (b) I.ogical Indications for the use of
in many systems, syndicates and monopo- Alcohol as a Therapeutic Agent.
lies, in commerce and politics, as well as in (c) Changes Produced F.xperimentallv
boards of health. A few of us may declaim in the Blood Vessels of Rabbits Subjected
against this tendency, as being a usurpa- to the Action of Alcohol.
tion of the rights of the individual, a re- The subject under discussion may he apstnction
of personal liberty, a destruction proached and studied with benefit from
of wholesome competition, and so on. Still many points of view. At the present time a
however this may be in the main, when the consideration of alcohol from a sociological
concentration of authority is plainly desig- view point would be of interest, but for many
nated for the common good, as in matters reasons, this side of the subject will be sepertaming
to the public health, it is not verely left alone.

ORIGINAL COMMUNICATIONS. .S7
Like many other questions of medical sens its germicidal power. In addition to
interest, the older they are, the more they this direct germicidal action, alcohol, indiare
subjected to discussion and criticism, rectly acts as a germicide by dissolving fatty
the more inreresting they become: especially material in and around the hair follicles and
in these latter years when they can be ap- allowing a deeper and more perfect action
preached, studied, and in some cases solved of other germicides such as the bichloride
by scientific methods of investigation. Such of mercury.
a statement is certainly true concerning this The influence of alcohol on digestion,
old yet often discarded drug— alcohol. and the role it plays as a food aretwoques-
Occuring as it does free in nature, or at tions which have been severely battered by
least, the elements which enter into its for- laboratory investigations and clinical obmation
are free, namely ferments and servations.
starches, it was natural enough for the an- When the drug is used in a concentrated
cients to use the drug as a remedial agent form it undoubtedly increases the amount
and as a beverage. Juding from the older of blood to the gastro-intestinal tube. This
writings the influence of alcohol upon the increased vascularity persists and as a renervous
system and the circulatory system, suit of its persistence leads to an over proboth
in a dilute and a concentrated form, duction of mucous and a connective tissue
was well understood. The modern concep- hyperplasia in the mucous and sub-mucous
tion of the action of alcohol upon the body coats of the stomach and intestines. The
both before and after absorption, and in mucous which results from an increased
dilute and concentrated solutions, differs in blood supply to the mucous glands is readily
some essentials and in many details from decomposed by the intestinal bacteria with
the views regarding its action which were the formation of acids or fermentation,
held some years ago. This change has been Just what part these acids play in chronic
largely due to the study of the drug from alcoholic auto-intoxication and to what
au experimental laboratory side. Approach- extent they inaugurate the diffuse connected
in such a way, many of the confusing ive tissue overgrowth in the body, which is
factors can be eliminated which exist in a most marked in the liver, blood vessels, and
very pronounced and exaggerated form at kidneys is an intensely live question with
the bed side, which may mask and over- whic i we hope to do something experimentshadow
the action of a drug and render de- ally.
ductions which are seemingly logical falla- When alcohol is used iu small amounts
cious. We frequently hear the remark that and in a well diluted form before or during
conclusions arrived at when the individual meals it acts to a less degree as an irritant
is eliminated from the eciuation must be of but simply this action increases the amount
slight practical value. In this statement of blood to the stomach and intestinal
there is a pronounced element of truth which glands. As a result of the glands receiving
can with ease be discerned when we think more blood, their activity is increased and
of the influence the mind exerts over the there is an increased output of digestive
various functions ot the body in health and juices.
in disease. This influence can not be con- When alcohol is given undiluted with the
sidered as it should be and can not be ap- idea in view of aiding digestion, it nndoubtpreciated
in most laboratory work. 'I'he ly does harm, as the stronger solutions
meatal status of an individual usually plays check the action of unorganized ferments.
but a feeble part in determining the action Alcohol is readily absorbed from the inof
a drug and on this account the jjhanna- testines and is usually quickly oxidized into
cological action of the vast majority of its final eiidproducts, CO2 and II .iO.
drugs can be scientifically determined and The influence which this drug has after
logical deductions for their use arrived at by its absorption is the part of the alcohol queslaboralory
experiments upon anesthetized tion which has been most severely discussed
animals. by the laboratory student and clinician.
THE PHARMACOLOGICAL ACTION OF ALCO- As a result of the rapid combustion of the
HOL. drug after its absorption it furnishes heat
The action of alcohol when used exler- and energy to the body, lessens the combusnally
depends upon the concentration of the tion of fats and carbohydrates and in this
solution employed. The stronger solutions, way indirectly acts as a food. This point
8O-9.S percent, are not so strongly germi- seems fairly well established and is genercidal
as the weaker, 30-40 percent, solu- ally accepted. The point concerning the
tions. When the stronger solutions come action of alcohol which is still the subject
iu contact with the bacterial cell they pro- of a lively discussion is whether or not it can
duce a superficial coagulation of the albu- be considered a circulatory stimulant. If
minous material of the cell body which pre- alcohol be given to a healthy individual in
vents the penetration of the drug and les- a fairly strong solution it is the common ob-

SS
THE CHARLOTTE MEDICAL JOURNAL.
servation that the heart quickens its action, experimental arterio SCLEROSIS by
there is an increased output of blood into the use of alcohol.
the arterial system and the pulse tension is As a result of the use of the higher aniraised.
A similar effect upon the circula- mals for teaching and experimental purtory
system can be produced by other gastric poses, there has developed in this countryirritants
such as ammonia, ether, and cap- an enormous amount of literature along thesicum.
This stimulating action of the drug line of experimental pathology. Such work
is very likely a gastric reflex. To deter- is not only essential to the proper teaching,
mine this point we have on several occa- of several of the rudimentary branches in
sions anesthetised a rabbit with Chloral the medical curriculum but it is the only
Hydrate Solution and connected the ani- way which many problems in pathology
mal's carotid artery to a mercury manome- and pathological physiology can be apter
so as to accurately record the arterial proached and solved.
pressure. At intervals of 1.^ minutes a The blood vessels of the lower animals
small soft rubber catheter was introduced
into the animal's stomach and ,iO c.c. of a
30 percent solution of Ethyl Alcohol adminwere
early used as a field for such experi-
mental work. Among the investigators
who have attempted to produce atheromaistered.
The heart's rate and the animal's tons changes in the vessels are Josie, Fischer,
blood pressure were recorded every five min- Kurt, Klotz, and Miller. \'arious drugs
utes. There was no appreciable rise in and other agents have been employed but
blood pressure and but a very slight accel- the most satisfactory results have been oberatiou
of the heart. These experiments tained by Miller who used solutions of Adcertainly
support the belief that the accel- renalin and Physostigmine.
eration of the heart after the use of alcohol It is a well known fact that the majority
i.s a gastric reflex from irritation and that of individuals who use alcohol continuouswheu
the reflexes have been abolished as a ly, develop some type of arterio-sclerosis.
result of the anesthesia the quickening of The severity of the process varies from a
the heart and the subsequent rise in pressure slight induration of the aortic valves and a
from alcohol does not occur. few atherematous patches in the aortic arch
I am firmly of the belief that there are car- to a diffuse arterial sclerosis which exists in
tain infectious diseases in which alcohol is the peripheral vessels as the classical ' pipe
of the greatest value as a circulatory sup- stem" arteries.
port. I do not say stimulant, for with the It was the object of our investigations, to
ordinary interpretation of this term it would determine first if such changes could be
convey a false meaning. In Pneumonia, produced experimentally by alcohol in the
Typhoid Fever, and more rarely Tubercu- vessels of the lower animals. Secondly to
losis we frequently see patients with a fast determine, if possible, if these changes were
heart, a soft, small pulse, rapid respira- due, per se, to the alcohol or if other sections,
and muttering or maniacal delirum, ondary factors entered into their produc-
In short these are outward manifestations tion, and thirdly to attempt to find some
of an over stimulated central nervous sys- remedial agent which would have either a
tem. The stimulus is the toxin and it at first direct or indirect influence upon the morbid
gives rise to this picture of stimulation, and process.
unless it is stopped leads to over stimulation. The rabbit was. the animal chosen for this
fatigue, and a state of inactivity of the Cen- work as they are comparatively cheap and
tral Nervous System which is manifested by easy to handle. The alcohol was givenljy
a state of coma which frequently precedes the stomach through a soft rubber catheter,
death. For the first few days 2,5 c,c. of a 10 per-
In such cases following the use of alco- cent solution was given and after this the
hoi, especially in Pneumonia it is a common amount was increased to ,S0 c.c. and the
observation to note that the delirium les- strength of the solution to 20 percent. A
sens, sleep is induced, the heart's action be- few of the animals died from accidental
coming slower and stronger. The cells causes. In those that lived the alcohol
of the arterial nervous system are so de- was continued for nearly eight weeks. At
pressed that they no longer respond to the end of this time the rabbits were killed
the stimulus of the toxin, the state of fatigue by chloroform, complete post-mortems were
is prevented and the integrity of the cell is held, and the heart, aorta, and iliac vessels
maintained. It has been clearly demon- were removed for microscopic study
strated experimentally by UoUy that as a There were fourteen animals in this first
result of overstimulation structural changes series which were subjected to the action of
of a degenerative nature develop in the cells Alcohol as described above. Of the fournf
the central nervous system and further- teen animals the vessels of ten showed disraore
that these changes frequently lead to tinct evidence of some type of arterial dean
actual rupture and death of the cells. generation. These changes varied greatly
.

ORIGINAL COMMUNICATIONS. 89
as to the severity and location. In four of were a few patches of thickening of the inthe
animals the vascular changes were evi- ternal coat which were in the early stages
dently early and consisted chiefly in a dif- of the formation of atheromatous ulcers,
fuse connective tissue overgrowth in the The second point of this work was to decellular
stage, which affected principally termine, if possible, the cause of the vascuthe
middle coat of the vessels but which lar degeneration. The following observawas
beginning to be more pronounced tion, we hope will have some weight and
around the blood vessels of the middle coat, throw some light on this side of the quese.
g. the vasa vasorum. This localization tion. Those animals which did not develop
of young connective tissue around these arterial changes and those in which these
nutrient
portant.
vessels of the middle coat is im- changes were only slight, gained in weight
I'or when the connective tissue under the use of alcohol, had good apetites,
reaches its fibrillary stage and contracts it
will inevitably compress the lumen of the
and showed no sign during life or at the
post-mortem of gastrointestinal irritation;
vessel which it surrounds and prevent an while those animals which developed the
adequate amount of nutrition in the form of most pronounced vascular changes and
blood from reaching tiie media. This will those in which these changes were fairly
aid, if not directly cause, degenerative severe, lost in weight under the use of alcochanges
of the middle coat. hoi, had a poor appetite, and a diarrhoea
In the vessels of three of the animals the
most marked changes were to be found in
during most of the time the alcohol was be-
ing used. At the post-mortem such anithe
inner coat. This consisted in a subendothelial
hyperplasia, which existed in
mals showed an acute
moderate severity.
diffuse enteritis of
patches, and which was most marked in the All of the animals were receiving the same
aortic arch. .A few of the patches were
loosing their nuclei, failing to stain and beamount
and the same strength of alcohol,
Some developed gastroenteritis and in these
ginning to develop into atheromatus ulcers, arterial changes were most pronounced.
The aorta of the three remaining animals Others did not develop a gastro-enteritis and
showed decided evidence of late degenera- in these animals there was either no arteriotive
changes. These changes existed as sclerosis or the arterial changes were slight,
well defined punched out or scooped out Rvidently some factor other than the alcoatheromatous
ulcers. Their location with hoi per se has an influence in the producone
exception was in the arch of the aorta, tion of degenerations of the blood vessels.
The inner and middle coats of the vessel Just what this is we are at present in no
were always involved, the floor of the ulcer position to say. The api)arent fact certainly
usually being formed by the outer part of affords an interesting field for speculation
the middle coal. In the aorta of one of the and investigation. It is not unlikely that
animals the ulceration was very extensive,
The ulcers were large, had a scooped out
in some individuals as well as in some animals
alcohol causes an acute catarrhal state
appearance and were found in the abdomi- of the stomach and intestines. As a result
nal as well as the upper aorta. The floor of this increased amount of blood to the
of one of these ulcers was formed by the mucous glands of the stomach and intestine
outer coal of the vessel, which was bulged they become hyperactive and produce an
nut on tlie surface as a sacculated aneurysm,
A detailed account of this work has been
excessive amount of mucous which is discharged
into the intestinerand here decorapublished
Medicine.
in The Archives of Internal
We feel certain that degeneraposes
with the liberation of
and other bodies which are
organic acids
absorbed and
five changes can be produced in the vessels lead primarily to a chronic auto-intoxicaof
the rabbit by the use of alcohol. (Jn
account of the small number of animals
tion, and secondarily to vascular degenera-
tioTi.
used the report is preliminary in its charac- conclusions.
used externally in weak solu-
ter. 1 . When
The (luestion naturally arises, might not lions alcohol is directly and indirectly a
these changes wliich were found in the vessels
have developed spontaneously and not
germicide,
2. When used in weak solutions, in the
be ascribable to tlie alcohol action. stomach and intestine, it acts mildly as an
To eliminate this possible source of error irritant, increases the amount of blood to
the vessels of eighteen presumably normal these structures, and increases the functionrabbits
were removed and studied micro- al activity of the gastric and intestinal
scopically. In fifteen of the vessels there glands.
was no evidence of general or localized ^. In strong solutions, by acting as a
sclerosis. In the remaining three vessels gastric irritant it reflexly increases the rate
there was in one a small round cell infillra- and perhaps the force of the heart beat.
tion of the media. In the other two there 4. After absorption it has no direct effect

90 THE CHARLOTTE MEDICAL JOURNAL
upon the circulatory system but through its
sedative action on the central nervous system
it prevents the heart from being over
stimulated and in this way is of distinct
value in some of the acute infectious diseases.
5. Arterial degeneration may be produced
in the lower animals by alcohol.
6. The degenerative vascular changes are
likely not entirely due, primarily to the
alcohol acting as such, but to the absorption
of products from the intestine which the
alcohol has indirectly caused to be formed.
Anapliylaxis and Its Relation to Practical
Medicine.*
By Dr. R. N. Duffy, New Bern, N. C.
Modern medicine is the result of a combination
of empiricism, genius and painstaking
endeavor. A great many of our
ideas and methods today were preconceived
in master minds; others there are which
were stumbled on. In the whole domain
of modern medicine there are no more interesting
subjects than infection, immunity
and serum therapy and there is no better
illustration of what genius and untiring effort,
preceded often by empiricism, have
done for scientific medicine than the history
of these subjects. The greatest advances
in the last half centur>^ of medicine
have been made along these lines and the
same will perhaps be true of the next half.
There are such infinite possibilities and
such alluring paths of study to the scientific
investigator in these new fields, and so
many yet unsolved problems that the vast
number of experiments and the results here
are not to be wondered at. "V'accination,
the Widal reaction, diphtheria and tetanus
antitoxin, tuberculin and mallein are the
conspicuous but only a few of the insults
of this work.
Serum therapy is in fact, however, not
new. Mithridates bj' taking gradually increasing
doses of poisons established in
himself resistance. It is stated also that he
fed ducks with poisons and then proposed
to use their blood as an antidote. Empiricism,
here as elsewhere preceded rationalism.
Vaccination was practiced and put
on its present basis by Jenner long before
the scientific explanation was given by
Pasteur's work on fermentation, vaccination
against anthrax, chicken cholora,
swine plague and rabies A little later also
the work of Koch and Metchnikoff, Nissen,
*The above paper was written at the request of
Dr. Watson .S. Rankin, Secretary of State Board
of Health of North Carolina, to be presented before
the State Society. It is intended as a resume of
Anaphylaxis from its inception to the present date,
and no claim for originality on the part of the
author is made for the data presented,
V. Behring and Bouchard served to open up
the portals of this vast new field.
Since the discovery of tetanus toxin by
Brieger and Frankel and of diphtheria toxin
by Roux and Yersin and the production
of their specific antitoxins by Behring and
Kitasato in 1890, the possibilities of this
new method of treatment seemed indeed
great and alluring, and much experimental
work has been done towards producing
specific sera in the treatment of the various
infectious diseases.
There is scarcely a useful method of
treatment in medicine which does not occasionally
have its compensating disadvantages
depending upon the many and variable
factors which go to make up the sum
total of results in the human organism. It
has long been known that the blood of animals
may be toxic to other animals when
injected into their circulations. Horse serum
has been used almost exclusively in
the various inoculations that have been
made in man on account of its comparative
lack of such to:;ic qualities. Untoward results
have been frequently noted, however,
after these injections and sudden death
even has occasionally been observed.
These phenomena were at first not understood.
\'on Pirquet and Schick collected
a number of cases in which the injection of
horse serum into man was followed by urticarial
eruptions, joint pains, fever, swelling
of the lymph nodes, oedema and albuminuria.
These symptoms appeared from
eight to thirteen days after the injection of
the serum. This reaction was termed by
Von Pirquet and Schick "Die Serumkrankheit"
or the "serum disease." It has been
known almost since the discovery of diphtheria
antitoxin that guinea pigs which have
been used for the testing of the antitoxin
die frequently when given a subsequent
dose, but no importance was attached to
the fact until 1905. However, when Ehrlich
was visiting this country in 1904 Theobald
Smith spoke to him about the phenomenon
in guinea pigs and Ehrlich gave the
problem to Otto to work out. His work
on the subject was published late in 1905
just before that of Rosenau and Anderson,
of the Ilygenic Laboratory, who had been
working on the subject at the same time.
When Rosenau and Anderson first encountered
the phenomenon they conceived the
idea that there might be some relation between
it and sudden death following injections
of antitoxin in man. They also
foresaw that the problem might have a
close relation to immunity. Both of these
hypotheses have been pretty clearly established.
Many observers before Rosenau, Anderson
and Otto had noted the phenomenon,

ORIGINAL COMMUNICATIONS. 91
as we have said, but they did not offer a strated, what is now well known, the fatal
satisfactory explanation. Asearly as 1S39, result of a second injection of horse serum
Magendie found that rabbits which had into guinea pigs. He showed that the phetolerated
two intravenous injections of egg nomenon was not due to the presence of
albumin without any ill effects, after a diphtheria toxin in the circulating blood
lapse of a certain number of days, died im- but that the presence of these toxins renmediately
after a further injection. Later ders the animals more susceptible than the
workers with precipitins have frequently injection of horse serum alone. He demonnoted
the same thing. Knorr, in lS9.=i, strated that immunity to the reaction might
found that guinea pigs develop an in- be obtained by repeated injections of large
creasing sensitiveness to tetanus toxin, amounts of serum at short intervals. He
Hericourt and Richet, in 1S9S, found that also demonstrated that specific precipitins
they were not able to immunize dogs played no part in the reaction,
against eel serum, but that, on the contrary, The most complete and brilliant work on
the dogs developed an increasing sensibili- anaphylaxis has been done by Rosenau
ty and finally died. Behring and Kitash- and Anderson of the Hygienic Laboratory
ima, in 1901, found an increasing sensi- of the U. S. Public Health aad Marine IIostiveness
to tetanus toxin on the part of pital Service. They have shown that,
guinea pigs. Portier and Richet, in 19ii2, although a single injection of horse serum
found that dogs given a very small dose of is usually harmless to a normal guinea pig,
a glycerin extract of the tentaclesof actinia, a second injection after a definite interval
after a lapse of fifteen or twenty davs, is usually fatal. The length of time necesquickly
succumbed to a subsequent inject- sary between the first and second injections
ion. Athus, 190.1 found that repeated in- they termed the "incubation period," and
jections of horse serum in ral)bits at some this was found to be about ten days. They
days interval, even in small doses, were demonstrated, as Otto had done, that the
followed by results which were local or poisonous property of the serum bore no regeneral
and benign or grave according to lation to the specific toxins or antitoxins in
the number and methods of the previous the serum. They found that the poisonous
injections. Richet, in 1904-19O.S, again principle was specific and that the reaction
experimenting with actinia, found that if would occur only after a second injection
congestin and thalassin (two poisons ex- of an homologous serum. They demontracted
from actinia) were injected into strated that a guinea pig may be sensitized
dogs in doses so small as to cause no symp- to several different proteids at the same
toms, that, after a lapse of twenty-two days, time and react to a second injection of each,
they became very sick or quickly died after provided of course the first reactions were
a subsequent injection. not fatal. Haemolysis was excluded as a
Von Pirquet and Schick (vide supra) in factor and also precipitin formation, which
19(1.5, however, were the first to reach origi- Otto also demonstrated. They advanced
nal and far reaching conclusions in regard the theory that the substance which sensitothe
phenomenon which they occasionally tizes the guinea pig is the same which later
observed in man after injection of horse poisonsit and that perhaps profound chemiserum
and which they termed the "Serum- cal changes in the central nerve cells take
krankheit." 'J'hey showed the relation of place after the first injection. They have
the phenomenon to the hypersusceptibility not been able to isolate the sensitizing subobserved
in animals and indicated the im- stance but they have shown that it is unportance
of these facts in general patholo- affected by the various chemical preservagy.
They cited the well known tuberculin lives: by drying; by precipitation with
reaction as analogous. amonium sulphate or magnesium sulphate.
Portier and Richet, in 1902, were the It is not affected by heating to 60 degrees
first to suggest the name Anaphylaxis to Centigrade for thirty minutes. Thyroidindicate
hypersensitiveness to a poison, ectomy and splenectomy have no effect on
This term is now employed to indicate the the reaction. The blood serum of sensi-.
state of hypersensitization of man and ani- tized animals contains the poisonous sub-
mals to proteid substances either poisonous stance ( "anaphylactin" j as is demon-
or non-poisonous. Anaphylaxis, then, strated by the fact that normal guinea pigs
is a condition of exaggerated suscepti- may be rendered anaphylactic to horse sebility
of the organism to a foreign sub- rum by the injection of the serum of sensistance
of proteid nature, which may or may tized pigs into their circulations.
not be poisonous. Rosenau and Anderson have shown fur-
Otto's work on the essential features of ther that the toxic principle is destroyed by
anaphylaxis was the first to appear. Otto heating at 100 degrees Centigrade for twendesignated
the phenomenon as the "Theo- ty-five minutes. It is not affected by vabald
Smith" phenomenon. He demon- rious chemicals nor alkaloids and similar

92
THE CHARLOTTE MEDICAL JOURNAL.
substances such as taka-diastase, pancrea- It thus seems that here, as in antitoxic im-
tin, rennin, myrosin, invertin, emulsin, munity, there is no law applicable to all
pepsin in acid or alkaline solution, inglu- cases, but that there are certain limitations
vin, malt, papain, stropin, strychnin, mor- which it will be necessary to work out.
phine and caffein. It is not affected by The explanation of anaphylaxis is not
freezing at 1.5 degrees Fahr. nor by filtra- certain. Several theories have been adtion
through porcelain, drying, precipita- vanced. As stated previously, Rosenau
tion aud dialysis, and exposure to the and Anderson believe that the substance
X-rays. Extremely minute quantities of which sensitizes the guinea pig is the same
the serum may cause death in the guinea which later poisons it and they think that
pig, e. g., .1 cc. profound chemical changes probably occur
A certain time must elapse between the in the central nervous system as a result of
injections before the animal becomes ana- the first injection. Vaughan, in 1906, exphylactic.
This period is from ten to plained the phenomenon by an application
twelve days. Second injections within this of lihrlich's side chain theor\'. He thinks
period have no ill effect. When an animal that the first injection of the strange proteid
has once entered into the condition of ana- is broken up into components, one of which
phylaxis it apparently lasts as long as the is toxic, but this breaking up takes place so
animal lives. slowly that the animal is not poisoned. The
Rosenau and Anderson, as well as Otto, body cells, however, learn by the first inhave
shown that guinea pigs may be ren- jection how to break up the complex moledered
anaphylactic by feeding them meat cule. When the next injection is made,
or serum. It is interesting along this line then, the proteid is violently disrupted and
that Uhlenhuth has found that the blood of the large quantities of toxic principle thus
rabbits becomes capable of precipitating liberated cause poisoning. Vaughan and
egg albumin after feeding for some time Wheeler, in 1907, elaborated this theory
with this substance and Metalnikoff has re- further by studies upon white of egg and
ported immunization after feeding one ani- bacterial proteids. They believe that in
mal with the blood of another species. the case of white of egg the poisonous por-
A most interesting fact also has been tion so influences certain cells of the body
worked out by Rosenau and Anderson and that a new ferment, in the form of zymothat
is that the hypersusceptibility develop- gen, is elaborated which remains in the
ed in a female guinea pig may be transmit- cells and takes part in the rapid breaking
ted directly to her young. This transmis- up of the proteid molecule at the second insion
is solely a maternal function. The jection.
milk of the mother was entirely excluded Gay and Southard found in guinea pigs
as a factor in the transmission. dying from a reaction and in those chloro-
Roseuau and Anderson have shown also formed that had previously recovered from
that guinea pigs may be actively but not a reaction what they consider as characterpassively
immunized against anaphylaxis; istic lesions. They found considerable
in other words, anti-anaphylaxis may be haemorrhages, in one or several organs,
induced. This may be arrived atby(l) both macroscopic and microscopic. Gasrepeated
injections of serum during the pe- trie haemorrhages were especially frequent,
riod of incubation; or (2) by recovery from They also found fatty changes in voluntary
a reaction due to a second injection during muscle fibres, heart muscle fibres and in
the stage of anaphylaxis. Besredka and nerve fibres. Their explanation of ana-
Steinhardt question this condition as a true phylaxis is that there is a substance in
immunity, but think it rather a return of horse serum, which they call anaphylactin,
the sensitized guinea pig to the normal which is not absorbed into the tissues, is
state. Gay and Southard also rather think not changed and is very slowly eliminated,
that the guinea pig is in a "refractory" con- Thus, after an injection of horse serum,
dition due to a prolongation of the period anaphylactin remains and acts as a conof
incubation rather than that they have stant irritant to the body cells so that their
been actively immunized. Rosenau and activity for the other elements of horse se-
Anderson, however, believe that the condi- rum is greatly increased. At the end of
tion is one of true immunity. two weeks constant stimulation by the ana-
Another most interesting phase of this phylactin, if another injection of serum is
subject is the induction of immunity to spe- given, the cells are overwhelmed in the excific
bacteria by rendering animals anaphy- ercise of their increased assimilating funclactic
to the proteids of the bacteria. This tions and functional equilibrium is disturb-
Rosenau and Anderson have been able to do ed to such an extent that either local or
in the guinea pig with extracts of colon and general death occurs.
typhoid bacilli. They failed to obtain im- Besredka and Steinhardt think that anaraunity
in their experiments with anthrax, phylaxis and anti-anaphylaxis are phenom-

ORIGINAL COMMUNICATIONS. 93
ena similar to the precipitating and absorb- death. In the most severe forms there deing
actions which govern the relation of velop paresis or paralysis and convulsive
colloids among themselves. movements, as in the guinea pig, and death
Otto believes that, according to the side rapidly follows. Wiley and Gillette each
chain theory, the first injection results in a have recorded a fatal case during the past
weakening or disappearance of the portions year. Landishas reported a series of seven
of the antigens which are in the body, and cases of untoward symtoms following the
thus ;ni apparent hyper-susceptibity re- use of Maragliano's anti-tuberculous sesults.
rum. Waterhouse records a personal ex-
Richet thinks that anaphylaxis is due to perience of sensitization following the use
is due to the presence of a toxicogenic sub- of antistreptococcic serum. Schmitt restance,
non-toxic itself, but producing a ports a personal experience in which he had
a poison by reaction with a second inject- moderately severe symptoms following a
ion of the extract. He supports his view prophlactic injection of diphtheria antitoxby
experiments with a mixture of the se- in. A curious instance about this case is
rum of a sensitized dog and the extract in that he is always subject to asthmatic atvitro.
He claims that this mixture is more tacks when exposed to the odor of horses,
toxic than the extract alone. Boone has had a similar experience; Wiley's
So much for a review of the phenomenon fatal case was affected in like manner manitself.
We are now lead inevitably, as in ner when about horses, and this has been
all subjects pertaining to medicine, to the true of many of the reported cases. Gilquestion
of its practical nature and we im- lette's fatal case had been subject to asthmediately
enter an alluring field of surmise ma for years. During the past year, F. L.
and speculation. How much is true and Taylor, Quigley, Drefoos and Thomas have
how much is false it remains for further in- each reported cases of collapse following
vestigation to thrash out. the injection of antitoxin, but none of their
There are certain differences as well as cases were fatal,
similarities in the reaction in man and the V. Pirquet and Schick, as stated preguinea
pig. In five or ten minutes after viously, have collected a number of cases
an injection in the pig there are symptoms in which the symptoms following the antiiudicative
of respiratory embarrassment; toxin were very mild and developed only
scratching at the mouth, coughing and after an interval of from eight to thirteen
sometimes spasmodic, rajiid or irregular days. The symptom-complex in these
breathing; the pig becomes restless and cases they designated as the Serumkrankagitated.
This stage of exhilaration is heit. As mentioned before, these cases
soon followed by one of paresis or com- usually exhibit urticarial eruptions, joint
plete paralysis. Spasmodic, jerky and con- pains, fever, swelling of the lymph nodes,
vulsive movements now supervene. Pigs oedema and albuminuria. The urticaria
in this stage may recover but usually con- may persist for months, as in a case reportvulsions
appear and are almost invariably ed by Blain. V. Pirciuet and Schich have
a forerunner of death. The symptoms do shown that the first injection renders the
not always follow in the order given. Death individual sensitive to future injections, so
usually occurs within an hour and fre- that, if a second injection is given in from
quently in less than thirty minutes. fourteen days to four months after the first,
A single initial dose in man may be fol- a reaction occurs almost at once or at least
lowed by a reaction, but never is this so in within twenty-four hours. They call this
a guinea pig. Both, however, react to a the "immediate reaction." If the second
second injection. In man. the symptoms injection is given after a period of four
very greatly in kind and intensity. As a months, the reaction, while delayed from
rule, the major syiniHoms come on a few fiye to eight days, occurs earlier than the
minutes after the injection but in a less se- first reaction, and this they term the "acvere
form the onset may be delayed for an celerated reaction."
hour or two. In the milder form' there is a Royer has collected thirty cases illustrafeeling
of faintness, substernal pain, some ting the effects of a second injection of
difficulty in breathing, paroxysmal cough, diphtheria antitoxin in man. He thinks
sneezing and itchiness, particularly of the there is little doubt that second injections
scalp. An annoying urticaria, oedma of of serum, after considerable intervals of
the face and swelling of the tongue may time, cause immedate disturbance several
occur, also nausea and vomiting in some days earlier than that met with as a normal
cases. In addition to an increase in in- reaction.
tensity of the above symptoms, in the se- The "immediate reaction" of V. Pirquet
verer type the patient becomes cyanotic; and Schich, according to accumulated stashows
signs of collapse; may froth at the tistics, occurs in from 18-27 % of cases remouth
aud there is a feeling of impending ceiving injections of antitoxin; the "accel-

94 THE CHARLOTTE MEDICAL JOURNAL.
erated reaction," in probably 30-40 % of be due to inherited hypersusceptibility from
the cases. These reactions are annoying the mother; in other words, inherited mabut
in no case have they resulted in death, ternal anaphylaxis? This maternal trans-
From the accumulated experience of others mission of anaphylaxis may also explain
it has been found that daily injections of the sudden and sometimes fatal symptoms
serum for a period of several days in no previously mentioned which one occasionway
increase the disturbances which are ally sees after first injections of horse serum
commonly expected about the eighth or in man. The demonstration of this matertenth
day; that with a day interval between nal function in guinea pigs by Rosenau
injections the rashes and febrile disturb- and Anderson is the first actual proof of
ances are more marked; three day inter- inherited hypersusceptibility. Inherited
vals cause still more marked symptoms; immunity has, as is well known, been preand
with four day intervals graver dis- viously demonstrated to be a fact,
turbances may be the result. The fact that Rosenau and Anderson
In the guinea pig, as we have noted, have been able to render guinea pigs imimmunity
to anaphylaxis may be secured mune to typhoid and colon bacilli by renin
one of two ways. Either by repeated dering them anaphylactic to proteid exinjections
of serum before the expected time tracts of the specific bacteria opens up a
for anaphylaxis to become established or new line of investigation into the specific
by the recovery of the pig from a second treatment of these and other infections,
injection during the stage of anaphylaxis. Passive bacterial immunity may be now a
In man, however, contrary to what one much easier problem than it has heretofore,
finds in guinea pigs, the evidences of hy- The time required for the development of
persusceptibilty are very variable in the anaphylaxis in the guinea pig and in cases
time of their appearance and, furthermore, of the "Serumkrankeit" in man bears a
repeated injections in the first ten days do close resemblance to the period of incubanot
develop immunity nor does recovery tion of some of the infectious diseases and
from a reaction render one immune to fur- anaphylaxis thus gives a possible explanther
injections. ation of this period. It is hardly a coinci-
Currie, after studying the effects of re- dence that the ten to fourteen day incubapeated
injections of horse serum in patients tion period of a number of the infectious
at the Glasgow Fever and Smallpox Hos- diseases corresponds so closely with the
pital at Belvidere, concludes that it is ap- time required to sensitize a guinea pig to a
parent from the facts detailed bj' him that foreign proteid. In those infectious disrepeated
injections of horse serum induce eases with a short incubation period, like
symptoms of hypersusceptibility in man, pneumonia, the crisis which usually occurs
but it is also apparent that the same facts about the tenth day may have a similar exlend
no countenance to the suggestion that planation. Those diseases which are prothe
death of persons suifering from diph- duced by soluble toxins, as tetanus and
theria is to be apprehended as the result of diphtheria, evidently do not come in this
repeated injections of antidiphtheric serum, same categor}'.
The fact that guinea pigs may be sensi- Finally, in regard to the injection of antized
by feeding them with horse meat or titoxin in view of the new light which we
horse serum brings up the interesting ques- have received on this subject by this recent
tion of the cause of certain cases of appar- work on anaphylaxis, nothing so far pubent
food poisoning in man. If man can lished should change our duty to a patient
be sensitized, like the guinea pig, by eat- suffering from diphtheria or tetanus. Aning
certain proteid substances, perhaps titoxin should be administered freely and
those interesting and obscure cases which should be given at frequent intervals, as it
one occasionally sees of sudden and some- has been shown (vide supra) that the untimes
serious symptoms habitually follow- toward effects increase in severity with the
ing the eating of fish, sea foods of various length of the interval between the injectkinds
and other articles of diet may be but ions. A fatal result is most unusual, but
a reaction of an individual in a state of an- it must be admitted that symptoms of colaphylaxis
towards the article eaten. lapse and even death may extremely rarely
Again, the maternal transmission of ana- occur after an initial dose of antitoxin,
phylaxis in guinea pigs is of great interest but, in view of the seriousness of diphthein
connection with the question of increased ria and tetanus and the marvellous effect
susceptibility in man to certain infectious serum therapy has had in reducing the mordiseases,
particularly tuberculosis. One talily of diphtheria especially, we should
often sees families in which tuberculosis not hesitate in the administration of antiacts
as a veritable scourge and the mem- toxin. However, as has been previously
bers of such a family seem to have no re- brought out, asthmatic patients seem to be
sistance to infection. May not these cases particularly prone to the serious untoward

effects of antitoxin treatment and these
cases had best be avoided. Gewin, in a
series of 200 patients given injections of
diphtheria antitoxin, gave every alternate
patient calcium, gr, 7 1-2 to 15, by mouth
when the antitoxin was injected. He
claims that in those patients receiving the
calcium chloride there was either no disturbance
at all or, at the most, very slight.
It would, therefore, perhaps, be wise to give
calcium chloride with every injection of
antitoxin as a prophylactic measure, and,
wherever possible, the administration of the
calcium chloride should precede the antitoxin.
There is still much work to be done on
this most important subject and the future
will probably bring out many interesting
points along this line. Rosenau and Anderson
believe that the results so far obtained
show that anaphylaxis has a practical
significance in the prevention and
cure of certain of the infectious diseases
and that this is true we hope may be shown
in the nearby future.
In conclusion, I wish to thank Dr. John
F. Anderson of the Hygienic Laboratory
of the U. S. P. and M. H. Service for mucii
valuable assistance in furnishing me with
literature and references.
Bibliography
Rosenau and Anderson, Journ. Infect.
Dis., vol. 5, No. 1, Jan. 1808.
Rosenau and Anderson, Rull. No. 20,
Hyg. Lab., U.S. P. H. and M. II. Serv.,
Washington, 1905.
Rosenau and Anderson, Journ. Med.
Res., 1906, 10, p. 179.
Rosenau and Anderson, Journ. Am. Med.
Assoc, 47, p. 1007, 1906.
Rosenau and Anderson, Bull, No. 36,
Hyg., Lab., U. S. P. H. and M. H. Serv.,
Washington, 1906.
Rosenau and Anderson, Journ. Res., p.
381, 1907.
R6senau and Anderson, Journ. Infect.
Dis., 4, p. 552, 1907.
John F. Anderson, Bull." No. 30, Hyg.
Lab., U. S. P. H. and M. H. Serv., Washington,
1906.
John F. Anderson, Jour. Med. Res., 10,
p. 241, 1996.
John F. Anderson, Ibid, 259.
Ricketts, Infection, Immunity and Serum
Therapy.
H. R. M. Landis, Progress. Med., Vol.
10. No. 4, Dec, 1908.
Knorr, Habilitatiouschrift, 31pp., 8 pis.,
800, Marbourg, 1905.
Hericourt and Richett, Com. rend. soc.
biol., .53, p. 137, 1898.
Behring and Kitashima, Berl. klin.
Woch., 38, p. 157, 1901.
.
ORIGINAL COMMUNICATIONS. 95
Portier and Richet, Compt. rend, sec
Biol. 54, p. 170, 1902.
Arthus, Ibid., 55, p. 817, 1903.
Richet, Arch, difisiol.. 1, p. 129, 1904.
Richet, Compt. rend. soc. biol., 58, p,
109, 1905.
Richet, Ibid., p. 112.
Dr. C. Von Pirquet and Dr. B. Schick
Die Serumkrankheit, Leipzig, 1905.
R. Otto, Das Theobald Smithsche Phan
omen der Serumueberumpfindlichkelt. v
Leuthold-Gedenschrift, 1 Band, 1905.
McClintock and King, Journ. Infect
Dis., 3, p. 700, 1906.
Currie, Journ. Hyg. 7, p. 35, 1907.
Besredka and Steinhart, Ann. de ITnst
Past., 21, p. 117, 1907.
Xicholle, Ibid., p. 128.
Besredka, Compt. rend. soc. biol'., 62, p
447, 1907,
Besredka, Ibid., p. 1053.
Besredka and S'einhardt, Ann. de I'lnst
Past., 21, p. 3S4.
Besredka, Ibid., p; 777.
Besredka, Revue Medico-Sociale,2, p. 10,
1908.
Vaughan, Journ. Am. Med. Assoc, 47,
p. I(tn9.
\'aughan and Wheeler, Journ. Infect.
Dis., 4, p. 476, 1907,
Gay and Southard, Journ. Med. Res.,
16, p. 143, 1907.
Otto, Munch. Med. Woch., 55, p. 1665,
1907.
Richet, Ann. de I'inst. Past., 21. p. 497,
1907.
Goodall, Journal. Hyg., 7, 607, 1907.
Uhlenhuth, Dent. Med. Woch., 26, p.
734, 1900.
Metalnikoff, Centralbl. f. Bakt., 29, p.
531, 1901.
Vallee, Med. Vet., 84 p. 308.
Petet, Compt. rend. soc. biol., 63, p.
296, 1907.
Landis, Therapeutic Gazette, Nov., 1908.
Waterhouse, British Med. Journ., Apr.
18, 1908.
Wiley, Journ. Am. Med. Assoc, Jan.,
11, 1908.
Schmitt, Ibid., Feb. 22, 1908.
Boone, Ibid., Feb. 8, 1908.
Gillette, Ibid., Jan. 4, 1908.
Quigley, Ibid., Mch. 7, 1907.
Dreyfoos, Ibid., Sept. 5, 1908.
Thomas, Ibid., July 4, 1908.
F. L. Taylor, Med. Record, July 4, 1907.
Blain, Ibid., June 6, 1908.
Royer, Therapeutic Gazette, June, 1908.
Gewin, Munch, med. Woch., 51, p.
2670. 1908.

96 THE CHARLOTTE MEDICAL JOURNAL. *
'
Acute Rbeumatism In Cblldhood.—Col- which has caused eighteen j-ears of sterility,
man, in The Edinburgh Medical Journal,
reaches the following conclusions as to
and after the menopause, at the age
sixty-eight years, caused hemorrhage.
of
A
!
treatment: part of that hemorrhage effusion being re-
The first treatment is rest, bodily and tained within the uterus, which was dismental,
absolute and prolonged. The duration
must vary according to circumstances,
placed by the calcified fibroid, it became
infected and caused symptoms of septi-
|
J
1
but it is better to overdo it rather than the
reverse.
cemia. Examination showed a hard tumor
filling the pelvis, which consisted of a calj*
Opinion varies greatly as to the value of cified fibroid, having only a thin shell of i'
salicylate of soda in endocarditis. fibromuscular tissue around it. According
In cases such as the author has reported to this author, the fibroid is a parasite
he is firmly convinced of the great value of which is never observed before puberty or
the drug. Strychnine and digitalis are after the menopause, except when it has
valuable, especially the latter, but its use existed during genital life. He believes
^
f
requires careful and daily watching. Small that; these growths result from the non-
^j
"
doses of bromide he has found most useful
in the early stages; these children are usufertilization
of ova and sterility. They occur
only in women who do not conceive.
J
I
ally excitable, and the bromide enables The prophylactic treatment recommended
them to rest much better. Later, the neces- is that every woman should be impregnated
I
I
sary drug is iron, given with or without the
salicylates. He prefers the ammoniocitrate
before the age of twenty-five. Each fibroma
arises around a single capillary. Microbic
'
of iron, but probably any easily assimilated
preparation is equally good. He has found
action has nothing to do with it. Theendothelial
cells of the capillary remain intact,
J
'A
that both iron and salicylates are readily while the adventitia develops embryonal *
taken by children in ordinary aerated lem- cells. Under the influence of an unknown
onade, and given in this way, medicine force these cells change and ditTerentiate,
*
time is looked upon by these children as becoming muscular. These muscle cells
oneof the most pleasant episodes in a weary may develop into connective tissue and
illness. fibroid elements, p-ibromata never give
j
5
',
As to diet, the author needs only to say symptoms except from pressure on the other
that it should be simple and nutritious, and organs contained in the pelvic. They never
that every care should be taken to avoid undergo cancerous degeneration, but may
^
1
any flatulent distention. become fatty or calcareous. In some cases
|
The Ophlhalmo Reaction In TyphoSd. plienomena of necrobiosis develop. In ges- |
., .,,, , ,r 1 TtT , M. tation thev mav soften or remain stationary, t
-Meroni (Munch. Med \Voch.) has inves- j^ ^^^ -^^^^ :^ ^^^^^^ ^^
.^
^^^^j^^ \
tigated the ophthalmo typhoid reaction of ,^.^,- . during pregnancy. If it is still J
Chantemesse. Ihe author made use ni his
^^f i^^^^^;^,^ ^^^^ retrogression and -J'
trials of a virulent strain of typhoid bacilli • , , ,• ^ ., fi n- j
,,. ^ . , J ,, nn 1/ . involution according to the author. Pmard j
cultivated in brothr The culture was treat- . v

EDITORIAL.
JamesBarrinalectureon J/^W5^...„,
Charlotte Medical Journal has advanced an original conception of
EDWARD
Publlstied Monthly.
C. REGISTER, M. D., EDITOR
this condition which is valuable from both
a pathologic and therapeutic standpoint.
()f course rheumatic endocarditis is the un-
r^HADinTTi? CHARLOTrt. IV IM. rC. derlying condition, but the actual evolution
^.^^ mitral stenosis probably depends upon
^7^7^^r7^^'^!^^^^:^^^^^!T:^^^^^rrr^^rrr an excess of calcium ions in the blood.
When these are present in excess the scler-
GAUGIUM SftUTS AND BODY METABO- ^^^^ changes which follow inflammatory
L''®'^processes
are apt to be carried to an extreme
A study of the therapeutic and physio- degree. Calcium salts also raise bloodlogic
action of the salts of calcium had led pressure, they increase the force of the carlo
some very important contributions to diac contractions, give rise to hypertrophy
our knowledge of the part plaved by this of the papillary muscles, cause violent colmetal
and its salts in the body economy. Hsion of the mitral cusps, increase the for-
Physiologv has taught us that it constitutes mation of fibroid tissues and gradually ceone
of the factors in the process of blood nient and unite the edges of the cusps tocoagulation,
a fact which has enabled us gether. This consideration conveys its
to treat hemorrhage and the hemorrhagic lesson for the treatment of the earliest
conditions rationally and successfully bv stages of mitral stenosis and also for the
the administration of calcium salts. In antecedent endocarditis before the valvular
pathology we learned that deposits of cal- disease has become established,
cium salts occur in the tissues under certain It >« obvious that a contracted mitral
circumstances. When a tubercular focus orifice offers a greater obstacle to the passbecomes
quiescent, calcification takes place age of the blood if the latter is thick, viscid,
therein. Muscles whose trophic nerve sup- and easily coagulable. Blood containing
ply has become diseased, as in infantile an excess of calcium ions is liable
paralysis, contain more than the average to get into this condition, and thus
amount of lime salts. A degenerated gan- add to the difficulty under which the
glioncellof the brain is liable to become circulation is laboring, fortunately there
transformed into a complete lime cast, •« a remedy at hand to counteract this--in
owing to calcium salts being precipitated citric acid. Administered three or four
uarondit. The calcification of arteries in times daily m doses of thirty grams, it
senility is a very familiar fact. washes the calcium salts out of the blood
An investigation into the physiology of and confers upon it a greater fluidity,
the female genital organs, bv Drs. Bell and These are but a few ol the many interest-
Hick, has led the somewhat startling con- ing considerations in regard to calcium and
elusions concerning the functions of cal- its salts. That it does play a most imporcium
in the body. They found that the tant part in the metabolism of the body is
normal regularity of menstruation depends evident. Lack of space precludes further
upon calcium metabolism in the tissues, elaboration. We would refer the reader.
The uterine glands excrete calcium and however, to recent issues of Fo/m I heramucin;
during menstruation local changes Pfi'ti^'"- i" which are found some very valoccur
in the uterine capillaries from which "able information along this line.
leucocytes and red cells escape. These escaping
leucocytes carry with them calcium
salts from the uterine glands and excrete
them. These conclusions have led to the
employment of calcium salts for quite a
new purpose. Thirty grains of calcium
gongbrning THB house „==.», ruv.
The House fly, Mnsca Domeslua, was
described by Carl von Linne in 1758. It
comes in the order Diplera (or two-winged
flies) and belongs to the idixaxXy Muscidae.
lactate every other day is found beneficial The tranformations are complete, there bein
amenorrhoea following acute or debili- ing four stages—the eggs, the leaves, the
tating diseases, the assumption being that puparium (containing the chrysalis) and
there is not enough calcium in the system the imago or perfect insect. The egg is
to permit of menstruation. When this white, elongate, cylindrical, a little smaller
function is established the calcium content and more pointed at the anterior end those
of the blood falls, but it soon rises again to the posterior. Its length is .()4-.0.S of an
a level suflncientlv high to stop the hemor- inch and about .01 inch in diameter. In
rhage. But if this rise in the calcium con- shape it is more or less like a slender grain
tent does not occur, then the hemorrhage of wheat and has a grove or on the side.
does not cease, but menorrhagia results. The eggs are usually deposited in masses
Therefore calcium salts are indicated in bv the female in the crevices of warm and
cases of two profuse menstruation. Sir moist horse-manure Heat and moisture

98
THE CHARLOTTE MEDICAL JOURNA]
are required for the normal development, ical standpoint when preventive measures
and they hatch in about twenty-four hours are considered. -;
after oviposition. The freshly-hatched The role of this common pest in the trans- t
larvae or maggots are .07 inch in length, mission of infectious agents has come to be |j
tapering or pointed at the head end and recognized to the extent that both scientific J
blunt at the other. When fully grown they and lay papers are laying a great deal of S
are from .25 to .41) inch .in length. They stress on the importance of dealing with *i
monitor change their skins three times, methods of prevention. Dr. Henry Skinner, 1
and the entire life of the larvae is from five president of the Entomological Society of 1
to seven days. After the third molt it America, recently published in the New 3
changes to an inactive or resting stage, the Orleans Medical and Surgical Journal an J
pupa or puparium. This is a small, elou- article on this subject, from which article j
gate brown, segmented, object, rounded at we quote freely. The knowledge of bacte- ^
the ends and contains the chrysalis. This riology, in conjunction with a knowledge of <
latter stage lasts from five to seven days, the habits of the house-fly, its settling on 3
when the imago appears. Thus, the whole all kinds of food, in addition to its habit of t
life cycle is about fifteen days. alighting on all sorts of effete germ-laden jj
The bodv of Musca domestica is black; material, show conclusively that it is a very |
the head has a longitudinal reddish, oval, dangerous insect, so far as the health of |
smooth area on the vertex, with the orbits mankind is concerned. t
and adjacent region golden or silvery in The keynote to the situation is along the 9
some lights; the hairs are black and the line of prevention. Horse-manure bears 3
antenna and plume black. The thorax is about the same relation to the house-fly that ]
black, tinged with golden rays on the sides, stagnant water does to the mosquito. If 1
with three dorsal gray longitudinal bands, this insect is prevented from ovipositing in
the middle one most distinct, the two later- manure, the fly as a pest would be largely '.,
al ones partially interrupted in the middle a thing of the past. Various substances j
and continued onto the scutellum; there is have been mixed with manure to destroy
^
a broad lateral golden gray band interrupt- the fly larvae, such as kerosene, chloride of t.
ed by the sutures. The base of the first lime, "residual-oil, " lime and phosphates. V
abdominal segment has a yellowish band These have been used with more or less S
interrupted in the middle- On the middle success. Stables should have smooth and 7
of the end of the two segments is a trian- hard floors and kept clean, so that manure ^
gular mesial golden spot, with an irregular cannot accumulate. It should either be i
band on each side, and farther down the used at frequent intervals or stored in prop- ; j
sides golden; terminal segment, golden, erly constructed bins or screened apart- '*:
Base of wings, scales and halteres, yellow- ments. A good method is to ram it tightly
]
ish white. Legs black. The male differs in barrels that can be tightly covered. The
^
from the female in the front between the most economical way of caring for very '
eyes, being about one-third as wide as in
the latter, while she is rather the smaller.
Length, .22 to .32 inch.
large quantities has not been determined. -^
In towns and villages it would probably pay J
to have it collected at stated intervals, as is '
The tongue is comparatively short, fleshy the case with garbage and ashes. The auto- >
and bilobed and blunt, incapable of biting mobile may become a factor m ths destruc- ,,
or piercing the human skin, and is adapted tion of house-flies, as in the near future the .{
only for lapping up liquids. Allied species ^°^^^ "^^y have only a hmited use. The
which bite may be confused with the house- problem is a very simple one, and as soon ^
fly as preventive measures are inaugurated '
The legs are very hairy and the fly, in
walking on rough surfaces, uses the tarsal
claws, and, on smooth surfaces, a fleshy
organ called the pulvillus, which secretes a
fluid that enables the fly to hold on to glass
.
more extensively the effective andeconomi- ']
cal measures will be discovered.
THE INBRVB TMBORY OP A^GIN|C%
PECTORIS.
Multiple theories have been advanced to
or like surface. account for the symptom complex to which '\
This insect will oviposit in horse-manure, the term angina pectoris has been applied. ,(
decayed vegetables, decayed meats, cow- The familiar arioial theory by which many \
dung, fowls' dung and human excrement, authorities have sought to explain the .\
The vast majority of them are, however, manifestations does not cover the ground, ]
bred in horse excrement, Further knowl- for the very good reason that in many fatal
edge in regard to the food of the larva is cases autopsy reveals absolutely no anato- J
desirable. It would be useful to know about mical lesions of the coronary vessels. The
what proportion breed in garbage and in de- nerve theory advanced by von Neusser seems
cayed meats, as this is important from a med- to fulfill the requirements and to explain j
|(

EDITORIAL. 99
logically what hitherto has been a puzzle cardia, much though they may differ in
to clinicians. This theoiy assumes that their anatomical foundation. Any and
inflammatory processesof the cardiac plexus every irritation wiihin that circle may cause
are the cause of the affection, and this, in alarm in the heart. In this waj' spinal afmany
cases, has been supported by the fact fections (tabes), injuries to the dorsal
that lesions were found in the nerves of the nerves and the rami communicantes, affeccardiac
plexus. If we consider that both tions of the nervus cardiacus magnus, neuvasoconstricting
and vasodilating fibres of ritic affections of the cardiac and coronary
the coronary area terminate in the cardiac plexus, and finally embolism and tliromplexus
and that these fibres connect with bosis of the coronary arteries, may produce
the spinal cord through the intermediary of the symptom complex of angina pectoris,
the sympathetic ganglia and the rami com- The result will be the same in all cases; in
municantes; if we keep in mind that the the center pain and anguish, in tlie periexcilatioiis,
which start from the centers phery vascular spasm with ischsemia of the
for the vascuhir musculature, proceed from myocardium. A healthy heart will overthe
gray substance to the anterior roots and come such an attack, even though it be
from therethrough the rami communicantes serious, but if the heart muscle is weak and
to the sympathetic, the possibility suggests reduced in efficiency, whether from deficient
itself that the sensory fibres carry thesensa- nutrition or fatty degeneration, myocarditis
tion of pain in a centripetal direction, or adhesions to tlie pericardium, then even
whereas the excitation of the centrifugal a rudimentary vascular spasm in the heart
fibres is manifested as a vascular spasm in muscle may lead to a catastrophe, just as a
the cardiac vessels. This would complete fatty degenerated heart may suddenly cease
a circle, in which not only primary excita- to work without the presence of an acute
tion, but also reflex processes may be mani- ischsemia.
fested in the course of the rami communicantes
through the connection of the spinal
cord with the sympathetic. This system
B1.00D PRESSURE AND UIFC
IMSIJRANOE.
also includes the pneumogastric nerve. The The practice of ascertaining the blood
investigations of Maass have shown that pressure has come to be recognized as of
vasoconstrict(»r fibres for the coronary artery prime importance. Its significance in the
terminate in the pneumogastric nerve, and making up of prognoses has within the past
since it is known that the rami communi- few years been impressed very forcibly upcantes
effect the connection of the sympa- on all genuinely scientific clinicians. Its
theticus with the cervico-brachial plexus, a importance in this respect should be realized
typical stenocardiac attack would be ex- especially in considering the acceptance of
plained by any irritation of that system, applicants for life insurance. Dr. Ralph
In order to bring about a stenocardiac at- (irace, in an article which appeared recenttack
it would therefore be a matter of in- ly in the Xew York Medical Journal, emdifl'erence
whether the causative irritation phasized this idea in forcible terms. To
starts in the end apparatus—that is the estimate correctly the pressure of the blood
sensitive organs of the coronary arteries—in in the vessels the most important evidence
the transit station—thalis the cardiac nerves is attained by the use of the sphygmoma-
—in the rami communicantes, or finally in nometer. Of this instrument there are
the central apparatu.s—that is the spinal many reliable makes, among which might
cord. The irritation of the sensitive con- be mentioned the Janeway, Riva-Rocci, &c.
Jiections v.ould therefore produce pain, and As is well known, blood pressure is estithat
of the centrifugal connections ( vaso- tuated by the force necessary to compress
motor I ischsemia of the myocardium. Ac- the artery and obliterate the pulse wave becording
lo wliich of these components pre- yond the point of compression. This force
vails, tiie polymorphic character of the is measured in millimetres of mercury,
stenocardiac paroxysms and the j)henomena In arteriosclerosis we have a condition in
of radiation would be susceptible of inter- the vessel wall which is best described as
prelation. The anguish could be exjilained diffuse permanent thickening, or a hyperas
being due to the centripetal connections trophy
and to the vagus, owing to an irritation of artery.
of the muscular elements of the
There may be a thickening of the
the oblongata. F.et us keep the complete external coat or of the media, and should
circle before our eyes; the spinal center of be distinguished from atheroma which is a
innervation, the dorsal nerves, the rami focal affection of the arterial wall affecting
communicantes, the cardiac nerves, the separate limited areas, probably of microaortic
plexus and the coronary plexus with organic origin and usually a disease of the
the sensitive terniin.Tl organs in their vas- aged. In simple arteriosclerosis the blood
cular walls. We shall be able to trace to pressure is not greatly raised as the increasone
common basis all the types of steno- ed resistance of the thickened vessel wall is

UK) THE CHARLOTTE MEDICAL JOURNAL. \
not SO great, but that the additional pressure high readings do not necessarily mean either i
'"<
of comparatively few millimetres of mer- arterial or kidney disease; we must recog-
cury is sufBcieiit to obliterate the pulse nize this hypertonic contraction of the ves-
wave, and simple arteriosclerosis need not sels as a factor in high sphygmomanometer
materially shorten life and the fear of cere- readings and depend greatly upon the micro- i
bra! hemorrhage lalerin life may be ground- scopical findings of the urinary analysis for I
less, but in arteriosclerosis with a coexistent our diagnosis of kidney affections,
hypertonus, the real cause of our high readings,
we have a condition of grave import- the causation of sex.
ance in the life expectancy of the applicant. Humanity has, since the beginning of I
The diagnostic value of the sphygmoma- time, found an apparently insolvable prob-
nometer then is not so great in uncompli- lem in the causation of sex, and the num- i
cated arteriosclerosis, and we must depend ber of theories that have been advanced to i
upon our tactile sense in outlining the account for it have reached infinity. None, |
thickened artery, which may be quite diffi- however, have yet been able successfully to i
cult as the elasticity of the artery is not account for all phases of the problem,
greatly destroyed and in the absence of Recently Dr. E. R. Dawson, of Great I
hypertonus do not become rigid. Britian, has advanced a theory which he •
The high readings that are obtained in a supports with profuse clinical evidence and I
hypertonic contracted vessel that may or facts, and which, to say the least, is fasci- '
may not be sclerosed is due to the thicken- nating because of its very simplicity. The j
ing of the vessel -ivall and the narroiL'ing of Indian Medical Gazette succinctly outlines i
its lumen. This hypertonia is brought about his theory in the June issue. The funda-
|
in two ways, through the influence of the mental idea is that the male parent has !
nervous system and by substances circulat- nothing to do with the production of the i
ing in the blood. The effect of the emotions sex of the foetus. This is determined by the I
upon the circulatory system through the ovary producing the particular ovum which I
vasomotor centre in the medulla is well is fertilized, the male element only being ]
known, and the effect of active business necessary to start the process of developlife
in modern times with the necessity of ment. According to Dr. Dawson a male
close application and the constant irritation foetus is due to the fertilization of an ovum i
through the nervous system is a great and that came from the right ovary, and a '
important factor producing this hypertonus female foetus is due to the fertilization of I
and increasing the danger of cerebral hem- an ovum from the left ovary. Certainly i
orrhage even in the comparatively young, not a flattering idea to the vanity of the
It is well known that the substances in- male. It seems fruitless to inquire why the i
the blood stream act directly upon the coats right ovary should have been chosen for the
of the vessel without the medium of the production of boys and left for girls, the !
nervous system causing contraction of the only explanation given being that perhaps i
muscular coat. The source of these sub- the weaker sex should be derived from the i
stances that even in small quantities cause weaker or left side of the body. It is fairly !
arterial contraction and raising of the blood well admitted that only one ovum is pro- i
pressure is through the alimentary tract, duced at a time, and a good deal of evi- \
particularly intestinal. As a result of these dence is brought forward by Dr. Dawson to .:
disorders of alimentation, toxic substances show that the ova are supplied alternately, i
are developed and absorbed into the blood first by one ovary and then by the other, i
which act directly on the vessel wall, cans- The strongest evidence on this point has I
ing this dangerous hypertonicity which been obtained from post-mortem records i.
should be an element of concern to the ex- where death has taken place after a few or I
amiuer. definite number of menstrual periods had !
This hypertonicity that exists either in occurred; it has been found in such cases i
the sclerosed vessel or the sclerosed athe- that the cicatricial pits or scars, the remains i|
romatous vessel or in the healthy vessel and of the corpora Intea, are equal in the two ;
gives us the high readings, can be relieved ovaries together to the number of periods 1
by proper hygiene, diet, etc., and we may passed. This holds good also for animals !
remove this so called high blood pressure in which single pregnancy is customary, as 'i
and find an applicant to be a risk of the has been shown by Heape in monkeys. The ,i
first class rather than one to be refused on contention that the male parent does not "
account of dangerous disease. The very influence the sex of the coming child is H
high readings that are obtained in cases of evidenced by such cases as those in which 'I
interstitial nephritis are caused by the path- a woman has one-sexed children by differ-
ological changes in the arteries that are in- ent men; or those in which the father provariably
met with in that disease, and can- duced both-sexed children with difl'erent ji
notbematerially affected by treatment; but wives, but only one sex with each wife— \\
'<
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EDITORIAL.
the father did not influence the sex; the mention it with the hope that our readers
women were "unilaterally" sterile. This will become interested in the matter,
has also been noted in animals: it is not
o«TAW8ft sanatorium.
uncommon to meet with emales whose off-
^^.^^ Sanatormm, located
soring IS almost invariably of the same sex, , ,, „ i t> ] . •
•
i i e
. V 1 •. •
1 w 1 'c . at the old Roanoke Red Sulphur Springs,
although it has resulted from intercourse . '
, . tt c % ,
1 1 A-a- . 1^ „,.»,„„»»,

102
THE CHARLOTTE MEDICAL JOURNAL.
ings provide ample shade and protection erring judgment was to be trusted in all
from direct sunlight. Open fire-places emergencies. A friend whose love made
make them comfortable and attractive. The the recipient feel and know that no ulterior
institution has its own dairy, laundry and motive ever inspired his acts. A companice
plant. Ten acres of beautiful pasture ionable, lovable, genial gentleman, his
furnishes grass for the cows. Food of the presence brought nothing but sunshine and
essential kind can be obtained
abundance and cheaply.
in great good cheer. Charitable and broad minded
he was able to see the good in men and
things. no » H H r-«RR
Kindly disposed toward those
DR. W. M. n. COBB. . .1 c . 1 • 1 r 1
younger in the profession . his cheerful en-
Xo death that has occurred in the med'- couragement and ready helpfulness has led
cal profession of North Carolina has caused many a voung doctor to cling to his high
a greater and more generally felt sadiiess ideals and has inspired them to genuine
than that of Dr. W. H. II. Cobb which accomplishment in their professional lives,
occurred, July 21, at his home in Golds- Hjg- ^ide learning and experience led his
boro, N. C. For some time past Dr. Cobb fellows to recognize in him a counsellor of
had not been well and his family and his wise judgment and profound insight. In
friends and those close to him were not un- society matters Dr. Cobb had long been a
aware of the seriousness of his condition, prominent figure. Becoming a member of
And so when the summons came no great the State Medical Society in 1S7S, he was
surprise was felt. Angina pectoris with made vice-president in 1892 and President
acute dilitation of the heart brought to a in i894. From 1S9S to 1900 he served as
close the life of a man than whom no finer a member of the State Board of Medical
specimen ever lived in the old North State. Examiners. To Dr. Cobb's efforts, as
Dr. Cobb had been active in the practice of much as to those of any other man, is due
his profession for almost half a century, the organization and successful career of
Born at the old ancestral home, "Mount the Tri-State (Virginia and the Carolinas)
Auburn," near Spring Bank in Wayne Medical Association, of which he has also
county, April 3, 1841, he had just passed been president. For years he was State
his sixty-eighth milestone, had almost lived Medical Examiner for "the Royal Arcanum
out his allotted time. At the age of twenty and was grand dictator of the Knights of
he graduated from the University of Penii- Honor,
sylvania INledical School in 1S61, and immediately
thereafter volunteered in the Con-
rabiesfederate
Service. He was made assistant No act the Legislature of North Carolina
surgeon in the famous Second North Caro- has ever passed carries with it a greater
lina Regiment, in which arduous position beneficence than that which made possible
he served throughout the war. Many a the establishment of a laboratory for the
maimed old soldier of that regiment and application of the Pasteur method of treathundreds
who have passed away in the in- ing those bitten by supposedly rabid anitervening
years were saved from death on mals. The number of cases that have been
the field, or in the hospitals by his skill as treated demonstrate positively the great
a surgeon and his attention as a physician, value of the department. At this season of
Soon after the close of the war Dr. Cobb the year the popular mind, naturally it
located in Goldsboro for the practice of his
profession and there for 40 years he devoted
seems, becomes imbued with the dread of
mad-dogs. Perliaps it is because of the
himself with his characteristic heroism and prevalent superstition of the influence of the
philanthropy to his work among all classes dog star. Rabies and hydrophobia are two
in the community, the humblest as well as ditfereiit terms meaning the same disease,
the highest receiving the same conscientious
care and treatment, never pausing to
the former meaning to rage or become mad.
This term applies more especially to the
enquire as to the financial ability of a patient
to requite his services. And so through
di.sease as it exists in the maniacal form in
the lower animals, while hydrophobia comes
the rolling years he has builded himself a
monument of unfathomable love in the
hearlsof Goldsboro people who today mourn
from the Greek, meaning dread of water,
As this dread of water is occasionally found
in the human subject, the term is properly
his death as a personal sorrow in every used in such a case. The lower animals
ho*ne.
His professional brethren,
will repeatedly attempt to drink water, even
members of though the act brings on a spasmodic conthe
various Medical Societies to which he traction of the deglutitory muscles. The
belonged, feel the bereavement as a per- higher excitatory centres in these lower
sonal grief. So long have they recognized animals are stimulated to a greater degree,
in him one of the towering personalities of and at the same time their receptiveness to
this State and section, a leader whose un- external impressions is deadened, conse-

EDITORIAL. 103
quently they repeatedly attempt to drink,
even though it produces much pain. Cumever
produces the disease. Subcutaneous
injections with a needle of very small diammins,
of the University of Michigan, dis- eter are very seldom successful, while applicusses
this subject interestingly in the Phy- cation of the virus to divided nerve filaments
sician and Surgeon. Hydrophobia is an is generally efficacious in producing the
acute infectious disease communicated to disease.
man by the bite of an animal suffering from The Pastuermethod of treatment is a prorabies.
It is due to a definite si)ecific virus cess of immunization which must be com.
which is transmitted through the saliva by pleted before the development of the diseasethe
bite of a rabid animal. Its natural After symptoms appear if is of no value,
habitat is in the nervous system, and it does This immunization can be obtained in those
not retain its virulence when introduced
into any other system of organs. It is eswho
have not been infected the same as in
those who have been bitten In dealing
sentially a nervous disease, and transmitted with the ordinary infectious diseases one is
by the saliva of rabid animals. When in- not always aware of the fact that he is inoculated
into a wound this virus must come fected. But this is not so in hydrophobia,
in contact with a broken nerve trunk in The individual always realizes when and
order to survive and reproduce itself. If by how severely he is bitten by a rabid dog.
accident it attacks the end of a broken nerve And were it not for the significant fact that
trunk it slowly and gradually extends to there is a period of so-called latent developthe
higher nerve centers and eventually pro- ment of the view, it would be impossible to
duces the disease. carry out the Pasteur treatment. The patient
The relation of water to the disease is very takes advantage of this fortunate provision
much overrated. A dog never develops of nature and is immunized betore the develrabies
because of the lack of water, or l)e- opment of the disease. This same prophycause
he is confined. The animal may be lactic principle is applicable in dealing with
overheated during the hot summer months, smallpox, tetanus, or bubonic plague,
and he may not have sufficient water to However, in these infectious and contaquench
his thirst, but these conditions alone gious diseases one is not always knowingly
cannot cause the disease. As far as we exposed and infected.
know, there has never l)een a case of spontaneous
rabies. Invariably, whether the
disease exists in man or animal, the history
EDITORIAL NEWS ITEMS.
will point to a previous infection bv a dis- „ ^ „ . ^ „ . .
eased animal. The transmission thus, from
Peachtrce Heights Sanatorium.
animal to auira-al, is necessary for the main- In Atlanta, Oa., on July 1, '09, the Peachtenance
of the disease. The virus very tree Heights Sanatorium for the treatment of
rapidly dies outside of the Ijody; it is of tuberculosis was opened to receive patients,
very low resistance to heat and dessication, This institution is located on the highest
and laboratory experiments conclusively
prove that it cannot exist in nature.
point on
Atlanta.
Peachtree Road, eight miles from
A beautiful tract of thirty-six
Rabies is not a hot weather disease, as
was ordinarily believed and maintained up
acres, a considerable portion of which is in
woodland—chiefly pine forest— and situated
to a few years ago. The number of cases on the main line of the Southern Railroad,
during the winter months of the last few
years has disi^roved this belief and the rechas
been purchased by those interested,
A handsome administration building has
ords of the Institute show an increase of been erected. In it are the administrative
about thirty percent, in the ijumber of cases and physicians' offices, recreation room,
over the summer months. However, these dining room and culinary departments, beconditions
are exceptional and due to the sides private rooms and baths.
occurrence of a real epidemic. Ordinarily For the accommodation of patients, the
we meet only sporadic cases, hut when the most approved types of lean-tos and indiconditions
are favorable, veritable epidemics vidual shacks have been installed, so that
have broken out and it is this matter which the full benefit of the fresh air treatment
requires the careful attention of those who may be had, combined with a maximum of
are concerned in the protection and preser- protection from inclement weather. The
vation of public health. needs of the ladies have been especially
It is known that infection depends largely borne in mind in the construction of these
on the part of the body and character of the buildings. The buildings are all to be
tissue into which the virus is inoculated, heated and lighted by the most imjjroved
The disease ahvaj's develops when iiijec- methods.
tions are made into the brain, into the eye, There is an abundant supply of pure
or into the nerve trunk. Intravenous innections
of the active virulent virus hardly
water, the source of which cannot be con-
laminated. A complete sewage system with

104
septic tanks is being installed, insuring
scientific disposal of all waste material.
The treatment is based on the principles
recognized in all the leading sanatoria of
the world. These principles, briefly stated,
are fresh air and sunshine, rest, good and
abundant food, an occasional dose of medicine
for the relief of troublesome symptoms,
and the careful application of tuberculin
and allied products.
Above all else, siipeivision is the most important
function of the sanatorium, and
patients will be taught the dilTicult art of
applying comparatively simple principles
to their respective cases. For this reason
we believe the sanatorium offers the best
opportunity for recovery in every case. And
a very large percentage of early cases may
be cured.
Special efforts will be made to render the
Sanatorium homelike and attractive.
Amusements will be provided, and the latest
current literature will be placed at the disposal
of the patients.
PERSONNEL
Dr. W. S. Kendrick, of Atlanta, is Medical
Director of the Sanatorium.
Dr. Lewis M. Gaines, of Atlanta, is Associate
Medical Director.
Dr. Edward G. Jones, of Atlanta, is Consulting
Surgeon.
Dr. M. G. Campbell, of Atlanta, is Consulting
Physician.
There will be a trained nurse in charge
and sufficient number of attendants to
guarantee the best service.
For rates and full information address
Dr. Lewis AL Gaines, Secretary, 822 Candler
Building, Atlanta, Ga.
Dr. Clemenger in London.
Dr. F. J. Clemenger, one of Asheville's
most progressive physicians, is now in London,
where for the pasi year he has been an
assistant to Sir Almoth Wright, of Opsonic
Theory fame. During the past eight months
he has served as one of the salaried assistants
on the staff of the Inoculation Department
at St. Mary's Hospital where Wright's
famous work has been done, and where it
is said on clinic days one hundred and fifty
cases are treated. To show in how great
esteem this work is held, it was necessary
to provide a new wing to the hospital. This
wing was opened up on July 1st for the sole
use of the inoculation department. It contains
well equipped laboratories and accommodations
for one hundred or more beds.
The cost of the wing was something over
two hundred thousand dollars. We congratulate
Dr. Clemenger on this recognition
of his abilities.
The Alamance County Medical Association
held a very interesting meeting in Burl-
THE CHARtOTTB MEDICAL JOURNAL
ington, N. C, on July 12th. Besides the
regular members of the society, Dr. Hubert
A. Royster, of Raleigh, N. C, and Dr. J.
W. Long, of Greensboro, X. C, were present.
Dr. Royster and Dr. Long both read
interesting papers, which were thoroughly
discussed by the members of the society.
I
i
!
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'
The Trustees of Wake Forest College,
N. C, have elected Dr. J. D. Powers to sueceed
Dr. W. S. Rankin, who resigned his
position as dean of the medical department
of that institution to become Secretary of
the State Board of Health of North Caro-
lina.
Dr. Powers is a Wake Forest man, and :!
has had two years' work at Bellevue Hos- ;
pital, New York.
The Macon Hospital in Macon, Ga., is
being remodeled, which will add greatly to
both the appearance and convenience of the
institution. A considerable sum of money ;
will be spent in the changes that are to be j
made for the benefit of the patients.
The Georgia State Sanitarium for the
Treatment of Tuberculosis is to be located
at Alto, Ga., on the Southern Railroad, 'i
near Mt. Airy. This site was selected by a i
sub-committee composed of Captain W. G.
Aoul, of Atlanta, Judge T. D. Tinsley, of
Macon, and Dr. II. R. Slack, of LaGrange. i
The State has appropriated $2.5,000 for the ,i
building of this institution.
i
The Alabama State Medical Examiners
met in Montgomery July 13th. One hundred
and fifty young medicos applied for
\
;
license, a nunrber which surpasses all former
records for Alabama. There were nine j
negroes.
,'
The Alabama State Board of Medical \
Examiners is composed as follows: Dr.
W. H. Sanders, Chairman, Dr. T. L. Robertson,
of Birmingham, Dr. D. F. Tallv, of
Birmingham, Dr. S. W. Welsh, of Talladega.
Dr. M. B. Cameron, of Eutaw, Dr.
i
J
I
J
i
S. G. Gay, of Selma, Dr. V. P. Gaines, of \
Mobile Dr. I. L. Watkins, of Montgomery, 'j
Dr. Glenn Andrews, of Montgomery, Dr. !
L. W. Johnston, of Tuskegee. j
Drs. George Ben Johnston and Murat '[
Willis announce the opening of their private
hospital, Johnston- Willis Sanatorium,
Sixth and Franklin Streets, Richmond, \'^a. :
Drs. Farrar and Brown announce that !
Dr. M. A. Farrar has purchased the inter-
est of Dr. E. F. Hayden in the Hayden and /
Brown Sanitarium. The institution will I
be known as the I'arrar and Brown Sani- i
tarium, and will be conducted in a strictly
ethical manner, under the personal man- I
agement of Drs. Farrar and Brown, for the i
'
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j
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j
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,

J
treatment of alcohol and drug addictions
of every character, also diseases of the
mind and nervous system.
The Hospital is located in Nashville,
Tennessee.
Dr. Reagan's Letter.
We reproduce Dr. Reagan's personal
letter. This is the first time that the Journal
has ever deviated from its policy, which
was established eighteen years ago. in regard
to publishing letters written to the
editor concerning the Journal, or any personal
friend. Dr. Reagan, I have no idea,
wants this letter reproduced in the Journal;
at the same time I want to publish it. It
reads as follows:
'My dear Dr. Register:—
I simply write to say that I enjoyed all
you said about Dr. Burroughs in your last
issue of the Journal. He has done more for
the young doctors than any man in Asheville,
if not in North Carolina.
With the best wishes for yourself, wife
and the Journal, I am as ever, the oldest
physician west of the Blue Ridge, and
formed the first Medical Society ever formed
this side of the Blue Ridge. We only had
seven physicians to begin with, now we
have over sixty.
Yours very truly,
J. A. Reagan,
Weaverv'jlle, N. C.
tion.
The new superintendent who succeeds
Miss Elinor Phillipps is Miss Helen Orchard,
of Richmond, Va. She is a Southern woman
and comes highly recommended.
Medical Department ol the University
ol Nortli Carolina.
The eighth session of the Medical Department
of the University of North Carolina
at Raleigh will begin on September '),
1909, at the same time as all the other I'niversity
Departments. Prospects for attendance
are good.
105
Some changes in the faculty have been
made. Dr. John Sasser McKee has been
elected demonstrator of obstetrics, and Mr.
James Madison Harris, of Kinston, assistant
demonstrator of clinical pathology.
Dr. A. W. Goodwin has resigned his position
as professor of diseases of the skin
and genito-urinarv' system, and the resignation
has been accepted. Dr. CO. Abernethj'
was appointed to fill the position for
the coming session.
Pellagra in Nashville.
There are fourteen cases of pellagra
among the children of the Baptist Orphanage
of Nashville. Tenn. The State Board
of Health has appealed to the Federal Government
for an expert to aid in stamping
out the epidemic.
Health Conditions in North Carolina.
The Bulletin of the North Carolina Board
of Health for May, 1909, showed that reports
were received from 81 counties. The
total number of deaths reported was 356;
175 white and 182 colored. The annual
death rate in a thousand population was
l,v.> for the white population, 23.7 for the
colored, and 16.9 for the total while and
colored. Of the total number of deaths 22
were due to pneumonia, 50 to tuberculosis,
27 to heart diseases, 58 to diarrhceal diseases.
The total infant mortality was 102;
47 white and 55 colored. There were 53
stillbirths.
Rex Hospital.
Work on the new Rex
Mortality Statistics of New Orleans.
Hospital building,
in Raleigh, N. C, has progressed very rap- The official report of the Board of Health
idly during the past few weeks. The work- of the city of New (Jrleans shows that durmen
are now engaged in finishing the ining the month of June, 1909, the total num-
sideof the building. The plumbing, which ber of deaths from all causes was 536; 327
i
' is har.dsome and costly, is l)eing installed, white and 209 colored. The death rate in
while the large quantity of tiling is already a thousand of population for the month was
laid. When completed the hospital will be 14.81 for the white, 26.88 for the colored,
stcond to none in the whole South. In de- and 17.76 for the total white and colored
;
I sign, workmanship, material and equip- population. The total infant mortality was
I ment it will be thoroughly up to date.
14f), 91 white and 55 colored; 119 under one
' It will be ready for occupancy October year of age, 74 white and 45 colored; 19
' 1st, though the contractor exjiects to be Isetween one and two years of age, 11 white
through work on or about September l.Sth. and 8 colored; and 8 between two and five
' Quite an event will be made of the dedica- years of age, 6 white and 2 colored.
Hie Fourth International Congress of the
Medical Press will meet this year at Budapest
on August 27 and 28, on the eve of the
Sixteenth International Congress of Medicine,
and under the presidency of Professor
Posnerof Berlin. The sittings will be held
in the Palace of the Academy of Sciences
( Akademia iitcza 2, Budapest V.), where
the asseuibly hall has been placed at the
disposal of the International Congress of
Medicine. For this congress, to which all
members of the medical press will be admitted,
no entrance fee or subscription will

jO^
THE CHARLOTTE MEDICAL JOURNAL.
be charged. The only condition of admis- Scott, Dr. H. B. Sanford, and Dr. T. D.
sion is that of being also enrolled as a full Jones, obstetrics; Dr. McCaw Tompkins and
member of the International Congress of Dr. H. Norton Massey, abdominal surgery;
Medicine Demands for admission should Dr. Sidney Baker and Dr. B. Giles Look,
be sent before August 1 to the general secre- gj-nscolop^ Dr. E. 11 Terrell, general surtarv
of the International Association of the gery, and Dr. B. M. kosebro, Dr. E. W _
Medical Press, Dr. Raoul Blondel, 103, Gee, and Dr. B. L. Taliaferro, diseases of
Boulevard Haussmann, Paris.
children.
Catatvba Sanatorium.
r 1- c^. . T^ Minutes of the Filty-SixSh Annual Mectf
The new sanatoi mm of the State Depart-
^^ ^^^ Medical Society ol tbc
ment or Health of Virginia for the care of
^^^^^ ^, ^^^^^ Carolina, Held at
tuberculosis was opened on July lo. ine
Ashevillc. N. C, in the Ballinstitution
is situated at the old Roanoke
^^^^ ^, ^^^ Battery Park
Red Sulphur Springs, in Roanoke County.
^^^^^ ^^^^ ^^^^ ^^^^
Dr. Truman A. Parker of Richmond is in
r , ., j.
temporary charge, and will remain at Ca- The fifty six annual meeting of the Meditawba
until a permanent superintendent cal Society of the State of North Carolina
can be chosen. was a most enjoyable affair and was well
attended by both members and distinguished
Faculty ol the Medical Department of the guests
University ol Louisville Reorganized. 'J^^Jg convention was called to order by
The board of directors of the University Dr. Brown, Chairman of the Committee of
of Louisville recentlv dismissed the entire Arrangements.
faculty of the medical department of the Rev. R. V. Campbell, D. D., pastor of the
institution, as it was found necessary to re- First Presbyterian Church, delivered the
duce the number of professors on the staff. Divine invocation.
When the five medical colleges of Louisville Dr. Brown then introduced Judge T. A.
were consolidated some time last year, a Jones, a prominent member of the Asheville
large staff was the result, and the necessity Bar, who delivered a very enjoyable address
for a smaller one has been demonstrated, of welcome, which was responded to, on
The following thirty-five members of the Ijehalf of the Society, by Dr. C. A. Julian,
old faculty have been reappointed as the of Thomasville.
new major faculty: Dr. J. M. Bodine, Dr.
^j^g President then read a very able ad-
Thos. C. Evans, Dr. C. W. Kelly, Dr. Will-
(j^ggg -The Relation of the Medical Proiam
H. Wathen, Dr. J. B. Marvin, Dr. L.
fgssion to the People Along the Lines of
S. McMurtry, Dr. II. H. Cirant, Dr. H. B. Hygiene and Preventive Medicine," at the
Ritter, Dr. I. N. Bloom, Dr. J. M. Ray, Dr.
conclusion of which Dr. Parrott, of Kiiis-
W. E. Grant, Dr. Louis Frank, Dr. Garj^^^
moved that the address be referred to
land Sherrill, Dr. William A. Jenkins, Dr.
^ committee to report on the same, and
John R. Wathen, Dr. George B. Jenkins, doctors Albert Anderson, J. T.J. Battle,
Dr. W. O. Roberts, Dr. P. F. Barbour, Dr. ^ j^ ^g,,{ and James M. Parrott were ap-
A. O. Pfingst, Dr. George A. Ilendon, Dr.
poi„ted to serve on that committee.
Hugh N. Leavell, Dr. Edward Speidell, Dr. ^^^^^ program was then taken up, and Dr.
E. R. Palmer, Dr. Bernard Asman, Dr.
k. j. Wood, of Wilmington, Chairman of
Charles W. Hibbitt, Dr. Irvin Abell, Dr.
^j^^ Section, "Practice of Medicine," read
V. E. Simpson, Dr. Granville Hanes, Dr. ^ paper entitled "A Further Report on the
B. F. Zimmerman, Dr. Carl Weidner: Dr.
peiiagra Problem," which paper was dis-
Henry E. Tuley, Dr. John G. Cecil, Dr.
mussed bv Doctors Rankin, A. J. Crowell
William C. Dugan, Dr. S. G. Dabney, Dr.
^^^ j^j g. Roberson.
William Cheatham, Dr. J. ^L Bodine was ^^ ^ Lapham, of Highlands, deelected
president, and Dr. 1. C. Evans
jjvered an address on "Modern Methods in
dean.
the Treatment of Tuberculosis in Switzer-
New Stall ol the Memorial Hospital, land," at the conclusion of which the Soci-
Richmond. Virginia. ety took a recess until half past three.
At a recent meeting of the board of directors
of the hospital. Dr. Lewis C. Bosher
was appointed chief, and the following
names were added to the visiting staff:
Seniors—Dr. Edward P. McGavcock, dermatology;
Dr. St. George Grinnan, pediatries,
and Dr. R.H. Wright, ophthalmology.
Juniors— Dr. C. W. Massie, Dr. Hunter R.
During the morning session Dr. Battle, of
Asheville, invited the members to visit Bilt-
more Hospital; a telegram, extending fra-
ternal greetings, was read from the President
of the State Pharmaceutical Society,
and a reception, to be held at Dr. James A.
Burrough's residence the same evening,
was announced, and the members, together
.

with their wives, daughters and invited
guests, were asked to attend.
TUESDAY .AFTERNOON.
Convention called to order by the President.
Dr. McBrayer, of Asheville, introduced
Dr. J. Garland Sherrill, of the University
of Louisville, Ky., a North Carolinian by
birth, who read a paper on "Surgical Diseases
of the Kidnev." which was discussed
by Dr. Lloyd Russell.
Dr. Templeton, of Cary, then read a
paper "The Legal vs. the Medical I'lofession,"
and was \ociferously applauded.
Dr. Cobb, of Goldsboro, moved that Dr.
Templeton 's paper be i)ublislied in pamphlet
form, and distributed tliroughout the
State. Motion seconded by several and
carried.
Report of Ivxamining Board read by Dr.
Ben. K. Hays, of Oxford. I'pon motion
of Dr. Anderson, the report received and
adopted.
"Surgery in the Year l/OO;" "Treatment
of Club [''oot," read by Dr. W'ni. Moncure,
of Raleigh.
Paper by Dr. Ellsworth I'^liot, of New
York, on "Some Clinical P'eatures of Tumors
of the I^emale Breast, with Special
Reference to ICiid Results." Discussed by
Doctors Weaver, J. Garland Sherrill, J. .M.
Parrott, Whittington, and J. A. Ragan.
Paper by Dr. Dunbar Roy, Atlanta, Ga.,
"Rational Status in the Present Day Treatment
of Nasal Diseases." Discussed by
Doctors Whittington, Kirk, and Whisnant.
Address by Dr. Charles Waddell Stiles,
of the Marine Hospital Service, on "Hook
Worm Disease." Discussed by Doctors
Julian, Wood, Bellemay, I'hilips, and
Templeton.
Paper read by Dr. J. \'auce McGougan.
Chairman Section of Railway Surgery, entitled
"Shock," discussion of which was
deferred until the next morning.
WKDNKSDAV MORNING, JUNK K).
Society called to order by the President.
Discussion on Dr. McGougan 's paper
opened by Dr. Balinson, of Winston. Dr.
Philips asked that the privileges of the floor
be accorded Doctors Lloyd and Kliot, of
New V'ork. Dr. McGougan's paper further
discussed by Doctors McCoy and Cobb.
"Traumatic Neuroses," by Dr. Samuel
Lloyd, of New York. Discussed by Doctors
Parrot and Mc.Nider.
The President here stated that the election
of two medical examiners for the nurses
of North Carolina would be had, office to
be held for two years.
Doctors Mc.Mullen, of fUizabeth City, and
Julian, of 'I'homasville, were nominated;
nomination seconded by several, and upon
EDITORIAL. 107
motion of Dr. Crowell, of Charlotte, these
two nominees were elected by acclamation.
"Tertian Infection, Golgi Organism,
Fatal with Gastro-Enteric Symptoms," by
Dr. J. J. Philips, Chairman Section Pediatrics."
Discussed by Doctors Parrott,
Albert Anderson, Cvrus Thompson and
Wood.
"Tuberculin in Diagnosis Applied to
Children," Dr. Richard Urquhart, Johns
Hopkins, Baltimore, Md. Discussed by
Doctors Stiles and Kirk.
Society took a recess until 2:30 p. m.
CONJOINT MEETING BOARD OF HEALTH
WITH THE NORTH CAROLINA MEDICAL
ASSOCIATION.
The conjoint meeting was called to order
at twelve o'clock Wednesday—immediately
after the adjournment of the State Medical
Society— by Dr. Thomas, Chairman, who
told of the retirement to take place by Dr.
Lewis, for fifteen years Secretary of the
State Board of Health, and expressed his
regret at Dr. Lewis' action.
Report of the Secretary read by Dr.
Lewis.
Upon motion the Secretary's report was
adopted.
A brief report of work done in the State
Laboratory was read by the Secretary.
Doctors Albert Anderson, F. R. Harris,
W. S. Rankin and C. W. Stiles made brief
addresses, expressing regret at Dr. Lewis'
retirement from office.
Dr. Shore was named as Dr. Lewis' successor
in office, with Dr. W. S. Rankin,
assistant.
Dr. Lewis then announced a meeting of
the Board of Health in another room at a
qnarterto three, W'ednesday afternoon, and
adjourned the meeting.
WEDNESDAY AFTERNOON.
Convention called to order by the President.
At the opening of the afternoon session
considerable discussion was had upon a portion
of Section 7, Chapter 4, of the By-Laws
adopted in 190.3, at the Hot Springs meeting,
finally ending in a motion of Dr. Templeton's
that the matter be taken under consideration
for the next year's work.
Paper by Dr. Rankin, Chairman Section
on Pathology and Microscopy, "The Influence
of Pathology on Materia Medica and
Therapeuticsr" Discussed by Dr. Wood.
"Serum Therapy in Meningitis," by Dr.
]•. R. IT'uris, Henderson.
Dr. Apijlegate, Cliief Surgeon of the
Southern Railway, introduced by Dr. Way,
and privileges of the floor extended him by
rising vote.
"Hematuria," by Dr. A. J. Crowell,

108 THE CHARLOTTE MEDICAL JOURNAL '.
Charlotte, N. C. Discussed by Doctors Thursday afternoon, june 17. :
Ragan and King. Convention called to order by the Presi- •
"A Plea for the State to Educate the dent.
Public in Infectious Diseases," by Dr. W. Report from the Nominating Committee a
P. Holt, Chairman Section on Medical read by Dr. Stanton, as follows:
j
Jurisprudence and State Medicine. Dis- "The Nominating Committee met and j|
cussed by Doctors Ragan and Stiles. organized by electing Dr. A. A. Kent, J
"The State's Duty in the Fight against President, Dr. B. F. Long, Secretary, and J
Infectious and Contagious Diseases," by the following gentlemen were nominated as J
Dr. J. W. Halford, Chalybeate Springs. officers of the Medical Society of North ^
The convention then adjourned until Carolina:
8:30 p. m. President, Dr. J. A. Burroughs, Ashe- ;
WEDNESDAY EVENING, JUNE 16. ^ '
""'^^l^: S^.'
'
a ^ r^ t? t ,,7 j
„ . ,, , , . ., Ti J First Vice-President, Dr. -. E. J. Wood,
Society called to order by the President.
Report of Chairman of Obituary Committee
read by Dr. Juhan.
Wilmington N C
Memormm of Dr. P. E. Hines, read by
^^^J^ Vice-President, Dr. John Q. ^
^^ ^^^^^ Wilkesboro, N. C. I
I^"^; A. W.Knox
^Inrd Vice-President,
ton. .Smithfield, N. C.
Dr. L. D. Whar-
A beautiful tribute to Dr^Hines was also
secretary. Dr. D. A. Stanton, High Point,
paid by Dr Templeton, of Gary.
^ ^^ Thompson.
Annual Oration 1 he Evo ution of Medij^^^^^^^
^, r y Bravvley, Salisbury,
cal Science, a Symposium of its Past and
L^^^er of Debate, Dr. D. A. Garrison,
Its Manifest Destiny," by Dr. Chas. W.
Q^gtonia N C
Mosley, Greensboro,
Treasurer,' Dr. H. D. Walker, Elizabeth V
Annual Essay, by Dr. W. L. Dunn. ^-^j. x C ^
THURSDAY MORNING, JUNE 17th. Delegate to the American Medical Associ- f
Society called to order by the President ation. Dr. T. E. Brown, Asheville, N. C; (
;
;
.
]
:
;
'
at 9:30.
The Section of Obstetrics was taken up,
alternate. Dr. J.
ville, N. C.
B. McGoughan, Fayette-
,'
and a paper read by the Chairman, Dr. A. Public Policy and Legislation, Dr. R. H. (
Bascom Croom, "The Country Midwife."
This subject was animatedly discussed
Eewis, Raleigh, N. C. ; Dr. Albert Anderson,
Raleigh, N. C; Dr. Geo. L. Thomas,
by Doctors Dickinson, Robinscn, Payne,
Cyrus Thompson, McKee Tucker, Sykes,
Wilmington, N. C.
Committee on Publication, Secretary ex-
Burroughs, Ashby, and Laughinghouse.
"The Treatment of Puerperal Eclampofficio.
Dr. H. A. Royster, Raleigh, N. C;
Dr. R. L. Gibbon, Charlotte, N. C.
sia, " by Dr. A. A. Kent, Lenoir. Discussed Committee on Scientific Work, Secretary'-rJ
by Doctors Spencer, Laughinghouse, Ashby ex-officio, Dr. T. S, McMuUin, Hertford, Jlfj
and Harris. N. C; Dr. Harlee Bellemay, Wilmington, i']
Dr. J. T. J. Battle here read report of the N. C.
J;
Committee appointed to draft resolutions in Committee on Finance, Dr. G. T. Sykes,
regard to Dr. Lewis' retirement from office. Grissom, N. C; Dr. T. Fearing, Elizabeth
Moved by Dr. Harris that the report of City, N. C; Dr. Wm. M. Jones, High
this Committee be received and filed and Point, N. C. i
spread upon the minutes, and that a rising Committee on Obituary, Dr. C. A.Julian,
vote of thanks be had to express further the
appreciation of the Society, of Dr. Lewis'
usefulness that he has been to the profes-
Thomasville, N. C. ; Dr." P. R. McFadden,
Randleman, N. C. ; Dr. J. W. McGee, Jr.,
Raleigh, N. C.
sion of North Carolina during his term of Delegates to Mississippi Association, Dr.
office; which resolution was unanimously C.J. O'Laughinghouse, Greenville, N. C;
carried by rising vote. Dr. James S. Rhodes, Williamston, N. C;
"Importance of the Early Recognition of Dr. J. W. Hopper, Wilmington, N. C; Dr.
the Indications of Caesarean Section," by C. W.Jordan, Asheville, N. C; Dr. J. R.
Dr. H. McKee Tucker. Discussed bv Doc- McCracken, Wavnesville, N. C; Dr. W.
j
i
tors Strong, Dees and Payne, H. H. Cobb, Jr.,'Goldsboro, N. C.
Frigidity, From a Sociological and Delegates to the ^'irginia Medical Associ- ;
Gynecological View-Point," by Dr. C. M. ation, Dr. M. Bolton, Rich Square, N. C. ; ]
Strong, of Charlotte. Discussed by Dr. Dr. Fletcher R. Harris, Henderson, N. C;
Thompson. Dr. R. E. Lee, Goldsboro, N. C; Dr. S. 'I
A Review of One Hundred Cases of M. Mann, Movock, N. C; Dr. R. O. Dees, "
Laparotomy," by Dr. \V. P. Whittington, Greensboro, N. C.
Asheville, N. C. Discussed by Doctor Delegates to the South Carolina Medical jj
Robinson. Association, Dr. C. A. Peterson, Mitchell i
j
''

Countv: Dr. \V. H. Ward, Plymoulli, N. C;
Dr. J.E. Aslicraft, Monroe, X. C; Dr. J.
D. Waldrop, Ilendersonville, X. C.
Place of meeting, Wriglitsville Beach,
third Tuesday in June.
Chairman .Committee of Arrangements,
Dr, George Thomas.
Moved by Dr. Register that the report, as
read, be adopted. Motion carried.
Treasurer's report read by the Secretary.
Moved by Dr. Harris that the Treasurer's
report, as audited by Doctors Anderson atid
Bolton, be accepted. Motion carried.
The President, after hearing the above
reports, stated that owing to the fact that
there were so few members present,—the
majority of them riding around Billmore at
the time— he thought it perhaps well to install
the new President and adjourn, and
Doctors Bolton and Register were appointed
to escort him to the chair.
Upon the installation of Dr. Burroughs,
Dr. Julian moved that the "Association extend
thanks to the good people of Asheville,
the Medical Society of Buncombe
County, the Battery Park Hotel and the
Press, for the kind notices and nice entertainment
given it while in the city."
Motion seconded by several and unanimously
carried.
Upon motion of Dr. Register theconven
tion adjourned sine die.
The following papers were read by title:
"Myiasis," by Dr. J. L. Nicholson, Richland.
"The Ivxperimental Study of the Action
of Alcohol in the Production of Arteriosclerosis,"
bv Dr. Wm. DeB. MacXider,
Chapel Hill, X. C.
"Diet in Typhoid I'ever, " by Dr. F,dw.
C. Register, Charlotte.
"The Phonemic Importance of Preventive
Medicine," by Dr. W.J. McAnually, High
Point.
"Impotence," by Dr. Baxter Ilaynes,
Cliffside
"Tonsilitis, Its Treatment and Importance
of Same, " by Dr. S. P. Burt, Louisburg.
"Apoplexy," by Dr. E. F. Strickland,
Bethania.
'•The Detection of Feigned Blindness in
One or Both Eyes," by Dr. H. H. Biiggs,
Asheville.
"Milk Sickness or Fall Poison," by Dr.
J. M.^ Hodges, Banners Elk.
"p'lve Hundred Cases of Headache," by
Dr. G. S. Tenant, Asheville.
"The Neglected Field of the Physician,''
by Dr. M. Eugene Street, Glendon.
"Selling Diplomas to Medical .Men," by
Dr. H. D. Stewart, Monroe.
"Clinical Notes on Sanitorium Work,"
by Dr. J. C. Walton, Richmond, \'a.
EDITORIAL. 109
"A Case of Osteomalacia," by Dr. J.
Steven Brown, Hendersonville.
"Pneumonia," by Dr. Stuart Mann,
Moyock.
"The Business Methods of the Physician,"
by Dr. E. G. Moore, Elm City.
"Report of Cases, "by Dr. W. O. Spencer,
Wiuston-Salem.
"Some Common Xervous Symptoms and
their Significance," by Dr. J. P. Munroe,
Charlotte.
"Bacteriuria." by Dr. J. Meigs Flippin,
Winston.
"Empyema in Children—Personal Experience
in Diagnosis and Treatment," by
Dr. J. R. Paddison, Oak Ridge.
"Prophylaxis in Typhoid Fever," by Dr.
W. P. Ho'rton, Xorth Wilkesboro.
"Typhoid Fever from the Experience of
a Practitioner in the Mountains of North
Carolina and Virginia," by Dr. S. E.
Pennington, Sturgills.
"The Liver," by Dr. J. W. Wallace,
Concord.
"Personal Experience in the Diagnosis
and Treatment of a Xumber of Cases of
GastricXeuroses,"by Dr. J, Allison Hodges,
Richmond, Va.
"The Play Impulse in Public Health,"
by Dr. W. A. Lambeth, Charlottesville, Va.
"Adenoids," by Dr. J. G. Murphy, Wilmington.
"Morphini-sm, A Variety of Comments,
by Dr. S. M. Crowell, Charlotte.
"The Increasing Frequency of the Use
of Xarcotic Drugs by Membersof the Medical
Profession and the Probable Cures for
it," by Dr. C. W. Ash worth, Greensboro.
"After Care of Surgical Cases," by Dr.
Henry Xorris, Rutherfordton.
"An Antiseptic Leech," by Dr. W. D.
Witherbee, Charlotte.
"The Surgical Treatment of Epilepsy,"
by Dr. Rigdon O. Dees, Greensboro.
"Dislocation of a Cervical Vertebra," by
Dr. E. T. Dickinson, Wilson.
', Foreign Bodies Migrating the Human
Body ' '—with Report of Case—by Dr. Brodie
C. Xalle, Charlotte.
"Report of a Case of Double Compound
Fracture of the Leg, '
' by Dr. Jas. A. Turner,
High Point.
"Perinephritis and Perinephritic Abscess,"
by Dr. R. H. Moorefield, Westfield.
"Framing the Gynecologist," by Dr. H.
A. Royster, Raleigh.
"Ephriam McDowell," by Dr. Joseph
Graham, Durham.
"The Urinometer in Obstetrical Practice,"
by Dr. J. S. Gibson, Gibson.
"The Management of Obstetrical Cases
Complicated by Contracted Pelvis," by Dr,
L. M. Allen, Baltimore, Md.
"

110 THE CHARLOTTE MEDICAL JOURNAL.
"Concerning Monsters," by Dr. R. H.
Whitehead, Charlottesville, Va.
"Pregnancy Complicated by Malformation
of Uterus nnd Vagina," by Dr. J. N.
Taylor, Bynum.
"Dead Fcetus, Seven Months with Complete
Placenta Previa," by Dr. J. M. Mc-
Ghee, Reidsville.
"An Analysis of Eighty Cases of Labor,"
by Dr. K. P. B. Bonner, Morehead City.
"A Study of the Curd in Infant Stools,"
by Dr. Charles Roberson, Greensboro.
"Healthful Children," by Dr. J. Steven
Brown, liendersonville.
"Anaphylaxis," by Dr. Richard X.
Duffy, New Bern.
"Pathology of HEemoglobinuric I'ever, "
by Dr. W. T. Parrott, Kinston.
"Arterio-Sclerosis of the Uterus," by Dr.
Robt. B. Slocuni, Wilmington.
' 'Some Recent \'iews Concerning Typhoid
Fever," by Dr. L. B. Newell, Charlotte.
"The Present Status of our Knowledge
of the Thyroid Bodies," by Dr. L H. Manning,
Chapel Hill.
"A Review of the Physiology of the
Heart's Action," by Drs. Wm. S. Jordan
and J. M. Lilly, Fayetteville.
"A Review of Some of the Recent Researches
in the Physiology of the Alimentary
Canal," by Dr. Robert H. Lafferty,
Charlotte.
"Gastric Functions—Harmones, " by Dr.
C. N. Peeler, Charlotte.
"Progress in the Administration of Medicine,"
"A New Era of Scientific Therapeutics,"
by Dr. H. Bascom Weaver, Ashevilk.
"The Origin of the Prescription and the
Financial Side of Prescribing," by Dr.
Charles S. Grayson, High Point.
"Cathartics," by Dr. U. A. Royals,
Yadkiuville.
"Fracture of the Skull," by Dr. I. F.
Hick, Dunn.
"The Dangers of the Present Tuberculin
Era," by Dr. W. L. Dunn, Asheville.
"Pulmonary Tuberculosis, a few Practical
Observations on, From the View-Point
of a Practitioner in Western North Carolina,"
by Dr. J. Howell Way, Waynesville.
"Some Phases of the Tubercular Problem,"
by Dr. P. R. McF'ayden, Randleman.
"Fallacies Past and Present in the Treatment
of Tuberculosis," by Dr. Wm. M.
Jones, High Point.
"Hemorrhage from the Lungs in Pulmonary
Tuberculosis," by Dr. W. R. Kirk,
Hendersonville.
"The Need of Aggressive Action in the
Crusade Against Tuberculosis," by Dr. C.
A. Julian, Thomasville.
"Relation of the Life Insurance Company
to the Agent," by Dr. Albert Anderson,
Raleigh.
"Medical Examinations Against the
Commercial Report," by Dr. J. T. J. Battle,
Greensboro.
"Life Irisurance and Mortality," by Dr.
J. ^L Parrott, Kinston.
The program of entertainment was as
follows:
Reception at Mission Hospital, 4:30 to
6:00 p. m.
Reception at home of Dr. Burroughs,
9:00 to 11:00 p. m.
TUESD.AY, JUNE 15th.
Cards for ladies at Battery Park Hotel,
10:00 a. m. to 12:00 m.
Barbecue at Overlook Park, arid reception
at Asheville- Biltmore Santarium, June
16th.
Musicale for ladies at the home of Dr.
Carroll, 10:30 to 12:30. Drive over Biltmore
estate in the afternoon, June 17th.
Privileges of all Clubs extended the members.
Marriages.
Dr. PUnzy Calhoun and Miss Mary Peel,
both of Atlanta, Ga., were married at St.
Mark's Methodist Episcopal church in that
city on the evening of June 30th. The
groom is a graduate of the Atlanta College
of Physicians and Surgeons, Atlanta, Ga.,
class of 1904, and is one of the moat prominent
young physicians of Atlanta.
Dr. A, A. Cannady and Miss George Ruth
Eliason, both of Roanoke, \'a., were married
on June 30th, at the home of the
bride's parents. Captain and Mrs. G. P.
Eliason.
Dr. Caunady graduated from the Medical
Department of New York University in
1888, and since that time has been very
successful in the practice of his profession.
On July 3rd, Dr. and Mrs. Cannady sailed
for Europe, where they will spend some
time.
Dr. Chas. H. Grey and Miss Ellie Mae
McAllister, both of Waynesboro, Miss.,
were married in the Baptist church in that
city on June 7th.
Dr. Thos. Victor Bachelor of Boviuia,
Miss , and Miss Maria Louise Young, of
Vicksburg, Miss., were married' at the
bride's home on July 20th.
Dr. Fletcher L. Brown, of Whiteville,
N. C, and Miss Maud Phifer, of Morganton,
N. C, were married at the home of the
bride's brother, Mr. I. A. Pliifer, of Spartanburg,
S. C, on July 17th.
The bride is a recent graduate of the

REVIEW OF SOUTHERN -MEDICAL LITERATURE.
Presbyterian Hospital, Charlotte, X. C,
and the groom is a recent orraduate of the
North Carolina Medical College.
Dr. and Mrs. Brown will make their
home in I'lorida.
Dr. A. R. Fikc, of Spartanburg, S. C, and
Miss Rose Wingo, of Asheville. X. C,
were married June the 30th, at the home of
the bride's sister, Mrs. Bivings.
Deaths.
Dr. J. B. Cowcn, of TuUahoma, Tenn..
dropped dead in a drug store there on July
24th. Ur. Cowen entered the Confederate
Army March 27. 1S61, as surge.on of Chalmers'
Regiment of Mississipians. He was
transferred to Forrest's command Dec. 12,
1S()1, and served continuously as surgeon
upon Gen. Forrest's staff until the close of
the war. He was the last surviving member
of Gen. X. B. Forrest's staff.
Dr. Cowen was one of the most noted
surgeons of the South. He graduated in
1S.S.5 from N'ew Vork University, X'ew
York City.
Dr. James Evans, of Florence, S. C,
died at Clifton Springs, X. Y., on July
1.5th. He was in his seventy-eighth year.
He was a surgeon in the Confederate Army
throughout the Civil War, and was subsequently
a physician of great prominence in
both his own Slate and elsewhere.
He graduated from the Department of
Xedicine of the University of Pennsylvania,
Philadelphia, Pa. in 1S61.
Dr. A. J. Swaney. an aged physician of
UTallatiii, Tenn., died at his home on July
2t)th, after a long illness.
Review of Southern .Wedical Literature
Neiv Orleans Medical and Surgical Journal,
June, 1909.
House-flies and Disease.— Dr. Henry
Shinner says that a source of danger that
has i)robal)ly been overlooked is that arising
from the fact that feces often containing
tlie bacillus typhosus is distributed
along the tracks from railway trains. I louseflies
could very readily contaminate food
from this source in the homes of persons
living along the railroad. About ten years
ago there was an interesting lawsuit in
Philadelphia, probably the first of its kind
in the world. Mr. Gabriel Upton sued the
city for damages on account of having contracted
typhoid fever. A verdict of fifteen
hundred dollars was awarded the plaintiff.
The case was won largely on account of the
great probability that the fever was carried
to the individual by Musca domestica. The
city diverted a sewer into a natural stream
that ran by Upton's house and alongside
his dining-room. Cases of typhoid lever
were proven to exist on the Hue of the sewer.
A large amount of fecal matter came down
the stream, and at times it was necessary
to start it going when the water was low.
The case was appealed by the city to the
Supreme Court of Pennsylvania, but the
city settled for the full award of thejury.
it is hardly necessar>- to dwell longer on
this subject of typlioid fever, as the possibilities
of the case are so self-evident.
Wherever flies can gain access to material
containing the Bacillus typhosus they are almost
certain to carry it to food.
House-flies have long been suspected of
being agents in the dissemination of cholera,
and a number of articles have appeared on
the subject since 1853. That they contaminate
the food of the well from the vomit
or dejecta of those ill from the disease, in
times of epidemics, is undeniable. The
worst cholera months are said to be those
in which these insects are most abundant.
A Brief Review ol a Years' Progress
in Typical Medicine.— Dr. J. M. Anders
points out that the subject of hemoglobinuric
fever is one that has a peculiar interest
for American internists and the general
practitioners of warm countries everywhere.
Plehn has recently discussed its causes,
prevention and treatment in extanso, and
his main conclusions are worthy of notice.
After showing the malarial nature of blackwater
fever, Plehn affirms distinctly that,
with few exceptions, the tendency of the
F:;uropean to sicken with blackwater depends
on the length of his sojourn in the
fever district, the condition being more
prevalent when the colonists are of longer
settlement than when there is a fresh arrival
of newcomers. There are two weighty objections
against the malarial origin of blackwater,
namely, the freeiuent absence of ma-
larial parasites from the blood and the failure
of quinin therapy; but Plehn has shown
by elaborate statistics that the plasmodia
are always found when the blood is taken
before the commencement of the hemolysis,
while they are regularly absent during the
height of the illness. The parasites may
be seen to disappear spontaneously on the
second or third days of the illness without
medication.
It is owing to the dissolution of the blood
that quick spontaneous disappearance of
the malarial parasites from the circulation
occurs, and this fact answers the principal
objections to the theory that malaria is the
origin of hemoglobinuric fever. F'rom the
facts adduced by Plehn, it would appear
that blackwater fever develops ouly after a

1X2
THF CHARLOTTE MEDIOAL JOURNAL
certain time, "through the action of latent He belongs to an order of sanitary priests
malaria without preceding fever. " j
Protec- and belies his vocation and betraj-s his trust,
tion against this disease can be established if he does not use the material at his disby
shortening tlie period of residence in the posal fully and faithfully. He is his brothcountry
where it prevails, e. g.. Central er's keeper; and as in these matters knowl-
^frica. edge means added life and happiness and
usefulness to the communities whose wel"
Atlatita Jounial-Record of Medicine, May, fare is his charge, he will reject no method
1909.
of labor and spare no endeavor which offers
The Principal Cause ol Typhoid Fever the prospect of increased power over disis
the Common House-Fly. Dr. J. W. ease."
.;
J
1
Palmer says that the function of the "ty-
phoid fly" in the human economy is to carry The American Practitioner and News, June, -f^
bacteria from one place to another and the 1909. j,'
one mostly carried by them is the typhoid Chronic Ulcer oi the Stomach and 'J
bacilli and what they lack of being respon- Duodenum.— Dr. \V. H. Watheu says that ,
sible for all cases of typhoid fever is more in the treatment of chronic ulcers that have J
than made up in causing other infectious resisted all medical treatment and cannot |
diseases. It has been shown that when the be cured except by surgical intervention, 1
"typhoid fly" is most abundant, intestinal there is some difference of opinion. In the 1
diseases are on the increase and these dis- pyloric end, if the constriction is consider- J
eases decrease just as soon as there is a fall- able, most operators only make a gastroing
off in the prevalence of these flies. They enterostomy, and these patients get well J
are great factors in the spread of tubercu- and may never suffer again. Gastro-enter- 1
losis, so we see that the domestic fly has ostomy ought never to be done, as a rule, fl
passed from a disgusting and troublesome except where there is obstruction in the 1
pest to a dangerous enemy to human life. pyloric end of the stomach or in the duode- "
The number of bacteria on a single fly num that prevents stomach drainage; other- -.
will some times reach many millions, de- wise the contents of the stomach will pass
pending on the season of the year and the out through the pylorus instead of entering i
locality of the flies. Dr. L. O. Howard the jejunum. This is a question that con- •
caught 256flies from several different sources fronts us. It has been shown conclusively j
by means of sterile fly net, introduced them by men like Mayo and Moynihan that the -i
into a sterile bottle and poured into the bot- majority of all cancers of the stomach orig- .J
tie a known quantity of sterilized water, inate in the base of an ulcer. Mayo puts it I
then shook the bottle to wash the bacteria at .54 per cent. Because of that fact Rod- „
from their bodies, to estimate the number man suggested, several years ago, that i
of organisms that would come from a fly where there is considerable chronic ulcera- •-(
falling into a lot of milk and found that the tion and induration of the pyloric end, to
j
average bacteria on each fly was over three make a resection of that part, including all
millions, hence the importance of keeping ulcerated or indurated tissue, and after
j
the flies from milk. These flies will injest closing the duodenal and gastric ends, then '
the typhoid bacilli, carry them around, de- make a gastro-enteroslomy. Mayo has apposit
them with their "specks" which are proved of this suggestion in some cases, and I
as virulent and dangerous as the germs they followed it, and so has Moynihan. i
leave when crawling around. A Review ol Several Thousand Pcr-
The Doctor—His Relation to Public sonal Surgical Anesthetics.— Dr. H. C.
Sanitation.— Dr. J. C. Beauchamp con- Woodard believes that patients with lung
eludes his paper by quoting the following and pleuritic susceptibility, and in pulmo- 1
from a paper at the International Congress nary tuberculosis, the lighter the anesthetic
i
on Tuberculosis read by Dr. A. Newsholme, is given means better chances for the patient.
medical health officer to the local govern- The use of the nitrous oxid and oxygen
j
. - i
;
ment board of England: method does not work successfully with
"Social physiology and medicine are even some of these patients; it frequently causes
more complex than the same sciences ap- dyspnea and cyanosis. These patients do
plied to the individual, and statistics must better with a minimum amount of anes-
-J
t"!
-A
be used to decipher their mysteries. As thesia and large quantities of air; therefore,
they are required, our duty is to use them chloroform has proven to me to be the best
with the same care to avoid fallacy and the because the air supply can be regulated
\^
J;
,i
same pains to control our results as are ex- better. When chloroform is ever used at
pected in deductive experiment. The serv- any the dangers are lessened if nitrous oxid
ant of public health is working on the lives
f men, and should be laying the fouudaand
ether are employed to produce anes-
thesia, and then switch to chloroform when
\
on of natural prosperity and happiness, the patient is breathing regularly, which ;
^
|
'
|

REVIEW OF SOUTHERN MEDICAL LITERATURE. 113
lessens the risk of getting a large dose sud- The Southern Practitioner, June, 1909.
denly inspired during the stage of excite-
Eczema and Its Trealmcnt.-Dr. R. W.
ment, which is the most dangerous time.
^^^^ ^^^^ ^^.^ j,^^^ ^^.^^^^^ ^y,,^ jj3 ^^^^^^
It has been shown that most deaths from
^-^^^^^ ^^ ^„ ^^^^^ ^^^ ^,,^^„i^ ^^^^^^^ ^^^_
anesthetics occur during the stage of excitej,,^
^^^^ ^^^^ ^^ ,,^ ^.^^^l^^ intervals, makment:
therefore, we should tr^- to lessen this
i„g Us appearance upon anv and all parts
exciting stage as much as possible. The
^f j,,^ ^^^j^,. ^^^^ jj ^^^^^^ becoming in time
author makes it a routine practice, when
^Hronic, and lasting for manv years, if not
possible, to give, twenty minutes before the
tiiroughout the entire life time. It is the
anesthetic subcutaneously morphin, gr
j,^,^^^ difficult disease in medicine to combat
1-6- J4, and atropm, gr. l-loO-l-lOO, which
successfully, and can only be cured, if inrelieves
the patient of that excitement and
^^^^^ j^ g^;^^ -^^ j,^. the most patient selfsheck
so often seen prior to the anesthetic,
^j^^^^^^ ^^^ ^^^ p^^^j ^^ ^^^ patient, and the
The Texas Medical Journal, June, 19(>9.
most painstaking care and perseverance
ui)on the part of the physician.
Acute Traumatic Tetanus Treated by in the treatment of eczema, we still have
Magnesium Sulphate.- Dr. A. P. Ileineck a great deal of latitude. At all times, if
says that the experimental work on this sub- possible, we must find the underlying and
ject has been done chiefly, almost wholly, exciting cause, and attempt to correct the
by Meltzer and Auer. They determined same by what means we have in our power.
that intraspinal injections of magnesium Arsenic and the different tonics by some
salts are capable of abolishing completely are supposed to exert a beneficial influence
in monkeys, at least temporarily, both tonic upon any and all cases of eczema, and
and clonic tetanic contractions. Clinically, while it may be so, the good effects from
experience seems to i)artially bear out the the same are derived from the tonic treatfurther
statement of these investigators that nient. There is no specific to cure eczema
intraspinal injectionsof magnesium sulphate that has yet been found. The key note to
in doses which do not affect the respiratory a successful treatment is to find the cause
center or other vital functions, are capable if possible, tone up the patient's system and
of abolishing completely all clonic convul- increase the eliminative functions of the
sions and tonic contractions in cases of body in every way. Kxternally to use nontetanus,
occurring in the human subject, irritating applications or cosmetics to the
The relaxing effects of the injections may eruption, clean the surface as far as possilast
twenty- four iiours or longer. None of \^\^ and use the cleanest, most healing and
the vital functions were influenced by the jgast irritating drug or drugs that you can
intraspinal injections of magnesium sul- ftnd.
phate in the author's cases. In some parts
of the body, "such as in the lower extremi-
,y,.^/,,/„ .Uedical SemiMonthlv, /une 11th,
ties, the muscular relaxation following upon '
1909.
the injections was complete. In other jjortions,
such as the mandibular, facial, or
cervical muscles, the rigidity was very much
lessened, but it was not completely over-
Ttie Importance ol Early Attention to
Obstructive Respiration in Children.—
Dr. T. A. While says that nasal catarrh.
come. This has been noted by other ob- pharyngitis, laryngitis, bronchitis, cough,
servers. In Miller's case, the injections indigestion, malaise, nausea, restlessness in
determined a profuse secretion of mucus, sleep, nervousness in the waking hours,
bronchorrhea, at times severe enough to headache, deafness, earache and suppuraembarrass
respiration, but easily controlled tion of the ears, impaired circulation, menby
atropine. Was there a relation of cause tal dullness, etc., are all directly traceable
and effect between the injections and the to impeded nasal breathing. Such children
elevation of temi)erature? This must also are more liable to croup and laryngismus
be decided by further study of the subject, stridulosa than children with free respira-
Meltzer and Auer have determined that t'on, and possibly diphtheria as well.
, • •
1 •
, 11 ,1 , Obstructed nasal respiration is also a frewhen
administered by the intravenous ^ „ .' . „,^• .,i^,;„„ „„a
quent cause of imperfect articulation and
route, the magnesium salts are very toxic,
retarded development of speech. The nasal
and that even small doses completely in- passages are the resonance chambers of the
hibit the respiration. Therefore, for the vocal apparatus, and unless kept in normal
administration of these salts, this route, the condition, the voice is altered in character,
, , , , , , and the articulation frequently impaired.
intravenous route, should never be employ- ^.^^^^^^ ^^^ ^^^^ ^^ ^,^^ ^j„,^^^- ^.^^_^ ^j^^ ^^.
ed. We employed the agent only in the
velopment of the face takes place, and more
shape of injections in the spinal subarach- rapidly than in later years, and the shape
noid space.
assumed by the maxillae at this period has

114
THE CHARLOTTE MEDICAL JOURNAL
an iuiportaiil bearing upon the resulting drugs, it is far belter to employ the hot. wet
composite. Free nasal respiration is essen- pack as an aid than to press the use of drugs
tial to their normal growth, and more or to the most heroic measures. The latter
less deformity of these structures accompa- course, so often followed, is what threatens
uies nasal obstruction, especially the high- to bring the most valuable remedies into '
arched palate, narrow alveolus and conse- disrepute. J
quent irregular teeth. Deficient chest de- J
velopment is another sequel of nasal ob- The Alabama Medical Journal, June, 1909.
struclion. A Study in Elioicgy of Typhoid Fever.
Scarlet Fever. -Dr. J. A. Owen believes — Ur. H. Johnston believes that if dust or
that the care of the skin is one of the most soil infection is one of the usual dissemiimportant
points in treatment; and here the nators of typhoid fever we would reason- m
author sounds a note of warning against ably expect to find that children were fre- |
the too prolonged use of emolients, which quently attacked. It is probable that the |
fill up the pores of the skin, prevent it from frequent mildness of the attack or atypical I
performing its normal function, and add to features of typhoid in children allow many j
the strain on the kidneys. cases to escape recognition. But without 1
Oiling of the skin should be limited to the considering this, typhoid in children is not |
eorly days of the disease, thereby hastening, at all uncommon. In the Washington in- ^
and not retarding, desquamation. Forthis vestigation one of the things markedly |
purpose, use eucalyptol, 1 dram, to an brought out was the extreme prevalence of 1
ounce of white vaseline or carbolized oil of typhoid amongst children. There it proved I
cocoa butter, as you may elect. largely a children's disease, and being true j
Special efforts at hastening desquamation jn this instance, under the same careful in- ;
by detaching the skin from the general body vestigation it would probably prove true"
surface do not shorten the quarantine, since elsewhere. If thif frequency of typhoid'J.
the soles of the feet are the last to become fever in children is explainable by a dust V
loosened. This process may be hastened by or soil infection, we would reasonably ex- ^
soaking soles once or twice daily in hot soda pect that in early childhood the sexes would \
solution for ten minutes; then in hot soap be attacked in about the same proportion; ';
suds for equal periods; then rubbing briskly but as childhood advances boys and youths ^
wtth a rough towel. should show a preponderance because they 1
A general warm soap and water bath, would be more liable to such infections
followed by a 1 to 5000 bichloride of mer- than girls and young ladies. The Wash- j
cury bath, should be required before the jngton statistics show that from five to nine i
patient is discharged. years girls are little more often attacked; j
Eclampsia.-Dr. J. W. Hiden concludes f'" ^en to fourteen boys lead; from fifteen j
that the use of morphine in moderate doses, ^^ "'"^*^^" n. proportion to population boys ^
given hvpodermically with veratrum, not are twice as often attackec; from twenty to ;
wenty-four the proportion is almost three ,
Snlv makes the latter drug safer, but ma-
teriallv aids in relaxing the vesical spasms, " °"^ '" favor of the girls. I '"ean^hat
three
thus requiring less veratrum than would
boys are attacked to one girl Thisj,
otherwise be the case. This is of no small
^^^'"^ significant,
import, for, though veratrum judiciously Cholecystitis as a Complication and 'i
administered is unquestionably of great Sequel ol Typhoid Fever.— Dr. E. M. '
value, yet it is equally true that when given Prince points out that the most constant j
in heroic doses, it is a drug to be feared; symptoms of cholecystitis are localized pain, ,f
and, with other aids at our command, he tenderness and tumor. Mayo Robson' claims 'I
sees no necessity for the massive doses that in all gall-bladder inflammation there
which some physicians have advocated, is almost invariably a tender spot at the .
It should also be remembered that morphine junction of the upper two-thirds with the i
is contra-indicated in only rare cases of lower third of a line drawn from the ninth
puerperal eclampsia, namely, those due to rib to the umbilicus. The pain tua3^ howan
interstitial nephritis. When the pulse ever, be referred to the epigastrium and
has been reduced within safe bounds by the vermiform appendix. The onset is usually
combination of morphine and veratrum, a sudden and chills and vomiting may be i
mixture containing potassium bromide, present. In febrile cases there may be a ?
chloral and veratrum, given in moderate rise in the temperature. If the fever has j
doses at staled intervals, is better than to already subsided, the temperature may jump 'v
rely on one drug only, especially so when up very suddenly. A leucocytosis of 10,000 \
this is a powerful cardiac depressant. to 15,000 is usually present. Jaundice is j
When we find the convulsions are diffi- seldom present, unless there is an extension J
cult to control with the conservative use of of the inflammation to the cystic and com-

REVIEW OF SOUTHERN MEDICAL LITERATURE. 115
mou ducts. This condition may persist for are yaid to contain, or to represent, as most
a few days with a disappearance or perfora- of them have it, as "gospel" and believe
tion. the composition of them variable, though
Perforation is usually ushered in with without anything but faith in the honesty
sudden pains in the region of the gall blad- of the manufacturer to support our belief.
der. Symptoms and signs of general peri- But few of us are sufEciently enough versed
touitis soon follow, the clinical course be- in chemical nomenclature to recognize the
ing mnch the same as in peritonitis from poly-syllabic thirty-five letter compound
perforations of any other cause. acetylamidobenzeuetriethylxanthine as a
These cases of chronic cholecystitis are mixture of acetanilid and caffeine, and
often operated upon and the presence of the fewer of us still would recognize the combacillus
typhosus demonstrated months or position said to be safer than chloral that
years after the attack. Then if many sur- is "a compound of chloraethanal with a
vive the acute cholecystitis which very higher polyatomic alcohol," as nothing
likely resulted during the typhoid fever, it more than a mixture of chloral and glyceris
quite reasonable to think there are many ine, and certainly few physicians are stupid
who die from the same cause during the enough to believe that glycerine renders
course of the fever. The author believes less dangerous a given amount of chloral,
that acute cholecystitis of sufTicient severity xhe Tberapeutlcs of Typhoid Fever.—
to demand operative procedure is of far more
common occurrence than has been heretofore
supposed.
^^ j-j^^ Moodv savs that it is now uni-
..grsally admitted that the bacillus of ty-
phoid and the malarial Plasmodium may
be found in the same individual.
Gulf Stales Journal of Medicine and Sargery
and Mobile Medical and Surgical Journal,
Indeed it may almost be assumed that
during the autumn and early winter months
func, 1909. every person living in malarial territory is
Immunity.-Dr. J. F. Peary says that cer- infected to a greater or lesser degree, and
tain germs, the diphtheria bacillus, the that whatever other pathological condition
pneumococcus and perhaps the typhoid may supervene it will be more successfully
bacillus should be included, localize them- managed if the malarial infection be first
selves by preference in certain structures, eradicated. Thereforeit would seem rational
and from these points

116
THE CHARLOTTE MEDICAL JOORNAI..
tubercular processes in tlie firmer tissues, eliminate the morally weak. This is a doc-
Properly selected febrile cases respond to trine hard to believe in view of the fact that
treatment. Other lines of treatment should so many pure and innocent women and
not be neglected when one is administering children are involved. .Morality has been
tuberculin. Tuberculosis in many instances evolved largely through intelligence and
is arrested, and not cured. It will remain these diseases are incurred in ignorance,
arrested if the one suffering from the disease
conducts himself properly. The patient
should not be dismissed too early. In
the administration of these agents other
means of restoring health should not be
overlooked, and eternal vigilance is its
both of their existence and their results. *
Morality will be greatly increased and
^
strengthened by enlightenment, for moralj
ity is to a large extent enlightened self
|
interest. Just as th'e most powerful agent in I
the reduction of alcoholism, which through '<
price.
all the preceding centuries has been so uni- ;>]
Notes on Trealment oi Typhoid Fever, versal and terrible an evil, has been the \
-Dr. J. B. Raird savs that if either diar- diffusion of exact information among the ,
rhoea or pain of any kind should prove
People regarding the alcoholic diseases, and
^he invariable impairment of every
troublesome, opium in some form should be
kind of
u.sed. We need not hesitate for fear of ^"'"^" capacity, physical, mental andj
«ioral,
"masking svmptoms" or of "obscuring
by is daily use in anything buti
developments.'
' Physiological amounts; similarly, the
The remedy is given
aulhorl
to prebelieves
the
vent untoward symptoms and
most potent means of dimmish-^
to forestall
disastrous developments.
'"? the venereal diseases will be the spread
of
Water mav be drank freely. The
exact information as to their
food
disastrous*
should be liquid for at least ten days after J-^^^lts, immediate and remote, upon the
^
the subsidence of fever, and of digestible '^""^" system.
^
and nutritious quality. The quantity should _ .,, „ „ ,, ,, ,. . r ^ *'
be ample for nutritive necessities, but lim- ^^'^^"''^ ^ Sc^ui/wrn Medicine^ June. 1909. y
ited, of course, by the digestive capacity— Summer Diseases ot Children.— Dr. W. 1|
milk, butter milk, broth, light soups, meat E. Fitch points out the necessity for scrupu- <
extracts, gruels, tea, coffee, cocoa, etc., are Ions cleanliness in regard to nursing bottles )j
sufiicient. Some practitioners of repute are and nipples should be impressed upon ''^ the
more liberal in the dietary and allow bread, mother or nurse. The careful selection of'
toast, eggs and similar soft articles. Milk
an artificial food, judicious bathing, with,
when It does not disagree—and it is a fact . ,, , , , , .
that it agrees with the vast majority of per- P'^"! o'' alkalmized water, and the immedisons—is
an ideal food. An unfounded and ate removal of soiled napkins to avoid exa
most unfortunate prejudice has recently coriation are imperative. An abundance ^
been manifested against sweet milk as a
diet in this and other diseases. This erron-
... c 1 11 1-1
eous estimate of an admirable article apof
pure, cool spring water, even though it]
, -^ • • a ( n i. i
r 4.
be vomited (especially m cholera infantum,
\ t- r .
pears to be restricted to narrow territorial ^ven when retched and vomited) should be
limits, and it is devoutly hoped that the given; while water is essential, it should al-<
little endemic of lactophobia will soon ways be given frequently and in small.
^ "^t^'
amounts. If vomiting does occur, its ejec-
tion from the stomach aids in washing out
Virginia Medical Semi- Mo7ithly, June 25th, ^^^^ Q^gan, and sometimes by overcoming
The Extent and Importance ol the
Venereal Diseases in the Social Body,
gastric irritability, subdues vomiting, Ice
is frequently enjoyed and should be crushed
—Dr. F. T. Simpsons says that when we and tied in a gauze cloth to prevent the
review the vast extent of the venereal dis- swallowing of large pieces. It is absolutely
j
eases, their damaging effects upon Individ- imperative that a reliable toilet powder, ,
nals of both sexes of all ages and their corespecially
the borated products, should be :l
ruptmg iiitluence upon the seed of human- . ,' , .
,., ,, ,
ity, it is difficult to conceive of any subject copiously and liberally used, since they j
more important to society than the preven- allay the distress caused from the acrid dis- j
tion of the spread of these secret poisons charges. Excoriation from acrid stools may <
which have doubtless in the course of the be prevented by annointiiig the neighbor- ;
ages wiped out maiiv slocks of people. It 1 j c .tu -^i i- -i u .

Book Notices.
Treatment of the Diseases of Children. By
Charles Gilmore Kerley, M. I)., I'rofessor
of Diseases of Children in the Polyclinic
Medical School and Hospital; Attending
Physician to the New York Infant Asylum
and Maternity, etc. Second edition,
revised. Octavo, pp. f)29. Price, S-S.OO.
Philadelphia and London:
ders Company, 1909.
\V. B. Saun-
This work, prepared for the general practitioner,
has met a positive want. It deals
with modern methods of management of
patients, in greater detail, than has been
attempted in other similar works.
The means and methods suggested are
not drawn frcmi the literature, but are based
upon the actual extensive experience of the
author. The book is highly commended
to the clinician.
The reception of the first edition of this
BOOK NOTICES 117
.
book must be very gratifying to the author
and publisher. Many improvements have
Ha ml -Book of Diseases of the Rectum. By
l.fuiis J. Hirschman, M. C, Detroit,
Michigan, U. S. A.; Fellow American
been made in this, the second edition, and
we are sure that the book will be more appreciated
than the first edition.
rroctoiogic Society; Lecturer on Rectal Dietetics for Nurses. By Julius Frieden-
Surgery and Clinical Professor of Procwald, M. D., Professor of Gastro-Enterti>logy,
Detroit College of Medicine; Atology in the College of Physicians and
tending Proctologist, Harper Hospital;
Consulting Gynecologist, Detroit German
Surgeons, Baltimore, and John Ruhrah,
M. D.. Professor of Diseases of Children,
Polyclinic; Collaborator on Proctology, etc. Second edition revised and enlarged.
"Physician and Surgeon"; Kditor Harper
Hospital Bulletin; Chairman Section
Octavo, pp. .19.S. Price, Si. .50. Philadelphia
and London: \V. B. Saunders
on Surgery, Michigan State Medical Association,
Detroit of Medicine, etc. With
Company. 1909.
This book has been well received. The
one hundred and forty-seven illustrations, principal change in the present edition is
mostly original, including two colored the re-writing of the article on milk, and
plates. St. Louis: C. V. Mosby Medical the addition of a chapter on the simple
Book and Publishing Co. 1909. S4.00 methods used in the detection of certain
net.
food adulterations and preservatives. The
Although nothing new or startling is book will be found suggestive and useful.
brought out, yet the book fills a long felt
want, namely, an office manual-guide for
the general practitioner. As in all other
lines of medical endeavor, the author emphasizes
the importance of taking nothing
for granted, but insists upon actual examination
of the patient seeking advice. The
field and limitation of local anesthesia in
rectal surgery are thoroughly discussed.
Owing to the important information gleaned
from a careful examination of the stool, a
chapter is devoted to the requisite technique.
Above all, the subject-matter is
based upon personal observation and is not
driblets from otliers. The cuts are admirably
executed and materially simplify the
text. The printers are to be congratulated
upon the excellent workmanship, and the
author upon the thoroughness of his contribution
to the knowledge of that oft-neglected
subject, rectal diseases.
The book contains MF> pages.
International Clinics. A Quarterly Review
of Illustrated Clinical Lectures and Especially
Prepared Original Articles by
Leading Members of the Medical Profession
Throughout the World. \ol. 2, Nineteenth
Series, 1909. Philadelphia: J.B.
Lippincott Company.
The reputation of this well-known publication
is well known to all lovers of original
work. Among the articles which especially
impress us in the volume before us
are the following:
"Mineral WatersinSyphilis," by Carriere
of Paris. .\n exposition of the value of
sulphur waters in rendering mercury soluble,
in preventing mercurialism, in ennabling
the patient to take large doses.
"The Cammidge Reaction," by Goodman
of Philadelphia. Any attempt toper-
feet a test for pancreatitis is worthy of attention.
"Surgical Pneumothorax as a Treatment
for Phthisis," by Dumarest of the Hauteville
Sanatorium, Paris. In cavities he
pumps nitrogen into the pleural cavity,
compressing and immobilizing the whole
lung, after the method of I'orlanini. Three
brilliant successes are analyzed, with directions
and cautions. It looks like a good
method.
The volume is bound in its usual style
which is attractive. It is somewhat larger
than many of the former editions, and the
illustrations are unusually good
Thornton's Pocket Medical Formulary,
New (9th) edition. Containing about
2,000 prescriptions, with indications for
their use. In one leather-bound volume.
Price, SI. 50 net. Lea & Febiger, Publishers,
Philadelphia and New York,
1909.
It would be difficult to mention a more

118 THE CHARLOTTE MEDICAL JOURNAL.
frequently useful work than Thornton's
Formulary. The author is peculiarly qualified
to render such a service, as he unites
in himself a knowledge of the three necessar>'
branches, being a graduate in pharmacy,
a professor of materia medica in a
leading medical college, and an active
practitioner of many years' standing. He
has here presented the collective experience
of the medical profession as to the best
measures for combating each disease. He
has arranged the various diseases alphabetically,
and under each has given the
best formulcC for simple cases, as well as
for the various stages and complications,
with quantities both in the ordinary and
metric systems. A feature peculiar to this
work, and one of obvious value, is found
in the Indications and annotations for a
choice between the various formulee according
to the conditions to be met. Critical
study has been given to each formula in all
its parts, as well as to palatability and compatibility.
Xo point desirable in such a
work has been overlooked. The most experienced
physician will find it useful as a
reminder, and his younger confrere will
perform his duty better both to his patient
and himself with the brst collective knowledge
of his profession at hand for quick
reference. That practitioners widely appreciate
its value is shown by the frequent
demand for new editions, a point of special
importance in a work dealing with S3 rapidly
advancing a department as therapy.
In each of its nine editions, the author has
embodied the latest and best information,
so that the profession may consult this
hand-book with confidence in finding it always
up to date.
Vaccine and Serum Therapy, Including
also a Study of Infections, Theories of
Immunity, Opsonins and the Opsonic
Index, By Edwin Henry Schorer, B.S.,
M.D., Assisiant Professor of Parasitology
and Hygiene, University of Missouri;
Formerly Assistant Rockafeller Institute
for Medical Research. New York City.
Illustrated. St. Louis: C. V. Mosbv Co.
1909. $2.00 net.
In this work the author has brought together
the most important features of the
recent contributions to the subjects of vaccines
and immune sera. Infections and
immunity are briefly discussed. The greater
part of the book is concerned with a discussion
of opsonins, the methods of determining
the opsonic index and the importance
of opsonins in health and disease. He has
described clearly the technique employed
in obtaining the o^jsonic index, and has
pointed out the diflSculties and inaccuracies
associated with the method. The use of
the various vaccines is taken up to some j
extent, and the uses of the various sera are |
also considered. In short, the little work I
is a good resume of the enormous amount !
!
,
i
'•
of work which has been done in this field
in the last five years, and the book is well
worth the study of anyone who desires to
familiarize
subject.
himself with this important
Bier's Hyperemic Treatment in Surgery,
Medicine and all the Specialties: A Manual
of Its Practical Application. By '
'
^'^illy Meyer, M. D., Professor of Surgery
at the New York Post-Graduate
.Mfedical School and Hospital; and Pro- .;
fessor Dr. \'ictor Schmieden, Assistant '.^
to Professor Bier at Berlin University, I
Germany. Second Revised Edition. Oc- .1
tavo of 280 pages, illustrated. Philadel- \
phia and London: W. B. Saunders Com- |
pany, 1909. Cloth, S3. 00 net. \
The first lines of the introduction to this v
book embody the value of its purpose: i
"The physician who intends to make use of j
artificial hyperemia must first have a clear \
idea as to what he wishes to accomplish I
with it." The pages which follow try to i
suggest the indications and the ways of j
fulfilling these. 1
While hardly more than an extended .>
brochure, the work of these two distinguish- j
ed authors very graphically presents the j
whole subject, from the simple reactions I
caused by bandage congestion to the pro- 1
found obstructive hyperemia brought about I
by apparatus of special construction. Illus- J
trations are numerous and excellent, and '
the typographic arrangement readily pre- ^,
sents the purpose in a way to attract the \
attention and interest of the student reader. ;
Diet in Health and Disease. By Julius
PViedenwald, M. D., and John Ruhrah, :
M. D. Third Edition, Thoroughly Re- :
vised and Enlarged. The W. B. Saun- 1
ders Company. Philadelphia. 1909. '
Price, $4.00.
We have on two occasions spoken in .
complimentary phrases of the first and sec- j.
end editions of this excellent book on diet, \
the popularity of which rests upon the fact '
that its authors have endeavored to make it
a practical handbook for the physician. '
The book is somewhat larger at tlie present \
time than when it first appeared. After \
opening chapters upon the chemistry and i
physiolog\' of digestion and classifications \
of foods, beverages, and stimulants, it pro- |
ceeds to consider the various factors in their ;
bearing on diet, infant feeding, and the ]
diet for various special conditions and dis- \
eases, the latter forming by long odds the i
most complete portion of the book. There
are also chapters devoted to army and navy \
j
\

BOOK NOTICES. 119
rations and to the dietaries of a number of The Psychic Treatment of Nervous Diswell-known
public institutions, and recipes orders. By Paul Dubois. Sixth Edition,
as to the preparations of certain foods com- Revised. Price, $3.00. New York: Funk
monly given to invalids. In the discussion & Wagnalls Company. 1909.
of the subject of alcohol we are glad to note The new edition of this work has an exthat
the authors make the following state- cellent introduction by Dr. Dubois which
ment: "The use of alcohol is of u idoul)ted clearly sets forth the object of the work and
value in medicine, and the sweeping con- the foundational principle of the same. It
demnation it has received from many quar- is one of the best works on psychotherapy.
ters in recent years is not justified. Its use The principles are sound, and if carried out
and abuse have been confused." lead to cures, not alone to temporary relief.
„,,,.„,, The writer distinctly states that psychothe-
Essentials of Bacteriology. By M. \ . Ball,
^^ ^^^ ^^j^ weapon is only to be used
M. D., formerly Instructor in Bacteri-
;„ ^^^j^j,^ ^^^^^ It is a book that is valology
at the Polyclinic Sixth edition
^^,^,^ ^^^^ ^^^^^^ ^^ ^^^^ ,3^. ^^.^^^^ p^^^.
thoroughly .revised. 12 mo. volume ot ,itio„er, but is dangerous in the hands of
290 pp.. with lo.T illustrations, some in ^n those who attempt to apply its principles
colors. y.B. Saunders Company, 1908. ^-ithout thorough medical education. The
Cloth. &1.00 net.
^^^ ..,v^;^„, ^f k„^,^
rocks upon which the author's'success are
The writer reviews the subject of bacte-
found are thoroughness of examination.
riology in a concise manner, covering in a
sy^jp^thy, confidence, persuasion and edu-
few words the essentials in this ever-broadcation.ening
field. Xearlv everv new subject of '-y"""'
i „ , . ,,r
Studies of the
imp-frtance has been touched upon Human Form, by Robert ^V.
in the
^hufeldt.
last revision but, as in other books M D. Major and Surgeon. U.
of a like
nature, too much of the text is misleading, ^- ^^'?^^'
, y'Tfl'v ^^.^^'f .
C""!sinee
it is impossible to tell in a few words P=»">'- ^ledical Publishers and Printers,
91^'
important scientific discoveries which take \^'^
^1'^"^ ^^- I'l"ladelphia.
-»f. -'•"'
manv chapters in the original descriptions. " •
""''r^'
, -.i
*
i he
Theauthorsays that Trudeau
Study of he Nude with pictures as
uses tuber-
'llustratums of the text becomes more and
culin by beginning in afebrile cases with
MdCO mg.' B. K. or B. I-\, increasing I '""^^ f^^""f.t\"S '^.^^^^^
«f f''"'^'^^'. ^y
either the Artis, Sculptor or Scientist ^Iost
decigram every three davs until 1 cc. can
be iiTjecled without causing anv reaction." '.eautiful ly is this expressed by \ hit ler:-
'"deed the
The classification of bacteria at the end
Mimic worksof Art;
of
^^^fy
the book affords an excellent working table '
,,,^' -^.^Tu-^Sfi^tT I'!'
.,
t^. ,u^ i„K„.„ ^^ hen Dr. R. W . Shufeldt first began the
for the laboratory,
work of collecting and classifying the nude
Medical and Minor Surgical Diseases of in the "Studies of the Human Form" he
Women. By Samuel I, ile, M.I)., late Surgeon-in-chief
to LynchburgCity Hospital:
did not realize the enormous undertaking
he contemplated, but gradually as month
Surgeon -in-chief to St. Andrew's Home, after month he continued in his efforts toetc.
Illustrated. Pp. .il4. Southern Medi- ward a perfect classification, he disclosed
cal Publishing Co., Baltimore, 1909. to his personal view the task he had set
This book was written with the aim of himself.
placing the minor details of this class of After seven years of hard labor in his
work in the hands of students and practi- Studio he gives to the world the only work
tioiiers as a ready reference. Dr. Lile does of its kind ever published in this country
not deal with the major surger>' at all, as and superior to aay other ever published in
only a small per cent, of physicians ever
become operators; the majority being so situated
that their patients cannot be properly
F'urope.
The contents of the "Studies of the Hu-
man I'orm" show how thoroughly Dr.
cared for after the operation; so his object Shufeldt has done his work,
has been to give only the gross physiologi- The value of this most remarkable publical
anatomy of the female generative organs cation is apparent after even a slight peruand
the pathological anotomy . The author sal of its pages,
has dealt carefully with diagnosis, medical The book sells for Sl.S.OO net.
treatment, sepsis, asepsis, antisepsis, hv- . ..,.,„., ^^^^ T", , „. , .
',. , ., ,.„ ..' .{, CHKMIC.AL FOOD i.s a nii.\ture of Phosphoric
giene, etc. \)r. Llles differentiates the
.vcid and Phosphates, the value of which Physicians
major from the minor surgery and clearly seem to have loss sight of to some extent, in the
. . 1 ... 1 J -.1 .1 Dast few years. 'Jhe Robinson Pettet Co., to
States what is to be done with those cases '^.^^^^ advertisement (on page XVI) we refer our
belonging to the former class. The book is readers, have placed upon the market a much iiii-
,, •,, . . 1 1 ,1 .1 nroved form of this compound, "Robinson's Phoswell
illustrated and the author gives many P,j„R,e Elixir.' Its superiority consists in its uniof
his own experiences. form composition and high degree of ;palatabiUty.

Abstracts of the Leading articles
of the month.
Radioactivity and Carcinoma.—Barlow,
in The British Medical Journal, says
that the original question with which he
started—namely, Do the physical agents
which are commonly supposed to give rise
to cancer (clay pipes, soot, etc. \ and do
samples of carcinomatous material afford
evidence of the possession of radioactive
properties?—is not conclusively answered.
In certain respects they behave like the
radioactive materials of the chemist or
physicist, but in no single instance do they
respond to all the criteria of recognized
radioactivity. The author says that many
of the substances affect a photographic
plate in the dark; but, on the other hand,
few can act on the plate if a screen is interposed,
and even in those instances in which
a positive result is obtained under these circumstances,
tt is doubtful whether the interposed
celloidiu screen is fairly so called.
Nevertheless, it is doubtful whether the
power of acting through a screen is a necessary
criterion of radioactivity, since he has
demonstrated that albuminous compounds
of recognized radioactive substances may
possess a power of acting on the photographic
plate which will not traverse an
extremely thin screen, and, indeed, may be
devoid of photographic powers altogether.
In the latter respect they are comparable
with clay pipe, inasmuch as neither type of
substance acts on a photographic plate and
both accelerate the discharge of an electroscope.
In the same category comes carcinoma
material which has been extracted
with acetone or with water and subsequently
with ether. Possibly, too, some specimens
of spleen and of the inorganic constituents
of bone are to be reckoned in the
same class. He takes up the cancer question,
and speaks of the different parts of
the body attacked by carcinoma. The
writer mentions the theory that it is possible
that the radioactivity is the common
factor which must be capable of stimulating
the growth of certain cells while it depresses
the growth of others, which must
reside in substances of the widest diversity,
which must act with varying intensities in
different cases though always with comparative
slowness, the natural action of
which must be progressive so long as it
persists. The x-rays cause carcinoma, they
stimulate ( like other radioactive substances)
the growth of cells, and, again, they retard
the growth of cells, carcinomatous material,
noncarcinomat^us material, extracts of animal
tissues, various substances usually regarded
as casually related to carcinoma,
THE CHARLOTTE MEDICAL JOURNAL.
possess properties resembling those of recognized
radioactive substances to a greater or
less degree when considered from the
physicist's point of view, and there is evidence
that hey possess powers of stimulating
or depressing the division of animal
cells. Such similarities are at least suggestive.
Treatment ol Incoercible Vomiting of
Pregnancy.—Wallich (Ann. de Gyn. et
d'Obst. ) mentions the three classical diets
in vomiting of pregnancy as, milk diet,
water diet, and lactovegetable diet. Pinard
advises the milk diet whenever we have the
symptoms of autointoxication, only a small
dose of milk being .given at a time. If we
find that these small doses are well borne,
then the amount of milk taken is to be increased.
If the urine increases, and vomiting
ceases a cure is obtained: but in some
cases even small doses of milk cannot be
retained, ^^'e must then give only water,
in small doses. This diet cannot be persisted
in for more than four to eight days,
since it is the diet of inanition. At the end
of some days a small amount of milk is
added to the water and the p oportion of
milk gradually increased. When the water
diet is not well borne, all feeding by stomach
must cease for twenty-four to fortyeight
hours. Subcutaneous injections of
serum are made at the same time to replace
the water withdrawn from the system in the
urine and feces. Another diet that has
been proposed consists of farino-vegetable
soups and purees, which produce no poisons,
but these substances are not better
borne than milkr Calming drugs must be
given at the same time. Inhalations of
oxygen lessen the number and severity of
the vomiting attacks. If the urine incveases
in amount and vomitin.g ceases, all will be
well. We must not wait too long while
using these measures, but if they fail should
have recourse to the induction of abortion.
When there is an acceleration of the pulse
and fever, it is time to use obstetrical interference.
In some cases the cause of the
vomiting is uterine or ovular, and in these
cases only abortion will do any good.
Marriage of Women Having Cardiac
Diseases.— Renon (Gaz. des Hop. i believes
that the question of whether a woman
having cardiac disease should marry is to
be determined by the form and extent of'
that disease. Many women having wellmarked
cardiac disease pass successfully •
through a number of pregnancies. The
question whether there are changes in the'
arterial tension and kidney condition is im-^
portant. If there be constant alterations
in the tension of the pulse, marriage should;
be avoided. The kinds of trouble to which!

ABSTRACTS. 121
,
women are subject are two. Insufficiency chronic eczema of infants is a constitutional
of the heart is generally found in the earlier disease and must be differentiated from
part of the pregnancy, about the end of the various forms of dermatitis that likewise
fourth month, when there are dyspnea and affect infants. The etiology of such eczema
palpitation, sometimes ending fatally. To- depends upon two factors—congenital pi'eward
the end of pregnancy acute pulmonary
edema may supervene, and the case
disposition and feeding. Overfeeding and
chronic constipation are the usual concomimay
end fatally in a short time without de- tants of the seborrheic form of eczema,
livery having been effected. In cases of
cardiacs who have married, the pregnancy
Improvement and cure usually follow the
change from pure milk diet to mixed diet
should be carefull\' watched, the urine ex- at the end of the first year. The second
amined frequently, and the general nutri- variety of eczema occurs almost exclusively
tion watched. After the fourth month all in artificially-fed children. Such children
fatigue should he avoided and the patient are weak, pale and thin. The eruption is
should live a very quiet life. Labor, if not as strikingly evident as in the first form,
slow, should be terminated by version or and consists of scattered patches of dry,
forcejjs. Hereditary arthritism and aortic scaly infiltrated lesions that may be found
lesions should contraindicate marriage for
the sake of the offspring, who will probably
over the whole body. While local treat-
ment of these forms of disease must be used
inherit a tendency to these conditions. Car- in every case to make the children comfortdiacs
shouhl not marry other cardiacs or able, the cure depends not upon this treatrelatives,
ment, but upon changes in the diet of the
Tumors ol the Cerebellum In Cbildren. children.
—Ilepfner iWratschebraja C'.azeta) men- pal point
Reduction of milk is the princiof
managing these cases, and
tions the case of a girl six years of age, in carbohydrate food must be given to make
whose case the diagnosis of cerebellar tumor up the deficiency in the food-stuffs. After
was arrived at by exclusion during the pa- the fourth month of age this is very easy,
tient's lifetime, certain symptoms having as the child can be fed on various cereal
suggested an organic affection of the brain, i)reparations and also given fruit juice. In
aside from an accurate localization of the later months the albumin of eggs must be
growth. These symptoms consisted in persistent
headache, prolonged vomiting withavoided,
as it is as badly borne as the milk
preteids. Whey mixtures may be used in
out visible involvement of the gastrointes- cases where the child is too young to take
tinal canal, complete inability to stand, sit
or even hold tlie head up; at last, spastic
any other food but some form of milk. The
whey may be modified with sugar and cereal
paraplegia of the lower extremities. Fur- gruel, a diet with which Finkelstein had
thermore, choked disk was distinctly dem- great success in the treatment of eczemaonstrable.
In the differential diagnosis a tons children.
tumor of the brain cortex was excluded by on the Treatment of Severe Urethral
the absence of all p.sychic disturbances, strictures.—C oh n 'Berliner kliuische
unilateral paralysis of the extremities, or Wochenschrift) says that there are a numconvulsions.
An affection of the middle ]jer of strictures of the urethra in which
brain was contraindicated by the absence there is, suddenly, an apparent relapse after
of paralysis of the oculomotor nerves, ptosis a certain distention has already been ator
strabismus, as well as contralateral hemi- taiued by means of gradual dilatation. In
plegic paralysis of the extremities. The these cases, in addititm to the organic
tumor had accordingly to be located in the changes in the urethral membrane, there is
cerebellum, this assumption being justified a state of congestion. In accordance with
by the clinical symptoms presented by the the method of v. Frisch, the author restored
' patient. While headache, vomiting and the caliber of the urethra for the introduc-
' choked
disk are general symptoms which tion of a sound by means of the instillation
, are produced by intracranial neoplasms of of a few drops of a one-per-cent. adrenalin
different localizations, these symptoms are solution. Injections of adrenalin solutions
most distinctly marked in tumors of the were used with good results,
cerebellum. The growth was found to be Ten cubic centimeters of a 1:5000 adrena
very large sarcoma, which exclusively alin solution was injected into the urethra
occupied almost the entire cerebellum, with- a„d removed after about five minutes. Imout
extending to the other parts of the brain . mediately thereafter it was possible to intro-
case, therefore, furnishes an interest duce a bougie of suitable size. By means
The ;
[ing contribution to the study of malignant of repeated injections of this kind it was
1 tumors of non-tuberculous character in possible to introduce bougies of progressive-
\y larger sizes. In the case of very sensi-
Chronlc Eczema oi Infants.— Peer, in tive patients the addition of eucaine is
I The Munch, med. Woch., says that real recommended. Eucaine, and other anes-
; children.

122
THB CHARLOTTE MEDICAL JOURNAL.
"^'SeZZir^:':^^ s^ve as an ex- ^'e adrenal^ was ad.iniste.d subcu^
.p,e of U.e use and action of the adrena. —usl^^^^
.^^rhlo^id? solutt^1
hn solution m one of the cases citea Dy
^^^^^ ^^^^ minutes, as the attached histories
*
P Vortv-two years old, contracted gonor- of the cases show, there was a sudden allerhea'for
the first time about twenty years viatinn of the attackin more severe cas«
ato and since then has had it at intervals the dose was increased to 1 Cc, which put|
r;e'4raryears During the last three an end to the attack within five minutes,
years the patient noticed a thin stream. A s,a,istics ol General Anesthesia.—
physician diagnosed a stricture of the ure-
^,g^,|,pj. (Deutsche Med. Wochensch.) gives
thra and employed bougies for three months. ^ ^^^^^ ^^ ,^ ^^^^^^ among 71,052 anes-
The stream of urine improved. After a
^j^g^jj^j, j^ (he year 1908, that is about 1 ini
lapse of a year and a half the patient again
^^^^.^^^ ^^ .^ somewhat higher for chlorofoni)'
noticed a thin stream, and since about four
-^^^ ^^^^^^ although the latter is the more
weeks was obliged to urinate frequently,
Qf,p„ f^iio^.ed bv post-operative pneumonia I
and there was some difficulty in urination
^^^ e^grmany, however, ether has displaced i
The examination showed a stricture ot ^^,„roform to such an extent that the lalte) i
the cavernosus urethra. The stricture was .^ ^^^^^, employed in onlv about oiie-fourti i
discovered by means of a button-sound, ^o.
^^ ^^^ ^^^^^ -^j^^ ^^^ Esmarch inhaler ha;
18, Bougie No. 12 entered the stricture
^^j^j^^j^g^j its prestige. The developmen' i
but did not pass through. Bougie iNo. lU I
^^ ^^^^^ anesthesia has done much tore
passed through easily. At intervals ot two
^^^^ ^^^^ dangers of anesthesia— at least 2; j
r^^^
method preferred by th(
j
days bougies were introduced of a contmu- ^^^ ^^^^^
ally increasing size up to 18. At this point ^^^j^^j. consists in the administration o ,
it was not only impossible to pass a larger ^^^^,,^^1 ^^^ the evening of the operation an( ;
size, but even No. 14 could not be intro- ^^ ^ 0005-0 0008 grm. scopolamin and CO'.'
duced. Ten grammes of a 1;5000 solution ^^ ^ ^^ morphin, one to two hours be for. 1
of adrenalin was injected into the urethra jj^j.(,Qg;g 'j-jig anesthesia is slowly initii;
of the patient and allowed to act for a tew ^^^^ ^^^ ^^^^ ^p ^^ tj^^ p^i^t of arrest o J
minutes, whereupon it was possible to mtro- ^.^ ^^^^ prevention of resistance, but no
duce a No. 19 bougie. The same experi- ^^ formerly to the point of complete arresii
ence was repeated twice in the course of the
^^ ^^^ reflexes. This plan has the advantl
treatment. In both instances the injection
^^ ^^.^^ ^^^^ humane by avoiding an;
^
of the adrenalin solution made it possible
^^j^j^^l excitement before, during, an.i
to introduce a larger sized bougie, up to-
^^^^^ operation, while vomiting and post)
No. 26. The urinary stream is normal and
^^^tive pain are prevented and the danj
the patient is able to urinate without dith-
^^^ ^^ pneumonia greatly reduced.
""""He comes to the conclusion that adrena- P«»ys"«»"'*--Wi«1^7ski( Wi^en.klfei
lin is a good adjuvant in cases of stricture Woch.) has seen during the last five yea
of the urethra that are complicated by con- 35 cases of a simultaneous inflammation
. several serous membranes, fatal m four n
^^
stances. The polyserositis develops in threl
On the Treatment ol Bronchial Asthma, gtgges. In the first there is merely a serof!
— JagicC Berliner klinische Wochenschrift) effusion in the pleura, pericardium aiij
calls attention to the fact that we possess a peritoneum, but no fev:r or appareil
, . , ,. t v,^ 1, otto^T..= r.f changes n the internal organs or glanc
remedy m adrenalin to check attacks of
^^^^^ ^|tients complain only of gener,
acute asthma. He states that he has seen ^^^^,,^33 ^^^^ vague pain in the chest ati;
such prompt and strikingly good results abdomen. Adhesions form and the condj
follow this method of treatment in several tion grows worse under increased tempenj
cases of genuine bronchial asthma in vari- ture, with debility and irregular stoo ,
ous instances in the last three years that he Exceptionally the condition may inipro^i
considers adrenalin preferable to all other and the improvement may persist tor se
indicated remedies, such as morphine, atro- eral years. The third stage is charactej
pine chloral hydrUe, etc: This pertains ized by high fever, cachexia and edema .j
especially to the use of adrenalin in the case the feet, and autopsy reveals cheesy d,:
of very young individuals in whom there generatien of the lymph glands, Parench,.
are no complications, such as emphysema matous degeneration of the internal orga.,,
or diseases of the heart and arteries. No and tubercles disseminated over the sera;;
untoward after-effects, even after a long- membranes while the lungs and digesti,
continueduse of this remedy, were observed, tract are intact. Treatment consists ]
:
;

ADBVETISEMENTS.
The Girculatorj Dangers
Common to Hot Weather
particularly for the aged and infirm, are easily avoided by^e ilBeof
Gray^s Glycerine Tonic Comp.
Its adtainistration in two to four teaspoonful doses throughout
the hot season aids digestion, tones the nervous system, strengtnens
the heart, and goes far toward maintaining a safe circulatory balance.
Unlike most tonics, Gray's Glycerine Tonic Comp. has no
contraindications, and can be used with maximum benefit at all
seasons and under all cooditioas.
THE PURDUE FREDERICK Ca
«» BROADWAY. NEW VORK OTV
RESISTING FORCE.
The treatment, control and cure of tuberculosis,
« especially in the incipient stage, is generally
conceded to be a matter of rest, fresh air, sunshine and proper diet. Oftimesa
patient needs help,—to keep up body warmth and supply new—resisting
force—to the blood.
EMULSION CLOFTLIN
because of its great ability as a nourishing tonic and
blood replenisher, is peculiarly adapted to—supply this
needed help—and— resisting force. Its great— palatability—
overcomes in most cases—the objection—and
solves the problem—of administering Cod-liver Oil.
R Emuisum Olei Morrhuae—(Cloftlin)
An efficient preparation for those needing Cod-liver Oil, superior
to Iron, bitter tonics or the prevalent alcoholic extractives.
THE CLOFTLIN CHEMICAL CO.
FrM.
—
7S-77 Cliff St., N. Y.

THE CHARLOTTE MEDICAL JOURNAL
..PnPr^l strenethening measures, forced pWegmonous tendo-synovitis necrosis of
|
Wdin^ and possTbly injections of some the tendon occurred in only one instance,,
prepTrition oFarseSc, supplemented by that of a woman seventy-two years old.
earlv aspiration of the effusion, this latter ^^^ Eltect ot Hypophysis-Extract Upon »
'
having a favorable effect on the circulation ^^^ Bloodvessels.— (Wiener med. Wochand
nourishment of the regions involved
^chrift). The extract employed by Dr. J
and hastening the development of adhesions
p^^^ ^^.^g prepared from the posterior nervous (
which modify favorably the further course
j^^g ^f the hvpophysis, 1 ccm. correspond- 1
of the affection. The negative findings m jj,g (^ q q^ of t^e dried substance. About]
the heart, lungs and kidneys differentiate
t^^o per thousand of the efficient substance^
the polyserositis from disease in these or-
.ivere contained in the extract. Intravenousc
gans. He emphasizes the constant absence injection was followed in the first place by
of the usual symptoms of pleurisy or peri-
^ 1^^;^^ transitory lowering of the blood <
tonitis, also the simultaneous involvement pressure, passing into a moderate rise of
of all the serous membranes, suggesting pressure. The same phenomenon could be
some general cause, probably endotoxins determined over again by repeated infec-'
generated in some comparatively small tutJo„s.
The hypophysis-extract furthermore t
berculous focus, these endotoxins reaching gi^owed a well-marked diuretic action. The]
^
and irricating the serous membranes. Some examination of excised arteries from beeves
old focus in the Ivmph glands or urogenital
j^^ Ri„ger's solution to which hypophyseal !
apparatus was discovered in all the cases
extract had been added, served to show that I
that came to autopsy. This assumption of
jj^g carotid, mesenteric, and femoral arter>
the etiology explains the benefit from prompt underwent shortening (as under the addil
evacuation of the effusion which removes tjon of adrenalin ), whereas the renal arteries i
quantities of these endotoxins while favor- ( become lengthened opposite findings undeii
ing production of adhesions. The author addition of adrenalin ), at least in their pen i
is convinced that many cases of alleged pj^gral portion towards the renal pelvis'
"pericardiac pseudocirrhosis of the Hver'^' r^-^^ findings upon the coronary arterieii
and "chronic hyperplastic perihepatitis" ^^gre not entirely uniform. The pupil ol
really belong in this class of polyserositis, ^j^^ excised eye of frogs is dilated by hypo i
The Hot Air Treatment of Acute Sup- pli>-eal extract as well as by adrenalin.
puratlons ol the Hand.-Islen(Munchener j^ ^^^ Method oi Sphincteiic Contro:
Med. Wochensch) gives the results obtained ^^^^J. colostomy.— Ryall, in The Edin i
from this method of treatment. Before re- ^^^j-gij Medical Journal, describes hismeth.
sorting to it the pus is evacuated, this being ^^ ^]^^^. ^i^^ rectus is split vertically atn
done under anesthesia. The incisions are ^^^e sigmoid is drawn out and divided at i
made on the palmar surfaces and sides of convenient point. The lower segment ii
the fingers down to the tendon sheaths, the closed and replaced in the abdomen. Th;
site of the suppuration sought, pus and upper segment is made less bulky by re'
necrotic tissues removed by irrigation with j^o^jng the appendices epiploicee and free 1
saline solution, and the wound cavity cov- ^^„ ^^ ^f mesenteric fat, but without in an i
ered with iodoform gauze. The hot air ^^^y interfering with its blood supply. Thj
treatment is begun on the day of the opera- artificial sphincter is then made in the fo :
tion, at first twice daily for a period of two lowing manner; A loop of muscle fibres;'
'
hours, the gauze, if necessary, being previseparated
from the posterior aspect of tb
ously loosened by immersion of the affected
rectus on either side of the wound. Eaci
part in a warm saline solution. During the
joop is then drawn over to the opposite sic
interval an alcohol dressing, 90 per cent.,
qJ ^^^ wound, so that one loop overlaps ttj
is applied or one moistened with aluminum other. The overlapping loops thus form i
acetate. Abscess cavities are covered with ^.^^^ ^^^^ through this the bowel segment ;
iodoform, the pus never being expressed (jrawn. Sutures are then inserted to keeL
but washed out with a saline solution. It ^-^e muscle fibers together above and belo i
is important to remove dead skin. For the ^^^jgre the bowel comes through. Ancho i
hot air application Bier's apparatus is em- ^^^„ stitches are inserted through the sky:
ployed, the temperature varying from 90 to ^^^^ muscle inside to keep the bowel in pi
110° C. This method produces marked re- gition. The wound is then closed abo',j
lief of pain and greatly shortens the heal- ^^^j below the bowel and the cut edges 'i
ing process. The results were often sur- the latter are sutured to the skin. Adouhi
prising, suppuration ceasing after a few gpiiincter is thus formed consisting of long
days and the wounds assuming a clean ap- tudinal and circular fibres. The longitucf
pearance and closing in eight to fourteen j^^j fibres are those of the anterior portit
days. The tendons were preserved and the of the rectus and the circular fibres ai;
cicatrices were soft. In seventeen cases of formed by the loops from the posterior pj,1
:

.
ABSTRACTS.
of the rectus. This operation can be modified
by makiv.g double loops on each side
and making them overlap one another
alternately. A similar operation can be,
and has been, carried through the external
oblique, and likewise can be done wherever
the bowel is brought through muscle. A
somewhat similar operation can also be performed
for gastrostomy and appendicostomy
I
Urinary Bacterial Infections in Clilldhood.—
Box, in The London Medical Lancet,
discusses descending and ascending
urinary affections in childood. Box believes
that the common cause of bacilluria
is due to an ascending infection, a view
whicn is corroborated by the sex incidence
of the disease. It is twice as common in
females as in males. The commonest infection
is that of the colon bacillus. This
bacillus is frequently present in the urine
of children suffering from thread worms,
which suggests that scratching may be in
ipart the medium of infection. The clinical
manifestations of infection of the urinary
passages in childhood may be pyelitis,
cystitis or incontinence of urine without
obtrusive evidence of local inflammation.
The possibility of the presence of pyelitis
should always be borne in mind when dealing
with cases of obscure fever in childhood,
whether of a sustained remittent, or
of .1 relapsing character. Cystitis of a more
or less acute character is not at all uncom-
. course
' childhood,
: cases,
mon in childhood. In incontinence the
of the disease appears to be not altogether
afebrile. Slight elevation of temperature
at night, rarely over 100° P., may
occur for weeks at a time. The cystitis of
when caused by the colon bacillus,
calls for a guarded prognosis. Some
^ largements
especially those with acute onset and
marked bladder symptoms, clear up under
the simplest medicinal and dietetic treatment.
Sclilalter's Disease; or, "Rugby Knee."
—Thompson ( lidinburgh Medjcal Journal
mentions a case of this not uncommon but
frequently unrecognized condition, which
usiil to be known as "Rugby Knee," and
w;w a bar to taking part in military drill
Ijeiiiuse of the inability to kneel. He quotes
James Paget's description of the symptomatology
of this condition, which is as follows:
"Much more common are the en-
of the tubercle of the tibia,
which are often seen in young peoi)le given
to athletic games. They complain of aching
pain at and about the part, especially
during and after active exercise, and the
( tubercle may be felt enlarged, and is often
1 too warm. The pain often continues, more
or less for many months, and there may be
)
I Cnk booldM. ' T«lc r
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enlargement of the bursa under the ligamentum
patella, and the tubercle may remain
too prominent: but, common as are
these cases, especially in our public schools,
1 have never known grave mischief ensue
in any of them, and they will get well of
themselvesr They may represent one of
the least degrees of periostitis due to strain;
the increase of the prominence of the bone
is only just beyond that which may be
deemed the normal limit for the attachment
of vigorous muscles."
The writer reports a case in a school boy
fifteen years old, who had been conscious
for three or four years of sensitiveness at
the upper end of the skin bones of each leg.
This sensitiveness was felt only on forceful
extension of the leg, as in kicking, when
anything came against the shin, or on
kneeling when the pain was very severe.
The case had been diagnosed rheumatism,
possible tuberculosis, and housemaid's
knee. He had had for treatment, a course
of massage, painting with iodin, and electricity.
Two years before the knee had been
radiographed.

THE CHARLOTTE MEDICAL JOURNAL.
In Summer Complaints
THINK. C
OF USE
ALKARHEIN I[N
INDIGESTION.
We do not claim that it will cure all cases of dyspepsia, but it will be sur-
prising how useful it will prove in very many derangements of the gastro-iutesti-
nal tract.
COMPOSITION-With Physiological Action.
Rhubarb A superior laxative because it does not impair but
2 1-2 Grains improves the digestion—Is a tonic, also astringent.
Golden Seal (with the acrid resin removed)—The great tonic
' '"^ Grams a^d corrector of the mucous surfaces.
Polassium Bicarbonate
Antacid. Increases Alkalinity of the blood and the
oxidation and excretion of effete matters.
Pancreatin Promotes intestinal digestion, converts starch into
I Grain sugar and dextrose; proteids into peptones; emulsi-
fies fats, digests the casein of milk.
Ceylon Cinnamon valuable in atonic conditions of the intestinal mu-
cous membranes, with flatulence and diarrhea.
Spirit of Peppermint and a minimum of Simple Elixir is a menstruum that
will commend itself to physicians.
Think of Alkarhein in acid dyspepsias, flatulent colic, infantile colic, cholera
infantum, cholera morbus, diarrhea and all abnormal acid conditions of the ali-
mentary tract. Think of Alkarhein in these cases and prescribe it as thousands
of physicians have been doing for many years with the confidence born of ex-
perience.
ORIGINAL WITH AND PREPARED BY
The Wm. S. Merrell Chemical Company
Manufacturing Chemists.
CIINCHNINATI

INDEX FOR AUGUST.
Table of Contents for August, 1909.
OriginaX Communications.
Some KTceut Vievvs Concerning-
the Nature of
Typhoid Fever, by L. B.
Mewell, A. B., M. D.,
Cbarlotte, N. v .,
Clinical iNotes on Sanatorium
Worlc, by J. C. Walton,
M. D., Richmond,
Virg-inia,
Healthful Children, by ,J.
Steven Brown. M. U.,
Hendorsonville, N. «..,...
The Surgeon and Gynecologist—Not
an Entitv, bv
CM. Strong, M.D., Charlotte,
N. U
An Antiseptic Leech, by
W. D. Witherbee, M. D ,
Charlotte, N. C,
Present Statusof the Pellagra
Problem, by Edward
JennerWood, S.B.,M.D.,
Wilmington, N. C,
The Growth and Developmuutof
Pieventive Medicine,
by Arthur K. Guerard,
M. D., Flat Rock,
N. C,
Alcohol, by Wm. deB. Mac-
Nider, M. D
Anaphylaxis and it.'i Relation
to Practical Medicine,
by Dr. R. N. DutTy,
New Bern, N. C,
Editorial.
Calcium .Salts and Body
Metabolism
Concerning the House Fly,
The Nerve Theory of Angina
Pectoris, ".
Blood Pressure and Life
Insurance,.
The Causation of Sex j
Catawba Sanatorium, !
Highlands, N. C 101
Dr. W. H. H. Cobb, 102
Rabies, lOJ
Editorial News Items 103
Marriages, 110
Deaths Ill
Review of Sottthern Medical Lit-
erature, Ill
Book Notices.
Hand- Book of Diseases of
the Ueetura, by Louis J.
Hirschman, M. C, Detroit
Michigan, U. S. A., 117
Treatment of the Diseases
of Children, by Charles
Gilmore Kerley, M. D.. 117
Dietetics for Nurses, by
Julius Friedenwald, M.D. 117
International Clinics 117
Thornton's Pocket Medical
Formulary 117
Vaccins and Serum Therapy,
by Edwin Henry
Schorer, M. I) 118
Bier's llypi

128
THE CHARLOTTE MEDICAL JOURNAL.
No treatment availed. The parents were that the cause of the myxedematous sympapparently
anxious for the young lad to tomsas the atrophy or absence of the thyroid
take part in foot-ball and continued in Iheir gland in infants either congenital oracquired
efforts to find out the cause of the trouble, When beginning at a period after birth its
which objectively produced a decided swell- cause may be acongenital smallness and coning
at the lop of the shin bones. sequent insufficiency of the gland. When
Examination disclosed, a little above the there are too great demands for the typhoid
tubercle of each tibia, a rounded projection, secretion, which will occur sooner or later,
most marked when the knee was flexed, the symptoms of myxedema come on.
Radiographs accompanying the report show Either the thyroid elaborates a substance
the condition clearly.
useful to the organism, the absence of which
Tuberculosis ol the Hip-Joint.- Walder- causes the symptoms, or the office of the
Strom 1 Clrlbltt. fur Chirurgic ) treated 60 gland is to remove from the circulation subcases
of tuberculosis in and around the hip- stances that are deleterious, which are not
joint. In 18 of these cases the X-rav ex- removed when atrophy has occurred. At
amination showed the presence of an isola- whatever period of the child's life this luted
focus in the femoral neck, within the sufficiency occurs, the development of mmd
reo-ion of the capsule. Based upon careful and the growth of the skeleton immediately
X-rav examinations, the author believes cease. The patient becomes an idiotic
the coxitis in these 18 cases to have origi- dwarf—an entire idiot when the suppression
nated from these isolated foci in the femoral of function is early, an imbecile when it
neck. In three cases onlv did the patient occurs later. As the thyroid plays so imcome
under treatment before the focus had portant a role m the genital system of the
gone on to coxitis or destruction of the female, there are more myxedematous fefemoral
head. Two of the patients were males than males. The dwarf is afflicted
entirely cured bv operation, and one recov- with a solid edema of the skin and mucous
ered with a slight coxa vara and good fuiic- membranes, which gives him an expresstion.
Among the remaining cases 10 pa- ionless, swolen face, a thick tongue, and
tients could certainly have been freed from hoarse voice. The patient shows a great
the tuberculous disease in the same manner disinclination for all kinds of movements, is
if thev had come under treatment at an cold on account of the lowered temperature,
early stage. He points out the importance lias a feeble and comprsheiisible pulse, and
of evacuating every known focus in the an open fontanelle. Puberty never becomes
femoral neck without damaging the joint, established. The only successful remedy
for the following reasons: (l) There is no is the use of thyroid extract,
method to ascertain within a short time Treatment of Labor in Contracted Pelwhether
the tuberculosis is stationary or vis.—Schauta (Jour. Obst., Gyn. Brit,
progressive in character. (.2) The focus in Emp.) states that our aim should be to leave
the fermoral neck is situated so as to have labor in contracted pelvis as long as possi-
oiily a short distance to travel before reach- ble to the natural forces, and these failing,
ing the joint when progressing in any direc- to perform only those operations which will
tion but toward the trochanter major, (3 ) most likely save both mother and child.
After the focus has penetrated into the joint The management of labor in contracted
very extensive destruction follows. pelvis will shape itself in the following man-
It is essential to save as much bone ma- ner, provided it is carried out from the comterial
as possible at the time of the opera- mencement in a skillful manner and in an
tion. The author therefore makes use of institution under strict asepsis. In cases
Rydygier's incision, with temporary detach- with a conjugate above 8 cm. there is a
meiit of the trochanter major. The focus is possibility of spontaneous birth, and therethen
located and carefully removed, under fore expectant treatment is to be adopted,
very accurate aseptic precautions. The In cases under 8 cm. Cesarean section is to
operation is terminated by reattachment of be kept in view. In cases bordering on the
the trochanter after injection of iodoform above, that is with a conjugate of 8 '2 to 7/^
glycerin and primary suture. cm. hebosteotomy is to be considered. This
The same method is utilized by the author operation, in a conjugate of 8 to S'2 cm.;
for foci in the femoral neck, with otherwise would be an alternative operation to spoupurely
synovial tuberculosis of the hip-joint, taneous birth; in a conjugate of 7 '2 to 8 '2
Iodoform glycerin injections are made into cm., an alternative to Cesarean section,
the hip-foint during the operation. The The choice would be determined by the size
after treatment is carried out with the assist- and hardness of head, the strength of labor
ance of plaster bandages of extension dress- pains, the voluntary efforts and general
ings. condition of the patient. This method of
Spontaneous Infantile Myxedema.— treatment should be looked upon in the
Beudry (Jour, de Med. et de Chir.) believes future as typical. All other methods hith-
i,

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Hence it is indicated in
Cholangitis, Cholecystitis and
Cholelithiasis.
Etlective in Typhoid l'"e\er, as a preventive
and curative agent, being an Intestinal
Antiseptic.
Effective also in Toxemia of Pregnancy.
.Sample, literature and clinical report.s upon request
LAINE CHEMICAL CO.
Manufacturing Chemists.
NEW YORK.
Officers f the North Carolina Medical Society.
President. Jas. A. Burrouffhs, AshevUle.
Ut Vice-President. E. J. Wood. Wilmlnifton.
2nd Vk-e-Presideiit. Jno. Q. Myers, Charlotte
Ird VIee-Presldent. L. D. Wbnrton, SmillitleK
Secretary. D. A. Stanton. Hiitli Point.
Treasurer. H. D. Walker, Elijabetli City.
COUNCILLOlia (3 TEABS TERM).
1st DUtrlct, Oscar Mc-MuUan. Elizabeth City.
Kill
,...,.11. Wil ingti
Orator. Cyrus Thompson. Jacksonville.
Essayist. R. V. Brawley, Salisbury.
Leaderof Debate. D. A Garrison. Uastonia.
Committee on Public Policy and Legislation : R. H. Lewis.
Raleigh; J. A. Burroughs, .\sheville (exofficio): Geo. G.
Thomas, Wilmington; .Albert Andei-son. Raleigh.
Committee on Publication: D. A. Stanton. HIgl. Point
{exofficio); H. A. Royster, Raleigh ; R. L. Gibbon, Char-
Committee on Scicnlifi
\ex-offlno]; T. S. Mc
Wilmington.
I
' .
.
It,"
JJh
SJh
Wh
«lh
lOlli
.,
..
"
••
"
',' ,'
11,1 , Kalelgh.'
M „ ,. M, ..tie
,7 u .-,w.h, ri..,iiUn,utain.
i.' m' Taylor. Mcirgauion.
James A. Burroughs. Asheville.
Elizabeth City: Wm. Jones, High Point.
Committee on Obituaries: C. A. Julian, Thomasville; R.
P. McFayden. Randleman ; J. W. McGhee, Raleigh.
House op Dbleoates, A. M. A.: Dr. J. Howell Way. Waynesville: Alternate, Dr. P. J, Thomas, Wilmington; Dr.
A. J Crowell. Charlotte; .\lternate. Dr D. S. George, B.iyboro; Dr. T. E. W. Blown. Asheville; .alternate, Dr, J. V
McGougan, Fayettcville.
i , Htteville Committee on Finance: G. T. Sikes, Gi-is3om; I. Fe.aring,
Medical Society of the State of North Carolina meets in Wrightsville, June 16-19,1910.
The Tri-State Medical Association of the Carolinas and Virginia (only members of
State Societies eligible). Next Annual Meeting: Richmond, Va. Date of meeting
February 8, 1910. President, Dr. I.eGrand Guerry, Columbia, S. C; Secretary-
Treasurer, Dr. J. Howell Way, Waynesville, N. C.
NEW/ ORLE/\INS ROLVCLINIC
Post Graduate Medical Department Tulane University of Louisiana. Twenty-third
Annnual Session opens November 1, 1909, and closes May 28, 1910.
Physicians will find the Polyclinic an excellent means for posting themselves
upon modern progress in all branches of medicine and surgery. The specialties
are fully taught, including laboratory and cadaveric work. For further information,
address:
NEW ORKEANS POLYCLINIC
Postoffice Box 797. NeW Orleans, Louisiana

130
THE CHARLOTTE MEDICAL JOURNA]
erto used in the treatment of labor in con- tongue being absent. The stools are infre"
tracled pelvis should be looked upon as quent and of an ochre color. Meteorism
atypical. Craniotomy on the dead child and abdominal pain are generally absent,
may be indicated in a conjugate under 9>^ Hemorrhages and perforation of ulcers are
cm. Craniotomy on the living child may very exceptional. The Peyer's patches are
become necessary if the mother is in a state not much swollen or deeply ulcerated,
of in 'ection or refuses to undergo any of the There is rather a septicemia than a true
typical operations. Artificial induction of typhoid condition. Rose-spots are not alpreniature
labor may also have to be per- ways present, one-third of the cases never
formed in cases in which the mother is suf- showing them. Sometimes they appear earfering
from illness and Cesarean section or Her and are more abundant than in the
hebosteotomy at the normal term would be adult. Relapses are more frequent than in
too dangerous, or where it is positively the adult, and the rose-spots return with the
known that the children are abnormally fever. There is generally a desquamation
large or the mother absolutely refuses an which is distinguishable from that of scarlet
operation. The application of forceps above fever only by the absence of the large
the brim and prophylactic turning should, plaques of skin that appear in the latter
if possible, be entirely removed from the disease. There are two distinct forms of
list of methods of treatment in contracted typhoid fever; a very slight one, of short
pelvis. The application of forceps above duration, and a severe form, more curable
the brim might exceptionally be tried before than in adults. The causes of the less secraniotomy
on the living child is resorted verity are perhaps the good digestion the
to, and it will probably be possible occa- development of the lymphatic system, and
sionally tosave a child. Before craniotomy the general good condition of heart, kidon
the living child is undertaken, prophy- neys, and liver. Frequent complications
lactic turning may be justified in certain are meningitis, paralysis, and otitis,
degrees of contraction in a simply flat pelvis, Pneumococcus Vaccines in the Treatwhen
Cesarean section of hebosteotomy, on ment ol Pneumonia and ol Some of Its
account of illness of the mother, is out of Complications.— Harris in The British Medthe
question, and a trial with the forceps ical Journal states that, clinically, death in
affords little hope of success on account of this disease usually comes from cardiac
the high position and mobility of the head, failure, especially in those virulent cases
Forceps above the brim and prophylactic terminating about the fourth day of the
turning we find their indication in such attack. Under these conditions the vaccine
atypical cases as a last attempt to save the treatment in many instances will indeed re-
life of the child before craniotomy is resorted duce the fever but fails to avert a fatal
to— forceps when the head is fixed, turning result. The toxemia already induced is too
when it is movable. In a conjugate under profound for merely the arrest of the infect-
6/-2 cm., Cesarean section is absolutely in- ing process to be successful. Hence the
dicated: if the case be aseptic, with suture vaccines should be used at the earliest posof
the uterus; if septic, with total extirpa- sible moment and be accompanied by the
tion or supravaginal hysterectomy. use of a antitoxin. It is not improbable
that in the case of the pneumococcus the
Typhoid Fever in Children.— Marfan success of a vaccine is due not simply to the
(Jour, de Med. et de Chir.) describes ty- fact that it should be autogenous, but the
phoid fever as it occurs in children. It is fact of a vaccine being autogenous narrows
more infrequent in children than in adults, down the issue to (1 ) the right organism
and is rarely seen before the fifth year, being selected, and (2) the vaccine being
The youngest patient attacked by typhoid prepared, if not unduly subcultured, from
.seen by the author was nine months old. an organism of requisite virulence. Fraenk-
The general methods of infection in infants el's pneumococcus is, however, as far as
ore by milk diluted with impure water, the we know, invariable; it is not like the strepuse
of unsterilized milk, and the washing of tococcus (Gordon) an inclusive term for
milk containers in bad water. A wet-nurse several varieties. On the other hand, we
may give the fever to her nursling. At birth know from the staphylococcus and colon
a child may bring with it into the world the bacillus that these may be so subcultured as
germ which has attacked the mother dur- to lose their original virulence, and that
ing pregnancy. The onset of the disease is vaccines so prepared are of little use, theramoresudden
than in the adult and it reaches peutically. If, then, a potent and reliable
its acme sooner. From the second day the stock pneumococcus vaccine is to be obtaintemperature
is very high. Diarrhea is ab- ed, it should be make from as virulent a
sent, and constipation the rule. There is strain as possible. There is unhappily no
an exaggerated hypothermia and very few difficulty in the early months of the year in
digestive troubles, anorexia and the typical obtaining as much as is wanted. The truth
.

ADVERTISEMENTS. 131
THE CHARLOTTE SANATORIUM
Corner West 7th & Church Sts. Charlotte, N. C.
D. A. Tompkins, President. E. C. Register, M. D., Vice-President.
W. D. Witherbee, M. D., Secretary.
private hospitaliucor-
A p o r a t e d
Aug. 1907.
The building
is athree-stor>',
fire -proof
structure. Private
rooms for
fifty patients,
The building
is specially
designed for
the purpose of
giving patients
all the conveniences
that
modern architecture
affords.
The equipment
is complete in
every detail, all the latest and most modern appliances are found m each department.
SPECIAL EQUIPMENT
The most Improved hydrotherapeutic apparatus. Complete Electrical Equipment,
Sun parlors, two Surgical Operating Rooms, Electric Elevators, \'acuum Cleaning
System and Rooms with Private Phones.
The Training School for Nurses consists of a Superintendant and Corps of forty
nurses.
CHIEFS OF THE DIFFERENT
Medicine
EDWD. C. REGISTER, M, D.
Nervous Diseases
J. P. MUNROE, M. D
Diseases of Digestion
Surgery
G. W. PRESSLY, M, D.
C. M. STRONG, M. D.
Eye, Ear, Nose und Throat
E. R. RUSSELL, M. D.
DEPARTMENTS
Cancer and Skin Diseases
W. D. WITHERBEE, M. D.
Genito-Urinary and Rectal Diseases
A. J. CROWELL, M. D.
Anaesthetics
W. 0. NISBET, M. D,
A. M. WHISNANT, M, D.
J. C. MONTGOMERY, M. D.
F"or Ruther Information Address E. :. C. Register, /W..
CHARLOTTE, IN. C
D.
The Jefferson Medical College
1825 Of Philadelphia 1909
A Chartered University since 1836.
S"? th annual session beg:'"^ SSept. -2-4- th I909, and ends June

132
THE CHARLOTTE MEDICAL JOURNAL.
of this aiguuieiU can only be verified by a fallen it is best to feed the child more in
great number of observations. With regard order to prevent loss of weislu.
to the treatment of acute pneumonia by inoculation,
the practical conclusions which — — 7^
alone can interest the busy clinican are:
/Vli SCC I Icl 116011 S*
(1) that successful inoculation for pneumo-
that inoculation does no
nia is possible; (2 )
harm; (3) that a vaccine from one or a
number of virulent strains should oe used;
Typhoid Fever and Malaria In Jackson-
ville.
(4) that it should be introduced as early as
possible; (5) that the estimation of the
'pijg jj^jf MiHion Club of Jacksonville,
Florida, has issued a circular calling attenopsonic
index is not necessary; (.6) that the
observation of the temperature and physical
signs is in pneumonia a sufficient guide in
gauging the repeti;ion of the dose. Infections
of the lung by the pneumococcus
which fail to resolve after an acute pneumonia,
as well as pneumococcic mfections
of other areas, ought certainly to be treated
with a pneumococcic vaccine; and these
cases appear to afford a reasonable prospect
tj^jj jq jj^g sanitary condition of the city,
tjjjs quotes the United States Census OlEce
mortalitv statistics as saving Jacksonville
ranks third "among the verv large number
of municipalities in which t'vphoid fever is
continuously, or nearlv continuously, preva-
jgnt with high mortalitv." The tvphoid
^eath rate is given as 15.5, per lOO^OOO of
population. Jacksonville is also placed
second in the list of highest death rates from
of success. malaria among the minor cities, with a rate
of 78. In a list of total death rates the n ame
FeedlnglnMeastes and scarlatina.--
^^ Jacksonville appears at the top with a
.\obeeourtandPr.MerklenlGaz desHop)
^^^^ ^^ 38 per 1,000. The circular then
mention the genera employment of a m.lk
states that "everv resident should demand
diet 111 measles and 111 the hrst weeks ot
of the public authorities that every swamp,
scarlatina, this has been found usejul in
• marsh, and creek of Greater Jacksonville
... , , r 1
preventing kidnev troubles from becoming , , , , u 1,1, d 1 ^ j .u »
. . ^, - ,. ,
_, ^, ^ be placed under one Health Board, and that
serious m the latter disease. The authors ^^/ ^.^^ ^^^^^ ^^ .^^,^^^ ^^^ ^,j ^^^^.
seek in the examniat.on of the urinary ex- i^^provements necessarv to reduce the high
cretion a scientihcconnrmation ot the ptac- A^^tu ^„t^ t^ *u^ „„, ^^ f „;,.;i;,=^ „„
, , n^ ^t J ^i_ i_ ^ . J death rate to the average ot civilized comtical
results, lo this end they have tested .. *
,,
the urine and studied the changes in body
weight on a milk diet, on a general diet,
and on a diet rich in sodium chloride. In
'
New Morphine Snbstltatcs.
scarlatina it is with the milk diet maintain- Gelseminine is rapidly growing in favor,
ed from the urinary elimination is most as presenting most of the'benefils accruing
regular. With other diets the elimination {^om the use of morphine without anv of
of urea and that of chlorides present more jts disadvantages. Gelseminine is a sedaor
less marked oscillatiuns. With ingest- tive; uniform in its actions, widely applicalon
of salt there is sometimes noted a re- ble, and safe in that when the doses are
tention of chlorides. With milk alone al- pushed beyond a remedial limit it affords
buminuriais least frequent. The weight in unvar>'ing indications (ptosis, etc.) of this
scarlatina varies and diminishes no matter fact long before an unsafe dose has been
what diet is used. For all these reasons reached. It can be given in the usual way,
the milk diet is to be preferred to other meth- or hypodermically, causing no irritation in
odsof feeding, and it should be continued the latter instance. It is especiallv applifor
three weeks. It should be adhered to cable as a sedative, antipvretic and relaxabsolutely
during the febrile stage; later it ant in cases of children, as well as in those
may be varied by milk, soups and vegeta- of adults.
ble gruels. After the third week the diet xhe Abbott Akaloidal Co. presents gelseshould
be increased in variety, some meat minine in granules containing 1-250 of a
being given and purees of patatoes, peas, grain (per 100, 26c; 500, $1.15; 1000,
and lentils, and cooked fruits. The urine $2.25), and hypodermic tablets containing
should be carefully examined for albumin 1.50 of a grain (per tube of 25, 35c; 100,
during the whole time. In measles the $1.30).
elimination of urea is the same whether This remedy combines beautifully with
milk or barley water IS taken. There is no golanine, the "vegetable bromide," one
justifaeation for giving albuminoids in the grain of which is equivalent, as a sedative,
early period of the disease, since the appe- to 150 of K. Br.
tite is poor and vomiting often occurs. Four This is furnished in granules of gr. 1-67
or live grains of salt may be given every as follows: 100, 24c: 500, $1.28; 1000,
twenty-four hours. After the fever has $2.50. This combination is especially in-

^tttmai
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To obtain the best results5
in I
Anaemia, Neurasthenia,
Bronchitis, Influenza, Pulmonary
Tuberculosis,
and during Gjnvalescence after
exhausting diseases employ
fellows ^
of
Syrup
Rypopbospbites
Contains—Hypophosphites of Iron,
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Manganese, Potash.
Each fluid drachm contains the
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Special Note.—
pure strychnine.
Fellows' Hypophosphites
is Never Sold in Bulk.
Medical letters may fee addressed to
The Fellows Company of New York,
26 Christopher St., New York.
^

134
THF CHARLOTTE MEDIOAL JOURNAL
dicated in "tic," in all facial-nerve affec- tains, are important adjuvants. He adds
tions, as a general sedative and a hypnotic that the treatment of bronchia] asthma is a
where cerebral congestion predominates. grateful, but b}' no means an eas}' task;
success requires much skill, a determined
A preparation that has been on the mar- will and perseverance.—Deutsche Medizinket
for the past twenty-five years and one ische Wochenschrift.
that is known all over the country as a superior
antiseptic, is called Campho Phe- Carrol Soup lor Infants.
niciue, put up in both liquid and powder .
acute
form, it is one that can be used in all .^"^^ '"ff"',':
T*^,"""^, ^'°"'
nitesnnal disturbances, p ^,
cases of minor and major surgerv, in the
h. Moro
f^^"'^
'
. r , ., , , 7, ^ „„,.„ hifrlily recommends a soup prepared as foltreatment
of boils, carbuncles, ulcers, cuts, ,"-'„. f i^ t
, , ,
l^^^' I^'^"^,
etc., and will give the verv best results "y[°^^ "«
Peeled ^^'"'^'^f .f^^\
wherever indicated. The fact that so many
ma.hed and bo, led cu witli water,
phvsicians of oiominence all over the couu- ""^ ''
fr^"^^[""^';' '^^^""^^- 7 '"^''
i« tjien rubbed through a very fine sieve
Irv are using this preparation is conclusive
added together with
evidence as to the veracity of our state- 6 gm. of salt to 1
f."^
''"'"
ments. We are always willing and glad to l'^^^
°V'' ^ fT ^"^'!i IT
supply any physicianor surgeon with sam- "° "^
^""ll'^'T .
vv.th u^ t
he best results In acute cases °i the
plesofCampho-Pheniquefor experimental
1" ^ vomiling and diarrhea will cease in from
^ ^ ' one to three davs and the fever and general
Joliann Holt's Mall with Iron. symptoms of marasmus will rapidly dis-
, ^ . , r ^ appear. In the chronic affection and in
(Peptonates of Manganese and Iron
)
j^f^^^g suffering from atrophy, the result is
ITS PHYSIOLOGICAL EFFECTS. no less prompt, and a rapid gain in weight
By the light of modern science we know
that the effects of Iron on the blood are twofold:
1. Iron i'/z'//?« the red cells, being to
the hemoglobin what the sun ray is to
chlorophyll; (2) Or it r/a;/.? their growth,
being to the red cells what the soil is to the
'=a" he noted. The stools are soft, very
copious, and yellow or reddish-yellow. One
o^ the most pronounced results following
feeding with carrot soup is retention of water
vvithin the system of the infant.—Muench.
^^d. Woch.
seedling. In the first case, it is said to
res/ore; in the second, to regenerate. TrcatmenI ol Inlantile Eczema.
The whole effect of Iron requires the association
of managnese in a digestible
^
^he true chronic eczema of the infant is
p^bably a constitutional disturbance, and
the presence of staphylococci is due to sec-
T-4.»..mZ7*im.i ondary infection. Two factors can be rec-
. Treatment ol Astbma. . -
, j- ^ t^ t^ -^ i
ognized, according to E. Peer, a congenital
Doctor Treupel regards asthma as a disposition and improper feeding. Two
special form of neurasthenia, and believes varieties of eczema can be seen: The weepthat
it can be effectually cured by impress- ing form of fat children, with pasty coming
the fact of its curability on the patient plexion, which forms thick crusts and is
and obtaining his co-operation. The main usually accompanied by constipation, and
point is to influence and control the dread tlie disseminating, dry type, which causes
of suffocation and to regulate the breath- intense itching and runs a chronic course,
ing. The latter is accomplished by various Combinations of both types are common,
exercises, training the patient to breathe The treatment of infantile eczema is difdeep,
with a slow inspiration, at the same ficult, so that many physicians prefer to
time raising the arms over the head and wait for a spontaneous cure, particularly
then, during expiration, applying the hands as fever, convulsions, and even death have
to the front and sides of the chest, squeez- been known to occur. This is usuallv due
ing the walls together to aid in expelling to the presence of a well-defined status
the last traces of air. These exercises, or lymphaticus, though sudden death may altheir
equivalents, should be repeated once so be the result of a staphylococcus sepsis,
or twice a day for fifteen minutes. Electric External treatment is secondary in imlight
sweat baths and potassium or sodium portance to the internal. The crusts are
iodide have proved very useful in his ex- best removed slowly by applving dressings
perience when applied during the intervals of oil or vaselin. If there is much weepbetween
attacks. Sedatives may be useful ing, moist applications of very dilute alumm
the acute attack, but should be used only inum acetate will combat the inflammation,
m emergencies. Exercises and hydrother- Zinc paste is then used, and the parts are
apy, with a transient change to a more kept covered, so that the child cannot
favorable climate, the seashore or moun- scratch. The following additions may be
'

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DREVET MANUFACTURING COMPANY, 57-59 PRINCE STREET, NEW YORK
Dr, F T. Meriwether^s Private Hospital
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AsKeville, N. C.
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Modern in all respects, Trained Nurses.
In Asheville's superb climate; centrally located, but on a quiet and retired
street. Miss B. A. Veal, Supt.

136 THE CHARLOTTE MEDICAL JOURNAL. ..;
necessary: 5 to 10 per cent, naftalan, where aglycosuric. A moderate percentage off
there is delayed healing; 1 to 3 per cent, sugar is, therefore, not objectionable, pro- J
tumenol, if the itching is intense; 1 to 5 per vided a larger amount of carbohydrate is '-^
cent, lenigallol, for pronounced weeping; utilized. As a rule, the amount of bread )
2 to 5 per cent, sulphur, for the seborrhoic should not be reduced below 60 Gm. Ex- 'i
type; J^ to 2 percent, salicylic acid, for ceptions are where patients suffer from neu- ;
the dry and infiltrated form, etc. In very ralgia or other complications, as the symp- j
dry, obstinate types, the addition of 1 to toms generally disappear more rapidly if no J
1 per cent, of oleum rusci or oleum cadini sugar is excreted. A stricter diet should 1
will be serviceable, with small doses of also be enforced in very recent cases, in the'?
Fowler's solution internally, while the dis- hope that the process may be cured.
seminated form is often benefited by sul- Where an operation is contemplated, it
phur baths. is also desirable to have as little sugar in ^
The most important change to be made the urine as possible, though even large ^
in feeding is reduction of milk. Breast-fed wounds may heal with moderate glycosuria. '
I" more serious cases of diabetes, the fats :s I^
infants should receive only five feedings,
and gruels mav be added to the diet after are also imperfectly oxidized, leading to
the third month. In artificially fed chil- fatty degeneration, lipemia, and the excre-'
dren the amount of milk is reduced ji to tion of acetone. In such cases, the decom-
'A
liter. If no improvement is noticed in from position products of sugars, such as carbo'
one to two weeks, the milk is cut down still hydrate acids, glyconic acid, saccharic, an'
more, and the carbohydrates (gruels, sugar) mucinic acids or glycosamin, can be admin
are increased. There mav be a loss of isteied with good results, or the sugar may ,;
weight, amounting to from 5 to 10 per cent,
After the fourth month cereal decoctions
be given per rectum. Little benefit willre^
suit from the administratien of levulose o^
may be used more freelv, and the juice of lactose. •,
fresh raw fruits in teaspoonful doses is in- 1'l»e best results are obtained from oatdisated.
In the second half vear. finely meal, which will reduce the amount of i
mashed, stewed or raw fruit, potato, and sugar and acetone, often to a remarkable |
green vegetables can be given. In very ob- degree. What this action is due to is at j
stinate cases it may be necessary to with- present not known.—Berl. klin. Woch. ,
hold milk altogether for a few weeks, if the
child is over six months old. Skimmed or
buttermilic is usually better than full milk.
In the second vear the diet consists chiefly
of vegetables and fruits, with 1-4 to 1-5 liter
The Sign ol "Tapolagc" in Pulmonary
Phthisis.
I
I" 1904 Erni described a symptom which ;
of milk. Meat can usually be added by frequently exists in pulmonary tuberculosis,
the third or fourth year, but" eggs and broths 1" certain cases percussion—above all in

ADVERTISEMENTS.
St, Luke's Hospital
UHH) WEST GRACE STREET,
— RICHMOND, VA.
[JS^^AO AI.
Both
Owned and personallyconducted
Ijy Dr. Stuart JIcGuire for the exrlusive
use of his private patients.
r.uildin.n erecle(! for the purpose
lowliich it isdevoted, and combines
Uie comforts of a home with the
conveniences of a modern sanatori-
I.ocatiou in residential section
convenient to all parts of the city
by means of the street car service.
Capacity forsi.xty patients, single
and double bed rooms, No wards.
Designed especially for surgicHl
and gynecological eases. No contagious
diseases, insane or colored
patients received.
Cost of bed, board and general
nursing from $14 to J18 per week
For further information, address
the Secretary.
BROADOAKS
SANATORIUM
Morganton,
North Carolina.
A Private hospital for llie
Treatment of Nervous and /Mental
Diseases, Inebriety and Drug
Habits
A home (ur llic Permanent Care
oi SELECTED CASES OF
CHRONIC NERVOUS AND
MENTAL DISEASE.
1^0U J S O. BEALIv, AI. r».
Medical Officers reside in the SANATORIITM and devote their
whole time to its service. New addition just completed admits
of thorough classification of patients, and gives better faci-
lities for the care of all. Billiards, Tennis and other diverting
ainusemenls.
Coni7)lete equipment for Hydrotherapy now being installed.
Correspondence with physicians solicited.
1

Treatment ol Empyema of flie Nasal
Sinuses.
Mortens describes a suction apparatus of his own
construction, which he claims is of great aid in the
diagnosis of suppuration of the ethmoidal cells and
the sphenoidal and frontal sinuses. This apparatus
is especially valuable in diagnosing suppuration of
the ethmoidal cells. The apparatus consists of a
suction pump to which a muck nasal tip is attached
by means of hose with a vanknmeter intervening
lo register the suction power. Suction being continuous.
With the apparatus in motion and lo to 15 cm.
mercury pressure registered, the muck tip is placed
into one of the nostrils of the patient. The patient
is then instructed to repeat the word "Tik" to bring
about the shutting off ot the naso from the oral
pharynx. The patient's otlier nostril is then closed
by applying pressure with the linger. The lateral
opening of the nasal tip is closed with the physician's
finger, thus suction is brought about in the
nasal cavity. Fifteen to twenty-five centimeters
applied for three to five minutes suffices usually to
draw pus from the sinuses into the nasal cavity,
when it exists. If applying suction pus appears in
the nose previously free from purulent discharge,
the diagnosis of empyema is made. Not only is
this method valuable for diagnosis, but also for
therapeutics. Ridding the cells of pus frees the
mucous membrane and favors restoration. The
suction applied causes hypertemia of the tissues,
which, according to the Bier theory, tends to healing.—
Deutsche Med. Woch.
Adrenalin: Its Action on tbe Skin.
Sardou discusses the remarkable benefits to be
derived from painting the skin with adrenalin.
His results are based upon the results obtained in
54 cases during the last six years. Among the conditions
treated were toxic erythemas, urticaria,
acne, sunburn, bee sting, eczema, pruritus, nevus,
contusion, inflamed chilblains, headache, and congestion
of the facs from indigestion, sciatica without
neuritis, arthralgia, arthritis, varices, etc. The
adrenalin applied to the skin is rapidly absorbed
and acts on the vessels in the region. Durable
vasoconstriction is obtained by a moderate, graduated
application of the adrenalin, rrnewed according
to the effects produced. Too large a dose, at
first, paralyzes the reaction. Hffin.orrhoids are
benefited when moderate nnd recent, unless tliey
are the result of portal hypertension. The measure
may also fail on account of sclerosis and paresis of
the walls of the vessels. The effects of the adrenalin
are similar to those of constriction hypertemia.
When applied locally it re-enforces the local defenses
without waiting for general reactions, the
outcome of which it is impossible to foresee. The
adrenalin is able to act in the depths of the tissues
and to aid their defensive efforts, or the adrenalin
may arouse them to more effective resistance.
Annales generalcs de Medecine.
Hydrocepbalus, Chronic Iiilop&thic Internal,
Cured by Draizcage ol tbe
Ventricle.
Halben states that all the main symptoms have
retrogressed since the operation done by Pavr last
October. The patient was a girl of sixteen ; Payr
introduced into the right lateral ventricle a piece
of an artery about 2 millimeters in diameter taken
from a calf. The artery had been hardened in
formalin and dipped in paraffin, and was fastened
to allow couim\inicatiou between the ventricle and
the epidural and subdural space at the top of the
head. The headaches, choked disc, nystagmus,
—
THE CHARLOTTE MEDICAL JOURNAL.
abducent paralysis and tremor all vanished once 01!
by the end of a month, and vision, which had beeUi
1-2 on each side, was 4-5 and 5-5 when the patient
was discharged two weeks after the operation,]
Slight headache at times is the only trace left of'
the former trouble, except that the papilla look3i|
little dirty. The patient had always suffered mo
or less from headache, but the other symptoms i
developed about five months before the operatic
—Deutsche medizinische Wochenschrift.
Hypertropby ol tbe Lymphoid Tissua
ol tbe Pbarynx and Its Relation to 1
Tuberculosis. |
P. Nobecourt and Leon Tixier have examinedl'
twenty-two children from thirty-one mouths tAj
four years of age, all of whom had large adenoids;
and enlarged tonsils, but none of whom had pnlmonary
tuberculosis. They sought for appreciablej
tuberculous lesions and used tests for the presenoej
of tuberculosis; the subcutaneous method, ophthal-|
mic reaction and skin reaction were used as tests,:
A table of the results is appended. Bacteriologica'
and histological examinations of the tissues rt
moved were made. Of the children thirteen had;
no sign of tuberculosis; six had doubtful signsjj
three were considered clinically tuberculous, andj
two were clinically doubtful. The skin reaction;
was positive twelve times; the ophthalmic reaction]
was positive four times; only five infants out of thtj
twenty-two could be considered free from tubercu-|
losis, and yet almost ali enjoyed excellent health.;
The portions of tissues removed and examined!
never showed tuberculous foci. The authors conclude
that tuberculosis of the tonsils and adenoid]
tissues of the pharynx is rare. In these children]
who were openly tuberculous the inoculation ol;
guinea pigs with the tonsilla tissue never produced
tuberculosis. The lymphoid tissues didnotserv«j
in these cases as the door of entry for the bacillus 1
tuberculosis —Gazette des Hopitaux. ;
Pulmonary Empbysema and FaJty De-I
generation ot tbe Diapbragm in
Dipbtberttic Intoxication. I
G. :\Iya has observed in children «ho wert- sub-
ject to severe diphtheritic intoxication a cdiuiition'
of emphysema of the lungs, which may go .=0 fai
as rupture of the vesicles of the lungs ami sub-
pleural, and even subcutaneous emphysema. The
type of case in which this is .seen is that in >. liicb i
there is a necrotic angina with great enlarj;i;nienl 1
of the glands of the neck, myocarditis, albumniiiria, i
cutaneous hemorrhages, and muscular astiie nia '
Such cases generally result fatally. In life tlie arei |
of resonance of the lungs extends down to lli< ;
seventh rib in front and the twelfth behind, aiic .
the vescicular murmur is enfeebled, while inspira
,
tion is short and superficial. In these ca?es tber<
is no laryngeal stenosis, and hence the coulitifir I
cannot be referred to the extra effort required foi
resjiiration. At autopsy the clinical evidences i
confirmed by finding the macroscopic and micro
scopic characteristics of etuphysema. In thest
cases there is also found a fatty degeneration of tin
muscular fibers of the diaphragm, which aid:
lack i)f elasticity of the lungs, due to deficient
power of the elastic fibers in producing the euiphy
sema.— Rivista Di Clinica Pediatrica.
Graduated Rest In Pulmonary Tuber;
culosls.
It is possible to give the lungs approximate, nolj
complete rest. This latter measure should be pre^
scribed sufficiently early and for suBBciently lonfj
periods. .\11 patients who exhibit even the smallest
1'
| i,

' > ' " '
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sign of invasion by tuberculosis must be treated
•with the utmost rigidity. Rectal temperatures
should be taken while the patient is in bed and so
long as there is any fever, bed rest must be maintained.
Such cases'should not be put out on verandas
in long chairs. Absolute silence must be
maintained when, during rest in bed, the temperature
rises over 100.4 degrees at any time of the day.
If this limit is not exceeded, the patient may visit
the lavatory and perform the usual duties of the
toilet. The' morning temperature should be taken
before breakfast, and it should fall at least as low
as 97. H before the patient is allowed to get up.
Cases commencing with an initial htemoptysis are,
as a class, the cases which exhibit the least fever,
and consequently require the least rest, but all require
some rest in bed at the commencement of the
bleeding. Later such patients may be allowed to
exercise cautiously Early resting prevents acute
and incipient cases from becoming chronics. Patients
who manifest at the outset the most violent
constitutional symptoms, if they eventually survive,
ultimately make the most perfect recoveries.
All these suggestions apply to laryngeal lesions
with double force. The cough should be controlled
with opium derivates, and absolute silence must be
maintained for a period of even months. So soon
as the temperature falls, laryngeal patients may be
allowed to exercise.—E. E. Prest in The London
Lancet.
State Board Examination Questions of
West Virginia, 190S.
.\n-\to:mv and embryology.
1. Give the character of a vertebra.
2. Describe the skin and its appendages.
3. Hip joint: Describe it, naming variety, giving
bones and ligments.
4. Name the regions of the abdomen and give
contents of any two.
5. Describe the brachial artery and name its
branches.
6. Describe the inguinal canal. Wherein does an
artery differ from a vein?
7. Give origin and insertion of triceps muscle.
8. Describe the gall-bladder and bile-ducts.
9. How many bones in the human skeleton?
Classify them.
10. Describe the blastoderm.
PHY'SIOLOGY .\ND HI.STOLOGY.
1. Describe the principal phenomenon that occurs
when a muscle is physiologically active.
2. State with what principal functions pulmonary
endothelium is fn. lowed, and describe the origin
and character of the blood which an alveolus utilizes
during the physiological action.
3. Give the source and state the character of the
blood supplying hepatic parenchymatous cells, and
describe the two principal functions they possess,
4. State the effects of battery currents on the normal
human nerves.
5. Give the process of regeneration of uterine
mucous membrane following pregnancy.
6. Describe the physiological aspect of atavism.
7. Account for the contraction and dilatation of
the pupil.
8. Name the circumstances influencing secretion.
9. WTiat are structural elements? What is a typical
cell?
to. Give the elements of the nervous system; the
connective tissue.
1. Give tests for urea and acid, give chemical
differentiation.
2. Test urine for albumin, sugar, indican, and
phosphates.
"HE CHARLOTTE MEDICAL JOURNAL.
3. Name antidote for phenol and treat case of
poisoning,
4. Make tests differentiating the alkaloids, morphine
sulphate and quinine sulphate.
5. Define medical jurisprudence.
6. Give symptomb of lead poisoning and treatment.
7. Wdat are ptomains, and in what found? Give
symptoms and treatment of ptomain poisoning.
y. What is hard water? How does it become
hard? Give two ways of softening it.
What are the antidotes of bichloride of mercury?
Give treatment for poisoning therefrom.
1... What isHjO, H0O2, NaCl, H2SO4?
M.VTERIA MEDICA AXD THERAPEUTICS.
I
I . '.ive origin and uses of carbolic acid.
2 Cinchona: Where found, chief alkaloids, uses,
ami iliise.
;,. Apomorphine: How obtained, use, dose.
4. .Abstracts, extracts, infusions, tinctures, mixtures:
define each.
5. What are hypnotics? Name three most important
ones, doses, and indications.
6. What is the temperature of tepid bath, warm f
bath, and hot bath; indications for each.
'j
7. E uTienagogues: When and how to be used ; ;
name three, with doses.
8. Name five mineral astringents; give dose of '
each. !
9. Sweet spirits of nitre, Hoffmann's anodyne: |
indications and dose of each.
10. Prepare and administer a purgative high rec- ;
tal enema, \
PRACTICE OF MEDICINE AND PEDIATRICS.
1. Dysentery: Etiology, complications and seque !
Ise, and treatment. ;
2. Rheumatism: Give the different forms; treat I
each. j
3. Tonsillitis: Differentiate from diphtheria; ,
symptoms and treatment.
4. Give etiology and treatment of hemoptysis.
5. Intussusception: De6ne, diagnose, and treat, j
6. Cirrhosis: Etiology, symptoms, and treat- j
ment. |
7. Ascites: General causes, symptoms, and treat- ,
ment. !
8. Intestinal catarrh of children: Symptoms and |
treatment,
]
9. Describe the lumbricoides and give origin, 1
symptoms, and treatment.
10. What diseases does meningitis complicate in 1
children?
OBSTETRICS AND GYNECOLOGY. ]
T. Differentiate pregnancy from three possible
ailments that simulate it.
j
!
2. Whatoccasions vomiting of pregnancy? When |
is it pernicious, and what is remedy? i
3. What preliminary knowledge of the patient j
should the accoucheur have? !
4. Describe the possible hemorrhages of preg- j
nancy and your method of checking them.
5. How long would you work with the newborn 1
to bring about respiration, and with what methods? '1
6. Fully describe the third stage of labor, giving |
1
methods and danger of delay in delivery.
7. Milk leg: \X^hy so called, cause, and treat- (
ment?
8. When is curettage indicated? Give your way it
of doing it.
9. Give nosology, symptoms, and treatment of i,
menorrhagia. 1
10. Nosology, symptoms, and treatment of .-'
vagiuismus.
SURGERY.
I . What is suppuration? Give causes and symp- jl
i

I
«43««
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THE CHARLOTTE MEDICAL JOURNAL
2. Describe Syrae's operation for amputation at 12. In anatomy of brain what is corpus
the ankle.
callosum?
3. Give the indications for reopening wounds.
4. Give the differential diagnosis of hydrothorax 13. Give origin and exit of pueumogas-
and empvenia.
tric nerve.
5. Give in detail the treatment of a compound 14. Give origin and exil of trifacial nerve.
fracture of the tibia.
15. What is contained in middle medias-
6. What are the clinical symptoms and what is
the surgical treatment of a purulent effusion into tinum?
the knee joint?
16. Name subdivisions of alimentary ca-
7. Name the different kinds of fractures, and give nal.
differential diagnosis between fracture of neck of
17. Where in the topography of the abdo-
femur viwl dislocation of ihe hip joint.
8. Give in detail treatment of a punctured wound men is the si.q^moid flexure? The appendix?
involving the deep palmar arch.
18. Into what and how far from the pylo-
9. Give causes, symptoms, and treatment of ric orifice of the stomach does the ductus
osteomyelitis.
10. Give causes, symptoms, and treatment of
phlebitis.
comunis choledochus open?
PHYSIOLOGY.
SPECI.4L PRACTICE.
1. Give diagnosis of ulcer of stomach.
2. What is amebic dysentery?
3. Describe and treat adenoids.
4. What would you suspect from continued
hoarseness?
5. Describe enucleation.
6. Define, describe, and treat cataract.
7. Diagnose impacted cerumen and treat.
8. Test the hearing. What is the most common
cause OS deafness.
9. Describe locomotor ataxia.
10. Describe paresis.
B.\CTER10I,OGY AND HYGIENE.
1. What is the difTerence between parasites and
saprophytes?
2. What is the bacterium concerned in septicemia?
How does it enter the body?
3. Describe the bacteria found in pneumonia.
How are they transmitted?
4. Give a minute description of disinfecting the
hands and instruments before performing an operation.
5. What group of bacteria are most resisting to
disinfectants? Why?
6 What hygienic principles should be applied to
our public schools?
7. Can tuberculosis be prevented? If so, how?
S. How would you prevent the spread of diphtheria
and scarlet fever?
9. Give sanitary treatment of the puerperal state.
10. Disinfect a house after the recovery of a case
of diphtheria. Give details.
Board ol Medical Examiners, State of
Georgia—Examination Questions.
ANATOMY.
1. Name articulations of occipital bone.
2. With what bones does the clavicle articulate?
3. What bones make up the pelvis?
i, Name bones of tarsus.
5. What muscles form quadriceps exten-
sor, and where is its conjoined tendon inserted?
6. What muscles comprise pectoral group?
7. Give origin and insertion of pectoralis
major muscle.
8. What blood-vessels pass to and from
liver?
9. Name branches of external carotid
artery.
10. Name branch of femoral artery.
11. How is circle of Willis formed?
. . .
1
What four elements do all quaternary'
principles contain? Practically into what
must albuminoids be changed before absorption?
2. Name the intestinal glands. Tell where
each variety is situated, What do they
secrete and name the ferments.
3. Describe the renal circulation.
4. Give the chemistry of respiration.
5. Give origin and function of the hyponerve.
CHEMISTRY.
1. Give tests by which mercuric compounds
can be distinguished from mercurous
compounds.
2. Give the chemical and pharmaceutical
names and formulas of two preparations of
sodium.
3. What are leiicomains? Antitoxins?
4. Give a chemical and physiological antidote
for morphine. Explain action of
each.
5. What is the normal reaction of pancreatic
juice, and to what is it due? Of
gastric juice? To what is it due?
MATERIA MEDICA AND THERAPEUTICS.
1 Give classification of medicities with
definition, and example of
their alphabetical order.
each group in
2. \'eratrum viride: Preparations, physiological
action, therapy.
3. Gelsemium: Preparations, physiological
action, therapy.
4. Opium: Preparations, its six principal
alkaloids; official preparations of morphine;
treatment of acute poisouing.
5. Salol: Definition, physiological action,
therapy.
PATHOLOGY
1
Describe the pathological changes in
the three stages of acute lobar pneumonitis.
2. What pathological changes occur in
the air-cells during pulmonary hepatization?
3. Give the morbid anatomy in acute
yellow atrophy of the liver.
4 (a) What is productive inflammation?
.

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For The STOMACH , '^'l &nA as found m
vs j«outD Pf?OPERLY fe'i; PEPTENZT/nE
"EED lire Digestive fc?) aiakes it
:ELL5 la ordtr («) DIFFERENT
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THE CHARLOTTE MEDICAL JOURNAL.
(/>) What is suppurative inflammation? 5. What are the contraindications respec-
5. Describe fatty degeneration as distin- lively to the use of the three principal anesguished
from fatty infiltration of tissue. thetics—nitrous oxide, ether, chloroform?
PRACTICE OF MEDICINE. What is dislocation? Fracture?
. , , ^. n c 1 Give differential diagnosis between
1. Acute articular rheumatism: Defini- f,,,uire and dislocation,
tiou, etiology, morbid anatomy, symptoms,
,^ De.=cribe CoUes' fracture!
complications, diagnosis treament
2. Cholera asiatica: Definition, etiology,
morbid anatomy, symptoms, complications
and sequels, diagnosis, prophylaxis, treat-
.
^ ^^^^^.^^^ treatment of same.
^^ ^^^^^ .^ hemorrhage?
^ ^ ^^^^ ^^^^^^^ ^.^^ ^^^^^^ epistaxis?
^^ Describe operation for ligation of
'^^^ ,^ „ r .,. ,. , ,. sublavian arterv in its third portion.
3 Dysentery: Definition, etiology, chn- ^3 ^^^^^ ^^^^^.^^ ^ .^^ ^^.
ical forms, anatomy of each form, d.agno-
^^^^,-^^^^ ^^ ^j^dle third of leg?
^'^'
^''ff^f^" V ,.
4, Hydrc phobia:
„ ^ .,.
,, ,
Definition, pathology, ,
14.
.
Describe complete ^ indirect inguinal "
symptoms, diagnosis prognosis, treatment.
^H'^q-^^ symptoms of strangulation,
5 Uncinariasis: Definition, etiology,pa-
^^thods of reduction, and operation if stranthology,
diagnosis, treatment.
^^^^^.^^ ^^.^^^
OBSTETRICS. ^(j Describe an approved operation for
1. What attention should be given to the the radical cure of oblique inguinal herni.
kidneys of pregnant women?
2. What are the symptoms of threatened SImptllied Technlc for Radical Cure of
eclampsia? Inguinal Hernia.—Murray (British Med.
3. What are the causes of antepartum Jour.) says that the chief cause of failure
hemorrhage? How should they be man- after operation for inguinal hernia is inaged?
complete removal of the sac. The writer
4. What is the usual procedure in the further says; "in examining patients in
delivery of the placenta? whom hernia has recurred I have been at"
5. How would you manage a breech pre- once impressed by the position of the scar,
sentation? The skin incision had been made far too
PEEIATRICS. low—in fact, it encroached upon the scro-
1. Give etiology, complications, and du- t"- and did not extend upwards further
ration of pertussis. than the external abdominal ring. Through
2. Give treatment of acute adenitis. such an incision it is impossible to excise
3. Define ophthalmia neonatorum and the sac completely. The lower end of the
give its treatment. skin incision should not extend more than
4. Give synonymand treatment of scabies, one-half inch below the external abdominal
5. Give diag-nosis and treatment of bron- ring. I always open up the inguinal canal
chopneumonia.
for about one and one-half inch, and, havrvvwrornr-v
i"? found and isolated the sac, make a
uvMicoLoc^
^.^^^
, ^ n
^^ pulling it vertically upwards, and
1, Define endometntis.and give Its causes,
^^ ^^^ g^^^^g ^-^^ brushing back with gauze
varieties, and treatment.
^^^ ^^1^^^ structures clinging to the neck of
2. Give a differential diagnosis between
^^^ ^^^ j continue to pull the sac upwards
ovaritis and ovaralg.a. ^
and push bank the surrounding structures
^ , ,
0. Give the pathology of (a) hydrosalumil
I bring into view a marked thickening
pinx, id) hematosalpinx; give the diagnosis
^f ^]^^ peritoneum. This thickening is to be
and treatment of each.
f„^„d on the pubic side. I always look
4. Is ventrofixation of the uterus justifif^^
^^ ^„j ^..^en it appears know I have
able? If so, state under what circumstanreached
the limit of the sac. Bv transfixing
ces and describe the operation
^^^ jy,,^^ ^^e peritoneum through this thick-
.5. What IS the menopause, and m what
ened portion the limits of the sac have been
manner would you explain the theory that ^^^^^ ^^^^ ^^.^eu it is cut away the ligait
IS a critical period in a woman's life?
^^^ed stump at once disappears from view
SURGERY. beneath the internal oblique. This thick-
1. Define abscess; aneurysm: With what
condition may aneurysm be confounded?
ening of the peritoneum is physiological,
It is present during infancy as well as dur-
2. Make briefly a diagnosis of coma from ing adult life, and when operating for iuinjury,
apoplexy, uremia, opium poisoning, guiual hernia should always be looked for,
and alcoholic intoxication. as it is the only true indication that the
3. Define peritonitis. limits of the sac have been reached. The
4. State two or more ways in which the sac being thus completely removed, I unite
peritoneum may be invaded by bacteria. the divided aponeurosis of the inguinal

ADYERTIESMEWTS,
Inflammation's Antidote)
• ' *
A rational method of treating lo-
cally all forms of disease in which
inflammation and congestion play
a part.
THE DENVER CHEMICAL MFG. CO.,
NEW YORK

XXX THE CHARLOTTE MEDICAL JOCRNAL
canal. Formerly, I did this by overlapping, coryza makes its appearance. Used prophybut
more recently I have taken a double lactically in this manner, it serves not only
hold of the ap jueurosis on either side with to prevent the irritative cough, but guards
the needle, and so with four or five stitches against the development of middle-ear innarrowed
and lengthened the inguinal ca- flammations.
nal. The cord is not interfered with, and,
tfter tying several small bloodvessels, the rl^.^jl^'^: ,P' Cystoscopy in f^i^Zh^.^^'Sl^^Kl^Lf^^^^
Ike Detection ol Obsolesskin
incision is closed. On the seventh
, ^, , , . -11 * ccd TabercJe sa She KiSiney.— I. Fenwick in
day, tae subcutaneous wire or silk stitches ,„. ,,, ^^ r i " t i c
, , The Glasijov.- Medical 1 1 4.1 Journal refers to one
are removed, and, as a general rule, the •
^i ^ l-
i i- ,
. ^ . ' ,' ,^ ,• , ,\ case, that ot a woman m whom radiography
paueiit IS allowed to get up on tue tenth •.,,», r j j i
',
, , , , ., , ,, r demonstratea the presence of rounded renal
day, and leaves the hospital on the four- .
i j j r ,i r
^\, J c, ,1 4- ,. • prominences considered as cvsts and full of
teeuth day after the operation, not wearing ^ '
^ •
i ^ v,
u t-i
^ • c 1 • J TT 1 caseous material like cream cheese. The
a truss or support of anv kind. He is ad- , .
i j i, £u
. J . . . .
'
1 t-i ^ 1 . pelvic space was replaced bv fibrous tissue,
vised not to return to work until at least L, , ' ^-V j tm
, . , J ,, The ureter was a fibrous cord. The organ
two more weeks nave elapsed." , ,
•
i » .
x.
was removed and proved to contain such
Sterilization of Tuberculous Women material and to be of the exact size sketched
During Pregnancy.— Martin discusses the by the author. He was able to make his
effect of pregnancy upon a woman suffering positive predictions by the use of radiograpy
from tuberculosis and considers the advisa- and cystoscopy. The writer knew the pability
of ending the pregnancy and prevent- tieiit 'had tuberculosis somewhere in the
ing further conception by performing the urinary tract. Kighteen years ago he had
paiihystereclomy on the gravid uterus. He examined her with the cystoscope and found
lays down the following rules for the opera- ulceration of the bladder near the right
tion: (1) There must be definite physical ureter. Later experience has convinced the
signs of tuberculosis or the probability of author that such ulcers signify tuberculous
its presence must be made strong by the disease of the corresponding kidney. When
sudden failure in the patients general con- seen the second time, the cvstoscope revealditioii
and loss of weight, following quickly ed the cicatrix of the old ureteral ulcer, and
on the beginning of pregnancy. (2) The it was evident that the uterer was imperviinterruption
of pregnancy has no influence ous and functionless. The next question
if the pulmonary process is far advanced,
or the woman is approaching the second
half of pregnancy. In such case the procedure
is of value only in case of the sudden
onset of edema of the larynx or the lungs,
vvas, was the presence of the kidnev detri-
mental? Radiography now determined the
presence of the cvstic masses above referred
to. Catherization of the left kidney showed
evidences of consecutive nephritis induced
(3) Suitable cases for the interruption of probably by absorption from the foci in the
pregnancy are those in whom the disease is right kidnev. It was therfore deemed adviin
an early stage and the pregnancy is in sable to remove the original source of infecthe
first third of its course. A valuable aid tion. He savs that the kidnev is always
111 determining the suitability of the patient radiographed for him in two positions: in
is foundin theconjunctivaltuberculinreac- one the patient takes a deep breath and
tion. (4) If the interruption of the preg- holds it while the X-ray is switched on; the
nancy is indicated it should be done under effort thrusts and keeps a mobile kidnev
lumbar anesthesia and the simultaneous down; for the next plate the patient breathes
sterilization and complete extirpation of the easily and naturally while the kidney rises
gravid uterus should be done. and falls easily. If the shadow of the organ
Tito Trcalmcna corresponds in position in
oJ Nasopiiaryngeal Catwo
plates we
tarm in Children.— Hecht (Therapeut. ^>' '^'"^^ 1'=^^'^ a dangerously fixed
^f
Monatsch.j observed
k'dney to deal with. If the shadow had
that very severe convulsive
attacks of coughing originate re- '^°''^^' }^^ "''-^" '^ movable and may be
flexly by way of the nasopharynx ^^''^ "^^^^^ '""'•
affected
by the catarrh. During the night especially,
with the patient in the recumbent position,
the secretion runs down at the posterior sur-
Suits Against American, Medical Association.
face of the pharynx and determines the re- According to a clipping from one of the
flux at the larynx, This occurrence is es- Chicago newspapers, "separate suits for
pecially frequent in measles. The
remedy consists in installations, at
best
first
$100,000 damages each have been brought
in the United States Circuit Court in Chievery
three hours, then three times daily, cago, by Dr. S. Lewis Summers, and the
of a sozojodal, zinc solution (>^ per cent.) Organic Chemical Manufacturing Compainto
the nose. This treatment isprescribed
by the author in measles as soon as a-severe
uy, both of this city (Chicago), against the
American Medical Association, for alleged

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Added to fresh cow's milk it approaches
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It is very easily prepared, and with simple
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When mother's milk fails give
Mellin's Food
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desiring a quietj homelike institution combined
with every modern facility and equipment.
A private hospital, delightfully situated,
bright, well ventilated, amid attractive and
quiet surroundings.
Correspondence with physicians solicited
Southgate Leigh, M. D., Stanley H. Graves, M. D .,
Surgeon in Charge. Associate Surgeon.
James H. Culpepper M. D., Miss M. A. Newton,
Associate Physician and Pathologist. Superintendent.

XXXII THE CHARLOTTE MEDICAL JOURNA].
misrepresentations about the products of acid and clears up the administration of
the plaintiff Company in the publication of these tablets. This remedj' is also reliable
the Association." The suit, it is declared, in the treatment of diarrhoea, enterocolitis,
"will expo.se a systematic attempt to give a dysentery, etc. In dysentery where there
monopoly to certain German chemical man- are bloody, slimy discharges, with tormina
ufacturers, shulliiig out American i)roduc- and tenesmus, a good dose of sulphate of
ers. One of the features expected to be magnesia, followed by two antikamnia and
brought out is how patients are compelled salol tablets every three hours will give reto
pay tribute to certain German manufac- suits that are gratifying,
turers of standard drugs and remedies. If
prescrtbed by physicians under their trade-
Poison Oak.
mark names, which are easily remembered, At the solicitation of a fellow physician
their cost is three or four times as great as
when prescribed under the technical names,
at St. Bartholomew's Clinic of this city, I
was induced to use Tyree's Antiseptic Pow-
As the latter are complicated and hard to der in the case of an indolent ulcer, which
remember, few physicians use them, prefer- had resisted all jirevious atiempls at healring
the simpler ones.
"The position of Dr. Summers is stoutly
ing. The rapidity with which this case responded,
led me to try it in a wider field,
supportedby such experts as Professor Sam- almost everywhere an antiseptic was indiuel
P. Sadler, of the College of Pharmacy cated. Last July I employed the powder
(who was amemberof the Council on Phar- in a case of ivy poisoning (a young lady),
macy and Chemistry of the American Medi- She had been suffering for over a week, all
cal Association for three years), and Dr. home "remedies" having failed. I applied
Henry Beates, Jr., President of the Penn- locally, as a lotion, a teaspoonful of the
sylvania State Medical Examining Board,
who both vigorously oppo.se the findings of
powder dissolved in a pint of water and
also for dusting the inflamed surface, the
the Council on Pharmacy and Chemistry on powder diluted 1 in 10 with powdered talthe
subject." cum, the itching and swelling subsided
While we profess to know nothing of the within 24 hours, and a cure was effected by
true merits of the case, and cannot commit the fourth day.—Arthur J. Schneidenbach,
ourselves to an opinion, it may yet be re- M- D-, St. Bartholomew's Clinic. Sample
marked that in view of certain reckless or with chemical formula, bacteriological and
hasty judgments by this Council on Pharmacy
and Chemistry, we are not surprised
that suits have been instituted. We preclinical
reports free upon application. It
will not irritate the most sensitive skin,
22c. per box. J. S. T>Tee, Chemist, Washsume,
however, that the Association is fully ington, D. C.
able, financially, to meet the losses, if
sutts should be awarded in favor of
the Tbe Treatment of Carbuncle and Kindred
the Diseases.
plaintiffs, but it should teach a lesson to the When I find a case of carbuncle 1 inves-
Council, which thus implicates the whole tigate it just as I would any other ailment.
Association, to be more careful in its future correcting morbid conditions, both systemic
publications. and organic, by the use of proper remedies.
'
Good Results in Stubborn Cases.
Every physician knows full well the ad-
Abbott's "Clean out, clean up, and keep
clean" is the motto, and Salithia to effect
with the W-A Intestinal Antiseptic (Sulvantages
to be derived from the use of anti- phocarbolates Comp. Abbott ) q.s. are the
kamnia in very many diseases, but a num- remedies of choice. While doing this, satber
of them are still lacking a knowledge urate with Abbott's calcium sulphide, an
of the fact that antikamnia in combination unexcelled product, and apply to the carwith
various remedies has a peculiarly hap- buncle a Saturated solution of Menthol
py effect. Particularly is this the case Compound (Abbott)—at least 4 tablets to
when combined with salol. Salol is a most 1 pint of water. Patients compare it to
valuable remedy in many affections and its pouring water on a fiery coal. The pain is
usefulness seems to be enhanced by com- relieved immediately and does not return,
bining it with antikamnia. The rheuma- and that is the desideratum with the patient,
loid conditions so often seen in various That's all. Only keep till resolution is
manifestations are wonderfully relieved by
the use of this combination, and the painful
complete.
With a little common sense, a good supstiffness
of the joints which remains after a ply of the alkaloidal granules and tablets
rheumatic '
attack are also relieved by 'Anti- we can control everything controllable readkamnia
and vSalol Tablets" containing 2l'h ily—but quality of medicine is of great im-
grs., each of antikamnia and of salol and portance. That's what Abbott gives us.
the dose of which is one or two every two M. W. C. Frazier.
or three hours. Salol ueutralizes the uric Carrizo Springs, Texas
i

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a fee of $5 oij is charged for the preparation of tlie operating room. Charges for professional services
are based on the nature of the case.
For lurtber Inlormatton address.
ST. MARY'S HOSPITAL. ATHENS. GA.
THE LAND OF THE SKY" NORTH CAROLINA
Medical and Surgical Treatment of Tubercular Diseases. lUevation 1,200 feet.
At the foot of and surrounded by the beautiful Blue Ridge Mountains. Pure mountain
water, cottage system, all approved modern methods of treatment used to suit individ-
ual cases. Strict hygiene, particular attention to diet. Climate and scenery unsur-
THE THERMAL BELT SANITARIUM. TRYON. N. C.

XXXIV THE CHARLOTTE MEDICAL JOURNAL.
The Differential Diagnosis of Acute been useless, and have not diminished the
Leultemias.— Schultze (Munch, med. number of cases among infants. Neither
Woch,) mentions the difficulty that exists has sterilization of milk. To have a bad
in differentiating; acute lymphoid and mye- effect milk must be full of bacilli from masloid
leukemias. In the chronic cases the titis. If milk was the cause, all the people
differential diagnosis is easy, but acute „.ho drink the same milk should be affected
cases are quite the re-erse, for here one has by it. On the contrar}-, only those exposed I
to differentiate the lymphoblast, the ante- to the contagion have the disease. Out of
cedent of the lymphocytes, from the myelo- autopsies on 1447 infants made by the j
'<
blast, which is the parent cell of the granu- author tuberculosis was found in 5,36 cases.
lar leukocytes. The two cells are practi- In all these cases the bronchial glands were
j
cally identical in size, each possesses infiltratedr The older the children, the .
strongly basophilic protoplasm, and their more frequently was tuberculosis found,
nuclei are similar. Schridde describes a if jt came from milk the younger children
,
'
|
i
narrow,
the lymphoblast,
clear border about the nucleus of should
but for most observers who are
have
kejit
it more
in the home
freciuentlv.
are less
Infants
affected
this is not a practical differential point,
Schultze makes use of the so-called oxydase
reaction (indophenoblausynthe.se) for
differentiating these cells and especially for
differentialiug the tissues of lymphoid from
than those of an age to mingle with the
public. Many of the chronic coughs and
asthmas of old 5)eople are tuberculous, and
the disease is transmitted to the infants of
the familv. Prophylaxis must deal with
!
those of myeloid leukemia. For carrying the removal of all cases from the family,
j
,
|
;
|
!
I
,
\
j
i
I
!
j
'
out this reaction a 1 per cent, aqueous solu- not with the care of milk and meats.
tionofaxnaijhthol and 1 percent, aqueous The Early Diaanosts of Puimonary
solution of dimethylparaphenyk-ndiamin Tubercuiosis.—Mausmann ( iJeut. Arch.
(E. Merck) are needed. The naijhthol, f. u\n. Med.) has been impressed by the
which is only slightly soluble, is warmed number of gastric cases in his practice
and then filtered after cooling. The two which presented evidence of apical lesions.
solutions, when united, form a blue color Those who raised no sputum he often sent
under the action of light through an oxi- to a lung specialist, and frequently his
dative synthesis. In the presence of an diagnosis of incipient pulmonary tubercuoxidative
ferment the process is greatly ac- losis was reversed. Feeling that he was
celerated. Myeloid tissue, when treated correct, he decided to examine the fasting
with these solutions, is stained blue, owing stomach early in the morning for small
to the presence of an oxidative ferment, particles of bronchial secretion. The au-
while lymphoid tissue remains unstained, thor's first patient gave no history of cough,
The method is especially applicable to but had definite signs in one apex, the
i
I
)
j
*'^-''^^-
The Ro3e of Huinan Contagion in Infantile
TubercuScsis.—Coniby (Arch, de
Med. des Enf.) says that the role of milk
and meat, of food products and intestinal
chief complaints being a feeling of fulness
and weight in the epigastrium. A very
small particle of mucous, enclosing pus
cells and lymphocytes, and a few alveolar
epithelial cells, were obtained from the
tuberculosis, is a small one in the causation stomach, and when stained showed about
of tuberculosis in infants. Children are ten tubercle bacilli in a field. In tiie last •,
born neither with tuberculosis nor with a two months he has had six similar cases,
])redisposition to the disease. If the chil- all with the same result. The writer bedren
of tuberculous parents are removed lieves the usefulness of this method and i
immediately from the surroundings in which suggests that some of the so-called "closed"
the parents
j
i
j
i
cough and spit, and are brought
up in good hygienic surroundings, they
urow up strong and well. If they remain
ill their homes they die of tuberculosis, deor
"healed'' cases may be shown by this
means to be in reality "open" cases of tnberculosis.
Hot Air in Surgery.
•
rived from the infected house. Pallor, Ronaniy and Muller have applied hot air J
emaciation, narrow chest, and micropoly- in surgery, at the Hospital Gouin since Febadenopathy
are symptoms not of a tuber- ruary, 1907. These applications have been
ij
culous predisposition, but of latent tuberculosis.
Transmission of tuberculosis by
chiefly made on diabetic andtraumatic gangrene,
cancerous ulcerations of the breast,
:
heredity does not exist, neither does predis- epitheliomas of the neck of uterus, can- ':
position. Those who assert that they do croids and certain cutaneous affections. He ,i
are guilty of misinterpreting simple facts,
In the immense majority of cases tubercuemployed
Gaiff's apparatus.
There is not the least doubt that this
'.
'i
losis is derived from the family by inhala- method is called upon to play an important I
tion. The measures taken against animal part in surgical therapeutics.—La Presse 'tuberculosis
and tuberculous milk have Medicale. i
'
'
'

ADVERTISEMENTS
The Success of Listerine is based tspoji Merit
The manufacturers of Listerine are proud of Listerine—because
It has proved one of the most successful formulae of modern
pharmacy.
This measure of success has been largely due to the happy
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:. e.. the antiseptic effect of the ozoniferous oils and ethers,
and that of the mild, non-irritating boric acid radical of Listerine.
Fharmacal elegance, strict uniformity in consrituents and
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Listenne to easily excel all that legion of preparations said to be
something like Listerine."
"The Inhibitory Acrion of Listerine." a 208-page book, descriptive of the
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but the best advertisement of Listerine is
LISTERIA!
Uhe HIGKSMITH HOSPITAL.
(Incorporated^
Fayetteville, NortK Carolina.
Centrally located, facing on C.reeii Slreel. e.\leii(lin

XXXVI THE CHARLOTTE MEDICAL JOURNAL.
THE PINE-S, Black Mountain, NortH Carolina.
A private Sanatorium specially equipped for the treatment of early
Tuberuclosis.
Besides the main building also have tents and cottages specially construct-
ed to insure thorough and constant ventilation. Altitude 2,800 feet. Situ-
ated in pine grove of twenty acres.
Rates on arplication.
CLYDE E. COTTON, m. D.
The Hygeia
Private Hospital and Sanatorium
101 West Grace Street, Richmond, Va.
DEVOTED EXCLUSIVELY TO MEDICAL AND NERVOUS DISEASES
"pXTENSIVE improvements and additions have just been completed, which make
•*— ' The Hygeia now the largest strictly private Medical institution in this country. All
approved Hospital facilities for ««/« cases, and full Sanatorium facilities ioxchronic
cases. Equipment: Baruch Therapeutic Baths, Electricity, Vibration, Electric Light,
X-Ray, Nauheim Baths, Massage, etc., together with laboratory methods of diagnosis.
Usual Rates. Descriptive booklet.
j, ALLISON HODGES, M. D.
I
TKe Telfair Sanitarium,
QREENSBORO, N. C.
Nervous Diseases, Alcobolism
and Drug Habits.
Location picturesque and retired. Fresh
air, sunshine and quiet. The new sanita-
rium has 30 rooms. Most modern appli-
ances, electrical, vibratory, and hydro-
therapeutic.
Our treatment meets individual re-
quirements, with avoidances of suffering
or inconvience. l*'or detailed information
write for circular and reprints in Journals.
Ciinical Results Prove Therapeutics |
results, reported by thoiisamls of successful practitioners, demonstrate tl'
masarcin
Gives R.elief
Trial quantity
request, to phys
in any obstinate case and note
literature on
)s only.
VALVULAR HEART TROUBLE
ASCITES AND ANASARCA
EXOPHTHALMIC GOITRE
BRIGHT'S DISEASE
CIRRHOSIS OF THE LIVER
Messrs. Thos. Christy & Co., London Agents.

SOUTHERN MEDICAL SOCIETIES.
MISSISSIPPI VALLEY MED. ASSOCIATION.
Pres., J. A. Witherspoon, M.D., Nashville,
Tenn. Vice Pres. Louis Frank, M. D.,
Louisville, Ky. Second Vice Pres.,
A. E. Sterne, M. D., Indianapolis, Ind.
Secy., Henry Enos Tulley, M. D.,
Louisville, Ky.
Treas. S. C. Stanton, M. D. Chicago, 111.
Next Meeting St. Louis. Mo,. Oct. 13, 13,
and 14th 1909.
SOUTHERN SURGICAL and GYNECOLOGICAL
ASSOCIATION.
Annual meeting at Hot Springs, Va., Oct.
5-6, 1909.
W. D. Haggard, M. D., Sec,
Nashville, Tenn.
Stuart McOuire, M. D., Pres.,
Richmond, V^a.
SOUTHERN .MEDICAL ASSOCIATION.
Annual meeting at New Orleans, La. Nov.
9-10-11-12, '09.
Oscar Bowling, .M. D., Sec. Shreveport, La.
Giles C. Savage, M. D., Pres.
Nashville, Tenn.
MEDICAL ASSOCIATION OF THE SOUTHWEST.
Annual meeting at San Antonio, Texas,
October, 1909.
F. H. Clark, M. I)., Sec, El Reno, Okla.
Jabez N. Jackson, M. D. Pres.,
Kansas City, Mo.
TRI-STATE MEDICAL ASSOCIATION OF THE
CAROLINAS AND VIRGINIA.
Annual meeting at Richmond, Va., Feb. 8,
1910.
J Howell Way, M. U., Sec,
Waynesville, N. C.
LeGrand Guerry, M. D., Pres.,
Columbia, S. C.
tBDICAL ASSOCIATION OF THE STATE OF
ALABAMA.
Annual meeting at Birmingham, Ala., 1909.
J. N. naker, M. D., Stfc,
Montgomery, Ala.
B. L. Wyman, M. D., Pres.
Birmingham, Ala.
FLORIDA MEDICAL ASSOCIATION.
innual meeting at Pensacola, Fla., April
7-9, 1909.
J. D. Fernandez, D. D., Sec,
Jacksonville, Fla.
J. F. McKinstry, Jr., M. D., Pres.,
Gainesville, Fla.
MEDICAL ASSOCIATION OF GEORGIA.
nnual meeting at Macon, Ga., April 21,
1909.
laude A. Smith, M. D., Sec. Atlanta, Ga,
Thos. D. Coleman. M. D., Pres.,
Augusta, Ga.
M :;s:$:gj^S:g:g:>:i:>; :> :;gC .a
KENTUCKY STATE MEDICAL ASSOCIATION.
Annual meeting at Winchester, Ky Oct
1909.
A. T. McCormack, M. D., Sec,
Bowling Green, Ky.
Jonu G. Cecil, M. D., Pres.,
Louisville, Ky.
LOUISANA STATE MEDICAL SOCIETY.
Annual meeting at New Orleans, La., May,
4-6, 1909.
E. M. Hummel, M. D., Sec,
141 Elk Place, New Orleans, La.
E. Denegre Martin, M. D., Pres.,
New Orleans, La.
MISSISSIPPI STATE MEDICAL ASSOCIATION.
Annual meeting at Jackson, Miss., April
13, 1909,
E. F.Howard, M. D., Sec,
Vicksburg, Miss.
J. W. Gray, M. D., Pres.,
Clarksdale, Miss.
MEDICAL SOCIETY OF THE STATE OF NORTH
CAROLINA.
.Annual meeting at Wrightsville, N. C,
June 16 and 19, 1910.
D. A. Stanton, M. D., Sec,
High Point, N. C.
Jas. A. Burroughs, M. D., Pres.,
Asheville, N. C.
NEW MEXICO MEDICAL SOCIETY.
Dr. G. K. Angle, Silver City, N. H. Pres.
Dr. G. S. McLandress, Albuquerque, N. M.
Secretary.
Dr. C. G. Duncan, Socorro, N. M. Treas.
Next meeting at Roswell, N. M., in the
fall of 1909, the date to be announce later.
SOUTH CAROLINA MEDICAL ASSOCIATION.
Annual meeting at Sunimerville, S. C,
April 21, 1909.
Walter Cheyne, M. D., Sec,
Sumter, S. C.
S. C. Baker, M. D., Pres.
Sumter, S. C.
TENNESSEE STATE MEDICAL ASSOCIATION.
Annual meeting at Nashville, Tenn.,
April. 13-15 1909.
Geo. H. Price, M. D., Sec,
146 8th. Ave., N., Nashville, Tenn.
B. D. Bos worth, M. D., Pres.,
Knoxville, Tenn.
MEDICAL SOCIETY OF VIRGINIA.
Annual meeting at Roanoke, Va., fall of
1909.
Landon B. Edwards, M. D., Sec,
Richmond, Va.
Stuart McGuire, M D., Pres.,
Richmond. Va.

HAY FEVER
For the treatment of Hay Fever the Adrenalin preparations are easily
the most efficient agents available. These are especially commended
Solution Adrenalin Chloride (1:1000).
Adrenalin Giloride, 1 part; physiological Salt Solution (with 0.5% Chlore-
tone), 1000 parts. Powerful astringent. Dilute with four to five times its
volume of physiological salt solution and spray into the narea and pharynx
(see Glaseptic Nebulizer adv. below). Ounce bottles.
Adrenalin InhsJant
Adrenalin Chloride, 1 part; an aromatized neutral oil base (with Z%
Chloretone), 1000 parts. Administer with our Glaseptic Nebulizer or other
atomizer suited to oily liquids. Ounce bottles.
Adrenalin Ointment (1:1000).
Effective either alone or as an adjuvant to Solation Adrenalin Chloride.
Collapsible tubes with elongated nozzles.
AdrensJin and Chloretone Ointment.
Each ounce contains: Chloretone, 20 grains (5%); Adrenalin Chloride,
2-5 grain (1:1000). Astringent, antiseptic and mild anesthetic. Collapsible
tubes with elongated nozzles.
ir -d
Glaseptic Nebulizer.
The most practical atomizer ever offered to the medical profession.
Combines asepsis, convenience, efficiency, simplicity. Readily sterilizable.
All glass except the bulb, tube and metallic base. Produces a fine spray.
Affords excellent results with but a few drops of liquid.
PRICE, COMPLETE, $1.25.
Write for our Literature on the Modem Treatment of Hay Fever.
PARKE, DAVIS & COMPANY
Laboratories: Detroit, Mich.. U.S.A.: Walkervflle. Ont.: Hounslow, Eng.
Branches: New York, Chicago, St. Louis, Boston, Baltimore. New Orleans, Kansas Citf,
Minneapolis; London, Eng.: Montreal, Que. : Sydney, N.S.W.; St. Peteraburs, Russia:
Bombay, India: Tokio, Japan: Buenos Aires, Arsentina.
:

-'" f^i-r/\jRs ^IBR/{}^Y
jharlotte Medical Journal.
A SOUTHERN JOURNAL OF MEDICINE AND SURGERY.
THE
Charlotte, N, C, September, 1909.
Ta6/e of Contents. Page 201.
clotting of milk in the stomach
may be overcome to a great
%
extent by the use of
Chymogen, ivhich under propi
conditions acts upon casein,
and precipitates paracasei
in a form which is easily
broken up and then pre
pared for rapid digestion
The particles of curd
are so small that the
infant can take its
food in the usual
w^ay from a
nursing
bottle
o
Literature
to Phytieiatu
Q a^.
A
MILK
CURDLING
AGENT
REMOVES THE PRINCIPAL
OBJECTION TO THE BEST AND
CHEAPEST OF INFANT FOODS
As Chymogen contains
sugar of milk, its use renders
cow's milk more like human milk
ARMOUR^COMPANY
Chicago
[f nttred at Ihc Poal-Ofticc al Charlotte, a* •econd-clas* matter.]

Diphtheria Antitoxin
For the treatment and prevention of
Diphtheria
Tetanus Antitoxin
For the treatment and prevention of Tetanus
(Lockjaw)
Tuberculin
For diagnosis and treatment of Tuberculosis
Neisser-Bacterin
(CONOCOCCIC VACCINE)
For diagnosis of obscure cases of Arthritis and
treatment of Gonorrheal Infections
Staphylo-Bacterin
(STAPHYLOCOCGJC VACCINE)
For treatment of Acne, Furunculosis and
Staphylococcic Infections

.
// is a fact that
ADVERTISEMENTS.
Angler's Petroleum Emulsion
is indicated and is effective in all forms of Summer Diarrhoea
of both adults and infants. Because —
1 Petroleum itself is sterile— germs cannot grow in it.
2. It is sedative, soothing and inflammation-allaying to
the entire intestinal tract.
3. Intestinal antiseptics and astringents are useful, when
given alone, only in the uj'perpart of the intestines. Suspend
them in Angier's Petroleum Emulsion and they are
carried to the lower part of the ileum and colon — just
where the trouble is located and just where thev are needed.
Samples oniy 1 ASGIER
CHEMICAL COMPANY, BOSTON, MASS.

THE CHARLOTTE MEDICAL TODRNAL.
^^W^j^^^^^^^^'^^^^^'f^^^^
SANMETTO GENITOURINARY DISEASES.
A Scientific Blending of True Santal and Saw Palmetto with Soottiing Demulcents
in a Pleasant Aromatic Vehicle
A Vitalizing Tonic to the Reproductive System.
SPECIALLY VALUAL E IN
f PROSTATIC TROUBLES OF OLD MEW-IRRITABLE ^ BLADDER-
CYSTITIS-URETHRITIS- "'EI-SENILITY.
'f DOSE:—One Teaspoonfut Four Times a Da;. OD Ci . M. CO., NEW YORK. >i
CAMPHO-PHENIQUE
A

C
ADVERTISEMENTS.
BOVININEI
Reconstructive Food
and Tonic
BOVININE represents the most valuable combination of
Food and Tonic elements known to the medical profession.
BOVININE has proven clinically to be most valuable in
all forms of Tuberculosis.
BOVININE enables the nerve cell to assimilate its specific
elements, which it fully supplies.
BOVININE promotes the metabolism of fat and albumin
in muscle aud blood, thereby restoring the bodily
health, .strength and normal powers of resistance.
BOVININE supplies full and complete nutrition through
its Food and Tonic properties.
THE BOVININE COMPANY
7S Wcs
fw York CItv 3
The Standard of Therapeutic Efficiency.
NOT ONLY VOU Till-: LAST YIvAR BUT FOR THE LAST QUARTER
OF A CENTURY HAS HAYDEN'S VIBURNUM COMPOUND GIVEN
DEPENDABLE RESULTS IN THE TREATMENT OF
Dysmenorrhea, Amenorrhea, Menorrhagia, Metrorrhagia
and otber diseases of the Uterus and Its appendages.
There has been no necessity for any chan,e;e in the formula of H. V. C. because
its therapeutic efficiency has made it "Standard" and so recognized by the most
painstaking therapeutists and gynecologists from the time of Sims.
Unscrupulous manufacturers and druggists trade upon the reputation of Hayden's
Viburnum Compound, and to assure of therapeutic results insist that the genuine
H, V. C. o/i/y is dispensed to your patients.
SAMPLES AND LITERATURE UPON REQUEST
NEW YORK PHARMACEUTICAL CO. K§gg,MA'^s°'
HAYDEN'S URIC SOLVENT ( Rheumalistn, Gout and other coaditions iodicating i

.
THE CHARLOTTE MEDICAL JOURNAL.
WHAT A DOCTOR PRESCRIBES. I
Hatchechubbee, Ala.,
April 30, 1908.
The Rock Hill Bugg^^ Co,
Rock Hill, S. C,
Gentlemen :
—
The wheels to my buggy
reached here about the same time as your
letter, and I waited long enough to take
several rides before replying to'your letter.
Am delighted with the job in every respect,
and shall be glad to advise anyone who
is looking for style, comfort, and perfection
in workmanship, to invest in a "Rock Hill"
buggy.
Yours truly,
R. A. White, M. D.
No 17 Doctor's Buggy
Further comment on the above letter is hardly necessary for
Dr. White has evidently used enough bnggies in his practice to
make his opinion worth something.
We are willing to guarantee that you will be just as well pleased
as Dr. White, if yoti will use a No. 17 Doctor's Buggy.
Rock Hill Buggy Co., Rock Hill, S. C.
"A Little HigKer in Price, But—"
DERMATITIS
AND
!n ail forms of dermatitis, but especially tliose
caused by poison ivy. Pond's Extract is a very effective
soothing and antiphlogistic lotion. It at once
relieves itching, burning and smarting, and promptly
controls the inflammatory process.
H%AKiiP%>A> VBtf^aM H 0^^
rUllUd LA I KAb I POND S EXTRACT CO
ji be rntlnly
'
ezelas{icb
New York and London.

ADVERTISEMENTS.
^11 the
tfc® Nmturml Oil
Samples by Express Prepaid - Mellier Drug Company. St.Louis
ANTIKAMNIA & SALOL TABLETS
Hare says "Salol renders the intestinal canal antiseptic and is the most
valued drug in intestinal affections." The anodyne properties of antikamnia in
connection with salol render this tablet very useful in dysentery, indigestion,
cholera morbus, diarrhoea, colic, and all conditions due to intestinal fermentation.
ANTIKAMNIA & CODEINE TABLETS
Especially useful in dysmenorrhoea, utero-ovarian pain, and pain in general
caused by suppressed or irregular menses. This tablet controls the pains
of these disorders in the shortest time and by the most natural and economic
method. The synergetic action of these drugs is ideal, for not only are their
sedative and analgesic properties unsurpassed, but they are followed by no unpleasant
effects.
The efficacy of this tablet in all neuroses of the larynx is also well known.
In coughs and colds, coryza and la grippe they will always be found of inestimable
value.
THE ANTIKAMNIA CHEMICAL COMPAWT

They Do the Business
and Never
Gripe
THK CHARLOTTE MEDICAL JOURNAL.
Specify
Abbott's
Saline Laxative
(Granular Effervescect Mairnesium Sulphate)
for general use— ^your patients will be
leased and benefited thereby.
Abbott's Salithia (the same with colchicine
and Lthium added) as an eliminant in. the so-called
"rheumatism" gives prompt and effective relief.
"Abbott's" is the original effervescent Saline Laxa-
tive. There are many piratical imitations, but no others
are equal m quahty or efficiency. You are urged to give
these preparations a trial—to specify them on your pre-
scriptions.
If your druggist cannot supply you, send direct. Per dozen, in not less than
half doren lots, either ki..d ("Saline" or "Salithia") or assorted: Small, $2.00j
medium, $4.00; large, $8.00. Cash with order, delivery prepaid.
Samples to interested physicians on request.
THE ABBOTT ALKALOIDA L COMPANY
Manufacturing Chemists
CHICAGO
NewYork.251 5th Ave. SanFrancisco,371 PhelanBldg. Seattle, 225 Central BIdg.
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Catalogue Free Angola, N. Y.

ADVERTISEMENTS
Is pre-eminently
serviceable in the .ARJENIATED
treatment of the severest (y>iUw J^^MtM^jj^)
grades of Anemia, Debil-
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of its synergetic combination of medicinal,
nutrient and reconstructive agents, so effected
as to be easily assimilated, perfectly absorbed,
without irritating, constipating or disturbing
digestion.
THE PALISADE MANUFACTURING CO.
'iampUt on f-cijueit. YONKERS, N. Y.
"KELENE."
For Local Anaesthesia
Also an Adjuvant to Ether
In General Anaesthesia
Avoids use of Hypodermic Needle. No
Dangerous After Effects. No Disturbance
to System from Injection of Drugs.
See GOLD Medal awarded at the Jamestown Exposition
WHAT IS IT?
EVERY DOCTOR SHOULD KNOVi/. ASK THE SOLE
MANUFACTURERS
FRIES BROS., 92 READE STREET, NEW YORK

VIII
THE CHARLOTTE MEDICAL JOURNAL.
Oarolirxa JMedioal College
CViarlotte, IV. O.
OLDEST MEDICAL COLLEGE IN THE STATE
SESSION OF 1908-1909 BEGINS SEPTEMBER 15, 1908.
W. O. NISBET, M. D.
Professor of Diseases of
the Digestive System and
Dean of the Faculty.
JOHN P. MUNROE, M. D.
Professor of Neurology and
Practice of Medicine.
I. W. FAISON, M. D.
Professor of Pediatrics and
Clinical Medicine.
E. C. REGISTER, M. D.
Professor of the Principles
and Practice of Medicine.
B. C. NALLE, M. D.
Professor of Physical Diagnosis
and Clinical Medicine.
R. L. GIBBON, M. D.
Professor of Practice of
Surgery.
G. W. PRESSLY, M. D.
Professor of Principles of
Surgery.
A. J. CROVVELL, M. D.
Professor of Rectal Diseases
and Genito-Urinary Surgery
and Secretary and Treasurer
of Faculty
FACULTY
E. R. RUSSELIv, M. D.
Professor of Diseases of the
Eye, Ear, Nose, and Throat
W. D. WITHERBEE, M.D.
Professor of Dermatology,
and Materia Medica.
C. M. STRONG, M. D.
Professor of Gynecology.
C. H. C. MIIvLS, M.D.
Professor of Obstetrics and
Clinical Gynaecology.
C. N. PEELER, M. D.
Professor of Anatomy and
Superintendent of Dispensary.
R. H. LAFFERTY, M. D.
Registrar and Professor of
Chemistry and Physiology.
h. B. NEWELL, M. D.
Professor of Pathology.
WM. ALLEN, M. D,
Professor of Bacteriology
and Assistant in Pediatrics.
C. A. MISENHEIMER,M.D.
Clinical Professor of Surgery
J. P. MATHESON, M. d'.
Clinical Professor of Diseases
of the Eye, Ear, Nose and
Throat and Professor of
Yygiene.
.
DR. PARKS KING
Assistant in Surgery.
DR. WM. STRONG
Assistant in Gynaecology.
DR. C. S. McLAUCHLIN
Assistant in Anatomy.
DR. MYERS HUNTER
Assistant in Obstetrics and
Clinical Gyansecology.
Dr. E. C. BOYETTE
Assistant in Medicine.
HAMILTON McKAY, A.B.
Assistant in Anatomy.
BENJAMIN TEAM, A. B.
Assistant in Chemistry.
S. A. HARDING
Assistant in Bacteriology.
C. M. LENTZ.
Assistant in Genito-Urinary
Diseases.
CALDWELL WOODRUFF.
Assistant in Histology.
H. B. MALONE
Assistant in Clinical Microscopy
aud Pathology.
,
For Catalogue address
A.J. CROWELL, M. D., Charlotte, N. C.
|N. Y. ROST GRADUATE!
* JW&dlc&l School eindi Hospital I
cond Avenue and T' yentlethi reet, INeu/ "Vortc GIty.
and leading school for practitlo ;rs. Teaching wholly elin d personal, or ir
eds ill the Hospitol ; 3.50 oi
adapted to the specialist i ery department. Special
carrying the students with individual instruction from the cadaver
the wards and the operating room. Similar courses in each of the specialties,
,nd electro-therapeutics, tropical medicine, Public Health aud Sanitation Id
psonin therapy, etc. Unusual and advanced work readily arranged for. The
t the year aud may be entered at any time. For full information address
George Gray Ward, Jr., M. D. Secretary of the Faculty.
%

ADVERTISEMENTS,
Milk prepared with Peptogenic Milk Powder contains
no Digestive Ferment, no Pepsin, no Pancreatin
npO talk about "pancreatin" in the milk prepared with Peptogeiiic
Milk Powder by the ordinary method, for the feeding of the normal
infant, is to talk about something that does not exist.
There is an enzyme in Peptogenic Milk Powder, viz., the proteolytic
principle of the pancreas, which has an especial affinity for the proteids of
milk, and its peculiar activity in this re.-pect suggested its employment as
a means of solving "the problem of the proteids" in adapting cows' milk to
the digestion of the nursing infant.
In preparing the food, this enzyme is brought into action by applying
heat; its energy is controlled by time and temperature; as soon as it has
made the proteids soluble and non-coagulable like the albuminoids of moth-
ers' milk, it is destroyed, utterly rcmoied, \ty heating to boiling point.
From which is evident the absurdity of the talk still persisted in;
about the enzyme in milk prepared with Peptogenic Milk Powder.
Fairchild Bros. & Foster.
New York
STAFFORD WATER
Noted for its Remarkable Remedial Properties In
PARENCHYMATOUS NEPHRITIS,
ACUTE NEPHRITIS, ALBUMINURIA,
and Its Therapeutic Value and Efficiency in
DIabetis. Chronic Interstitial
Nephritis and Cystitis.
For Sale; THEO. F. KLUTZ & Co., Salisbury, N. C.
For Literature write
S. M. PURCELL, Salisbury, N C.
HURWELL & DUNN CO., Charlotte, N. C.
D. P. FRIERSON, Charleston, S. C.
PATRICK McINTYRE, Asheville, N. C.
MURRAY DRUG CO., Columbia, 9. C.
COLBURN, MORCAN

THE CHARLOTTE MEDICAL JOURNAL.
COCO-QUININE, LILLY
l|I Pure Sulphate of Quinine—no other Cinchona Alka-
loid
—
in Palatable Liquid Form.
*[ Palatability—The Quinine is suspended in a bland,
chocolate-flavored, syrupy medium which completely masks
its taste. The dose may be large yet so palatable, as one
physician said, "A child will take it and lick the spoon."
tji The Patient gets All the Quinine. In Coco-Quinine the
Quinine Sulphate enters the stomach free from coatings or
masses which delay solution and retard absorption. It is
the best form of administering Quinine to all classes of pa-
tients, particularly children and others to whom pills, tablets
and capsules are inadmissible.

f ^ Peak's
/^^^*=^=^\ Supporter
ADVERTISEMENTS.
For after operations of
APPENDIGinS.
Cmcinnati Heat Ray Therapeutic Lamp,
,vith special 5o c. p. heat generatiug lamp
ind removable condensing hood J7.50; new
00 c. p. Therapeutic Lamp. ^15. 00.
INevA/ Hospital Eciijlpmer
! th^ajTWocher
HERNIA. Etc.
No. 1004 Conibination Nebulizing
and Atomizing Outfit, Oxidized Steel
Tank, 3 Bottle Nebulizer, Atomizers
and Lever Pump, complete.
Special price, - - - $50,00
TAULBEE'S LATEST OPERATING SCISSORS, don't pinch, 8 inches
long, made in straight-sharp, curved-sharp, or curved-blunt, each
|2.60; set of 3 J6.00.
THE CINCINNATI OPERATING ROOM.
We Make All Kinds of Hospital Furniture.
LlsttSent Upon Reqtaest.
& ^ON Co.
inrglcal Instrument Makers. Orthopedic Apparatus, Trusses. Elastic Stockings
1 9-2 1 -23 W. Sixth St. Cincinnati, Ohio

THE CHARLOTTE MEDICAL JOURNAL.
NEURILLA FOR NERVE DISORDERS NEURILLA
If Patient suffers fromTHE BLUES (Nerve Exhaustion),
Nervous Insomnia, Nervous Headache, Irritabitihy or
General Nervousness, ,f>ive four Hmes a day one
_ teaspoonful NEURILLA
H Prepared from Scutellaria l^ateriflora*
Fassi flora Incarnata and Aromatlca.
DAD CHEMICAL COMPANY, NEW YORK and PARIS.
Just Published
GENITOURINARY DISEASES
'"" SYPHILIS
By EDGAR G. BALLENGER, M. D.
LECTURER ON GENITO -URINARY DISEASES, SYPHILIS AND URINALYSIS, ATLANTA SCHOOL OF
MEDICINE; EDITOR JOURNAL-RECORD OP MEDICINE; GENITO -URINARY" SURGEON
TO PRESBYTERIAN HOSPITAL, ATLANTA, GA.
"Barely a page of this work can be read without finding at least one
, instructive and interesting point. The experienced teacher, the skilled
genitourologist, and the learned syphilographer, is revealed in every line."
Medical Record, New York.
With 86 Illustrations. 276 Pages.
F^ractical, Concise
F»rlce *3.00, Carrying; Charges Prepaid
E. W. Allen & Co., Publishers
ATLANTA, GA.
PHILADELPHIA J. ^011^1^ !^ GRADUATES INI
I COLLEGE o
POLYCLINIC D yJ\JUUU\XU R MEDICINE!
With the beginning of the winter session, October 4, 1909, a threee-month's course
j
in diseases of the eye, and the regular courses in diseases of the ear and of
'
the throat and nose will be started. For detailed description see 1909-1910 announcement.
Laboratory courses in general and clinical pathology; special pathology of the eye, \
skin, and tiervous system; tropical tnedicitie; bacteriology; general and special operative sur-
gery, and operative gynecology. Address all communications to i
R. MAX QOEPP, M. D., DEAN, !
Lombard Street, above IStb Street, PUIadelpbia, Pa. I

ADVERTISEJIENTS.
BUFFALO LITHIA
SPRINGS
WATER
III ALBUMINURIA OF BRIQHTS DISEASE
\[i PREGNANCY AND SCARLET FEVER
DR. JOS. HOLT. o/Xezc' Orlea>is Ex- President of the State Board of Health of Louisiana,
says; 'I have preprescribed BUFFALO LITHIA WATER in affections of the
kidneys and urinary passages, particularly in Gouty subjects, in Albuminuria, and in
irritable condition of the Bladder and L'rethra in females. The results satisfy me of its
extraordinary value in a large class of cases most difficult to treat."
DR. GEORGE BEN JOHNSTON, Richmond, Va. Ex-President Southern Surgical and
Gynecological Association, Ex-President Medical Society of Virginia, and Professor of
Gynecology and Abdominal Surgery, Medical College of Virginia: "it is an agent of great
value in the treatment of the Albuminuria of Pregnancy.'*
DR. J. T. DAVIDSON, M. D., New Orleans, La, Ex-President, New Orleans Si/rgical
and Medical Association, says: "I have for several years prescribed BUFFALO LITHIA
\Va ter in all cases of Scarlet Fever, directing it to be drunk ad libitum, YiWh the effect of
relievingall traces of Albumin in the urine, and have found it equally efficacious in
enial diseases recjuiring the use of alkaline water."
HUGH M. TAYLOR, .M. D.. Projessor of Practice or Surgery and Clinical Surgery,
University College of Mcdiciyie, Richmond, / '«.• "I have used, with good results BUF-
FALO LITHIA WATER in Uric Acid Diathesis, Gout, Rheumatism, Albuminuria of
Pregnancy, Scarlet Fever, diseases of Women, Renal and Vesical Calculi, and Cystitis,
ad in many instances with signal \i^\\ih.\.."
Medical Testimony on request. For Sale by Druggist generally.
BUFFALO LITHIA SPRINGS WATER CO., BUFFALO LITHIA SPRINGS, VIRGINIA.
Fifth Edition Ready Sept, 8th
"The Practice of Medicine"
WITH SPECIAL REFERENCE TO
DIAGNOSIS AND TREATMENT
"The Leading Single-Volu me Text-Book on the 'Practice of Medicine'"
By JAMES TYSON, M. D.
Professor of Medicine in the Universil> of Prnnsylvonia and Physician to the Mospilal ilal cof
the
University: Physician to th» Pennsylvania Mospilal, etc.: Author of "Bright's Disease
and Diabetes," and "Guide lo the Examination of Urine."
WITH A SECTION ON 'ANIMAL PARASITES AND CONDITIONS
CAUSED BY THEM." WRITTEN BY DR. ALLEN J SMITH
FIFTH EDITION. Revised and Enlarged. 5 Colored Plates and 245 other Illustrations.
Octavo; xxvlil -{ 1425 pages Clotb. $5.50 or Hall-Morocco.
$7.00. Net.
"It is an exceedingly satisfactory exposition
of the medicine of the present day, and no
doubt it will long maintain its deserved prominence."—X
Y. Mrdirtil Jrwr)i(il.
It represents the outcome of much welldirected
labor, and constitutes a reliable and
useful text-book." - 77,r LannI, London.
P. BLAKISTON'S SON 8t CO.,
Publisliers,
Ptiiladelphia

THE CHARLOTTE MEDICAL JOURNAL.
Atlanta College of Physicians and Su^eons.
(Consolidation in
A. W. Calhoun, M. D., LL.D., President
J. S. Todd, M. D,, Emeritus,
Wm. Perrin Nicholson, M. D., V.P.
Wm. Simpson Elkin, A. B., M. D, Dean
W, F. Westmoreland, M. D.,
Floyd W. McRae, M. D.,
J. Clarence Johnson, M. D.,
H. F. Harris, M. D.,
Wm. S. Goldsmith, M. D.,
Jas. B. Baird, M. D.,
E. Bates Block, M. D.,
Atlanta Georgia
! of the Atlanta Medical and the Southern Medical Colleges.
F'aculty :
A. L. Fowler, M. D.,
T. C. Davison, M. D.,
Dunbar Roy, A. B., M. D.,
John G. Earnest, M. D.,
Bernard Wolff, M. D.,
Michael Hoke, M. I).,
Chas. E. Boynton, A. B., M. D.,
John C. Olmsted, M. D.,
Cyrus W. Strickler, M. D.,
S. T. Barnett, A. B., M. D.,
Marion McII. Hull, M. D.,
F. Phinizy Calhoun, A. B., M. D.,
The fifty-fifth annual session of the Atlanta College of Physicians and Surgeons begins Wednesday,
.September 22nd, 1909.
With a group of five college buildings, arranged upon the university plan, and a corps of fifty-ihree
professors and instructors, this Institution stands second to no medical school in the country. The
laboratory facilities are unsurpassed.
The main college building contains the Chemical, Physiological and Materia Medica Laboratories,
and the Carnegie Pathological Institute contains three large laboratories, each equipped with an
ample number of microscopes and all necessary apparatus and appliances for teaching Histology, Bacteriology
and Pathology. A separate aud distinct building is used for practical anatomy.
A four years graded course of seven months each is required, the last year of which is devoted
largely to clinical and practical work. Our students have access to the Grady Hospital, across the
street from the college, and all the principal infirmaries and hospitals in the city. A large out-docr
clinic, where more than 25,000 patients are treated a year; affords other valuable clinical instruction.
The buildings are new and commodious, and one attractive feature in the ne%v building is the Gymnasium
with shower baths. Here the student is taught the use and application of exercises for various
diseases. For catalogue or other information, address WM. SIMPSON ELKIN, M. D., Dean.
Atlanta College of Physicians and Surgeons, Atlanta, Oa.
A PRIVATE HOME EXCLUSIVELY FOR
Alcoholic, IVIorphine and Drug Habitues and
All Forms of Neurasthenia
GREENSBORO, N.C.
JACKSON SPRINGS SANITORIUM.
A new and modernly arranged building including modern diagnostic
apparatuses and various electrical appliaiices for the treatment of noncontagious
diseases. Special attention given to renal, hepatic, digestive
and nervous diseases.
Patients have free access to the celebrated Jackson Springs mineral
water which took second prize at the St. Louis World's Fair. This
water is especially indicated in above named diseases.
Centrally located in Moore County, N. C, amid the sand hills and
long leaf pines. Elevation 700 feet above sea level. Rates reasonable.
For further information, address
A. M. mcDONALD, TVl. D.
0\A/ner and yv\anager
aacicson Springs, IN, C:.

ADVERTISEMNTS.
I PROF ESSIONAL C ARDS I
DR. GEORGE W, PRESSLY
Charlotte. N. C.
Pkactice Limited to Sukoeky.
DR. W. O. NISBET
Diseases of Digestion
Offices: 9 North Tryon Street
Phones: Office, 21. Residence, 1196.
Qffice Hours: 8:00 to 10:00 a. m., 11:00 a. m.
to 1:00 p. m.; 3:00 to 5:00.
Special Hours by Appointment.
DR. JOHN R. IRWIN.
Charlotte, N. C.
Special attention given to Abdominal
Surgery and Diseases of Women.
ANDREW J. CROWELL. .M. D
Charlotte, N. C.
Practice Limited To Genito-Urinary and
Rectal Diseases.
Hours: 8.30 A.M, to 12. M.
4 to 6 PM. Sunday by appointment
DR. A. M. WHISNANT.
18 S. Tryon St., Charlotte X,C.
Office Hours:
8:30 a.m. to 1 p. m., and 3 to 6 i).ni.
Sundays by appointment. Practice
limited to I%ve. I'.ar, \oseand Throat.
E. R. RUSSELL. M D.
J. P. MATHESON. M. D.
J21 S. Tryon Street, C .^ki.otte, N. C.
Hours: 9 a. m. to i p. ni., and 4 to 5 p. ni
Sundays 9 to 10 a. m.
Special hours by appointment. Practice limit
to the F.ye, fiar. Nose and Throat
Phone 41*^— 6S7.
E DR. GEO. M. NILES.
I
I
Diseases of Digestion.
408-9 Candler Building.
k Atlanta. Ga.
JOHN P. MUNROE, M. D,
SPECIALIST IN NERVOUS DISEASES.
Offices Charlotte Sanatorium. Charlotte, N. C.
CONSULTATION PRACTICE.
Will tneet phy.sicians in adjacent towns and
country for consultation in general medical
cases.
W. D. WITHERBEE, M. D.,
charlotte, n. c.
Practice limited to treatment of Cancer and
Skin Diseases.
Office, Ch.^ri.otte Sanatorium.
CHARLES M. STRONG, M. D.
Diseases ol Women and Surgery.
Office Charlotte Sanatorium, Phone .521 jjj
Residence 609 S. Trvon Street. *
Phone 144. t
DR, CHARLES H. G. MILLS
|
Really Bulldlnq. Cbarlotle. N C. f
Practice limited to Gvnecologv and ^
Obstetrics.
*
DF?. GEO. \A/. I=>RESSLY JjJ
Xow has his office at the Charlotte *
Sanatorium and does all his work there. *
I'K.ACTICI' LIMITED TOSfKGICAL CASE.'l.
DR. EDVA/IIN OLy^DA\OIN. |
SPECIALIST
TKe Baltimore Medical College
PRELIMINARY FALL COURSE BEGINS SEPTEMBER i.
REGULAR WINTER COURSE BEGINS SEPTEMBER 20,
Liberal Teaching Facilities; Modern College Buildings; Comfortable Lecture Hall and
Amphitheaters; Large and Completely Equipped Laboratories; Capacious Hospitals and
Dispensary; Lyingin Department for Teaching Clinical Obstetrics; Large Clinics,
Send for Catalogue, and address DAVID STREEl'T, M. D., Dean,
712 Park Ave., Baltimore. Md.
|
-Jj

THE CHARLOTTE MEDICAL JOURNAL
Elleg'ant PHarmaceutical ^Specialties.
Attention is caUed to tlie EXCELLENCE and VALUABLE THERAPEUTIC PROPERTIES
of These Preparations.
ROBINSON'S LIME JUICE & PEPSIN ROBINSON'S PHOSPHORIC ELIXIR
Pnre fonfentrattd Pepsin fombined with
Pore Lime Juice.
An exceedingly valuable combination In cases o
Dyspepsia. Indigestion, BilloUBnees, Heartburn anc
MalAsslmllation
APERIENT AND CHOLAGOGUE
Impaired Digestion Is the consequence of a seden
tary life, coupled with nervous and mental strain.
RELIABLE PEPSIN is one of the best DIOESTIVI
agents known. PURE LIME JUICE with its aper
lent and cholagoqce characteristics, with the Pepsii
furnishes a compatib'e and most efficient combin
ation as a remedy for the disorders named.
ROBINSON'S LIME JUICE and PEPSIN is PALAT
ABLB and GRATErnL to the taste.
DOSB— Adnlt. dessertspoonful to tablesponful
after eating. Chi dren one-half to one tespoonful
according to age'
l>rlce, 6 oz. Bottles. SO cents.
16 oz. Bottles, $1.00.
Solution Albumina.te of Iron .
Syrup Albuinina.te of Iron Comp. I $1
We make &Uo FLEXNER'S
A lodiSed and Improved Form of Chemiral Food.
A Solution of the Phosphate of Iron, Sodium
Potassium and Calcium, in an excess of Phosphoric
Acid.
Each fluidounce represents:
Phosphate Sodium 12 gr.
Potassium 4 gr.
Calcium 4 gr.
Iron 2 gr.
FREE Monohydrated Phosporic Acid 16 grains,
Each fluidounce is approximately equal to [30]
thirty graius of Monohv drattd Phosphore Acid.
Free'and Combined,
Unsurpassed in excellency and palatability.
An invaluable remedy In the trcRlment of NER-
VOUS EXHAUSTION. INCIPENT PARALYSIS-
DERANGED DIGESTION. MELANCHOLIA. GEN
ERAL DEBILITY. RENAL TR.OUBLES. ETC.
Dose—The average dose is o dessevlspoou [2 fldrs]
diluted w.th water, to be takeu immediately before.
PINT*, $1.00.
I Pint^ I Solution Albuminito Iron and Slrychnine. - - I V4 Pints
00 Syrup !
Albuminate Iron wllh Quinine and Strychnine . 1 $1.00
Please Specify R0B1^S0NS Original Bottles. For Sale by Druggists.
fttr/p:^a^ri8^. ROBINSON-PETTET CO., ^^i^^irT^'^""
(INCORPORATED.)
Pamphlets Gratis to Practitioners by Mail Upon Request. LOUISVULE, Ky
BLOOD
DYSCRASIA as a pathological
entity is as indefinable as ever. But recent
physiological studies have emphasized
anew the part played by certain constituents of
the blood as protective, restorative and reparative
forces. Modern therapeusis, therefoie, finds a
fundamental utility in the correction of any varia-
tion or deficiency of these forces. Herein lies
the speciail value of ECTHOL—an eligible
preparation of selected Echinacea Angustifolia
and Thuja Occidentalis, presenting m potent
form a remedy of uncommon anti-morbific power.
When other remedies of the so-called
alterative type fail to exert the slightest effect
in the various forms of blood dyscrasia,
ECTHOL may be depended upon to promptly
produce tangible results.
BATTLE & COMPANY
LONDON ST. LOUIS PARIS

Intestinal
ADVERTISEMENTS.
^
'"°'"® .°f*«" «*"« *°
Dyspepsia if
•^ • • "Lazy Liver" than is gen'
erally supposed. Most cases require: (1) A
physiologic cholagogue. (2) An intestinal antl
septic, and (3) A proteid digestant.
Qohgestin
(Saa "Ntia and Non-Official Rtmedtet ")
Increases and liquefies the bile flow.
Checks Intestinal Putrefaction.
Relieves Intestinal Dyspepsia, and
Overcomes Intestinal Auto-toxemia.
SE— One (1) tablespoonhil WELL-DILUTED
after each meaL
STRONG COMPANY, 58 Wuren street. New
Formula, samples and literature upon requfst.
WZ 'u!
STRUMOUS
DISORDERS
^^^^^'^^^* with their train of symptoms pointing
to faulty or perverted metabolism, demand remedies capable of readjusting
normal cell processes. Of these
lODIA
is strongly suggested as the standard tonic-alterative. Clinical experience, ex-
tending over many years, has shown that it possesses striking individuality as
a reliable means to the end of stimulating cellular functions, promoting the
elimination of waste products and re-establishing metabolic activity.
lODlA, therefore, has a well-defined field of application in Syphilitic,
Scrofulous and Cutaneous Diseases, Rheumatic and Gouty Ailments,
and wherever a reliable altero-reconstructive is required.
BATTLE & CO.
(established 1875)
LOI^DON ST. LOUIS PARIS

I
THE CHARLOTTE MEDICAL JOURNAL.
"We Progress Through Change"
"THE ALLISON LINE"
of physicians' tables, chairs, cabinets
and specialties show the "Progress"
we have made through years of constant
improvement and "Change." If your
equipment is old fashioned and out-of-
date you have failed to progress with
the times and a "Change" is due.
Three things are essential to the successful
practitioner of medicine—knowledge, self-confi-
dence and the proper appliances. If you
have the first two, we can supply the third.
We are confident that we can
supplement your difficulties to
a minimum. An examination
of our catalogue will show to
casual odserver why the word
"ALLISON" has become as
s5'non3^m for the BEST.
W. D. ALLISON CO.
INDIANAPOLIS, IND.

Oar
ADVERTISEMENTS
THE CHILD THAT
FAILS TO THRIVE
may require noihing more than a lew days'
treaiment with
to encourage a belter systemic oxygenation and
promote a more active, pcrleel and complete
digestion and assimilation ol its food supply. 58
Samples and H. J. BREITENBACH CO.
Literature apoQ
Application. NEW YOBK, U. S. A
Bacteriological Wan Chart oj- our Dillerential Diagnostic Chart wm
be lent to any Physician npon application.
PEACOCK'S
BROMIDES
In Epilepsy and all cases demanding continued bromide treatment,
its purity, uniformity and definite tiierapeutic action
insures the maximum bromide results with the minimum
danger of bromism or nausea.
CHIONIA
is a gentle but certain stimulant to the hepatic functions and
overcomes suppressed biliary secretions. It is particularly
indicated in the treatment of Biliousness, Jaundice, Constipation
and all conditions caused by hepatic torpor.
REE SAMPLES ,
.1TER«TUBE TO PEACOCK CHEMICAL CO., St. Louis, Mo.
PHARMACEUTICAL CHEMISTS

THE CHARLOTTE MEDICAL JOURNAL.
PROMPT POWERFUL
Rheumatism and Kidney Remedy
Formula— Colchicum, Hyoscyamus, Rhus Tox., Chirette, Gaultheria,
Potass. Iodide, Magendie's Sol. (i miii. in lo),
Cactus Grand., Cannabis (i min. Tr.in lo) Potass, Acet, , Phytolacca.
Dose— lo to 30 drops, in water.
Indications— Rheumatism, Neuralgia, Lumbago, Gout, Gravel, Stone and Kidney Troubles,
and for Organic Disease of the Heart, especially \'alvular disease.
We ask a trial of the 1-Own-A Remedy at our expense, as we guarantee it to
give marked relief within 2 to 6 hours from first dose, and particularly recommend
it for chronic cases, as the more you use it, the better you become ac"
quainted with it, the more highly you will think of it, the larger you will find to
be the percentage of cases, all the requirements of which it will fully meet.
Left entirely in the hands of the profession, for prescription.
Put up in only one style, without menstruum, at retail
price of $1.00. Eacb bottle ivill make a 16 ounce bottle,
with eacb teaspoonful containing 10 drops (not
minims) of tbe I-Ovim-A Remedy proper.
Professional testimonials, and samples sufficient to test it for two or three
weeks, sent by mail to any PHYSICIAN upon direct request to
I. O. WOODRUFF & CO.
Manufacturing Cbemists
257-9 William Street New York
Cj/sto^en-J^ithia
An effervescent tablet of Cystogen (cs H12 Ni)
3 grains and Lithium Tartrate 3 grains.
Uric acid solvent and alkaline urinary
antiseptic.
DOSE—One or two tablets in a glass ofwater,
three or four times daily.
The idea of this combination was given us by observing
the large number of physicians using CYSTOGEN
with LITHIA in gouty and allied affections.
Where Cystogen is indicated, Lithia is of advantage
Where Lithia is prescribed, Cystogen is indicated.
INDICATIONS— Rheumatism, gout, urinary deposits, calculus, cystitis, prostatitis and
gonorrhea. A good urinary antiseptic during convalescence from typhoid and scarlet fever.
Cystogen—Crystalline Powder.
Cystogen—5 grain Tablets.
Samples on request.
CYSTOGEN PREPARATIONS:
Cystogen-Lithia (Effervescent Tablets).
Cystogen-Aperient (Granular Effervescent Salt
with Sodium Phosphate).
CYSTOGEN CHEMICAL CO., St. Louis, U. S. A.
;

The Charlotte Medical Journal
Antitoxin or Serum Tberapy in the Treatment
of Whooping Cough, Measles
and Scarlet Fever.*
By Stephen Harnsberger, M. D., Catlett, Va.
This paper is the compliment of a paper
read at George Washington University Hospital,
Nov. 14, 1908. r read that paper for
three reasons:
(1) To emphasize the fact that textbooks,
the general practitioner's main source
of information, holds to the same treatment
of whooping cough that was used a half
century and more ago.
(2) To suggest a modification in the
treatment cf whooping cough that not only
adds to tlie comfort of the patient hut keeps
down complications; and as the complications
are the usual causes of death in this
disease, it lessens the mortality.
(3) To impress the importance of a better
individual initiative and to urge the
profession to wake up to the probable good
to be had from antitoxin in the treatment
of whooping cough.
About three years ago, I read of where
an injection of diphtheria antitoxin in a
whooping cough patient was followed by
almost immediate disappearance of the
paroxysms and a rapid recovery. This interested
me. I read another such statement
during the early part of last year and
I determined "to wage an instant trial" as
soon as opportunity favored me.
During the session of the Medical Society
of Virginia in Richmond, last October, 1
called to see Mr. Belt, representing the II.
K. Mulford Co., as I wanted to know on
what terms I could get diphtheria antitoxin
for experimental purposes. Reporting our
conversation to his Company, their Dr.
Stewart wrote me promptly, offering nie
every assistance and help at his command.
In my next letter, I asked to be furnished
with all the printed matter he could gel
bearing on the use of diphtheria antitoxin
in the treatment of whooping cough and
other diseases of childhood. In reply he
gave me a letter of introductio!i to Dr.
Henry B. Kryan, of I'hiladelphia: evidence
sufficient that nothing of importance had
been written on this subject. I wrote Dr.
Bryan, telling him what I wanted, as well
as of my inclination to thoroughly study
the action of antitoxin in such diseases.
Dr. Bryan's reply was plainly to the point.
He mailed me clinical experience and ob-
•Read before Tri-State Medical Society, Charle.ston,
S. C,
CHARLOTTE, N. C, SEPTEMBER, 1909.
servation taken from his case records, and
which I shall take pleasure in presenting to
you presently.
In the meantime I mailed letters to a number
of painstaking physicians requesting
them to notify me of cases of whooping
cough, measles and scarlet fever occurring
in their practice, offering to furnish the
antitoxin and my services free of charge.
I was anxious to be able to add something
to Dr. Bryan's statement of bed-side facts;
but the time has been so short in which to
make my observations, that I shall defer
my personal report to some future meeting.
Dr. Bryan's report: "Antitoxin—a substance
developed in the body counteracting
poisons generated or planted there.
"Without at the present time going into
any explanation why diphtheritic or any
other specific antitoxin could be rationally
of any benefit in the treatment of measles
or scarlet fever, it may be of interest to
some physicians to learn of some of my experience
in the use of diphtheritic antitoxin
in the treatment of such diseases, while in
charge of the children of St. \'incent's
Home and Maternity Hospital of Philadelphia,
Pa.
"As a reason for having used the diphtheritic
antitoxin in scarlet fever and meas-
les, it will be well to remember that it is
generally conceded that the tissues and
fluids of the body contain, or at once manufacture
antitoxin, the effects of which are
directly antagonistic to the toxin of disease.
The secretions thus formed are capable of
protecting the body from invading bacteria
and are distributed to all the tissues of the
body and found especially in the serum of
the blood.
"In the treatment of measles—a disease
which Osier asserts stands third in the deathrate
of eruptive fevers, and Ilolt speaks of
an epidemic in 1892, in the Nursery and
Children's Hospital, of New York, in which
the mortality was .35 per cent., and in nine
thousand three hundred and thirty-nine
(9339) cases of measles in the hospitals of
Paris, there were three thousand and ninetysix
(3096) deaths, or a mortality of thirtythree
and five tenths (33.5) per cent.
"In the year of 1906 of the history of St.
Vincent's Home and Maternity Hospital
an outbreak of measles occurred among
our four hundred children. One hundred
and seventy-one children contracted the
disease, most of whom were under three
years of age. This occurred in January,
1906. As each child showed the first symp-

138
THE CHARLOTTE MEDICAL JOURNAL.
toms of measles five hundred units of anti- son, aged nine, giving him ten (lO) c.c,
toxin was immediately given. In this par- the effects of which were very gratifying.
ticular instance the deaths numbered twelve, The next experiment was an adult, Leonmost
of which were from complications fol- ard A., with pertussis. History: Age 28;
lowing the measles, principally pneumonia; sleeps badly; appetite poor; bowels all right;
in addition we had five cases of cancrum urine normal. Present illness whooping
oris, four of whom are now living. cough.
"Thid death rate is far below any other "Aug. 4, '07. Coughs every half hour,
similar outbreak we ever had and I feel with vomiting. Treatment, 10 c.c. sterile
quite sure the antitoxin treatment was the
alleviating cause, as in every other way the
horse serum. Aug. 6, '07. Patient better
—coughs every hour, no vomiting, headtreatment
was the same as in previous epi- ache after coughing. Treatment, 10 c.c.
demies in this hospital. sterile horse serum. Aug. 9, '07. Patient t
"As to the use of antitoxin as a prevent- much better, rash on both arms, headache
|
ive of scarlet fever, I will simply state a gone, coughs every eight hours. Aug. 10, l
peculiar circumstance that rarely presents
itself to the medical profession: In March,
'07. Violent urticaria all over body. Aug.
|
12, '07. Patient perfectly well and at

ORIGINAI, COMMUNICATIONS. 139
tinuous and in a week's time the patient bers of this Association and of the entire
was practically well. profession should be grateful for this ad-
" 'The children who did not receive treat- vance towards specific therapy in the treatment
until the third week of the disease ment of whooping cough, measles and scarwere
not benefited so much as those who let fever.
received it earlier; one case did not seem
benefited at all, two were slightly benefited. Tlie Business Metbods ot the Profession.*
Four dtivs after treatment one case devel-
, ;. . , . , ti 1 J
oped urticaria, which promptly cleared up
after receiving a dose of oil. On recovery
•
t, t^ t-j ^^ -,, t-, ^-^ vi r^
By Dr. Edwin G. Moore, Elm City, N. C.
^'/r. President and Gentlemen:
from urticaria the whooping cough was I have formulated no prescribed rules nor
practically broken. The paroxysms of attempted any specific directions by which
coughing were le^s severe and vomiting you gentlemen may hope to learn from me
occurred once a day for a week. The how to direct yourselves into the roadway
child's health was improved in every way of business success. I cannot, in the comand
she rapidly gained in weight. pass of a short paper, 4ouch many salient
" 'Ten days after treatment a second case and essential facts, besides each one is exdeveloped
urticaria. This was the only one pected to contribute to this important symof
the lot who did not seem benefited by posium, and it shall be only my purpose to
the serum. The paroxysms of coughing speak in general terms, leaving you to conwere
very severe and s'le freauently vomit- tribute from your judgment and experience
ed food and bloody mucus. Once the rash such facts and knowledge necessary to the
developed, the whooping cough was prac- finish of this paper.
tically gone. Improvement was rapid. The selection of a subject of one's own
"'The conclusions are obvious: The choice admits of no apology for eypression
serum treatment is a benefit in pertussis— or finish for the privilege of quotation from
(1) it lessens the severity of the paroxysms; standard books and recognized authors,
(2) it prevents vomiting to a great extent; either to express an idea or emphasize a
(3) it improves the condition of the child, truth is a potential factor, and I might add
so that she feels better, sleeps better and a desideratum in the construction of a thesis
eats better.
"'The only bad effect is the urticaria,
on almost any subfect. But to be given a
subject and bidden to write with the injuncwhich
I think can be prevented by a dose tion to neither phrase nor paraphrase the
of oil in from two to three days after ad- spirit or essence of what has been written
ministration of the serum. before, in other words speak only along
"In reading over Dr. Webster's report, it original lines, is a task and responsibility,
should be remembered that these were in- the burden of which this speaker would be
stitution children; and while we do every- glad to donate to some more versatile
thing we are able to do, they have not the brother. Once before, when I was younger
physical or hygienic advantages of outside than I am now, a pretty maiden handed me
children. I think, therefore, our results an autograph album with the request that
are more convincing of the rational use of \ write something original. Happy was I
animal serum to combat diseases of which that my memory recalled that appropriate
any particular animal is not susceptible." couplet of an unknown author who under
Anaphylaxis; In closing, I wish to state similar circumstances on a former occasion
that I am mindful of the danger that lurks wrote as follows:
in the hypodermic use of diphtheria antitoxin
in the treatment of diseases other than
,. ,
•
, ,,.1.1 T 1
I
diphtheria. While I have no personal
"an ORIGINAL SOMETHING,
.
. ,
.
,
" I' air maiden vou would ask me to write
But pray tell me, how shalll begin?
knowledge of such deaths, and none are re- For I fear I have nothing original in me
ported by Dr. Bryaji, although he has given as Excepting Original Sin."
high as fifty-five ( 5.S ) inoculations of diphp^^
j^,jg j ^^^ ^j^.g^ ^^^ credit for havtheria
antitoxin to as many children under 3
j,,g ^j^^g ^ ^,^^^, dever act, but my audience
years of age, suffering with measles, in one
^vasnot so well' informed as you gentlemen,
afternoon, "that there is," says Dr. F. E.
^^^j perhaps not so critical.
Stewart, a certain amount of risk ininject- Someone has written a book on "The
ing alien sera, owing to the fact that cer-
Doctor's Wife," another on "The Doctor
tain people seem to have been sensitized in
Himself," and to all of the vounger brethsome
unaccountable way to horse serum,
^g,j j would commend the perusal of these
must be accepted as a fact." books, especially "The Doctor's Wife,"
The positive personal experience of Dr.
^j^^ jg ^^j^^^ ^^^^^ j^ goffer j^ost at the
Bryan rarely falls to the lot of one individual,
and I trust I do not presume beyond «Read before the Wilson County Medical Society
discretion, when I say that I think the mem- at Wilson, N. C, July 2nd, 1909.

140 THE CHARLOTTE MEDICAL JOURNAL.
hands of him who had promised to protect cess. A genius without energj' or moral
and defend her. character scales no altitudes and reaches
The code of ethics is a marvelous pro- no preeminence, and misdirected energy,
duct of mind and heart, superb in literary however much it toils, or suffers, or hopes,
design, ideal in conception of human love fails of fjrogress and languishes in defeat,
and human duty, touching only the high ^fen may be born equal but if so they fail
places of conscious virtue with the wooing to maintain this equality. Success may be
influence of poetry and song. I have heard possible unto all men but facts prove not
and read many tender and touching tributes along the same line nor of the same kind,
from divers sources extolling the virtues We need no historian, nor biographer nor
and prophesying the rewards of our beloved philosopher to tell us these facts, for we
profession, and I have been made to feel have only to look about us and behold for
glad that I was a comrade and could claim ourselves. Who among you does not refellowship
with that noble band of men who spect the life and memory, the mind and
go about on earth doing good and hoping character of those wise, kind-hearted and
to receive their crown of reward in the life courtly gentlemen in medicine who helped
ev^erlasting; but so far as I now recall I ta initiate this Society and gave it their
have neither seen nor heard any suggestion support and encouragement and walked
devising ways and means looking to the among us as our counselors and our friends?
promotion and betterment of their material Who did more to up-lift the high character
comfort and prosperity. So long neglected of our profession by precept and example
this maj' yet be one of the triumphs of the than the courtly and chivalric Dr. Ruffin,
twentieth century, and it may be possible and who did more of kindly deeds of charthat
at some distant day medical colleges ity and bestowed more of generous labor
to meet the growing demands of the profes- than the genial and kind-hearted Dr, King?
sion and the public will establish a chair of Each a striking individuality, yet above all
bi-metalism and economics, and State ex- a gentleman. Who among our citizenship
amining boards will require a suiBcient does not feel a sense of pardonable pride
evidence of proficiency in this branch or that Wilson county had the material and
department of knowledge that will at least the man who, irrespective of conditions and
give assurance of the candidate not becom- circumstances, could measure up to the
ing a subject of poverty or a charge of standard requirements and the crowned
charity. heights of a Federal Judgeship? Do you
The subject which your Society has as- tell me this is luck, or, if you please, an
signed me— "The Business Methods of the accident? I could not, and would not, be-
Profession"— I hardly know whether to lieve it if you did. I answer it is but antreat
seriously or in a lighter vein. I am other proof of the reward that grows out of
not sufficiently advised if the profession has that trinity of virtues—intellect, energy and
any "business methods." Those of you character. Without assuming further conwho
are so informed will have the oppor- troversy, and to be more concrete in extunity
to enlighten me, and while I have pression, I would propound the query,
walked only the beaten path of a country "Why do we practice medicine?" Are we
doctor, moving in silence and oftentimes in actuated by a distinct mercenary spirit, or
darkness, yet would I welcome the light are we missiona ies in the field of philanand
rejoice in its gladness. I have often thropy? Are we engaged as a matter of
felt impressed that of all professions it was livelihood, a bread winning proposition for
the least business-like, and had perhaps ourselves and dependents, or as a sportive
less of method and business direction. I recreation for pleasure or pastime? If either
will not be going very far wrong to state proposition be accepted, then I would in
that every trade, profession, or vocation is humility, yet in truthfulness, suggest that
either a question of choice or a matter of lawn-tennis, golf or membership on a baseenvironment,
a volition of purpose or a ball team would afford' more merriment and
coercion of circumstances, and in either possibly more money; certainly an easier
event it is the individual fitness or adapta- job with more reputation, though fleeting
tion that qualifies or disqualifies the meas- and ephemeral.
ured terms of success. Barring a few cases I am strongly persuaded that he who enof
accidents, success in any line, without ters this profession with the view of moneyexception
to medicine, is dependent more making or money- getting has not only
upon the eternal fitness of the individual missed his calling but his election also,
than to any co-existence of circumstances. The indifferent, the indolent, the lazy fel-
Tiie intellectual, moral, and industrial ele- low in search of an easy task where he may
ments or attributes of character must be find delight in the rose garden or rest under
blended and harmonized before the world the shade of the trees, had best seek him
can stand up and count him worthy of sue- another job. The ambitious seeker for dis-

ORIGINAL COMMUNICATIONS. 141
tiiictioii or applause may likewise be direct- zealous in his work, cultured in manner
ed toother and fairer fields, easier of access and safe in character, and it never has oband
more fertile in results. jected to pay the price necessary to give
But to the viiile man, the earnest worker, adequate support to such of the profession,
the seeker after scientific truth and with the Bad pay and inadequate support does not
purpose to contribute in some measure to- arise "de novo" with the public, but is
wards the alleviation of human suffering usually chargeable to the directness and
and the uplift of his fellowman, it offers an indirectness of the individual members of
inviting field, broad and wide and teeming the profession.
with possibilities. But the laborer is worthy You have given me the liberty and I am
of his hire, and a life devoted to such work going to make a rather startling statement,
and consecrated to such purposes deserves but I won't publish it; I am only telling it
and should have sucli compensation in at the hearth-stone of our family circle and
material things as will conduce not only to 1 don't want it to shock even tlie sensitive,
his physical comfort but insure his own The public has been long-sufiering and en
self respect. I would not indulge the hope dureth much, and I have no doubt some
of riches, but you are entitled to a compe- doctors have but little cause for complaint
tency of supi^ort, commensurate with the when they stop to consider the quality of
skill you dispense. To the most of us medi- service they barter in exchange. A doctor
cine is our profession and our business, our who is not informed in the accepted leachvocation
and the sole contributing factor as ings of his profession and does not make
our means of a livelihood. It behooves us due effort to acquaint himself, but is conto
give it our best service and demand of it tent to blunder along in a mis-shapen and
its best rewards. careless way, indifferent to the best interest
Happy is he who is content with his of his patient, and oblivious to his duty and
choice and finds the peace of satisfaction the demands of his profession, in my opinin
its field of labor. As Elbert Hubbard ion gets all that belongs to him, let the
tersely says, "If you don't get happiness credit sheet be ever so small,
out of your work, you will never know Mediocrity is the one great barrier in the
what happiness is." He who does not feel vvay of genuine progress; we attempt loo
a keen and abiding faith and interest in his much of labor and do too little of real
work fails in the higher and more dignified scientific work. There is too much of jealdevelopment
of his own personality and ousy and too little of true fraternal spirit,
contributes but little of real value to the A generous rivalry is a henlthy stimulus to
support and growth of his chosen profession, greater and larger development, but a harsh
It is such an one who becomes the unhappy, and bitter antagonism is the essence of all
drivelling subject of a jealous mistress, out littleness and is to be forever despised. It
of harmony with its true aims and purposes, jg a method and policy with some, and in
and the unmethodical and unbusinesslike fact it is their stock in trade, to wage a
personality that so frequently goes down in ceaseless and eternal warfare of direct, bitdefeat
and failure. ter and personal antagonism against other
The public may not judge you aright, it members of the profession, or secretly by
may be you are criticized too adversely or insinuationsor uncharitable criticism, under
accredited with skill you never possessed, cover, endeavor to cripple their influence
but every man is conscious of his own or hinder their progress. This is a measly
strength or his own weakness, with a defi- and contemptible means to an end, the sole
nite certainty unknown outside the realm purpose of which is to build himself by the
of his own conscious mind. destruction of another without regard to
But I want to tell you a 'secret, a truth cause or effect. Such poor policy is the
founded upon facts learned by observation growth of a poorer mind and heart whose
and experience, and it is this; The public day of judgment is near at hand. I pity
has neither appreciation nor respect for a
real poor doctor. He commands neither
the poor deluded soul who "knows it all,"
and seeing no virtue in others boosts himtheir
esteem nor their patronage while toil- self as a pattern of excellence and a paraing
here on earth, and it is only when foot- gon of wisdom, for he surely sees through
sore and weary with the race and the bur- a glass darkly. A professional braggart
dens of life he lays himself down in the bears a close relationship to a professional
slumber of death that mourners gather liar, neither of whom can be trusted or beabout
his last resting-place and with a bene- Heved.
diction of simple words speak a modest
farewell to his departed spirit.
The public spirit and the public conscience
demand that a doctor shall be com-
^^^ ^^^ „^, l^^ ^q^^^ to wage war
.
, , ,. -..Mr
"P«» ^^'^^ other m the private toils of our
vvork, for it is a deadly foe to our fraternal
peteut in skill and knowledge, honest and peace, disastrous to our professional prog-

142 THE CHARLOTTE MEDICAL JOURNAL.
ress and a dangerous enemy to our best Prophylaxis In Typhoid Fever.*
business hUerests By W. P. Horton, M. D., North Wilkesboro, N. C.
\\ e are told a house built upon the
sand" cannot withstand the fury of the The triumph which has been reached in
tempest nor the ravages of the storm, nor ^^^ ^^^^ of the medical profession in the
can a life without character as the bedrock
discovery of the real cause and spread of
for its foundation withstand the struggle o^ preventing the propagation of such germs |
for its existence with which it must con- ^^ '^^"^^ '^'^ disease has opened up many ij
tend. possibilities in the improvement of health,
Especially will you find it true in medi- strength and life saving of the American |
cine that her labors are exacting, even People. But there is yet much to be done, !
burdensome at times, and the exigencies of ^°^ effects of bad water, impure food, ill |
environment and the increased demands of ventilated hou.ses, and failing to isolate ,
modern society will call for the highest
contagious and art
infectious diseases is becomand
diplomacy to provide the
»ig
essentials and
more and more apparent every day.
necessaries for the maintenance and sup- ^^^ study which great sanitary authori- ;
.
port of a combined professional and do- ties have given the matter has imposed much |
mestic life. It cannot be said of her that ^°^^ distinctly the burden upon the municher
wavs are ways of pleasantness and her 'P^^' ^^^'^ ^"'^ Federal Governments in
paths paths of peace, but rather a hard booking after the health of the American 1
fought battle, a tense, strenuous life full of P^oP^e.
labor and of duty, but with a reward of
victory to all who are faithful and true.
But my purpose in selecting this is to dis- j
"^^^^ ^^°^ ^ ^°'^^^ standpoint, or more defi- |
Viewed solely from the vantage ground "itely some years observation in a mountain i
of business methods it pays to be a wise *^7"' where complications of malaria can I
man, learned in knowledge and science, f^fely be excluded by location and altitude,
skilled in art and culture, honest and truth- ^'lerefore when a patient presents symp- I
ful, dignified vet polite and courteous, ^*^'"^. °^ typhoid fever we can readily de- humane and charitable, courageous and
|
termme what we have to contend with. (
manly in all things that elevate and ennoble ^ ''" '^°, ~^
„,;V'"t °fT ^Tl" T'\ 't'^.
'
per cent, of the population , , . of North Wilkes- i
a true character and constitutes a true boro were stricken with typhoid fever, in !
gentleman.
Meet your own obligations to your credfact
this disease spread with such rapidity
^"'l to such an alarming extent that not
i
(
itors and make vour debtors meet
""^^ *^^ health officers,
theirs
but the citizens at
Do your part of 'real charity, or all of it if t''lfj''fnn'Jr ^^'f /°/
i
'^' """'" •^""
.
vestigation showed , , .
that four years , ,
previous
you wish, but require people who can pay some negroes who lived in the immediate
you to do so—they will think more of you vicinity had quite a number of cases of the
'
i
-|
i
and you of them. Be just in your charges u^ost malignant type, many of them having
and collect it, but don't render nominal l^emorrhage, and these cases were badly '
I
s„vice..„..i„, ,„ ,„„..se ,„,..„de or z':^^:';^:::"^'^ ]sS:t "^^'z
hold patronage, for it will not do it. Meas- water supply and underground drainage.
i
ure your fee by the value of your service. H vvas clearly shown by this history that ;
Don't make other people pay for your own these cases were caused by the germs find- j
mistakes; if you haven't knowledge, then '^n their way through the surface drainage J
j«u,.ow,.d.e, ,o„h„.ispi.„.y ,„ s.,e.
but don t get too wise, especially in your
own conceit. Don't know it all—leave a
^7Si ^:!.::;''\£s::i.'^is^
and only means of preventing the spread of
typhoid fever is to destroy the germs and
I
,]
i
little for the other fellow to prevent atrophy Prevent their accumulation, and the only .j
and stasis when you are gone Try
^^^^^^ that is sure is the application of
to be
^^^j' "o^^'e^'^"-- the first attack should be !
,
professional if thev /=>' will let you Be charit
11 t ,1,
w'" ^et you. He charit made in the treatment of the patient, and i;
able to the old doctor and merciful to the as I firmly believe in antiseptic treatment i
'
young. Don't be the dog in the manger, and there is no doubt in my mind but that ri
but be a gentleman of ^-"^' culture and ^'^'"t
charac- had the destruction of these germs ;:
when he recommended as a treat-
ter, a laborer of energy and purpose, and a '" t- f ""[^V
, „ J J » ment 1
good doctor who conserving all the rich tincture of'iodine, three parts of the first to
elements of manly virtue, hopes only for t wo of the latter; this was later improved on
for typhoid fever carbolic acid and •
that which is wisest and best and strives to ,„ , ^ ,
aft5,;„
'^^^^ before the recent meeting it
of the State i
^"^'" "•
Medical Society at Asheville, N. C.
'
'
'
'
'
-.:
)
l

ORIGINAL COMMUNICATIONS. 143
by Shumaker who recommended beta nap- questioned by any one today, and it is not
thol in much larger doses, which not only necessarj' to spend any more time on this
serves as an antiseplic to the ulcerated aspect of the subject. The more important
bowels, but seems to destroy typhoid bacilli, problem confronting us is how to restrict
it being much sirouger and should have a^^ suppress this noxious insect. In order
the same effect on the intestinal ulcer as tliat the house-fly may be controlled we
carbolic acid for external use, and there is must know where it breeds. This little pest
no better time to attack these little enemies is bred and born in the post heaps and
than when we have them bottled, as it were, nourished from the stables and closets until
The second attack should be made imme- it becomes wise enough to go to all accessidiately
after the evacuation by free use of ble tables three times a day for dessert. He
chloride of lime and other strong disinfect- crawls over the different articles of food
ants. Immediately after the application of with his infected feet planting his long verthe
disinfectant the stool should be removed bossis in the most delicate dish, only to
to some back lot where the last and fatal eject its filthy contents and refill with someattack
should be made by providing a tub thing better.
that will hold about three bushels, place it I" a comparative statement science has
with the bottom about ten inches in the shown more deadly germs contained in the
ground, partly filled with excelsior or straw trunk of a single house-fly than the trunk
and a carefully fitted plank over the top. o^ an elephant and the former should be
This is the point where the most is accom- regarded as the more dangerous of the two.
plished; first, by preventing the under- The house fly is too timid to go in dark
ground water supply from becoming in- places and can be eliminated from our
fected; second, by preventing the most closets by the small cost of twenty-five
common carrier of all germs, or better cents and a little extra care. The methods
1 known as the house-fly. propose will eliminate the fly from all in-
^^'''^^ substance and make the dangers
It is hardly necessary to cite authorities
^'^^-^
on the capacity of the house-fly which car- "^""."^ less tban the old and almost
, , [ , . .1 universal plan of burying the stool in the
ries bacteria from one place to another. j l- i i. ui r j j
„,. •• 1 1 1 J ground, which should be forever condemned
. . 1
1 his capacity has l)een amply demonstrated f ,, ,. , r • n^u .i v,
, /- • J Ti 1 a 1 . by the medical profession. \\ hen the above
and confirmed. 1 he house-fly is known to "^
. , ^ , • j . j .u
, , • '
1 ,, . J 1
J T. suggestions have been earned out and the
be strongly attracted bv noisome odors. It t" , , .i i ^ „ !,„
'
, I » "j 1 f 1 » patient reaches the convalescent stage the
hovers about and feeds and propagates on ' ,. .. ,
, , . , ,. ,, f
, . T. . r A application of a match to a half gallon of
human excreta. It eats pus, sputum, and ^^, ., , . , j n . v n
., .11-1 J , I f . •. coal oil used in and around the tub will
other pathological products. In fact its
, . ., i j ^ ,„j
, ... iY 1 ; J . f .1 I- complete the work and you can rest assured
habits are well adapted to favor the soiling '
,
, . .. . •
i
i • »
, ,, . . (.11 1 . cii •. that the germs from the typhoid patient
of the exterior of its body, and to fill its in-
" t- t-
.
have not been allowed to infect the water
terior with various species of disease germs
supply of the entire community nor has the
Pathogenic bacteria have been demonstrat-
multitude of flies of the entire town been
ed on Its proboscis, Us feet, and in its di-
^^^^
gestive tract and its excreta, the well known
^^^.^^^^ ^^.^ ^^^^ ^^ ^^^^ ^^ ^ ^^^^ J^^^^
tly .spects.
^j^^^^ gfjy ^gjjjg ^^^ ^jjjjj ^ mjjted effort bv
The kinds of infections it is best adapted
^^^^ gj^t^ ^^^^ county, with the cooperato
transport from place to place are typhoid
^j^,, ^f ^^^ American Health League of
tuberculosis and Asiatic cholera. By seedjj^^gg
^^^ms can we expect the slightest iming
our foods, notably milk, with these provement along this line.
germs which it obtain^- from dejections will _^_^____
cause localized family epidemics.
j^^ Case ol Osteomalacia.''
The bacilli of tuberculosis and typhoid „ , „, „ „ r^ u i n xt n
•
, ,. .. , I •» 1 .1 (1 By J. bteven Brown, M. D., HendersonviUe, N. C.
•*
may be disseminated by it, because the fly •'
will feed on sputum as well, and the bacilli
may pass alive through the digestive tract
Because of the rarity and gravity of the
disease, I feel constrained to report briefly
and appear in the fly specks, and has been
found living in the excreta of flies fed with
a case of osteomalacia, that quite recently
came under my observation. Dock has
sputum and excreta fifteen days after they
had passed. The severe epidemics of tybeen
able to collect reports of but ten cases
in America. Xo doubt others have occurred
phoid in our camps during the Spanish-
American war were attributed by the investigating
commission to flies. There can
without going on record.
The family history is fairly good; four
sisters and three brothers being alive and
beno doubt that the housefly is a potential
danger in proportion to the number of in-
jn good health, while one sister died at
dividuals living in our environments. *Reail before the recent meeting of the State
I believe that this position will hardly be Medical Society at AsheviUe, N. C.

144
CHARLOTTE MEDICAL JOURNAL
eleven of some spinal trouble. The parents and shivered as she expressed it. An exu-
were healthful.
dation appeared on left leg about six months
Patient is a native of Hominy, in Bun- after the ankle popped and on the right leg
combe county, is now forty-five, and may about six months after the thigh shivered.
weigh 100 pounds. Her normal weight Both legs are now covered with great fishy
was^lOT. The first point of special interest scales.
in her personal history is that normal men- Some five years ago the left arm broke or
struation was established at fourteen and bursted above the elbow. Much pain is
continued without noticeable irregularity now felt in the right shoulder.
till forty- four. Patient married before she Her pelvis is flat. She has no bedsores.
reached fifteen, and is still living with the The bowels move regularly. She craves
husband. Contrary to classical history she
never miscarried, and never even became
pregnant. At twenty-four a case of socalled
erysipelas developed in her right leg
and continued for six months, leaving an
ulcer which remained for some months
longer. A few years later she often suffered
from supposed rheumatic pains in her hips.
When about thirty-three she endured what
she called "deep boring pains" in the marrow
of the bone of the left leg. After suffering
this torture some six months, she
says she felt "her ankle pop as she was walking
across the room. She was unable to
use this limb for IS months. Then for a
year and a half she managed to hobble
around. About this time her fingers and
toes began to be emaciated and drawn and
her right thigh began to ache and throb.
Two or three years later the thigh bursted
much fruit. Her teeth are bad. ,
The cause of this serious disturbance in i
metabolism is usually referred to child- r
bearing. It might better be referred to some .J
dyscrasia of the sexual organs independent^
of child-bearing. The disease occurs far...
more frequently in prolific mothers, but {
may occur in sterile women and even in «
men. The remedy par excellence in theJ
early stages is castration.
Amoebic Dysentery wllh Abscess ol
Liver Conlirmed at Autopsy.
By Win. Allan, M. D., Professor of Parasitology|
North Carolina Medical College, Charlotte, N. C. J
During eighteen months residence in^^
Charlotte, I have neither seen nor heard; i
anything of tropical abscess of the liver.: f
Inasmuch as our dysentery death rate
equals our typhoid death rate, liver abscess

ORIGINAL COMMUNICATION. 145
can be no uncommon thing here. In the July 30th, 8:30 a. m.—Hemorrhage from
last fifteen months I have seen twenty-five tlie bowels. Patient very weak. Bowel
cases of amcebiasis, with ten deaths. In movement less frequent during the last
only one other case was liver abscess sus- twelve hours,
pected. J*ily 31st.—Hemorrhagic bowel move-
Case.—Mr. P., admitted to the charity ment continues. Patient very weak. Death
ward of St. Peter's Hospital, July 22, 1909; at 5 p. m.
white, male, age 5.S, married, box-maker. Autopsy Notes.
Well-water, vegetables from home garden. July 31st, 9:00 p. m.
Family histor3', negative. Past history, Both lungs adherent over posterior part
typhoid, pleuris)', bowel, stomach and liver of upper lobes one and one-half inches betrouble
fifteen years ago. Passed a renal low apices, showing sclerosed tubercles,
calculus some years ago (says it is in his Xo caseation. Heart pale and right venbladder
yet). No urinary symptoms until tricle collapsed. Left ventricle somewhat
last week. Has had dysentery off and on hyperlrophied. Abdomen opened and omenfor
a great number of years. tum found covering the intestines. Omentum
Present Condition.— Patient comes in com- adherent over middle of ascending colon
plaining of bloody flux, from which he has under border of liver. Stomach sagged
suffered for three months. Is greatly pros- down toward pylorus; cardiac end distendtrated,
emaciated and anemic, has straining ed; pyloric end contracted. Stomach not
and tenesmus at stool, with gross blood and opened. Small intestine normal from pymucus
in the movements. Has protracted lorus to caecum.
attacks of hiccoughs, which have caused From caecum to anus the colon was
soreness of the abdominal muscles. Some everywhere very much thickened and intenderness
over the sigmoid but none over filtrated and extensively ulcerated. The
the liver. Sleeps well, good appetite.
Physical Examination.— Nothing elicited
ulcers were sometimes as large as a half
dollar. Extensive areas of capillary hemorexcept
increased liver dullness. This extended
two inches below the costal margin
rhage into the wall of the colon were pres-
ent. On the front side of the middle of the
and across to the left nipple line.
Laboratory Report.— Urine: Acid, sp. gr.
ascending colon was what seemed to be a
perforation with dense adhesions to right
10.20, no albumen, no sugar. Microscopi- kidney, omentum, liver and gall bladder.
cal: Blood and pus, probably from the This was under the edge of the enlarged
bladder. Blood: Haemoglobin 70. Differ- liver. Spleen and pancreas normal on gross
ential count, polynuclears 92, monononu- appearance. Kidneys, gall bladder, adrenculears
8, eosinophiles 0. Sputum: Thin, als, prostate and urinary bladder not exgray,
liquid, offensive, no amoeba present, amined. Bile readily squeezed into the innot
examined for T. B. Feces: Liquid testines.
with blood and mucus, linlamoeba Ilisto- Liver enlarged with large dark -bluish
litica present in considerable numbers. blotch covering left half of right lobe. Left
Patient ran no temperature, pulse 85 to lobe extended to left anterior axillary line.
95, respiration IS to 22.
Diagnosis,—The diagnosis of amoebic
dysentery with abscess of the liver was
Right lobe two and one-half inches below
the ribs with gall bladder to the umbilicus.
On section an abscess was found a little
made on the strength of the fecal picture, larger than a hen's egg, one inch above
on increased liver dullness with hiccoughs and one and one-half inches to the right of
controlled only by morphia, and on the ab- the point where the gall bladder emerges
sence of eosinophiles with 92 per cent, from under the liver. Abscess full of green
polynuclears. and white thick, viscid pus and mucus.
Notes.—July 22nd. Patient has prolonged This has not been examined for amoeba.
attacks of hiccoughs which can be relieved
•
only by morphia. The Apparent Divorce ol Modern Medi-
July 27th.— Has had hiccoughs off and cine and Surgery, and Some ol lis
on for the last few days. Colonic irriga- Consequences.
tions had to be abandoned because of the
weak condition of the patient. High enemas
in bed were tried but without effect as only
bv J. Allison Hodges, M. D., Richmond. Va., Phv-
-charge Hygeia Hospital.
a quart could be introduced. Kept pretty
steadily under morphia. Xo effect on the
The opinions expressed in the discussion
of this subject are offered neither in the
bowels, which moved from fifteen to twenty capacity, nor in the spirit of a teacher, or
times a day.
July 29th.— Patient rapidly growing
weaker. Anemas stopped. Lead and opium
a critic. They are the result of an experience,
embracing observation of many cases
from many capable physicians and surpills
substituted for morphia. geons, and are intended to be suggestive

146
THE CHARLOTTE MEDICAL JOURNAL.
and helpful, and not dogmatic, nor deroga- This is especially true of surgical results,
tory. for it is imt sufficient, nor, in fact, is it war-
The sole purpose is to aid the profession ranted, that a case be simply determined to
as a whole, in the proper extension and de- be mainly surgical, to be operated upon,
velopment of medical and surgical science Much more is necessary; for while it is
as practiced today. usually easy, for instance, to differentiate
In former days, the science of medicine the organically diseased from the nervously
embraced the science of the practice of medi- diseased, yet it is, in my experience, quite
cine as well as that of the practice of sur- another matter to differentiate the organicgery,
but in the advancement of that science ally diseased patient, who, because of this
in recent years, it appears to me that, un- condition, becomes nervously upset, from
fortunately, there has not been that close the neurotic individual who becomes orunion,
that intimate sympathy and co-oper- ganically diseased, and still all these facation
between the practitioners of the two tors are of most vital importance, and rebranches
of the profession that are for the quire the best thought and experience of
best interests of the development of the both physician and surgeon acting conscience
of medicine in toto, and for the pa- jointly, and in perfect imion.
tients resultantly. This harmonious cooperation would
In their enthusiastic endeavors to obtain throw a much-welcomed light on the postbrilliant
results, both medical and surgical operative statistics of the surgeon's long
practitioners have been more or less un- list of tabulated statistics of abdominal
mindful of obligation to their patients' cases of such and such a disease with a
rights, and each has acted more or less in- given mortality, which are now well-nigh
dividually and separately. valueless, and show us more clearly the re-
As a result of this competition, so to mote, as v.ell as the immediate effects obspeak,
the surgeon has achieved the most tained. It would also, as some writer has
substantial standing for his branch of the said, probably light up that twilight zone
profession, and by his audacity, as well as between the so-called organic and funcby
his skill, he has magnified his branch of tional affections, embracing the neurasthe
science to the temporary disadvantage thenic class of disorders, as well as illumof
his co-worker in the field of medicine, ine the Stygian darkness of that purely
and by degrees, modern medicine and sur- neurotic zone, in which neurologist, phygery
have become estranged, and appar- sician and surgeon often grope aimlessly,
ently divorced. helplessly and hopelessly.
This would be eminently proper if all In the next place, in regard to the quali-^
cases of disease could be separated into fications of physicians and surgeons, there: i
only two classes, namely, medical and sur- are distinctively two classes, the agnostic^V
gical, and, further, especially if all sur- and the diagnostics. .
geons, as well as physicians, could be de- The agnostic physician is the one who i
nominated as wholly capable and elEcient, reveals his knowledge, or the lack of it .
but this classification cannot be justly rather, by drugs, dopes and demeanor. He i
claimed, nor approved by competent judges, looks wise, drugs every symptom, and doses i
In regard to the first proposition, the every patient. This type is ea.sily recognizclassification
of diseases, it is important in able.
order to properly treat a case, whether med- The agnostic surgeon is the operating i
ical or surgical, and especially if surgical, surgeon, who operates first, last, and all
not only to consider the symptomatic part the time. He no sooner discovers some deof
the equation in evidence at the time, but parture from the normal in structure, thaa i
also to estimate candidly the future possible he rushes to the rescue. His type is familiar, :
developmental features of each case, and to us all.
this is no easy task for the skilled physician The results of both of these classes of 1
or surgeon, much less the tyro in either practitioners are notable—they frequently i
branch of the science. score, but they more usually fail.
And yet this is done every day, and the On the other hand, the diagnostic phy- j
patient mercilessly relegated to the one or sician, just as the diagnostic surgeon, ap- I
the other, acting separately and independ- proaches each case with caution and care, \
ently, just as the case is determined to be calling to his aid every facility furnished
one either of surgery or medicine. by his skill and experience, both in prac- i
The results are often obvious, for while a tice and in the laboratory,
symptomatic cure in medical cases, or an But just here, to my mind, comes the :
anatomical cure in surgical cases may be fatal error to the patient and the profession
secured temporarily, yet a disability fre- alike; for, while they work enthusiastically
quently remains which vitiates the most and scientifically, still they work single- ;
successful life-saving result. handed and unaided. i
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ORIGINAL COMMUNICATIONS. 147
American medicine and surgery have ajTwell by a thorough study of the whole hujust
right to be proud of their achievements, ;< man anatomy and ohysiology, as well as
but to advance more adequately the essen-' pathology of the system, before they limit
tialpurposesof medical and surgical science, their work along definite lines. Again, the
[there must be mutual interdependence and physician, as well as the surgeon, naturally
,
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co-operation. Even the best in either branch has not the ability nor the time, to cover
must admit that they are not infallible, and the broad expanse even of the field of medi-
Ithat not absolute efficiency, but only a cine on the one hand, or of surgery on the
reasonable degree of it, can be expected of other. What is the result? Naturally you
them; for if they are honest, they must ad- may have a brilliantly equipped medical
mil that the masters of medicine and sur- man, and yet it is absolutely impossible for
gery are few in number.
As a matter of fact, however, this is
him to be skilled in surgical diagnosis. On
a the other hand, you may have a man highly
diflScult and disappointing view for most of skilled and equipped in surgery, in surgical
us to assume, and rather than to admit it, knowledge and dexterity, and yet wanting
even to ourselves, we prefer to fight single- in the broad essentials of the knowledge of
handed the battles that daily arise, often- the practice of medicine. Consequently,
times forgetting that it is not all of medi- you can understand very easily that if we
cine to drug, nor all of surgery to operate, wish to accomplish the best results, there
In the new "physiologic" era which is must be an inter- dependence between the
to succeed the present, or "pathologic" era physician and surgeon in getting the clearof
medicine, we are to take less care about est diagnosis, and resultantly, the best lines
Uhe entrance of possible germs into the
system, and much more care about keeping
of treatment for their patients.
It is a fact, too, that the one on the one
: the patient in such a condition that he can side, as well as the one on the other side,
resist them, if they do get in, and to this becomes biased in his prognosis, as well as
I
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tend we will need the freest co-operation uf in his diagnosis, and that oftentimes both
both ])hysician and surgeon for the fullest the physicians and the surgeons become
of our beneficent science. nihilists to the therapeusis of the opposed
I
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development
Unquesiionably, tome, the apparent di- party, as we may term it, and the physician
vorce of modern medicine and surger\- is thinks that the surgeon can accomplish
, largely due to one factor, which, while it nothing, as the surgeon thinks very often
; has
probably done more to give us an inti- that the physician can accomplish nothing,
mate knowledge of certain lines of the This is obliged to result in ill effects for the
science than anything else, yet has its patient, who has certain well defined rights,
serious consequences and disadvantages, for which we ought to have the sincerest
,
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What, then, is this factor? I believe it can
be summed up in the one word, "specialregard.
It is also a fact that neither one,
as a rule, follows the case from the bedside
ism," and I believe, further, that when I
• conscientiously, and carefully, and thorobservations
along, say. to the operating
table, to see whether his diagnosis is conoughly
understood and studied, specialism
has as many disadvantages, probably more,
firmed or not, or sometimes to the autopsy
table, to see whether or not his diagnosis
than it has advantages. and prognosis were well-founded. Surely,
What ar:- some of tliem? One of them is
the undeniable fact that men, unprepared
by sufficiency of knowledge and ripe experience,
rush too precipitately into the
different specialties of medicine, and as a
then, unless we have cooperative work
which is directed all along the line, and
confirmed or not confirmed, we cannot be
definite in our diagnosis, and we do not
learn from the case in question as much as
result they are not prepared to cover the we should.
broad domain of the science.
It is also a fact that many of the special-
It is also true that these opposing ideas
as to therapeusis held by the medical man
ists who go into the different branches, and the surgeon, lead at times to deplorable
while they have added infinitely to our intimate
knowledge of these branches, have,
results, and often to chronic invalidism in
a number of patients, who could be saved
because of their limited study in a certain that terrible wreck of their lives in the
direction, become biased, or in other words, future. I need not pause here one second
many of them have become "faddists," and
can see nothing outside of their special line
of work.
to dwell upon this, because it is too familiar
to you all. I am able, however, to say this
—that the exploratory' incision, often, of
It is also true that there are many "spec- the operating surgeon, and the "horse-back"
. ialists" who are not specialists, and it is guess of the practicing physician, would be
not unbecoming in us, I feel, to caution the largely done away with today, if we recog-
, young
men who gu so largely and so rapidly nized that the physician doesn't know it
, into the different lines, to prepare themselves all, just as the surgeon doesn't know it all,

148 THE CHARLOTTE MEDICAL JODRNAL
and that if they worked hand in hand, and repeat that we should not go mad with the I
shoulder to shoulder, for the best interests idea that the laboratory tells us everj'thing i
of their patients, they would consult about and that its methods are perfect, for in every i
these cases, and not let the inevitable result case we should bring to bear common sense :
which is noticeable to me today follow, and sound judgment in our analysis of i
What is that result? It is this—that in the them. And, besides, it is a fact that sim- j
great number of cases, the patient himself, pie exploratory incisions are not so harmj
these days, is getting to be the diagnos- less as would usually be supposed. Many '
tician, and he is saying whether his case of you know that even exploratory incisions
should be referred to the physician or to in certain diseases lead to metastases that
the surgeon. Now, I believe we are largely are irremediable by the surgeon's knife or
responsible for this very state of affairs. It tae physician's pills, if that incision is left ;
has been frequently noticed, I am sure, by open even for a few days; and another !
many of you, that when the physician and thing, many a time these incisions direct a
\
surgeon work independently of each other,
that the diagnosis often of the same case,
j
patient's attention to himself, which is unavailing
to the patient, and is, indeed, ex-
referredfirstto the one and then to the other, ceedingly harmful in
j
a majority of these!
is different, hence the skepticism of the cases. All of us will grant, I believe, that I
patient. Now, I cannot believe that if the intimate pathological knowledge is abso- I
true spirit of co-operation existed, that this lutely necessary in the practice of medicine, \
could be true, because if the medical man and yet I believe it is more important even
j
!
,
knows what he should know, and the surgical
man knows what he should know, and
each worked in harmony with the other,
to the surgeon than to the physician, and
while I wish not to condemn these researches \
or methods, yet I would urge that they be
certainly it would be the same diagnosis in applied not only to the gross specimen, but I
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the same case. I believe we are led away to the microscopic specimen, and that final
'
too often by the fact that we wish only to judgment should be made up, upon the data
determine whether it is mostly a medical elicited, only when a well-balanced judg-
'
case, or mostly a surgical case. We are ment has been brought to play upon them
not after an exact diagnosis, and that you at the bedside. <
know, in the advancement of medicine, is I would add, also, that the question of i
what the specialists were created for, and, the mental impression, both medically and ]
acting jointly, should be able to secure. surgically speaking, in many of these cases,
Frequently, also, because of the non- when we make a wrong or inexact diagco-operation
of the physician with the sur- nosis, is of far more importance than we
geon and the surgeon with the physician, would ordinarily judge. In short, special- j
many of the most important details and ism often divides the responsibility, and
facts bearing on the future of the patient, the patient suffers; for neither the physician
as to operation or non-operation, are neg- nor the surgeon feels the interest, nor the
lected by the surgeon, especially when he intimate desire to aid the patient, that both 'I
overlooks the question of heredity, or when of them combined, and working harmoni- •
I
I
he overlooks the question of individual con- ously together, would do. What is the i
stitution, of which he can know but little remedy then? Are physicians and surgeons
when the case is new to him. coming closer together in their work these S
When he overlooks, furthermore, the days? Is either profession capable of treat- 1
i.
question of the individual temperament, i"g alone many of the common diseases
which I believe every surgeon ought to be that come to us? Is it to the patient's best \
thoroughly familiar with, so as to know the interest, in other words, that this state of ii
resistant and non-resistant tendencies of his affairs should be brought about? Unhesi- j
patient, he is culpable, for I believe this tatingly, I answer affirmatively, for there is
method of rushing precipitately and hastily often a woeful lack of similarity between
^
into an operation, without all of these col- the diagnosis of the physician and of the i
lateral antecedents, which are of such im- surgeon in the same case, frequently due to i
portance to the future of the patient, and, a lack of proper knowledge on the part of
often, without previous needful prepara- each, as well as proper study, together, of
tion, is as often unwarranted, as it is un- the case in question. The surgeon fre- ''
necessary. quently fails to study his case thoroughly !;
I am aware that laboratory methods in beforehand, and the physician as often fails 'i
the advancement of our profession have to follow his case to the operating table to «
taken a very high place, but I wish to say see whether or not his diagnosis has been 'I
that, from my experience, laboratory meth- confirmed by the incision of the surgeon. [
ods, unaccompanied by close clinical ob- I wish to mention very briefly in con- .1
servation, do not make diagnoses that are elusion, that the "operative" surgeon is, I ii
confirmed upon the operating table, and I believe, today, passing out from being es- il
j
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ORIGINAL COMMl'NICATIONS. 149
sentially an operative surgeon. The skilful night's sleep, Trional grs. x is always
diagnostic surgeon no longer operates for given. In the morning the patient receives
every tumor, benign or not, as it comes, a simple enema of soapsuds and a second
because the tendency of modern surgery is preparation. We always begin to operate
more conservative than ever before. Radi- as early as possible in the morning, as by
calisra is becoming a thing of the past and so doing the patient is saved the nerve rackis
rapidly fading away before the greater ing waiting and often the tearful farewells
and more exact knowledge of the surgeons of the family; the surgeon and the nurses
of today. But I do say, that because of are cleaner than later in the day. It is all
lack of thorough study of the cases, jointly, important to have a skilled anpesthetist at
many cases of ovaritis, abdominal neuroses one's command who is to be trusted with
and appendicitis, if you please, are oper- the administration of nitrous oxide gas,
ated upon when they are not those diseases,
but are reflexes from some other cause,
ether, chloroform or ethyl chloride as we
may elect; who will reassure the nervous
Furthermore, when we get this exact cooperation,
we will not make these mistakes,
patient and gain their canfidence as well as
attend to the various pre-anaesthetic details,
because we will then know, for instance,
how much neurotic element there is, and
how much real pelvic pain. In other words,
such as seeing that the table is properly pre-
pared and that the patient is sufficiently
clothed and covered. It is our practice to
we can sort out and deal with the evidence invariably give a hypodermic injection of
of pelvic pain, and the physician can help morphine sulphate gr. 1-8— gr. 1-4 fifteen
the surgeon in his desire to be conservative minutes before the aneesthetic is commenced
and constructive, and not radical and de- and it is better in patients who are nervous
structive.
In conclusion, I believe that all of us,
to anesthetize them in bed and carry them
to the operating table. My own preference
[physicians and surgeons, wish and strive is for ether as the ansesthetic of choice
iOnly for the best results for the patient, but though I have used scopolamine-morphine
in our desire to be onesided, and all-power- anaesthesia in some fifty cases with excel-
ful, as it were, we run off too much into lent results and I believe that its use is inspecialties,
and wander away too far from dicated in certain cases. No time should
each other. We should come back and get be wasted by the surgeon when the patient
closer together, both for our own and for is brought in the operating room and his
the patient's benefit. Many a time the sur- procedures should be as rapid as is consistgeon
may m.ike an anatomical cure, may ent with good, clean, thorough work, as
remove a p ithological lesion, but even then shock is unquestionably increased by oper-
it is just as necessary and just as essential ations unduly prolonged, just as nausea is
that the referring physician should continue increased by large amounts of ether. It is
to treat the patient before a permanent cure not at all uncommon in some of the large
can be effected, for many of these cases re- clinics connected with teaching institutions
quire not only the treatment of the lesion, to see a patient fully anaesthetized and kept
medically or surgically, but also the medi- waiting for ten or fifteen minutes whilst the
cal and psjchic treatment of the patient, surgeon talks, or to see him stop in the
and to get the best and most lasting results midst of his operation to explain or dilate
we must have, even unto the end, hearty upon some condition which he wishes to
:o-operation, and an united interest, both make clear. Except in those cases recjuirn
the primary diagnosis and succeeding ing drainage I use a very small, light dress-
;reatment, on the part of both physician ing, consisting of about four thicknesses of
ind surgeon. . gauze, secured by narrow strips of zinc-
The Care ol Post Operative Cases.
oxide adhesive plaster. On the patients'
^^^^j^,, ^^ bed any damp clothing isimmedi-
Jy Henry Norris, M. I),, Kutlierfonlton, N. C,
Surgeon to The Riitlurford Hospital,
As the title of this paper implies, it has
ately removed and Until the patient has rejrained
consciousness they are watched
every moment by a skilled nurse who is
do with the care of post operative cases, competent to take the pulse intelligently
>ut necessarily much of this care must be- and to note and record symptoms. When
fin before the operation, and I propose to morphia has been given beforehand and
)riefly outline the methods used in The ether properly administered there is not apt
ilutherford Hospital, prior to and after to be much nausea, when it occurs, how-
>perative procedure. The day before opera- ever, it can often be relieved by raising the
ion drachm doses of salts are given every patient's head a little or by giving inhalalour
until the bowels have been freely
noved. When possible the patient is given
tions of vinegar or sips of very hot water.
We expect the patient to complain of pain
1 full bath, followed by careful preparation in the wound, which is usually of a burn-
)f the operative site. To insure a good ing character and passes off in the course

150 THE CHARLOTTE MEDICAL JODRNAL. |
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of a few hours if the sutures have not been Perinephric Abscess-Report of Two
tied too tightly; of thirst, for which cool
Cases.
water should be given frequently in small By T. E. W. Brown, M. D., Asheville, N. C.
quantities; of backache, which may be made Mi'. President and Members of the Society:
more bearable by turning the patient from The subject of my paper is "Perinephric
side to side, rubbing the back with alcohol Abscess." I desire to briefly refer to the
and by the proper adjustment of pillows, anatomy of the kidneys, then review a few
Six or eight hours after an ordinary abdo- of tl,e causes of perinephric abscess and to
minal operation the patient should be fairly
briefly run over the symptoms and course
comfortable and long continued expressions of ^j^ig disease.
of pain should cause us to make sure that ^he anatomical relations of the two kideverythiiig
is as it should be. A too tight
1,^^^ ^re very numerous and interesting, and
or uncomfortable dressing is sufficient to unless they are borne in mind by the phykeep
a patient awake all night. I think it gidan he will be at a loss to explain many
is advisable not to give the patient morphia symptoms, and will be slow in arriving at a
when they are conscious unless we are con- diagnosis, with consequent delay in providvinced
that they are in actual pain. I do not ing proper treatment.
believe in using the catheter until the blad- Ea^h kidney rests on the lower part of
der IS actually distended and causing pam. ^^^ diaphragm, Ouadratus Lumborum and i
At the end of twenty-four hours food is pgoas Magnus mliscles, with anterior laygiven
in liquid form; buttermilk or thm ers of lumbar fascia intervening. The last
broths, and the feedings are increased in dorsal ilio-inguinal and ilio-hypogastric
frequency and amount until the third day nerves pass outward behind each kidney.
when the patient receives solid food entirely. The colon is in relation anteriorly with both
If the bowels have been thoroughly emptied kidneys. The right has the descending!
duodenum along its inner margin anteriorl>|^ (
before operation, about the third day is soon
, r ^, ^ J ^, while the left is m partial contact with I
enough for them to move and they are en-
^3

The reason for this is that the blood and
lymph supply of kidney' and perirenal tissue
being continuous infectious material escaping
through the urine finds a place of least
resistance in the bruised and contused perirenal
tissue. This class of cases is very
interesting, becanse the injury may be overlooked
and urinalysis is negative.
Symplomatology.
When the suppuration is secondary to the
disease in the kidney, there are first the
symptoms of that disease; later, there are
those of the suppuration itself, and these
may be divided, first, into those common to
suppuration anywhere, and, second, those
due to the anatomical location of the process.
The suppurative process may here,
as elsewhere in the body, begin violently
and pursue a severe course with the rapid
development of a large abscess and septic
symptoms. It may begin mildly and pursue
a slow course, requiring several weeks
to produce fluctuation. Pulse, temperature
and blood count indicate suppuration.
Special Symptoms.
The anatomical relations of the kidney
to the diaphragm will account for painful
inspiration, resembling the pain of pleurisy,
will explain painful cough and the development
of pleurisy with or without elTusion.
.The fact that the last dorsal, ilioinguinal
ORIGINAL COMMUNICATIONS. 151
by occupation; family and previous personal
history negative; non-alcoholic. Six
weeks before I saw him, while hanging a
set of harness on a peg, the box on which
he was standing turned over, causing him
to fall across the edge of it, striking his left
loin. He continued to work for ten or
twelve days, when he had a slight chill,
associated with pains in the region of the
left kidney. From this time he began to
lose appetite, flesh and strength, and he
thought that he had fever at times. Four
weeks after he received his injury he discontinued
his work, but was not confined
to bed. He had lost thirty pounds in weight,
at which time I saw him. Examination
shows a strong man, reduced by emaciation,
with a stoop and a limp, and complaining
of slight pain in the region of the
left kidney, in which region there is to be
seen a slight fullness. Heart and lungs
normal. Bimanual examination reveals a
deep-seated swelling in the region of left
kidney, tender, and uninfluenced by respiration;
no constipation or vomiting, no reflected
pain.
Treatment.
Incision and drainage with prompt recovery.
The second case is far more interesting,
and at the time very obscure. This patient
was twenty-four years old, strong and ac-
,
,
•
land the iliohypogastric nerves pass down
behind the kidney explains the pain in the
tive, slightly given to alcohol, with no history
of gonorrhoea. He had just begun to
hip, flank, groin, scrotum, testicle and recover from a severe attack of acute pro-
thigh. The rigid spine is explained by the ductive nephritis which had its possible
;kidney resti:;^ on the ([uadratus lumborum cause in alcohol, fatigue and exposure to
muscle; the flexed thigh by the relation of cold and wet, at which time he also receiv-
the kidney to the psoas maguus muscle. A ed a slight injury to the left flank. About
'left abscess can cause painful accumula- ten days after convalescence from his
tion of gas and faeces in ascending and nephritis had begun, when there was no
transverse colon. Constipation may be very fever, and all oedema of feet and face had
tobstinate, even alarming.
disappeared, and the patient was out of bed,
Diagnosis
he was suddenly seized with a severe pain
in the left flank, accompanied by a chill
i May be very easy or very di flic alt. I will
and vomiting; there was intense desire to
not go into detail, but will ([note Ransohoff
urinate associated with agonizing pains in
,in describing the local features.: He says;
the head of the penis. I saw this patient
"Ir\ intaneous oedema makes the diagnosis
introduced and about twenty ounces of
Tnatmint.
urine was withdrawn. This urine wasfilled
with pus. I'Vom this time on, for about
Ill' ision and drainage for the primary forty-eight hours, the catheter was required
i-'-i is sufficient. l'"or the secondary cases, every four or five hours on account of great
he condition of the kidney demands its pain in the bladder, associated with an in-
'ijroi)er treatment.
The I first case I have to report is as foltolerable
desire to pass water. The temperature
during this time was about 102,
lows; Male, 36 years old, harness-maker and patient was very sick. Catheterization

152
THE CHARLOTTE MEDICAL JOURNAL-
with irrigation was continued at intervals Eczema.
of six hours for forty-eight hours longer, at By Albert D. Parrott, M. D., Kinston, N. C.
the end of which time there was very slight, Eczema is an inflammatory disease of the
if any, complaint. The temperature had skin, of which we find the acute, subacute,
dropped to normal in the morning with a and chronic forms, depending on the duraslight
afternoon rise. At the end of forty- tion, &c. It is usually attended with some
eight hours more the patient was able to itching, exfoliation, or shedding of the cuvoluntarily
void his urine with but slight tide, and usually with the exudation of
pain. During the second week, pains in serous, or seropurulent fluid which is found
left flank became more prominent. Biman- upon the denuded surface, or beneath the
ual examination painful, and giving an in- cuticle. Vers' often we find in one case,
definite sense of resistance in region of kid- erylheuia papules, vesicles, or pustules, and
ney. Patient was allowed out of bed be- its lesions evince a decided tendency to cocause
there was very little temperature dur- alesce, and thereby form large infiltrated
ing the evening, though urine still very areas.
cloudy. Through the second week, tern- Sy?iiptoi?is.—I should say that eczema is
perature gradually rose and persisted with decidedly a protean disease. I once heard
fluctuations throughout the twenty-four my Professor remark that if a student has
hours, patient steadily growing sicker, thoroughly mastered Syphilis, and Eczema
though pain in left flank not much increas- and their respective treatments, that he
ed. He was greatly troubled by accumu- practically held the key to the rest of Derlations
of gas in the ascending and trans- matology in the palm of his hand. To my
verse colon which caused considerable pain mind this is in a great measure true. Alunder
the margin of the ribs on the left side, though as yet we know only the elementary
Constipation obstinate. All catharsis in- principles of these two diseases, and just a
creased the pain, and purgation was fol- smattering of their Symptomatology and
lowed by marked prostration; there was a treatment. We really know nothing of the
limited area of tenderness below the tip of pathology of either. Every case of eczema
the twelfth rib. will present one or all of the following
At the end of eighteen days, operation prominent symptoms:
advised, though not accepted until eight (I) Redness,
days more. On the 27th day from his chill, (2) Infiltration,
under chloroform anesthesia, incision made (3) Itching,
down to the kidney, revealed a thin lay Jj (4) Tendency to moisture.
of blistered brownish fat surrounding the (5 ) Crusting, or scaling,
kidney and enclosing about a pint of pus. (6) Fissures, or cracks in the skin.
The kidney was greatly enlarged, measur- This disease may, and often does begin
ing six inches in length, by three and one- without any marked constitutional disturbhalf
in thickness; capsules very tense, and ance. We sometimes find accidental fever,
when it was delivered and incised, the en- malaise, anorexia, &c. Commonly the first
tire cortex everywhere was filled with pus, thing that attracts the patient's attention is
as was also the pelvis of the kidney. After itching, and upon inspection we find the skin
several incisions and failing to find healthy slightly reddened, it may be scalv, papules
kidney, it was removed. scattered here and there, or vesicles and]
On his return to bed, the bladder was tules may be present, and sometimes just a
washed out and from that time on no more slight exudation of moisture, or weeping is
pus appeared in the urine. Patient passed found. There is a great tendency for all
thirty-seven ounces of pus during the first forms of eczema to segregate in various size
twenty-four hours; sixty during the second, patches, with more or less infiltration, illand
forty-two during the third; temperature defined, and shade off almost imperceptibly
reached normal on the third day. into the surrounding skin, so that it is ex-
Two years "have passed and ceedingly
patient has
hard at times to say where they
returned to his occupation of traveling sales
^"^' ^^'^^ ^^^ outlying lesions adjacent to
jjjan. them. Their shape is irregular, of many i
A--: ^u i r 11. • • sizes, sometimes very diffuse, and involving
At times there is a trace of albumin in ^^^^^ ^^^ ^^^,-^^ cutaneous surface. Somehealth
""''" '"'°-'' ^ times they are swollen and of a dark red
color, at times they are tinged vellow.
These two cases are fair examples of the Starting with a few leisons, thev multiply
great variation that may exist in the etiol- with more or less rapidity, the individual
ogy, treatment and prognosis of perinephric lesions coalescing and patches are thus
abscess.
formed. It may be quite evanescent clear-
Refere7ices: jng away in a short while, or many weeksi
Gray's Anatomy, Osier. Ransohoff, Tyson, or months may elapse, or it may becom(

ORIGINAL COMMUNICATIONS. 153
chronic, showing little or no tendency to first written about, this was called lichen
recovery. There is uo rule of constancy in simplex, on account of its slight resemblance
regard to the course of the disease, though to lichen. It consists in an eruption of
at times we encounter cases that occur and rosy-red, pointed, or acuminated, discrete,
recur with remarkable periodicity, at certain grouped, and sometimes confluent papules,
seasons of the year. It may be in the sum- The papules are sometimes surmounted by
mer. spring, autumn, or winter. Any or vesicles which remain discrete, or later con-
ail parts of the cutaneous surface may be fluent: This is perhaps the itchiest of all
invaded, but it seems to have a special pre- varieties. Great excorations consequent
deliclion for the flexures of the joints, the upon scratching occur. This breaks down
face, the scalp, and the sulcus behind the the vesicles of course, and gives exit to the
ear. We may find only a single patch, or serum, and converts it into a moist patch,
there may be many. It is found on both This variety is generally found on the exsides
of the body, but with no decided sym- tensor aspects of the limbs. It is often remetry.
The principal subjective symptoms bellious to treatment.
are itching, which is present to a greater or Eczema J 'esicitlosum, is the most common,
lesser degree in all forms, and which is often and most characteristic form, and consists
so annoying as to cause the subject to ex- in a variously sized eruption, rounded,
coriate the skin bv vigorous attempts at pointed vesicles, that appear on a reddened
scratching. It is extremely prone to excer- surface in immense numbers. Amildtingbations
and remissions. The sensation of ling usually precedes the outbreak. There
burning, and tension are noticable for the is intense itching, and more or less swelling
most part in the initial stage of the attack, attends it. The vesicules are arranged in
or sometimes during an exacerbation of a groups, which sooner or later coalesce, and
subacute, or chronic case. It is generally rupture of themselves, and discharge a clear
conceded that there exists five forms of this mucilaginous fluid, which has the quality
disease. They are called erythematous, of stiffening, and staining the linen, and on
papular, vesicular pustular, and squamous, drying, forms a yellow crust. The physi-
The erythematous form is dry throughout cian rarely sees the vesicles, in fact because
its entire course, and it may be well to stale they rupture so early. Then a crop of new
right here that this form is the only one vesicles form about the old patch, these in
whose characteristics, course, ultimate re- turn rupture early, discharging their consults,
&c., is clear cut, and unchanging, tents, with more crust formation. And so
The other varieties mentioned above are the process continues. When the crust is
subject to many alterations, appearances, removed a raw surface is exposed. Eventvery
erratic, and at times produce a pecu- ually the discharge ceases, the hyperaemia
liar symptom-complex to deal with. lessens, scaling takes place, and after a time
Ecsema Kryl/iiiiiatosiuii.—This is most fre- skin reforms and returns to the normal,
quentlyseen u])on the face of adults though This form seeks parts of the skin, flexures
it often occurs elsewhere, and frequently in of joints, flexures surface of limbs, behind
children. It commonly begins as one, or the ears, &c.
several ill-defined red patches, but by virtue Ecsema Piisiulosim.—This variety occurs
of the coalescence of smaller ones, a contin- in the more or less broken down, cachectic,
uous patch is formed. Sometimes the entire or those of the strumous diathesis. This is
face is invaded, generally only a portion, the most common form of eczema seen in
Often the inflammatory process is attended childhood. In them it occurs by preference
by marked edema of the eyelids, and at times on the face and head. The eruption conassuming
a dangerous phase.- 1 can recall sists of pustules from the beginning, or it
one case, where the corneal surface was in- may develop from vesicles. The pustules
vaded extensively, by continuity of surface have a tendency to break down, and disproducing
corneal ulcers. This isextremely charge, which when dried forms foul greenrare.
The individual experiences great dis- ish crusts, which is very revolting, when
comfort on account of the l)urning and stilT- the scalp is diffusely matted. At this time
ness of theskin. The face feels harsh, dry, the poor sufferer is rendered almost crazy,
and thickened. If it occurs in the folds of though it is not so itchy as some of the other
the skin, slight moisture may be present, forms.
It is exceptional for vesicles to develop. Ecsema Sqamosum is the final stage
After a varying length of time the symp- through which most of the cases pass on
toms may subside, and complete recovery their way to recovery. The skin is very dry
take place, the lesion fading away, com- red, and covered with thin parchment, or
pletely, and not in the centre alone. On the paper like scales. It may continue this way
Other hand, it may assume a chronic form, a long time, with occasional exacerbations.
and continue as a tormentor for years. Then it may pass away entirely, and the
Eczema Papulosum.—When eczema was skin return to normal. In this condition it

154 THE CHARLOTTB MEDICAL JOURNAL
is very easy from some local injury to light declares that it is due to an undiscovered
it up again. In this form the skin is thick, parasite.
indu.ated, and presents a leathery appear- Pathology.—There is really less known
ance, and about the joints, it cracks at about the pathology of eczema, than there
times, showing that its usual amount of is about the pathology of Syphilis. Suffice
elasticity is interfered with, when the joint it to say that eczema is a catarrhal inflamis
extended. mation of the skin, similar to that of the
Eiiologv-—Very much like its symptoms, mucous membrane, which has its focus
its causes are legion. It often arises from chiefly in the papillary layer of the skin,
purely local causes, but even then, we must and the rete mucosum. The process being
assumethat there is some predisposition to it, superficially located, is the reason why
on the part of the skin. We often see it on the there is so little scar-tissue formed when the
hands of washerwomen, carpenters, and inflammation has subsided. It is generally
ccnstituting what is known as trade EC- conceded that a tropho neurosis is mainly
ZEMA. responsible, when not due to local irrita-
Perhaps for a score of years they washed lion.
with the same soap and water, and used the Diagnosis—A positive and differential
same plane and saw, without any manifes" diagnosis would consume too much space ^',|
tation of eczema. Then under the same for an article of this kind, but if the six car- I
local conditions, but with some unknown dinal symptoms are kept in mind we will :
internal constitutional state an eczema su- not often go astray. Redness, itching, I
pervenes. Generally speaking the external infiltration, or thickening, exudationor, I
irritants that most frequently cause czema, a tendency to weeping, crusting or scaling, i
are the sun, water intense artificial heat, cracking, they will be a great aid in the '
acids, alkalies, traumatism, rubbing of op- diagnosis. Add to them the tendency the
posed surfaces, parasites, in fact anything diease evinces to locate in the folds of the ]
that will produce a dermatitis, but the pro- joints between opposed surfaces, bebind the '
cess does not stop as a simple dermatitis, ears, and the mucilaginaus quality of the I
but goes further, and a catarrhal condition exudate, which stiffens, and stains linen, i
of the skin results. It has been frequently and mate hairs together. Indeed a diagno-
;
observed that children with eczema grow sis of eczema will fit one out of every three
j
markedly worse as the mercury descends,
showing that cold has an undoubted influsuch
cases.
Treatment.—While some cases arise from
'
i
ence for the worse. Vaccination has acted purely external causes and require only ex- \
as a local cause. Of the internal or predis- ternal treatment, but in the vast majority
posing causes, perhaps the most common of cases the patients general condition is
and active is some disturbance of the gastor- not good, and he needs treatment quite sepintestinal
tract—as indigestion, dyspepsia, arate and distinct from his skin- disease,
!
i
<
mal-nutrition, or some hepatic, or renal dis- In fact we should regard the bulk of our
order. Diabetes Mellitus, and nephritis are cases as a sick man rather than a sick
both common causative factors. Occasion- skin. If the patient be anemic he should
x
\
'!
ally we will see cases that have a purely have iron, plenty of fresh air, and moderate i
nervous origin, and recover immediately exercise. The metabolic flame cannot burn
when the proper equipoise is established, without proper and sufficient fuel, i. e. nour-
Rheumatism, gouty diathesis, varicose ishing food. This fuel cannot be consumed
I
i
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veins, &c., are other predisposing causes, without enough oxygen. Oxygen cannot
I am also quite certain that the anemias are be carried to the bodily fuel without suffic- ;
frequent etiological factors. And with all lent iron-bearing hemaglobin. If he is of :
these probable internal causes, nearly every the strumous type, codliyer oil is indicated, i
case dates its beginning co-incident with To our nervous patient give appropriate •
some exciting external cause. The disease doses of strychnia, hypophosphites, and ;
of course attacks al) ages, races, conditions, other good nerve bracers. Indigestion needs I
both sexes and is the dermatosis we are most the mineral acids, Nux vomica, pepsin, bis-
i
frequently called upon to treat. This is muth, soda, &c. Those with internal disthe
incentive for writing this article. It is eases need appropriate treatment. Where
very common in infants and children. In there is rheumatic tendency the acetate or
Buckley's tables, out of .3000 cases, 676 oc- potash, or the phosphate of sodium are incurred
under five years of age, and of these, dicated. Give colchium, or colchine for
520 were in children under three years. Of gout, lithia is also excellent. All the
the remaining cases 1234 were between
emunctoris should be kept functioning prop-
the
r . . J cr. J 1- ., , erlv. There is no specific for eczema, each
ages of twenty and fifty, and were divided
,^^^ should be carefully studied, and treated
about equally in each decade. Nearly one- accordingly. In treating eczema in all its
third of all skin cases are eczema. Unna stages rich gravies, stimulating foods, con-
'

ORIGINAI, COMMUNICATION. 155
diments like pepper and salts, sauces should which there is much tendency to moisture
be absolutely interdicted. This is especially as in the pustular, and vesicular eczemas
true in regard to alcoholic beverages. I Lassar's Paste is better than the zinc oxide
don't suppose there was ever a case of Ungt. Being a paste it allows the discharge
eczema cured where the patient indulged in to percleate through it. It is made as folalcohol.
I have seen cases of diffuse indu- lows:
rated aczema of tlie scrotum get entirely R
well, and one glass of beer cause it to return Zinc Oxide,
in one night, with increased severity. So Amyli a 2 drachms
alcohol is to be let entirely alone in treating Vaseliuil 2 oz.
this malady. Tea, coffee, and chocolate Ten or fifteen grains of salicylic acid added
are best let alone. Tobacco is harmful in to the above greatly increases its anti-prusome
cases. Constipation must be relieved, ritic quality. Ungts are generally objec-
If we have to give medicine for this, a com- tionable on account of their greasiness, and
bination of aloin, Xux vomica, and bella- oleaginous character, and where possible it
donna, the pills of iron and aloes, and ext. is much pleasanter to use lotions, especially
of Rhamnus Purshiona, are good. Arsenic in refined people and around the genitals.
is a time honored remedy whose curative The following is very good,
virtues are as old as the hills. It is good R
only in some chronic scaly cases. In acute Calami 1 drachm,
eczema it is very harmful. It is best not to Zinc Oxide /2 drachm,
prescribe it at all. Sometimes phosphorus Glycerine M XV,
one hundredth grain to one twenty-fifth Liq Amydlae 1 oz.
grain either in pill or oil, is useful in long Where pustulation is marked Peroxide of
standing eczema. There are no internal Hydrogen exercises a beneficial effect,
specifics for eczema. What will cure one When the acute symptoms subside Diachyol
case will actually aggravate another. in ungt is excellent. It is never advisable
Local Treatment.—There is one iron-clad to begin treatment loo boldly. If after
rule we can always follow with success in faithfully employing our protective, and
the local eczema. It is as follows: In astringent agents in the subacute variety
acute cases where we have heat, swelling, and yet no results are obtained, we should
redness, &c., employ soothing remedies: begin a stimulating treatment. The most
In subacute cases where the swelling has reliable one is tar, adding it at first in the
subsided, and where papulation, vesication, proportion of about fifteen drops of the oil
pustulation, or exudation is more or less of Cade, to the ounce of ointment-base, such
active, use astringent, and slightly stimula- as oxide Zinc Ungt. We alwa^'s need stimtiug
remedies: In chronic cases where we ulation in the chronic squamous eczema to
find thickening with scaling, stimulate in whip up flagging circulation, and to proall
cases, and protect the skin. This rule duce absorption of infiltration of the skin,
is infallible, and should always be kept in and to promote a return to health. Here
mind. Water must in all cases be kept tar is our sheet-anchor, and should be classaway
from eczema. W^here it is desirable ed as the Prince of skin-stimulauts. It can
to loosen the scales a little olive oil should be used in various strengths and ways. We
be employed. Very hot water may be used may use the oil of cade, oleum cadini, the
at times on chronic indurated types, then oil of birch, oleum rusci, or pixliquida.
very sparingly. It appears to be quite irri- The oil of cade is most used. I prefer the
fating. In acute eczema of course soothe, ungt:
Llq Calcis, Plumbi Subacetatis dil, solu- H
lions of borax and soda are good. Dust Ol Cadini Yi drachm,
with corn-starch bismuth, Lycopodium, or Zinci Oxide '2 drachm,
French chalk. Where there is severe itch- Ungt Aqua rosae q. s.,
ing carboiic acid may be used, incorporated or the cade may be added to the oxide of
in Ungt about Gtts X to the ounce.
Starten recommends the following:
Dr. zinc ungt in the proportion of a drachm to
the ounce, orpix liquida may be substituted
ft
Zinci Ozide >2 drachm.
Pulv Calamine prep 2 draciims.
in about the double strength. Sulphur in
my experience ranks next to tar as a stimulant
in squamous eczema. It is not as re-
Glycerine 1 oz.
Liq Calcis 7 drachms.
When the acute stage has about passed
and a sub-acute condition is present a proliable
as tar however. It is most useful in
circumscribed patches, and may be used in
vaseline or simplex ungt in the strength of
one to two drachms to the ounce. In some
tecting and soothing Ungt is to be used and very sensitive skins it produces a good deal
the best to be obtained is the benzoated of dermatitis. I have used green soap with
oxide of zinc ungt. If the case is oue in varying success, but do not attach much im-
—

156 THE CHARLOXra MEDICAL JOURNAI, '
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portance to it. Many attempts have been taken her place as a power in Europe. Sir
made to find a suitable substitute for greasy Isaac Newton, Christopher Wrenn, George
or oleaginous applications in the treatment Fox and John Locke, were prominent men.
of skin diseases. For instance we ha'-e Swift, Pope, Dryden, Congrove, Prior and
Dr. Unna's plaster mulls, in which plaster Steele belonged to this period. The habeas
mass is incorporated with the mulls. I corpus act and bank of England were each
have not used the above however. In treat- about forty years old. Cromwell had been
!
ing eczema we should not be content by sim- dead nearly forty years.
|
]
ply telling our patient to daub or smear the In 1700 The Art and Science of Surgery
medicine on any "old way", but should in- included very little more than the Doctrine
struct him iu the way he should use it. Our andTreatment of Wounds, Fractures, Luxa-
|
Ungts should not be smeared on the skin, tions, Tumors and Ulcers, with a descrip-
but nicely and evenly spread on linen or tion of Operations, Inslruments aud Band- I
or muslin, and bound down with a snug aging. This division was common for j
bandage, or with a ring of elastic webbing, many years later than the da'e under con- '
In all chronic patches it is well to rub in sideration. About this time the practice of
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our tar and other ointments. lithotomy was taken over by the surgeons
j
i
Suffice it to say in concluding under the leadership of Douglass and our remarksonthetreatment
of eczema that there Cheselden. For a period of 2,000 years
is no one drug, or combination of drugs this operation had been considered to be
embodying all that is desirable in the treat- "so difficult and dangerous that it had been
metit, or ultimate result, but each case, is a ordained to be the entire profession of one
case unto itself, and is to be considered so, man free from other studies and practices."
and treated accordingly, to obtain the best The field of surgery was limited almost
and most brilliant results.
Prognosis.—Paradoxical as it
entirely to morbid conditions affecting the
may seem extremities and surface of the body. New
some cases are never cured. So we cannot growth involving the viscera belonged abalways
give absolute assurance of curing
eczema. We sometimes are forced to accept
solutely to the domain of internal medicine.
The great field of inflammatory conditions
the fact that some individuals are "3czema- affecting the viscera was undreamed of.
tons", and to cure them, regeneration is
necessary. Of course it is our duty to cure
our cases as fast as possible, and not take
refuge behind the incompetent man, and
The literature was in a most deplorable
condition. No book existed which covered
the entire field. The best books on the different
subjects had been written by men
tell our patients that we are endangering widely separated and in different languages, 1
their lives by curing their eczema. making it very difficult to acquire a working
knowledge of the best, and forcing the j
•
Surgery and Surgical Literature of the ambitious to travel far to learn all that was
Eiglileentb Century.* to be known.
By T. E.W. Brown, M.D., Ashevine,N.C., Chair- As a result of this condition whenever a i
man of Section of Surgery and Anatomy.
surgeon became proficient in any one line
Mr. President, Guests and Members fo the
j
it was customary for him to travel from i
Society: to town, from one country to another. In
;
On occasions like the present it is the cus- ^^'^ ^^^ quacks and pretenders developed tom to discuss new theories and methods,
:
^nd flourished, and to them were largely and to lay plans for the future; for this
,
left those disorders and operations requiring reason we are apt to forget those who have
,;
^^^ greatest skill. Germany is said to have i
preceded us, and have laid the foundation swarmed with them. Today the author of
for modern surgerv. a» article hastens to give the latest refer-
Before we give our attention to the papers «nceto his subject, and seldom does he
dealing with modern surgical problems I
''«^^'' ^^ ^"y article published more than ten j
desire briefly to call your attention to the years back, but in 1700 the authorities most (
surgery and s-^rgical literature of
frequently
1700, so
quoted were Hippocrates, Celsus
that when we reflect on the great difference ^"'^ Galen, and any measure or method not
between now and then we will not
sanctioned by them was unorthodox
fail to
give due credit and honor to the men who ^o far as I can gather, the first attempt
have made this growth possible.
to cover the entire field of surgery and make <
In 1700 William III was Kino- "^ of
available for the student was undertaken i
En

ORIGINAI. COMMUNICATIONS. 157
mainder of this paper, and have frequently must be left to God's Providence and the
quoted him. strength of the patient's constitution."
In his preface he states that he was lead The closure of an abdominal wound by
to attempt such a work "because of the suturing was termed gastroraphy and was
general ignorance and insufficiency of the resorted to only when the wound was so
young surgeon and student in this branch large that it was impossible to retain the
of Physic, which at the time universally intestine in any other manner, and when a
prevailed throughout Germany especially, large wound divided the muscles transand
because the generality of surgeons, be- versely, the peritoneum remaining intact,
ing unequal to the more difficult operations, In an operation concerned with a hernia
were content with being able to cure a slight the rule was to leave the peritoneal sac and
wound, open a vein or abscess, or at most all or most of the wound open, and to introset
a fracture or reduce a dislocation, leav- duce a tent; the wound was left to heal by
ing the rest to quacks." granulation. Heister tells us that in his
The necessary qualifications of a surgeon time the Russian surgeons frequently ligatas
laid down by Celsus, held good in 1700, ed the sac.
and were as follows: " He ought to have We are told that a great many cases of
quick, clear sight, intrepid mind, void of hydrocele in infants can be cured by fastall
tenderness, so as not to be at all moved Ing, chewing a little nutmeg every morning
by the outcries of his patient, to use no and breathing on the parts at the same time
more haste than is required, nor to cut less every day. When this failed it was customthan
is necessary." ar>' to bind a piece of caustic to the scrotum,
Prognosis concerning a wound or opera- retaining it there until the sac was open and
tion was given with reference to age of pa- the fluid had escaped, then to pack the sac
tient, the climate and as to whether the pa- with lint for a few days,
tieut was "Ilydropical, Consumptive, Scor- Before resorting to the use of instruments
bulical or Pocky." to elevate a depressed fracture of the skull
The care of wounds formed a large part a sternutatory powder was highly comof
the duty of a surgeon at this time on ac- mended, it being asserted that "the distencount
of the numerous wars and the fre- tion of the brain is so violent in the act of
quency of personal encounters. At the first sneezing that it will restore the depressed
visit the surgeon was called upon to pro- parts of the bone to their former situation."
nounce the wound either "curable or mor- It is interesting to note in this connection
tab" A wound was mortal when "it could that fracture of the skull by conire coup
not be remedied by all the art and industry was recognized and described by Hippoofman."
A curable wound was said to crates.
become mortal per accident, when the death Any preternatural enlargement of the
of the patient was "occasioned by his own body situated beneath the skin was called
ill conduct or by the ignorance or neglect a tumor, if it grew "from or upon the skin
of the surgeon, such as the failure to remove it was called a wart corn or excrescence."
a foreign body or to provide passage for In 1700 any new growth was either a
the discharge of blood from thorax or abdo- scirrhus or cancer. The definition of
men. scirrhus was 'any hard tumor situated
In wounds of the abdomen we find the beneath the skin and void of pain." The
following directions: "If you can discover tumor was thought to be due to the "inspisby
your eye or the touch that any viscus sation and induration of the fluids of the
situated in the abdomen has received a part, resulting from a previous inflammawound
from a sharp instruuient it will be tion." Trauma was the second factor in
advisable at the first dressing to fill the the production of a scirrhus, and when not
wound as tenderly as possible with a good due to either one of these causes it was
quantity of lint, well saturated with high ascribed to heavy phlegmatic, melancholic
rectified spirit of wine or spirit of turpen- habit of body." It was considered "no
tine, by this means the hemorrhage will be difficult matter to determine the principal
stopped, if no large blood vessel is divided, cause of a scirrhus." A scirrhus could
At the second or third dressing a tent should "cause inflammation, exulceration, cancer,
be introduced to provide proper passage for gangrene, tabes, stiffness or immobility in
the discharge of grumous blood and other the neighboring parts."
matters, which may kill the patient. If the A cure was attained with great difficulty,
patient is of plethoric habit of body it will palliative measures were not to be relied
be proper to bleed him, to prevent inflam- upon, and removal was difficult and danmation
and fresh effusion of blood. Also gerous because operative interference was
give him daily two or three doses of Mei- not indicated until there was great pain or
bomius's Balsam, which is of great efficiency the size of the tumor demanded it.
in healing internal wounds. Wh.nt remains When it could not be "dispersed, softened

158 THE CHARLOTTE MEDICAL JOURNAL
|
or removed with a knife, when pain developed
and when it spread itself unequally it
There was not much difference between
the surgery of 1700 and that of any century
was called a cancer. This is the malig- which preceded it, of which we have any
nant and worst state of a scirrhus." If definite knowledge.
the skin remained unbroken it was called
an ocult cancer. The most common loca-
In thai day the surgeon had no watch-
words. Today he has three which will
tion of cancer was the female breast; other never be discarded or laid aside.
locations were the lips, gums, tongue,
fauces, nose and parts of generation—it
The first letter in the first work was furn-
ished by Antony van Loenwenholk at Lonwas
also recognized in the male breast. don on Sept. 14th, 1683; the second by
The causes of cancer included those of Marcus Antonius Plenciz at Vienna in 1762;
scirrhus, and in addition it was said to the remaining were quickly found by Polfollow
the "application of lenient acrimo- lander, Davaiue, Weigert, Tyndall, Cohen
nious or caustic medicines to a scirrhus." and Pasteur, and then in 1824 Sir Joseph
A cancerous disposition of the body was Lister pronounced it; the pronounciation
j
;
;
thought to follow the eating too freely of has never changed—nor never will—it is
pork and lard. "Grief and trouble of mind" asepsis. At the Massachusetts General
were also classed as causes of cancer. Hospital on October 16th, 1864, VV. T. G.
j
;
|
j
Quacks claiming to possess infallible Morton and John Collins Waren pronounc-
secrets for the cure of cancer flourished ed "Ether" a safe and sure anaesthetic,
then as now. Heister, to prove that noth- The last of the three watch-words in moding
short of the complete removal with the ern surgery was given us by Virchow and
knife offered any hope of relief, quotes the Metchnikoff when they emphasized the imexpression
of Hippocrates that "no phy- portance of understanding morbid prosician
had yet been happy enough to dis- cesses.
cover a medicine from which he could To aseptic methods practiced on an anaes-
j
j
|
|
'
i
promise any certainty of a cure." He also thetized patient by a surgeon familiar with
recites the memorable case of Anne of morbid conditions is due to difference be-
Austria, mother of Louis XIV, "who failed
to be relieved of a cancerous breast, though
tween surgery of 1700 and the present day.
she submitted to the attempts of most every Effect of Fever on the Course of Infection
one in the kingdom who had any pretengarkankeiff
conducted a series of experilons
to the practice of physic or surgery
^^^,^ ^.^ ^^j^^^^ i„ ^^-^^ -^
j^^,^^
but particularly to those who boasted of had been induced by Aronsohn's method. I
their secret art m curing this disease."
The results seem to prove; U) that during |
A brief description o the operation for ^^^^^ ^^^ organism is more susceptible to ,
cancer of the breast wH give a fair idea of ^uto-infection by ihe bacteria inhabiting !
surgical technique in /OO.
^^^ ^^^ ^^^-^-^^ ^l^ 1^ .^^ infectious :
The patient was restrained in the proper ^j^^^^^^ g^^^om occur in this way; (2) that I
position by three or four strong and cour- ^^^.^^ j^, diminishes natural immunity, ,
ageous assistants, the breast raised from the ^^^^ renders the subject liable to infections i
chest by transfixing it near its base with a ^^ ^^^-^^ -^ -^ otherwise immune; and (3) I
double pronged steel instrument or by two ^^^^ ^^^ resistance of the organism to the I
strong ligatures passed at right angles to ^,^j^^„^^ ^„^ ^^^^^1^ of bacteria is so far |
each other through Its base or by seizing It decreased that even attenuated strains of I
with a strong pair of toothed calipers. The ^,^^ pathogenic characteristic lesions.- .
gland was then removed with one sweep ^eitsch. f. klin Med., V. 68, p. 295. I
made with a large knife or small sword. I
Diseased tissue in muscle or rib, when j
visible, was cut away. A few large vessels Comparative Value of Different Methods \
secured and the wound dressed with a large
*** Hcbotomy. 1
quantity of scraped lint, sprinkled with a Cyrille Jeannin considers hebotomy a real j
styptic powder or impregnated with plaster advance over symphysectomy. As to the i
of Paris, and the whole secured with a best method of performing the operation, he (
bandage. By many it was a common prac- prefers the open method, which allows of |
tice to treat the wound with suppurrants, prevention of wounds of the bladder, better |
corrosives or the actual cautery to make hemotasis, and better drainage. The in- |
the destruction of diseased tissue more cer- cision of Gigli is too far inward, that of i
tain. But many objected to this and cited Van der Velde too far outward, the median •
the observations made by Celsus that "such incision of Codereini being the best. In i
practice in no way aided the cure, but pos- the subcutaneous method we have the dan- I
sibly promoted a recurrence." Enlarged ger of wounding the bladder, and that of •!
axillary glands were removed through a thrombosis and infection .—La Presse Medi- •
separate incision. cale.
|
,

Charlotte Medical Journal
EDITORIAL. 159
"^ent of the sick whid. are evident to every
sensible phj'sician, and yet we hear advo-
Publisbed Monthly. cates for the State registration of nurses
EDWARD C. REGISTER, M. D., EDITOR boldly declare that "the domination of the
CHARLOTTE, N. C.
doctor and the man must cease when he
3^:;^^=^;=====:;===; leaves the sick-room."
THE PMYSIGIANS ^HATlO^AU BOARD OP Nurses all over the country are not slow
REGEINTS. ill catching the spirit of such sentiments,
A conviction has been growing for the and, as a natural result, physicians are
past few years in the minds of many physi- finding it more and more difficult to keep
cians that it would ere long become abso- nurses of the State Registration type from
lutely necessary for the medical profession modifying their treatment or changing it
to exercise its right and privilege of direct- altogether and substituting their own. The
ing and controlling the business of nursing, effect of such a course on the part of the
Recently a movement has been started the few who are seeking equal rights with the
avowed purpose of which is to correct these physician via the State Registration route,
tendencies. The Physicians National Board is felt in the supply of nurses both in private
of Regents, which includes some of the practice and in institutional work,
most prominent physicians of this country, Few physicians can be found who have
is undertaking the execution of such ideas not had unfortunate experiences with the
as it is believed will accomplish the ends meddlesome and prescribing nurse. The
desired. Dr. ICugene Underhill, of Phila- declaration of many physicians that the
delphia, is president of this association and State Registration movement tends to deeditor
of its official organ ' The Guide velop wholesale quackery, and to create a
Book". An expression of Dr. Underhill's class of insubordinate nurses, with a show
views, which likewise embodies the pur- of legal authority to apparently justify their
poses of the Physician's National Board of claim to equal privilege in directing the
Regents, we deem worthy of reproduction, afifairs of the sick-room, is undoubtedly
Everj' physician knows, and every nurse tiue. The State Registration movement
ought to know, that the business of nursing has also tended to place the control of nurswas
created by the medical profession. The ing in the hands of a few dictatorial perphysicians
have opened the door of this sons, whose desire seems to be to limit the
opportunity and put the nurses in the way supply of nurses, whose desire seems to be to
of acquiring the necessary knowledge and limit the supply of nurses to hospitals, and
skill. In view of the origin of the nursing to so manipulate and elevate prices, as to
profession and the overwhelming demand, prevent the poor and the great middle
one would sui>pose that there would never classes, from securing adequate nursing
be any attempt to eliminate the doctor from assistance.
a wise and proper guidance of the profession, It has, therefore, become necessars' for
or to create a monopoly of the business of the medical profession to regulate the businursing
in the interest of a few nurses. Yet ness of nursing. This is done in the interthis
very thing has been attempted. The est of the nurses themselves, in the interest
effort has been tolerated by the medical of the hospitals and training schools, in the
profession for some years. Within the last interest of the general public and in the infive
or six years, there has been a growing terest of the medical profession,
tendency and disposition on the part of a The Physicians' National Board of Refew
nurses, not onl/to ignore the physician, gentspropose to classify the nurses and issue
and the rights of other nursesand the needs a National Commission or other suitable creof
the public, but a disposition to usuriitlie dentials to all nurses who are duly qualified
the prerogatives of the doctor. The direc- and are willing to abide by the instructions
tion in which the few have endeavored to of the attending physician, and who will
lead the many is in the direction of disaster, not attempt to play the role of doctor or
State registration of nurses, which practi- encroach upon the rights of other persons
cally means the creation of two authorities or nurses in their efforts to relieve the sick
in the sick-room, is the weapon which has and suffering. Four classifications will be
been chosen for the creation of a monopoly, made, as follows:
and as a means of restricting the business 1. Commissioned and Official Nurses,
of nursing to a favored few. livery doctor (Those having completed a two years'
knows that the responsibilities of a case rest course or more in a general hospital or trainwith
the attending physician, and that it ing school).
can neither be shifted nor divided. The 2. Approved Nurses. (Those having
doctor must be in supreme command in the completed a two years' course in a special
sick room or he must not be there at all. hospital).
These are principles regarding the treat- 3. Attendant Nurses. (Those engag-

160
ing in nursing, after having had only a
theoretical or correspondence course of instruction).
4. Provisional Nurses. (Those having
been engaged in nursing for a year or more,
i.e., the so-called practical nurse).
This will be a distinct advance in the
profession of nursing. It will give all the
worthy an equal chance, and will eliminate
the unfit. It places the control of the nursing
profession where it belongs, namely, in
the hands of its creators, the physicians.
DR. GH«g. DUPPY.
The Journal is intensely grieved to record
the death of another of North Carolina's
grand old physicians. On the morning of
August 18, Dr. Charles Duffy passed away
at his home in New Bern, N. C. Death
was not unexpected, since Dr. Duffy had
for some time been afflicted with cancer,
for which he was operated on last February.
Following this operation he was greatly improved
for a time, but afterwards rapidly
grew worse. The oldest physician in New
Bern, Dr. Duffy was also one of the oldest
in the whole State. Born in Onslow county,
July 18th, 1838, he was therefore seventyone
years of age. Graduated from the University
of New York in 18.59, he had been
in active practice for fifty years. In 1870,
he became a member of the North Carolina
Medical Society and from 1872 to 1878
served as a member of the State Board of
Medical Examiners. In 1877 he was appointed
a member of the State Board of
Health by the State Medical Society, which
position he occupied for one year. He was
vice-president of the Society in 1873, and
president in 1879. Dr. Duffy thus held
every important office within the gift of his
professional brethren of the State. Prominent
in Medical Councils he was likewise
recognized as one of the finest physicians
in North Carolina. He was a magnificent
specimen of that type of old-time doctor,
now too rapidly disappearing. Although a
student before the days of modern development
in medicine and surgery. Dr. Duffy
was never left behind. He kept himself
thoroughly up-to-date in medical progress.
A courtly gentleman, a genial lovable doctor,
he held a place in the hearts of his
friends and patients that will not easily be
filled. As chairman of the State Board of
Public Charities, Dr. Duffy has carried on
a work worthy of the man. The good he
has done can be known only by Him who
permits no good deed to go unrewarded.
Entering his profession just on the eve of
that great conflict between the North and
the South, he volunteered his services and
become a surgeon of the Confederate Army,
THE CHARLOTTE MEDICAL JOURNAL.
i
'
in which capacity he served throughout the
war.
The Journal takes this opportunity of expressing
its profoundest sympathy for his ]!
bereaved family and relatives. W'e merely
voice a sorrow which is universal throughout
the whole State.
X-RftY BURNS. i
The subject of X-raj' "burns" has occu- .,
pied considerable attention in the last two i
or three years. So much publicity has been :
given to it that not only patients, but even
many physicians have formed the opinion I
that the Roentgen ray is too dangerous to
,
be used at all.
This is quite as erroneous a view as the
one that the ray is entirely harmless.
It brings out the point that the ray should ]
be used cautiously and by skilled hands. |
Under these conditions it is not only prac- i
cally devoid of danger, but it is one of our
most useful measures in a number of diseases,
to say nothing of its diagnostic value,
j
The so-called X-ray "burn" is really an |
inflammatory condition set up by an over- i
dose of the Roentgen ray; therefore its lech- j
nical name of dermatitis. This term, loo, |
is inadequate in the case of deep "bums"
v;hich involve tissues far below the skin.
To get results from the Roentgen ray it
|
must be absorbed, just as it is necessary to :
have absorption of drugs in order to get j
their effect. j
As the skin absorbs by far the greater j
portion of the rays, so the reaction is quicker ;
and more pronounced in the skin.
X-ray dermatitis is wholely and solely a i
question of dosage, or perhaps we should i
say over-dosage, for that is what it really is. i
A proper dose of the ray produces no i
burn. A full dose just brings the tissues to
the condition represented by the full physi- i
ological action of a drug. Carry the dose ;
beyond this point and we have a pathologi- j
cal condition produced as the result of an >
over-dose, just as with an over-dose of strych- i
nine or arsenic.
Just as soon as the dosage of the X-ray is :
better understood, and is easier to accur- i
ately measure, then "burns" will be as rare j
as are over-doses of strychnine, morphine i
or arsenic, and will only be the result of
|
gross ignorance or gross carelessness, ex- i
cept when intentionally produced. i
It is customary to treat cases with the i
X ray until a visible reaction takes place i
in the skin. However mild this may be, it
,
is in reality a dermatitis and marks a cor- (
responding step beyond the physiological !
dose of the ray. As long as it is slight it is i
harmless and is at present our only sure I
sign that we have given a maximum dose j
j
'
]
'
j

' attention,
of the ray, and must therefore await its
subsidence before giving more.
By observing the same caution in adding
to a maximum dose that we would in administering
morphine or strychnine, the ray
becomes as simple and amenable to use as
those powerful drugs have become.
MBCI1«NIGA1> VIBHftTIOIS,
I
' ject
The surprising rapidity with which mechanical
vibration has been adopted by the
medical profession is in itself a powerful
argument in favor of its therapeutic value.
The fundamental princii^les underlying
its use are dependent upon its influence on
nerves or nerve centers; thereby regulating
the action or function controlled by them.
The fact that nerve-centers respond quickly
to mechanical stimulation is by no means
new, but the working out of the present system
of vibratory therapeutics is comparatively
recent.
A tap or light blow will immediately increase
the activity of a nerve-center. A
succession of such strokes will carry this
up to a certain required degree of stimulation.
Pushing it beyond this point overstimulation
or inhibition results. Thus,
according to I'^berhart, vibration jilaces
these two agencies, stimulation and inhibition,
at the command of the physician,
enabling him to increase the activity of
sluggish organs or functions; or to soothe
the same parts when irritated or over active.
When the vasomotor centers of the sympathetic
system are influenced by vibration
we have a change immediately taking place
in the size of the various blood-vessels controlled
by them and an alteration in the
amount of blood determined to a given area.
This, then, makes it theoretically possible
to equalize the circulation, increasing the
blood sui)ply when local anaemia exists
and decreasing it when congestion is present.
The advantage of this is obvious,
especially in the case of congestion, for do
we not remember the old precept that continued
congestion results in inflammation.
\'ibration also increases the elimination
of poisons and waste through the lymphatics
and this is an important feature.
Taking into consideration the relatively
small cost of vibrators, in comparison with
their great range of usefulness they form an
important part of the "up-to-date" physician's
eduipment.
161
pleasing style and also because it is essentially
important that practicing physicians
should know that there is such a thing as
"serum disease". Many doctors who have
employed antitoxin in the treatment of
diphtheria will recall cases in which the injection
of the remedy was followed by very
untoward symptoms. These occurrences
have perhaps led to a certain, and in some
measure, a justifiable opposition to the use
of antitoxin; it is however an opposition
having its origin in ignorance. Theobald
Smith was the first to note that experimental
animals often succumbed to second injections
of serum which, when given the first
time, had not been harmful. Rosenau and
Anderson in the Hygienic Laboratory of the
Public Health and Marine Hospital Service,
and Otto, working in Ehrlich's laboratory
in Frankfort, independently investigated
Smith's observations and thoroughly elucidated
the problem.
Serum disease (Die Serumkrankheit) is
due to anaphylaxis which may be defined
as the opposite of prophylaxis (Lemann).
Just as the latter term indicates a condition
favoring protection, hence lessened susceptibility,
so anaphylaxis means a condition
of decreased protection and increased susceptibility.
We have for a long time been
accustomed to the idea that by certain
measures, for instance, vaccination or the
injection of antidiphtheritic or antitetanic
serum, we may increase the resistance of
our bodies to certain diseases, but it has
been only within the past three years that
attention has been particularly devoted to
the fact that the injection of certain foreign
materials decreases the resisting power to
future injections of the same substances; in
other words we have begun to realize that
a condition of anaphylaxis is produced, the
results of which may be quite as dire as
those of the disease we originally started
out to treat. The substances which possess
this action are probably proteids, and, because
employed most, the serum of the horse
concerns us most. The reactions are not
due to the antitoxins contained in the therapeutic
sera, for they are etiually produced
by normal horse serum; nor are they due to
any of the preservatives usually added to
the sera. The anaphylactic constituents
are unaffected by heat or cold, or chemical
agencies. The reaction is specific, that is,
an animal sensitized with horse serum re-
f\fif\pn\L,f\xi».
acts only to horse serum; sensitized with
Our last issue contains an article on Ana- egg-white, it reacts only to egg-white, and
phylaxis by Dr. K. N. Duffy, of New Bern, so on. Anaphylaxis is transmitted heredi-
N. C, to which we wish to direct special tarily from mother to off spring and the un-
not only because of the great in- toward effects increase in severity with the
terest which is being manifested in the sub- length of interval between the injections.
throughout the world, but because the
author has presented the subject in most
It has been shown that an interval of at
least ten or twelve days must elapse be-

162 THE CHARLOTTE MEDICAL JOURNAL.
tween the first and the second injection in ing rise to the high-arched palate, are not
order that the patient show anaphylaxis or to be attributed to the blocking of the nasal
heightened susceptibility. Von Pirquet has air-way, but are rather to be thought of as
pointed out the great significance of this arising quite independently of the hitherto
reaction in its relation to immunity. Thus supposed cause. In the majority of cases
the tuberculin reaction is one of anaphy- of so-called "adenoids" there are also to be
laxis. noted the existence of a subnormal tem-
In the light of such knowledge physi- perature and lack of proper development
cians will necessarily look \ipon prophylac- of the body as indicated by weighing. The
tic injections of sera with considerable constancy of a subnormal temperature in
skepticism. Indeed the possibility of sub- these cases of nocturnal enuresis which are
sequent anaphylaxis would seem absolute- successfully treated with thyroid extract,
ly to contra-indicate this practice, although and its disappearance coincidently with the
serum inoculation must still be looked upon bedwetting, led Williams to infer that there
as one of the most valuable therapeutic might be a relationship between the subnormeasures.
The thing more important than mal temperature and the incontinence. Howprophylactic
inoculation is positive diag- ever.heprefers to account for both by the exnosis.
This first injection might possibly istence of thyroid insufficiency. It is interremove
the one chance in a subsequent in- esting to note the theory of the pathogenesis
jection. In the future we shall probably of the bone deformity in cases of adenoids,
have to rely for prophylaxis upon vaccines One of the most important functions of the
rather than upon serum. Vaccines are thyroid secretion is admittedly the fixing of
simply the dead bacteria in suspension in calcium salts in the tissues. Without a
non-proteid media. It is the serum, or sufficiency of the secretion the salts cannot
rather the proteids in the serum, that does be utilized, bone-formation is defective, and
the harm. the child's bones fail to grow hard, and, in
It will be some slight comfort to know the case of the palatine arch, they yield to
that when an animal has once reacted ana- external pressure in such a way as to conphylactically
to a given substance it may vert the arch from a Norman into a Gothic
develop a condition which prevents a subse- structure. This same relative absence of
quent reaction, that
has been developed.
is, antianaphylaxis calcium salts from the tissues, due to the
thyroid insufficiency, may likewise account
rt NEW THEORY CONGERNINO THE ETi- for the Occurrence of dental caries in such
OL.OGY OF ADENOIDS. children.
The prevalent belief that adenoids and In adults a lack of thyroid secretion is
nocturnal enuresis bear a genuine causal associated with a boggy, heavy developrelationship
has for years been calmly ac- ment of fat, which obese condition is oftencepted
by the majority of the profession, times very characteristic. Such a state is
Certainly the common association of the also seen in children, but is usually associtwo
has apparently given reason for the ated with complete absence of thyroid secreassumption
that bedwetting is, in some in- tion. When, however, the insufficiency in
stances, due to the existence of an excess infants and children falls short of complete
of adenoid tissue in the nasopharynx. The absence infantilism is produced, the subfact,
however, that the removal of the ade- jects of which are rarely corpulent. In this
noids affords a very uncertain cure for the way is the undersize of such children acenuresis
would seem to introduce a doubt counted for; whereas in the adult the thyas
to the relationship. A new and distinctly roid insufficiency shows itself chiefly by
original view has been advanced recently inadequate metabolism and the consequent
in the British Journal of Children's Diseases excessive deposit of fat; in the child the inby
Leonard Williams when he expressed sufficiency prevents the utilization of calthe
theory that the above mentioned idea cium salts, bone formation is defective and
as to the relation of adenoids to bedwetting the child fails to grow. Administration of
is erroneous, and that both are due to an thyroid extract to such children causes
insufficiency of the internal secretion of the them to gain in weight and size rapidly,
thyroid. Acting upon this belief he administered
thyroid extracts with results so uni-
Indeed the weight gives an index upon
which the extract administration may be
formly good that he is of the opinion that gauged. As long as there is a gain the
fully 80% of children who are said to suffer remedy is doing good, but as soon as there
from adenoid vegetations may be cured by is a definite fall the borderline of safety
purely medicinal means. The commonly has been crossed, and the drug should be
observed signs of adenoids such as are suspended. Another sign of intolerance of
noted in the typical facies; listless eye, snub the remedy, besides tachycardia, is the
nose, open mouth, rabbit teeth, malforma- occurrence of sudden and severe nasal
tion of the jaws—especially the upper giv- catarrh. Williams affirms that this is really

EDITORIAL. 163
one of the most significant symptoms of he report attributes no abnormality to benthyroid
excess. Still another is elevation zoate while the experiments were going on,
of the body temperature beyond the normal, that there were nevertheless abnormalities.
bBNZO/\TE OP soD«. 1,1 the Chicago squad, several of the young
The long mooted question as to whether men were depressed. On the New Haven
benzoate of soda as a food preservative is squad, stomach troubles of one young man
injurious has at last been settled, so far as was attributed to 'cold weather' and to
it is possible to settle such a problem, by 'hard work.' It is rather noteworthy that
the Pure Food Congress which met in Den- cold weather and hard work should have
ver, Col., during the last days of August, had these effects rather than the chemical.
The resolution, adopted by a vote of 57 However, the report and resolutions of
to 42, follows: the Pure Food Congress will go far toward
"That this association indorses the report removing the popular belief in the injuriousof
the referee board of consulting scientific ness of this commonly used food preservaexperts
appointed by Secretary of Agriculture
Wilson, at the direction of President
tive.
auabama meoicau examiinbrs.
Roosevelt, upon the use of benzoate of soda The Alabama State Board of Medical
in food products." Examiners has announced the list of suc-
The report referred to was based on the cessful applicants in the recent examinaexperiments
carried out in Chicago, New tions. Of one hundred and fifty who stood
York and New Haven. the examinations saventv-three were suc-
These experiments consisted in the ad- cessful. Dr. Fred. W. Wilkerson, of Montministration
of quantities of benzoate of gomery, led the class.
soda into the food given to healthy young Only one of the successful applicants is a
men for periods respectively of two months negro, though six negroes undertook the
and one month. The work of Dr. Russell examination. Not a woman applied for a
H. Chittenden, of New Haven, Conn., a license.
member of the referee board, will be reraem- All successful applicants are residents of
bered. In the period of observation three- Alabama, with the exception of two from
tenths of a gram of the sodium benzoate Arkansas and two from Mississippi,
was administered daily to each subject dur- „ .^ ^ ^ ,
., , ,1 . J T .1 OSTEOPATHS SUCCEED IN GEORGIA.
ing the two months period. In the one- ~, ^, . , .
, ^ , /- ,
month experiment each man The Georgia Legislature, after a hot fight
received per
day during the first week six-tenths gram; ""^^^"^'y :
P^^f^ ^^^ '^^nl^' ^^"'^^ ^'^^ ^^^"^^
second week, one gram; third week, two
«^^ osteopaths are systematically presentgrams;
fourth week, four grams.
'"?. ^ legislatures throughout the country
It would
^"^er this b.l the governor is authorized
certainly appear that this administration,
when accompanied by
and directed within M) days to name fi\
a gi
of body weight and without loss of power
members of a board, who shall examine
='PPl'cants
to digest and absorb the protein and
and issue licenses to those who
fat of
the required percentage
the daily food must be taken as evidence "^^J^/^
that sodium benzoate
^he subjects in which applicants are to
in the doses admiiiis- ,
''« examined include anatoiny chemistry.
tared is not seriously detrimental to health.
toxicology, physiology, pathology, d-
Discussing the question Dr. Chittenden
nosis, hygiene, obstetrics, gynecology, sursaid
ffery medical jurisprudence, the principles
'Certainly huckleberries, cranberries,
of osteopathy
plums, prunes and
and such other subjects as the
other related fruits coiitain
appreciable amounts
examining board may require,
of benzoate. In
other words, the eating of a small quantity Virginia medigau examining board.
of huckleberries, raspberries or kindred The State Board of Medical Examiners
berries is accompanied by the taking into of Virginia held the regular semi annual
the system of more benzoate than in tlie examinations, June 22-2Fi, in Richmond,
administration of three-tenths of a gram of The results were announced through Dr.
sodium benzoate. R. \V. Martin, president of the Board,
"In the light of our experiments it is difcult
to say why benzoate in moderate
August 15th. There were 118 successful
candidates, including several young women,
amounts should be considered any more
inimicable to health than such a salt as
sodium chloride."
and a number of negroes,
RBX hospitau.
The new Rex Hospital in Raleigh, N. C,
There is, however, another side to the will be ready for occupancy by October
question which makes one doubt whether
these experiments were clearly and defifirst.
Miss Helen Orchard, of Columbia,
S. C, who for the past ten years has been
nitely conclusive. Dr. Reed, of Cincinnati, engaged in hospital work in Richmond,
has called attention to the fact that while Va., will be superintendent of the hospital.

164 THE CHARLOTTB MEDICAL JODRNAl. ,
GERIATRICS. losed, the ribs become harder and lose their I
We have long recognized the tertnpaedi- resilience, the costal cartilage, and the carat/icss-S
applying to that field of medicine tilages of the larynx and trachea become
dealing with the diseases of infancy and ossified, all through the deposition of lime
|
childhood. Without actually and accurate- salts. Waste proceeding faster than re- I
ly defining the stage of senilit}' and itsdis- pair, the chest muscles atrophy, and this
eases, we have nevertheless tacitly accept- with the bone and cartilage changes de- !
ed old age as one of the physiological pe- creases the mobility and elasticity of the
riods of life. Recently Dr. I. L. Nascher, chest walls, interferring with the expansion
of New York, has proposed the term^f/vVz/- of the lungs. The lung tissue atrophies,
rics, from geras, old age, and iafrikos, re- and the alveolar septa waste and finally are
lating to the physician, to cover the same obliterated, the vesicles coalesce, and we
\
'
]
field in old age that is covered
paediatrics in childhood.
by the term
That senility is a
have an enpliysematous
atrophied lung. Owing to
condition
this
in an
condition
distinct period of life having general fea- of the lung and the weak circulation of
tures normal to it and abnormal to all other senility we have an incomplete aeration of
periods is readily accepted. When any of blood an impeded pulmonary circulation, \
its manifestations appear during childhood with a tendency to hypostatic congestion
or maturity they are indicative of disease, and susceptibility to adynamic inflamma-
j
and medical skill is often able to remove tion. This adynamic inflammation which
them. Occurring during the period of life is the principal cause of death in old age,
when degeneration and decay are natural differs in many essentials from the pneu-
•
i
and inevitable medical skill may possibly monia of maturity. The sthenic type is inretard,
but death alone can stop the process- frequent and in only about fifty per cent.
|
esof decay. Physicians have come to look of these are
upon the features of senility, the atheroma- toms, chill
there
and
the classical
pain.
initial
There are
sympmany
j
;
i
ta, degenerations, ossifications, and calcifi- latent cases presenting no marked sympcations,
etc., as pathological features of toms, cases where the emphysematous
maturity instead of considering them nor- symptoms mask the symptoms of the pneu-
i
I
|
I
i
;
j
|
:
mal features of senility, and they are treated
as diseases. Any condition, feature,
function, or circumstance which prevails
monia, and cases where the symptoms present
do not point to lung involvement. In
many cases there is little or no cough, pain,
j
generally during one period of life must be dyspnoea, or expectoration. The physical
considered normal to it though it be a disadvantage
to the individual. The weaksigns
of senile
signs in pneumonia
pneumonia
of maturity,
differ from the
and there
ness of the infant and
themata are normal to
its liability to exanthat
period of life.
is a difference in the progress of the disease,
Few cases reach the stage of resolution,
The pains of labor
ture woman. I'or
are
the same
normal in the mareason
we must
and in these areas of engorgement
as foci for future inflammations.
remain
Death is
i
]
consider the degenerated organs and altered
functions of senility normal and physiogenerally
due to exhaustion or paral.ysis of
the heart or lungs. An important feature
j
I
logical. Childhood has received special in all diseases in senility is the presence of f
attention by physicians and a special symptoms referable to the senile conditions, i
branch of medicine has been assigned to and masking the symptoms of the disease.
it. Senility has received the attention of Dr. Nascher's article, published in the ')
but a few inve.stigators; aside from these it New York Medical Journal, certainly pre- \
receives no special consideration, its mani- sents some ideas worth consideration. His '(
festations are considered pathological con- view, so far as we are able to ascertain, is i
ditions of maturity, and its diseases are unique and the term he proposes is a dis- i
treated as though they were diseases of ma- tinct and useful addition to the medical vo- (
turity occurring in individuals who have a cabulary.
|
weak constitution. Having an Individ- j
uality of its own
typhoid probuems. |l
as clearly defined as child-
hood, , with anatomical features, physiolog- For many years the medical profession 'f
ical functions, diseases, and their treat- has supinely accepted the theory that wa- 8
ment differing from maturity it should be ter is the chief means by which the germs ,t
considered apart and distinct from ma- causing typhoid fever are spread. Recent- %
turity, and as a special branch of medicine, ly however our historic beliefs have receiv- \\
To such a specialty might be applied very ed more than one effective jolt. No less is 't[
aptly the term geriatrics. Dr. Nascher this true of the method of dissemination of {i
cites the following illustration to show the typhoid fever. In some cities, Washington ,<
marked differences between the conditions for example, the elimination of the hither- |:
existing in senility and maturity. In the to-believed chief source of contamination,')!
normal senile chest the sternum is anky- namely water, has had no effect on the M
'
|
'

165
morbidity from this disease. Everybody much more than the ordinary milk insnect-
*°"^^
alT;be%,W '^H°\Jr''''P''r"''"'^''"^ "°" P"^*'^^d is needed. Tvery
.11 the time, and that even when a c.ty is dairy which is allowed to supply
exempt milk to
from an
a
epidemic there must be city should be under vigorous
many control
sources The
of infection. The Yale Med- individuals engaged in trades like baking!
ca] Journal editorially on this subject cites where food is handled freely,
he
should
recent
also
results of studies by Kayser in be under sanitary inspection.
erniany. Thorough
1 his investigator has reported disinfection of all articles of attire
the results which
o several years' investigations, have been worn bv typhoid fever patients
-n the city of Strasburg, during which pe- before and during their illness should be dg
ri.M hundreds of cases were carefully orously carried out. The necessity for rout-
Hieir infection ine examination for bacillus carriers is also
t .red Xn ^'^ tiace when •Ki'"'"„''
1 possible. He found that in apparent, as about five per cent, of all tv-
Strasburg nearly one per thousand of the phoid patients become chronic carriers uiiniliabitants
(the total population being der existing circumstances. This means
1 ^' I OOO ) contract typhoid fever each year, several hundred carriers in a city of 150 f>f 000
the sources of infection raw milk is the All of these things go to show that
most^enous.
the
Over one quarter of the cases stamping out of typhoid fever, if it is
could
ever
be traced to tlie use of uncooked milk, systematically attacked, will be a
cream,
prolonged
or .sour-milk; less frequently to the and expensive process,
use of butter-milk. The mixed milk of
lar-e dairies was found to be at fault as « PftTHOOiNOMOMic sign or appeindiwell
as that of small concerns, and it was oiTis.
''"''' '^'^''' classical group
an
of
tliecitvwier
symptoms do not always
Bathin'.
n .m!,nf^^ \ ^^th'"8^ or swimming necessarily arise because of appendix dis-
'''' s ns!wr
And
llL
much more is this
w''.""''"^';^^"'."''-" Leo^ the
''"" ^'"'^"'^"^ '^'"'^ '"^^'^ cases in
1 . curredi,Ti'"eTr, which
'"f
the
^f ?, ^''"1'^- patients go about,
t.e N pursue their Comae vShnt/f
vocations.
"n f
/-^"l^'; t "••"> Patien s was respon- and at times complain of pain in the rieht
'"'•"/ '''^''''" ^" half of the lower
; I "all Ihes^-'T abdomen-over Mc Bur-
^'•^.^^^-^"•- "e.v's point, in the
. M afii
inguinal .'aland region,
1 had'f^h had or
not
even
been diagnosed ly- about the umbilicus. The first and most
ons ve;e uoiiZ \ yu^ "'"'^ '"" ""P"^'^"' ^"^^t'°" ^'^^ -"f"^^ the X'-
'\l.ttle over nine sician
,e X t nf.l.r
when consulted bv a person of this
,
l'^'^.*^^^" '"f-/^'l group, or even
•onacfw when called to a hKn case of a
\"^^''en
ercL
»-« acute character, is:
letn
Is
per
this
cent, appendi-
of^^H^^^^ ot the patients no definite citis'
"The studv'of ule'""''^ '" l'"''^ , ^ '^'^" ^'^''^^ ^^'^ ^"^^ly be called patho-
"""'^^"°"'^ "f '^' P*- Knomonic would
...
prove of inestimable value
ie c 1 ts shied shoued that certam trades were to the diagnostician. Dr. H. Illowavof
.^''^^ f-" ^'ew York^ has recently described iTi '^Xr-
uen h. ubie Mo i/'^^,/--^'
^f.^^]ff-rthe chives of Diagnosis"
^c^ a sign
owed He it. r' which he be-
lieves to be
lem
pathognomonic. It is Icsf elicited
ha^^^
''"^' f"°^.^^'^^ as follows: ', •S
The patient is
imr liuTr^ placed at full
'^^^^^^
; oemlers '""^^^
and H, ,
/"i"""'' °" =^ ^'' ''''^^'^- He is lounakers then in-
and those handling food or structed to flex the leg upon the thigh uid
re olfsr/hamUed " '"' ^'^^ ^'^''^'^ ^P"" ^^^ '"''"^
T't'- 'T "P°" 'he Ixe u
I,""'
V d • IZf !Z Tf 1 \ '" ""''^ V" '°" °f ''^''"^ '' '^ ascertained whether the
"" seae BlrbL f A
'° '^' movement, or rather the
^V'^
upward pressure,
peculiar -ex- causes
eiTtmn' .n Ir T^^tu^ any pain or soreness to be
^}:':\ ," /"'/"^, The investigation felt in the right half of the abdomen, i. e.
lioL- i't m ^^''"f"'^' * the appendicular region. If
'°"f none or very
°' '"'•'''"
'*'''^ '^ f^'* '^^ -
\se nfrn, 1 f r T ^'"Sh is more forcibly flexed
ise through infection from certain either by the patient's own effort
or
or by
other
the
sources of common food physician. Again it is inquired whether
•
.. ,. , any pain or soreness is felt or whether it is
nirs'tlfevrr'r^
great value, increased. Next the patient is directed to
extend the leg to full length with a quick
iI ihuidLl^r^ .
,'l>".cl fever in "'rl°^Pu''^"\'°"
cities. They show that and rather sudden movement, care being

•1(,5
THE CHARLOTTE MEDICAL JOURNAL.
observed to ask the question whether pain EDITORIAL NEWS ITEMS.
or soreness was felt in the region under inspection.
If neither of these movements
Pxcss Correspondence. i
has caused any appreciable pain or sore- i
ness, it is then best to direct the patient to Washington, D. C, j
execute the same movements with the left 3355 Meridian St., N, \V., Aug. 20. 1000. ;
leg, and to compare the sensation produced
g^j^Q^ ^f ^he Charlotte Medical Journal;— i
as to whether it is different from that caused '
t^
^ar c-
^
^^^
by the right leg, or whether it is the same
on both sides. Dr. Illoway claims that he
has found that invariably only when ap-
^^^^^^^ ^^
pendicitiswaspresent, vvhether as b^^^^^^^^^
the CharloUe Medical Jounial, regarding
mary ma ady or as a secondary volve^
causation of sex. According to Prinmen
did the flexion o the high upon he
, advanced by Dr. Dawson,
^^^.^.^^^ ^ ^^ ^^^^ ;
^^^^^^^^^ .^ ^^^ ^^i^^, .^1 „^,,3 -^^^ j
trunk give rise to a feeling o pain or a -^ ^^^^ ^^ ^ ,^^^^ -^ -^ ^, „ld as the |
sensation of soreness which the patient Pt /,„,. jtggif
would describe as being ''deep down --and ;;j'^
^^",t, 3- f '^^hizm Medizinische
even when this was not so marked the mpid . ^ .^ ^ sentence referring to this obexjens.o.
would cause quite an accentuation
^^^^^^^\^^'^^^ ^,^^ ^^^ ^^,,„„ ^^l,, i, i, erro-
of It. It may happen that the »^or,Ma6/e ^
fle.in^ of the thigh upon the trunk may jeoUy
cause some shght pam or soreness, but
^i e
p^^ ^^.^.^^.^^^^ ^^ ^^ ^
this ,s not due to an appendicitis there w,
^^the Sexes.
be no pain or soreness or ..v/.««.« It 1
the pain or even soreness on both flexion "", ° , ,^
WL..«.« that Dr. Illoway regards as a ^^^.^
(Theorieen uber die Entste-
^ n q-positive
and unfailing sign of the presen^^^^
of appendicitis. It IS said that this sign
twii ^p^^^du d ^r'oVrJ'same ^vum!
?urn^h:r;h: eye'Tpai:orre:es: ov^um. .
The passage ,s taken from Part I, I
^1^^^,^,^ ^^ ^i^e Origin of the Sex and Ratio !
Qesch echts uud uber das Gesch- |
rmalind t'^^^ of sex in i'
\^^ ^^^ i^ predetermined in the i
In ancient times the vie.v was
produced by the mLements described, val- ST^-Slfgsoi-'^'trartr::^;^^^^^^^^^
uable indications as to treatment, as to
^^^^^
;„ ^if^ightovarv; and the female ova 1
whether an early operation should be ad-
^f^^j^'; eft ovary. Births during unilateral
vised or whether an attempt may be made,
'l^l^^\^ the ovarv and after unilateral i
with safety to the patient, to cure the ail- . ^^^^ ^i^„-,,„ ,l,e incorrectness |
• " 2
ment by other measures. r
^t,.
It has been been so commonly observed ot tnis view .
!
1
i
in acute appendicitis that the patient keeps ' "Zur Bestimmung und Entstehung des
the right thigh flexed on the abdomen and Qeschlechls". (On the Significance and
complains of pain when it is extended that
Origin of Sex) . Zentralblatt fur Gynacolto
mention the phenomenon seemed super- ^gjg ^395 j^Jq^ 22.
fluous. It has likewise been customary to
Ditto: "Willkurliche Zeuzung von Kna- I
account for this by the movementsjto which y^^^ ^^^^ Madchen." (The Procreation of (
the psoas muscle is subjected in flexing and goys or Girls at Will.) Munich, 1895.
extending the thigh. None however have .p ^ winckel- "Die Bedeutung des!
so far attempted to utilize this knowledge
gig^gjo^i^e f^. die Entstehung des Gesch- :
for diagnostic purposes. While Dr. lHo- ,,
jg^jj^g (The Relation of the Ovary to the 1
way does not attempt an explanation of the
Qj.j^i„ ^f gg^.) Deutsche Praxis, 1808. I
sign which he describes, it is probable that jt "g
no one would dissent from the theory that
';
'
' 1 ui tu 4. „ „.v,^ 1
the pain and soreness are elicited through It is rather remarkable that a man who
^
the action of the psoas muscle. ^^s collected such a mass of cbnical data
. in support of his theory, as Dr. Dawson .;
has, should have failed to observe a case in (
Dr. J. F. Siler, Medical Corps, U. S.
.^^^lich a woman with only one functioning ^
Army, and Chief of Dept. of Tropical Med- o^^ry has yet produced children of differ- ;
icine in the New York Post Graduate Med- ^^^j sexes. Such cases are by no means t
ical School, has been sent to Peoria, 111.,
rare in an extensive obstetrical practice.
|
to investigate the recent outbreak of Pell a-
Ver)' truly yours,
gra. WiNTHROP Y. Foster. .
Dr. J. Irving Chapin, of Philadelphia,
committed suicide in a New Orleans hotel.
August 24th, by taking an overdose of formerly State Chemist, has been made
morphine. State Food Commissioner of Louisiana.
Dr. Hamilton P. Jones, of New Orleans, '
,
:
'
|
'
'

North Carolina Medical College Opens.
The North Carolina Medical College
opened, September Slh, for the session
I'Mi'i-io. The opening exercises were attended
by about sixty students already matriculated.
There are prospects for as
many more.
Dr. W. O. Nisbet, dean of the college,
extended greetings of welcome to the students.
President J. P. Munroe made the
formal opening address, speaking words of
encouragement and caution as to the proper
way in which to attack the studies to which
they shall now address themselves and the
best methods by which to derive the most
possible good from their collegiate medical
courses.
There are two young women students
among the number already registered.
Dr. Sidney D. Porter, of Moreauville,
I. a., was recently elected Special Medical
Insjjector to fill position made vacant by the
resignation of Dr. C. Milo Brady.
I he Board of Trustees of the Mississiiipi
Insane Hospital has decided to make permanent
the tuberculosis camp which was estalilished
during the latter part of (^lov.
\'ardaraan's administration. At that time
the board lacked funds for completing the
Duildings as planned, and temporary canvas
tents were brought into service. The
exiieriment proved so successful in the
marked imi)rovement of patients that the
Hoard has decided to make the camp a
[permanent institution.
The North Carolina State Nurses' Associaliun
held its seventh annual meeting at
W ii-htsville, August 18th and 19th. The
sessions were presided over by Miss C. li.
I'foll, of Winstou-Salem. A number of
nurses were in attendance. Several physicians
of note addressed tiie association in
adtlition to the large number of papers presented
by members. The State ICxamining
Hoard for Nurses met at the same time.
Ouite a large numtjer of nurses applied for
registration.
The Virginia Department of Health has
uii.pted a novel plan to carry out investi-
;.;aii..ns in typhoid lever epidemics. The
W'Xk is being undertaken especially in the
Sh.nandoah Valley, Staunton being the
cenler of operations.
.\ '.raveling laboratory has been placed
in the \'alley under the supervision of Assistant
Health Commissioner A. W. Freeman
and Dr. H. T. Marshall, professor of
ba. it-riology in the University of Virginia.
Di A. P. Waddill is in immediate charge
of tile laboratory.
The Louisiana State Board of Health
has recently completed an oflBcial list of all
registered practitioners of medicine in the
State. The total number of physicians is
2033, of which number 701 are in Orleans
parish alone. According to the estimate
made June 1, 1906, by the Bureau of the
Census, the population of Louisiana is
1,539,449, and making a calculation based
on this estimate, it is shown that there is
one physician for every 7.52 persons in the
State. In Orleans parish, making a similar
calculation based on a population of 350,-
000, shows there is one physician for every
495 persons in that city.
The Anti-tuberculosis Association of
Chattanooga, Tenn., is making splendid
efforts to obtain funds with which to establish
a hospital for tuberculous patients.
Hamilton county has donated a tract of
land containing seventeen acres, together
with $3,500 in money. The city of Chattanooga
has promised a like sum, and this
with other subscriptions makes a sum
amounting to about $10,000 available. The
building committee proposes to make a start
with this amount. It is the purpose of the
Association to make this hospital a purely
local institution, to exclude patients outside
the county of Hamilton.
Marriages.
Dr. T. O. Copbedge. of Castalia, N. C,
and Miss Anna Mae Spears, of Boonville,
N. C, were married Wednesday, August
4th, at the home of the bride's parents, Mr.
and Mrs. John A. Spears.
Dr. aud Mrs. Cophedge are now at home
in Castalia, where Dr. Cophedge is engaged
in the practice of medicine.
Dr. A. Roy Hogg, a prominent young physician
of Haralson, Ga., and Miss Gertrude
Allen, of Atlanta, Ga., were married August
24th, at the home of the bride's mother,
Mrs. N. E. Allen.
Dr. Hogg is a graduate of the Medical
College of Georgia. Class of 1905. Dr.
and Mrs. Hogg are at home to their friends
in Haralson, Ga.. where Dr. Hogg is engaged
in the practice of his profession.
Deaths.
Dr. Ralph B. Hanahan, one of the most
prominent citizens of Winnsboro, S. C,
died at his home July 31st. He was not a
native of Winnsboro, although he had spent
practically all of hig life there. He had
been a sufferer from heart disease for a long
time, and his death was not unexpected.
Dr. Hjniaban graduated from the Charles-

168 THE CHARLOTTK MEDICAL JOURNAL
ton Medical College in 1886, and was for a Dr. H. M. Young, one of Dothan, Alatime
druggist in Winnsboro. After his bama's most prominent physicians, died at
graduation he spent one year in the city his home in that city July 27th, after a few
hospital at Charleston. Since that time he days illness from dengue fever,
has been a practicing physician of Winns- Dr. Young graduated from the Medical
boro.
_ , „ „„ .„,
Dr. J S.Osment
Department of the Ihiiversity of Alabama,
r . Mobile, Ala., in 189.3. He was a well-
,
formerly a practicmg ^nowu and much beloved citizen as well as
phys,c,an of Chattanooga, Tenn., died at
the home of his Son m Birmingham, Ala.,
^„ ^„,i„^„^ physician,
'
August 11th. Ur. Oliver Buford. of Cartersville, Ga.,
died at his home on July 28th. The de-
Dr. W. J. Trent, one of the oldest, and best ceased was a very prominent physician, and
known physicians of Cleveland county, N. was, for a number of years, surgeon in the
C, died Sunday, August the 1st, at his United States Army.
home near Earl. He was 76 years old, and Dr. Buford graduated from the Medical
atone time he was a physician of great College of Georgia, with the class of 1881.
prominence.
Dr. Kent Black, a leading physician of
Dr. James McGuire, one of the oldest, Montgomery county, Va., died at his home,
and best known, and most prominent phy- three miles from Blacksburg, August 12th.
sicians of Mocksville, N. C, died at his Death came almost suddenly; before medihome
August 2l8t. He had been in declin- cal aid could reach the place,
ing health for some years, and was com- Dr. Black was a graduate from the Medipelled
to give up his practice some time cal College of Virginia, Richmond, Va.,
ago. class of 1878.
Dr. McGuire graduated from the New
York University, New York City, in 1857. .
Dr. E. L. Marechal, one of the best known
and most prominent physicians of Mobile,
Dr. T. W. Wliltlock, a well-known phy- Ala., died at his home August 19th. He
sician of Unaka Springs, Tenn., died at his had been ill for a long time, and death was
home July 29tli. He was about 60 years not unexpected.
of age. He graduated from the Medical Dr. Marechal was a member of many
Department of the University of Tennessee, local lodges and a member of the Board of
Nashville, Tenn., in 1893. Commissioners of Mobile county. Hegrad-
Dr. C. L. Stevens. d "1 "^ted from Medical College of Alabama,
d f r h If
nd for several years had been editor of the
century a practitionerinSonth Carolina, dieP
Mobile Medical and Surgical Journal.
at his home in Greenville, August 12th. His
death was sudden, and quite a shock to the ..,„„. .»'••
people in and around Greenville. He was Wf"*=^ «'
*^"'""f'^
surgeon of Hart's battery in the Civil War
n , ,
^^'^" "^ '
^?'i^r \,
and was at one time president of the South
^"'"8^^°" ^°' ^''^
well-known phy-
f'^^^f'^l'^^""^^
°" ^'^"^^^^ ^^h. He was for hirty years
Carolina Medical Society. He lived in ^,^,^|^^^f^"^"l^ Wilmington, ^T.,
Barnwell
N.
county until nine years ago, when
C and was one of the
^'^^''^ esteemed citizens of that section
he moved to Greenville. Tl' of the state.
Dr. William Forrester, a well-known Dr. Curtis graduated from Dartmouth
physician of Louisville, Ky., died at his College in 1342, later equipping himself for
home in that city, August 15th. He grad- the medical profession at Howard Univeruated
from the Medical Department of the sity. He was formerly of New Hampshire,
University of Louisville, Louisville, Kv., in coming to North Carolina in 1847 andloca-
1862, and since that time had been a promi- ted in Southport, where he had an extremely
nent practicing physician.
large practice in the town and county.
In 1852 he was appointed acting assist-
Dr. J, P. Rorex, a retired physician of ant surgeon in the Unired States Army,
Scottsboro, Ala., committed suicide at his filling the position for over a year.
home August 8th, using a doublebarrel
shotgun. There was no one present at the
home except the victim when the terrible The Phosphates of Iron, Soda, Lime and
incident occurred. Potash dissolved in an excess of Phospho-
Dr. Rorex was formerly one of the most ric Acid, "s a valuable combination to preprominent
physicians of north Alabama, scribe in Nervous Exhaustion, General Deseveral
years ago. Poor health and dis- bility, etc. Robinson's Phosphoric Elixir
pondency are thought to be the cause of the is an elegant solution of these chemicals,
violent act, (See page xvi).

REVIEW OF SOUTHERN MEDICAL, LITERATURE. 169
Review of Southern Medical Literature Department of Public Health, officered by
the ablest men, and beyond the reach of
PoHtios,
Texas
and
Medical foiirnal fulv 1909
make an appropriation ade-
_ ., ,„ , t^"t^
quate to meet the requirements, however
Psychology o Drunkenness.-Dr. E expensive it may be. It will be true econ-
Shepherd says that every fruit, plant and omy in the end." This end,-the eliminavegetable
grown contains this vitalizing tio„ ^f the preventable and the cure of the
substance known as spirit; remembenng curable elements of race decav,-is the misalso
that this spirit constitutes its life, and sion of rational medicine, to which all "exits
life is its happiness, its hv.ng its divine ceptional men," the enlightened, should
J°/\ "'""^'^ drunkenness ^^
of the plant ^^}; address themselves. Duty requires it; true
life be? Wouldnotan undue portion, an philanthropv dictates it; policv suggests it,
excess of spirit or hfe-if It could be secured and it is demanded by every consideration
—cause thejjlant to lose its poise, its bal- of humanity and race integritv. Will Conance,
its sobriety or sanity? Imbibing alco- ^gss heed the warning?
nolle fluids sufficiently, men lose control of
mind and bodv, and we say "thev are ,,r ^ , ,/•-, j c- , ,
drunk." We have but to review the above ^^'"' ^'''''"'' and Surgical Journal,
'^^"^/'fj
stated facts, then observe t/'^J'- ^yOv.
that man'sgeiiius
has devised methods whereby to extract to ^ Clinical Study of the Serum Dlaadistil
this spirit from fruit and grains,
"•**'* *»* and
Typhoid Fever.— Dr. II. P.
under the delusion that an excess of such J^row" and Dr. J. II. Kuiter say that from
spirit taken into ^^'=^ '^^"'^>'
his system as drink, will
'^^ conclude, first, that a positive
make him happier, he proceeds agglutmation test
to intoxiwith
bacillus typhosus
cate his senses, lose his reason
'"dicates
and degrade
that the patient from whom the
his whole being through the
^^"^'^
identical
^^^^'^
prin-
"'^s taken has typhoid fever
"'^
ciple which thfe Creator uses to create and ^^^ ^^^ typhoid fever within a comparaexalt
and make "^'^'>'
perfect
'"^^ent
every creature of
period. Second, in the ab-
His hand. Because a thing
^^"'^^
is good "^ ^ positive agglutination test the
it
doesn't follow a man should make a swin-
S-Vmptoms are due to some other infection.
ish glutton
''^"'^*
of
^):ion\A
himself, debauch his bodv,
be diligently sought for. In
'
deface creation and shame the earth.
^^"^^ '^^^^s '* '^ possible that the agglutinins
Men lose their reason temporarily through
have not yet developed in sufficient quandrinking
intoxicating liquors:
t'tV "i the
they often
patient's blood to give a reaction
lose it forever from a false
'" ''^ dilution of
impression
one in forty.
or
Subsequent
idea that they are gaining enjoyment in the ^^^'^ '^""^^^ '=^^^'' "P ^^'^^ Vo\ni. Third, the
realm of sensualism. Descending
Persistent
to a plane
absence of the reaction even in
of utterly disiipating
the presence
the divinest
of clinical
forces exsymptoms
of typhoid
f^''^*"
tant in
'^'^"''^ '^^'l
nature, wasting their very life and "^ ^'' «'^'« ^ positive opindraining
their highest vitality in the form
'"" ^^'^^ ^^^ disease was not typhoid fever,
of
'^^^
sex-intoxication, as surely
'"^^^
destroys common infections which give a
the
body with tlie disease called insanity—
Anneal picture of typhoid fever are miliary
softening of the brain—as
tuberculosis and paratyphoid fever.
it is frequently No
termed for courtesy's sake, as that the
"^ ^^^ latter infection was encountered
light- 'i^^^
ning can blast the splendid tree but erst- "\ """^ t^\'° l»u"dred and fifty-two cases.
while waving its branches in the happy
That a tuberculous bactenemia may recover
breezes, expressive of its delights '^
in being. ^?'^ estabhshed by I.andouzy in a paper
read at the sixth International Congress on
Elements of Decay in American Civil-
"uberculosis.
ization.— Dr. I". Iv. Daniel believes that
what sanitary science has done in other Tuberculous Laryngitis.— Dr. R. B.
countries it can do in this. And this is the Ilowan believes that it is in tuberculosis of
task to which the Committee of One Hun- the larynx that the most satisfactory results
dred on Federal Legislation, in collabora- from the use of tuberculin is obtained for
tion with the Association for the Advance- the reason that the action of the remedy
ment of Science, now addresses itself, can be accurately controlled by the local
While we may never be "civilized" up to a reaction produced in the larynx, and the
scientific breeding of people < as we do our dosage should be governed entirely by the
stock), or totally eradicate disease, it uii- local findings, That amount of tuberculin
questionably lies within the power and should be administered which is necessary
scope of science to eliminate much that is to cause a slight stimulation of the local
evil, and bring about great improvement, process, which will show as a slight hypereven
in the next generation, in the physi- einia. The dose should not be repeated
cal, moral and intellectual status of society, until this hyperemia has disappeared, nor
To this end government should create a should it be increased until this amount

170
THE CHARLOTTB MBDICAL JOCKNA]
fails to produce reaction. The effect of is high, and others when the bowels do not ;
tuberculin here is the same as elsewhere, stop moving give subnitrate of bismuth
It increases the amount of protective sub- eight grains, powdered camphor one grain, ;
stances found in the blood through a stimu- and extract of opium one-quarter grairi
lation of the physiological machinery of every three hours until the bowels are '
immunization. Its stimulating effects also checked. i
cause a local congestion about the tubercu- j
lous foci and thus hastens healing by bring- Atneruan Practitioner and News, Julv, 1909. \
ing the protective bodies of the blood to
.
^^^^^^ Disturbances During Preg- !
bear upon the tubercle bacdl. ,n greater ^^^^^_^, a. O. Pfingst says that in j
amounts than is usual in these conditions ^^^^ ^^^^^ ^^^^.^^^ ^.^^^ hemorrhage areas ;
1 his same action has a tendency to prevent
the bacilli from spreading to new foe.
^^^ ^^^^^^ scattered over parts of the fun-
Pbysiological Action of High Fre- visual disturbances vary in these cases and
^^^^ ^^^ ^^^^^^ ^^ ^.^^^^^^ ^,^^^ ^.^^^^,^ |
j
quency Currents.-Dr. A. Hennques draws ^re in no way in proportion to the area of I
the following conclusions: retina involved, extensive pathological I
1. High frequency currents, by reason of changes causing at times slight disturb- I
their great frequency and high voltage, ef- ^nces of vision, while minute changes may |
feet the rapid charging and discharging of affect the vision perceptibly. High degrees i
the cells of the body with electricity.
of amblyopia have been observed but com- i
2. They act without appreciable influ- plete blindness is rare. Both eves are nearly
ence on the motor and sensory nervous always affected, though not always in the ,
system. same degree. The defect of vision is usu- (
3. Their effect is an increase of the me- ally insiduous in its development. It may :
tabolic activity of the body cells in general, be mentioned that uremic poisoning may !
as evidenced by the increased oxygen ab- suddenly develop during albuminuric re- i
sorbed, carbon diovide eliminated, also as ti^itig and cause sudden blindness. \
shown by urinary- changes and by thermo- The prognosis with reference to visual I
genesis. acuity is not altogether unfavorable, total i
4. Their actionis accompanied by an in- blindness being exceptional and improve- i
crease of heat production and of heat elim- ment in vision after induction of labor be- \
mation nearly double the normal quantities, ing at times quite marked. However, the j
5. The heat elimination is attended by a higher the degree of amblyopia during the I
dilatation of the superficial capillaries pregnancy the less hopeful would be the |
throughout the body. prognosis for the mother after the removal |
Local high frequency currents are indi- of the cause,
cated in certain dermatological and super- Hirst, Silex and many others advocate
ficial affections. interference with the pregnancy in every
General applications of high frequency case of labor, complicated with Bright's
currents are indicated in vasomotor disturb- retina. As the danger of permanent blindances,
whether general or localized, and in ^ess increases with the duration of the inthose
diseases caused by defective metabol- flammation, some advocate the induction
ism, whether of gl and or muscle. of labor in these cases if occurring before,
the 6th or 7th month, and unless retinal
The Southern Clinic, June, 1909. changes be very pronounced, the disturb-
Sulpbate of Soda in Cholera Iniantum. ance of function great and urinary examin-
Acute Gonorrhoea and Acute Dysentery, ation unfavorable dietetic and medicinal
-Dr. J. Menweather says that m acute treatment is advocated when occurring
dysentery it becomes a pleasure to treat this jater
disease with sulphate of soda. It will relieve
every symptom. When you have a Streptocci.— Dr. E. S. Allen believes thai
patient with acute dysentery with abnormal as the streptococci does not excite in the
pains, griping, tenesmus, composed of resident cell any protective element, but
mucus, pus and blood, bowels moving ten ccmbining with the cell protoplasm, causes:
or more times during the twenty-four hours, such a rearrangement of its chemistry that
give the sulphate of soda every two hours if it is not at once paralyzed and undergoes
until the pains subside, griping and strain- retrograde changes, that it gives off a secreing
cease, blood, mucus and pus stop pass- tion, the chemistry of which must be difing.
Give the sulphate of soda on the sec- ferent from the original secretion, and is
ond, third and fourth daos, enough to pro- toxic—for we know that degenerated albU'
duce three or four evacuations each day minoid products are most toxic. In con^
until the tongue is cleaned. elusion let me say that having received
Some cases will require quinine and little encouragement from our streptococcic
sulpho-carbolate of zinc if the temperature antitoxinic and what result -is favorable is
'I
j
j

REVIEW OF SOUTHERN MEDICAI. LITERATURE. ]71
probably due to the leucocytosis generated
by the horse serum alone that it might be
well to tuni our attention to agents that
have to do with bringing up the white blood
cell number, and then stimulate the white
blood cell, say of the horse, to protection
by injecting dead streptococci—and instead
of trving to get an antitoxin in the serum
of the horse—extract the leucocytes by
centrifugal means, and make an emulsion
of the white cells, for in them we have only
the protective agent against the streptococci.
The same precaution probably would
have to be observed—as in antitoxin, to get
several varieties of streptococci, or probably
by culture media develop ihe streptococci
to its typical long chain-form: all other
varieties being probably lowed in the evolutionary
stage from the sophrophyte to the
obligate micro-parasite.
Mrginia Medical Semi- Monthly, July 9lli,
Treatment oi Consumption.— Dr. W. 11.
Coffman says liiat a patient who is bleeding
freely should be put to bed as soon as
possible, and should be propped straight
up, comfortable, with a bowl or other large
receptacle containing a little water, in his
lap, so that when the gushes of blood come
he may be able to dispose of them with the
least possible exertion. He should be kept
iu bed for at least ten days after the bleeding
is over, because it takes about this
length of time for the organization of the
clot, which is nature's means of stopping
the bleeding. lie should have a small
hypodermic of morphia to control the cough
and the nervousness from which so many
bleeding patients suffer.
Of drugs, nitrite of amyl is probably the
only one that has any immediate effect on
pulmonary hemorrhage. Calcium chloride
is said to be useful in controlling the tendency
to bleed. It may be given in five
grain doses e\ery three hours, until five or
six doses haveVieen given; then, three times
daily for about three days.
Many cases may be controlled by lowering
the blood pressure. This may be done
by giving large doses of epsom salt: also,
by the use of such remedies as veratrum
viride.
In vieiv of the fact that any patient with
an open cavity is liable to bleed, it is well
to have an occasional record of his blood
pressure, so that when he does bleed you
will Ije in a position to know when you
have reduced the blood pressure enough.
Fifteen to twenty points are usually sufficient.
'I'here are, however, a few cases
in which veratrum viride does no good,
that are promptly checked by the use of
adrenalin. It is probably well to restrict
for one or two days after a hemorrhage the
patient's rational food, or, at least, the
fluids.
Etiology and Patbology of Summer
Oiarrbeas ol Children.— Dr. E. P. Torupkins
points out that at one time it was
thought that sterilizing would do away with
most if not all the bad effects of impure'
milk. But sterilized milk is cooked milk,
and Nature never intended babies to live
on cooked food. Heat sufficient to kill
some of the harmful bacteria is sufficient
also to destroy the beneficial ones which
hold in check or destroy the dangerous
ones. Yet this is not all the damage heat
will do, and a lower degree of heat even
than that required to kill the microbes. For
instance, Hippius and Spolverini have
proven the presence, both in mothers' milk
and in cows' milk, of a ferment which is
destroyed or enfeebled by only a moderate
amount of heat. Spolverini says that the
sterilization of milk produces six disadvantageous
changes in it, namely:
First.—It expels the carbonic acid gas
which stimulates the secretion of the gastric
juice.
Second.—Diminishes the amount of lime
and free phosphoric acid, increases the insoluble
calcium phosphate, and precipitates
the anti-scorbutic citric acid.
Third.—Destroys a large part of the lecithin
of the nucleiu.
Fourth.—Coagulates the soluble albumin
and changes and renders unabsorbable the
casein.
Fifth.—Unites the fat globules in larger
masses which are less easily digested and
absorbed.
Sixth.— Destroys or weakens the ferments,
and thus are lost to the child antitoxic
and immunizing compounds of great
value.
Scarlet Fever.— Dr. J. D. Morgan says
that if there is one thing he is positive about
in scarlet fever it is that suitable warmth to
the body and milk diet give the best results.
It was Jaccoud who laid such stress upon
the sole use of milk. There are few or no
cases that do not show a trace or more of
albumin; and time and again the patients
have been given animal broths, eggs, etc.,
only to see the albumin increase. Thompson
regards nephritis as part of the disease,
and urges care in the diet, which should be
milk and cereals for the first three weeks.
K. Oppenheimer warns against allowing
the patient to become chilled. The diet,
he says, is more important than in any
other infectious disease, on account of the
tendency to nephritis. Rubens holds his
patients to strict dietetic measures, avoid-'

172 THE CHARLOTTE MEDICAL JOURNAL.
ing all nitrogenous food and alcohol, and
giving mainly a milk diet. In that way he
ially vulnerable to the action of thyroid,
The tubercle bacillus which, as you know,
wards off serious kidney complications. is also pathogenic when dead, owes its mor-
The use of opium in any form has been bid action to an endotoxin rich in phosfound
very pernicious. Quieting and rest phorus; being thus rendered extremely inin
nervous cases can be easily attained by flammable while the blood'soxidizingpower
bromides and chloral,
is enhanced simultaneously, this pathogenic
As a purgative, nothing is better than a organism is promptly destroyed. This ap-
- little Rochelle salts flavored with orange or plies also to lupus. In syphilis, the use of
raspberry juice. thyroid, based on the views I have advanc-
Many ear troubles are brought about by ed, has been termed "marvelous" by other
too much spraying and improperly blowing observers. It has been used with success
of the nostrils. in acute infections, including the exanthemata
which may often be curtailed by its
Riehmond Journal of Practice, May, 1909. judicious use.
Adhesion of the Placenta.—Dr. W. R. -,-, ., , ., j. , , , r , ^ ,„
^^'^ ^•^''«'^«'«« Medical Journal, July, 1909.
Wilson says that recent research has demon-
'*'***
strated that the fetal layer of the decidua Wasserman Reaction for the Sehas
a tendency in abnormal cases to pene- *"•" Diagnosis of Syphilis.— Dr. J. P.
trate toward the uterine wall, thus invad- L°"« concludes that the serum reaction for
ing the spongv or material
syphilis is
layer of the
specific. It is found positive in
decidua. As a consequence, the villi at- ^'''^ '-"' P^*" '^^"^- ^o 98 per cent, of all cases,
tach themselves to the ""'^!* syphilitic
wall of the sinuses,
manifestations. It is found
establishing a direct adhesion
Positive in
between the
50 per cent, to 60 per cent, of
fetal decidua and the musculature.
^*^^"t cases.
The
cause of this change is no ^^ longer '^ considered
^°""

REVIEW OF SOUTHERN MEDICAI, LITERATURE.
there will be little or no extravasation.
After six hours have elapsed, peristalsis is
reestablished and extravasation occurs with
rapidly spreading peritonitis.
If operated on within the first six hours,
the result as illustrated in this eeries of cases
will be uniformly good.
After this the prognosis becomes more
unfavorable generally as the time fjrogresses.
As much rapidity in operating as
is compatible with careful work, free stimulation
and in the presence of shock and
hemorrhage, together with drainage and
Fowler's position, aid materially in the patient's
chance for recovery.
Richmond Journal of P>acticc, Junt\ 19ii9.
Surgery ol tbe Perlpberal Nerves.-
By Dr. J. S. Ilorsley, Richmond, \'a.
Atlanta Joiirnnl-Record of Medicine, July,
1909.
Tonslileclomy versus Tonsillolomy.—
Dr. H. II. Lokey gives the following decription
of the operation
After the patient is anaesthetized, if with
a general anesthetic, keep the mouth open
with a mouth gag, and with a tongue depressor,
placed well back of the base of the
tongue, expose the field of operation and
with Iceland's tonsil knife separate the
faucial pillars from the tonsil. Then with
a Marquis forceps, passes through the loop
of Farlow's snare, and with the tongue depressor
in the hands of my assistant, the
tonsil is drawn out towards the median line
and the loop of the snare forced well down
over the tonsil, being careful to avoid liav
iug the uvula within the loop. Then grasp
the snare with both hands and with one
grip remove the tonsil. The I'arlow snare
is supplied with a screw mechanism by
which it can be more slowly removed, but
do not use this except at occasional times.
After the operafion, wipe the blood from
the throat and inspect the field. If there
are any fragments of tonsil, left, remove
them with the Roberts' or Farlow's punch.
Then take a piece of wet gauze, wrap it
around the finger and make several sweeps
between the pillars across the raw surface.
This aids in freeing the wound from fragiits
of tissue and also assists in checking
the hemorrhage.
Pellagra.— Ur. E. S. Cross believes that
it is not impossible that further investigation
may show a relationship among these
similar conditions. Pemphigus, leprosy,
egotism and dermatitis venenata may have
to be eliminated Ijy the history and course.
Acute cases of pellagra are practically
always fatal I'atients in the earlier stages
of the chronic form may be entirely relieved
:
by change in diet. The outlook after mental
change has appeared is, of course, unfavorable.
Aside from removal of the patient from
unhygienic surroundings and the substitution
of a suitable diet, treatment is largely
problematical. Arsenic has, perhaps, met
with greatest favor and may be very well
given as atoxyl, hypodermically. Local
conditions are to be met symptomatically.
Iodine is said to relieve the burning and
itching of the skin lesions. Protargol in
doses of l-,5 of a grain daily has been advocated
for controlling the intestinal conditions
on the theory that an aspergillus, susceptible
to small amounts of silver may
play a part. Hydrotherapeutic measures
are useful to combat certain of the nervous
symptoms, but cases with chronic mental
change require asylum care.
Indigestion Due to Causes Commonly
Removable by Surgery Dr. E. G. Jones
says that of twenty adults complaining of
stomach trouble of chronic duration it is
perhaps conservative to say that twelve
have affections with which surgery has
nothing to do; the remaining eight have
( 1) appendicitis, or (2) gall stones, or (3)
ulcer or cancer, or (4) an obscure lesion
such as perineal adhesions, hernia, cecal
tuberculosis, etc.
If these persons are under forty the proportion
of appendix and ulcer indigestion
will be increased at the expense of the cancer
and gall stone indigestion; if they are
beyond forty the cancer and gall stone indigestion
will be increased at the expense
of the appendix and ulcer indigestion.
lught of the twenty, therefore, can be
offered no reasonable hope of a permanent
cure by medical measures. They can all
be offered much by surgery—except the
cancer patient, and of all visceral cancers,
gastric carcinoma is perhaps the most surgical
if diagnosed early.
/ 'irginia Medical Semi-Monthly, July 23rd,
1909.
Tbe Influence of Sleep on Arterial
Sclerosis.— Dr. \V. W. Beveridge points
out that where individuals are so situated
that sleep is impossible, as soldiers on the
march, or sailor at sea in a storm, an unusually
long period of sleep is necessary to
compensate for the long delay. Not only
does this pertain to the human race but to
animals as well, for all know that animals
well housed and worked only during regular
hours and with regular hours for sleep,
require much less feeding and do better
than those otherwise attended.
This theory has economic value only in
so far as it can be applied to every day life.

174 THE CHARLOTTE MEDICAL JOURNAL.
The author believes that a more thorough food, approximate time needed for the diunderstaiidingaiidobservanceof
thenatural gestion of some principal foods, alcohol in
phenomena attending sleep would have various liquors, substances excreted in milk,
definite value and application to the affairs notes on feeding, diet tables, hypodermatic'
of health; that the retrograde changes inci- medication, poisons and their antidotes,
dental to old age that are ushered into mid- eruptions caused by drugs, important indie
life long before the individual should compatibles, synonymous terms, medical
show signs of physiological death might be Latin translated, leading remedies classiaverted
by a more careful study of the pro- fied, "shall the doctor trust to chance,"
cesses that apply the nutritional products therapeutic suggestions, materia medica.
direct to the cell. Whatever sleep is, it is As the "manual" is to be had for the askthe
process, or presides ovei the processes ing the edition of 40,000 ought soon to be
that convert food into the organic life of a exhausted.
5.f'- ^>^ J'.f/ °i^^^ organism is a cellular ^^^ American Pocket Medical Dictionary.
life. The life of the cell depends entirely
Edited by W. A. Newman Dorland, M.
on the integrity of Its repair. ^ ^ editor "The American Illu.strated
Surgical Diseases ol the Kidney.— Dr. Medical Dictionary." Sixth Revised
J. G. Sherrill says that in microscopical Edition. 32 mo. of 598 pages. Philasearch
for the tubercle bacillus in the urine delphia and London: W. B. Saunders
great care must be observed not to confuse Company, 1909. Flexible leather, gold
this organism with the smegma bacillus. edges, $L00 net; thumb indexed, $1 .25
Recent investigations by Young and Church- net.
man have shown that smegma bacilli are The popularity of this book was such i
surface organisms, and that it is easily pos- that the fifth edition was larger than any '
sible by a process of retrograde irrigation previous edition. Hence it is that the editor i
to completely wash them from the surface has been encouraged in a special effort to ;
of the urethra. Careful sterilization of the make the present edition reflect the ad- i
external parts is, of course, essential before vances of medical literature. The fact that I
the irrigation is commenced. When these the work has been steadily growing in favor \
measures are correctly carried out the ordi- must be a source of gratification to both
nary staining methods may be employed editor and publishers.
for the detection of tubercle bacilli.
For the present edition the text has been
' fully revised and many hundreds of new i
Book Notices. words have been added. Most of these i
words are not to be found in any other book i
Manual of Therapeutics. Parke, Davis & °^ '? '^^^^^'
. j .t. . i
Company, Detroit. Mich. J}^ improvements made in the presen I
'"^^'^
This little volume of 650 pages, bound .''\°" ,
,f ""^l ^" increased utility of i
th.^htte volume
in flexible leather, contains a fund of in-
• (^^,„„t- .c t-- 1. i It IS handsomely printed on thin paper or
formation in a compact form which, alone, , ,., j i j i- i ..
^-.v^„ ;t ,.„„, 1 ui it ..u- good quality and bound in limp leather.
makes it very valuable, not to say anything *> ^ -^ ^
about the convenience and necessity of Tuberculosis: A Preventable and Curable !
knowing the exact drugs and their percent- Disease. By Adolphus S. Knopf, M. D. I
ages entering into the various specialties. New York: Moffat, Yard & Co., 1909; !
The description of drugs and their thera- This volume is presented to the medical I
peutic indications are given concisely, and and lay public with a view of placing be- ;
altogether a wide range of material, as the fore each the most important points in the I
appended "contents" shows, is embraced, prevention and cure of tuberculosis. It is
;
i
Contents: Weights and measures, the intended to show that tuberculosis is a pre-
(
!
metric system, percentage solution table, ventable and curable disease, rarely heredithermometric
equivalents, average weights tary, and that in children of tuberculous
and measurements of adult human organs, parents the pre-disposition can be overcome
average weights and heights, respiration at through hygienic and dietetic precautions,
!
j
various ages, facts regarding the tempera- The book is serviceable, therefore, to the I
ture, the pulse at various ages, dentition physician, to the patient actually affected, )
table, doses proportionate to age, the care and to that portion of the public who are (
of surgical instruments, obstetric calendar,
baths in common use, important abnormal
interested in the
plague.
fight against the white '
constituents in urine, the urinary solids. The chapters are devoted to those points i
diiferential table of eruptive diseases, direc- that tuberculous patients should know of ';
.iods for modifying milk for infants, per- their disease, to the duties of the people in
|
centage composition of various foods, per- general, the duties of the physician, the !
centage of nutriment in certain articles of family of the patient, the community in

BOOK NOTICES
which he lives, etc., to the sanitorium treatment,
to the duties of modern municipal
health authorities, etc., etc.
The book is adequately illustrated, well
indexed, and is in large type.
Dr. Knopf has succeeded admirably in
presenting a volume containing what the
patient should know and eliminating that
which he should not know of his disease.
Atlas and Epitome of Ophthalmoscopy and
Ophthalmoscopic Diagnosis. By Professor
Dr. O. Haab, of Zurich. Edited,
with additions, by George E. deSchweinitz,
M. D., Professor of Ophthalmologv,
University of Pennsylvania. Second Revised
Edition. Philadelphia and London:
\V. B. Saunders Company, 10(i9.
The second American edition of Haab's
Atlas of Ophthalmoscopy is an excellent
work for all students of ophthalmology, as
well as for those who are interested in the
subject. It is of convenient size, well
printed, and the chromo-lithographic plates
are very good representations of the conditions
depicted. The first part of the work
is devoted to a description of the technique
of ophthalmoscopy in all of its phases.
Then follow the colored plates. A description
of each plate is found on the page opposite
to the plate. There are a number of
colored plates illustrating the pathology of
many of the diseases of the retina and choroid.
These are fully described. The work
is quite complete and we take pleasure in
recommending it.
Principlesof Pharmacy. By Henry V. Amy,
Ph. ()., Ph. I)., Professor of Pharmacv
at the Cleveland School of Pharmacy,
I'harmacy Dept. of Western Reserve University.
Octavo of 117.S pages, with 24.5
illustrations, mostly original. Cloth,
$.5.00 net; Half Morocco, $6.00 net. W.
B. Saunders & Co., Philadelphia, 19nv.
The subject of pharmacy as understood
by the writer consi.stsof the practical application
of the sciences of physics and chemistry
to medicines and their preparations,
as well as sufficient botany to appreciate the
character of those vegetable drugs entering
into pharmaceutical preparations. An ex
planation of the principles underlying the
science of chemistry is given in brief intro
ductory chapters to Parts III. and I\'.
While not desiring to hamper instruction
by artificial limitations, the entire subject
of pharmacy is so vast that some gleanings
of essentials from those substances of minor
importance appeals to teachers as imperative,
and we are fortunate in having a
means of elimination in the use of our national
standard, the United States Pharma
copeia. Of course, no pharmaceutical in
Struction would prove suflBcieut were all
unofficial drugs excluded, but the existence
of a pharmacopeia makes it possible to use
that work as the basis of instruction, and
in drilling the student in official substances,
ample opportunity is afforded to refer to
those unofficials suggested by the pharmacopeial
preparation under consideration.
This book explains the pharmacopeia from
its pharmaceutical standpoint, and if that
standard says that a certain chemical is
"dextrogyrate ketone," or that a certain
drug is a "sclerotium" the average student
should be able to learn what such terms
mean without having to search through a
dozen books. The author disclaims all
attempts to offer this as a text-book in
chemistry or botany.
The book consists of seven parts:
Part I. deals with pharmaceutical processes
and a striking feature is the discussion
of the arithmetic of pharmacy.
Part II. deals with the galencial preparations
of the pharmacopeia and those unofficials
worthy of notice. It will be noticed
that, wherever possible, these preparations
are grouped around a typical pharmacopeial
receipe, thus avoiding repetition.
Part III. deals with the inorganic chemicals
used in pharmacy, has an introductory
chapter on chemical theories, and discusses
chemical arithmetic very fully.
Part IV'. discusses the organic chemicals
used in pharmacy, and that according to the
most modern classification. Like Part III.,
it begins with an introductory chapter on
the theory of the clsss of chemicals discussed.
Part V. is devoted to the chemical testing,
and presents a systematic grouping of all
the tests of the pharmacopeia, a feature not
found in any other book.
Part VI. takes up the prescription from
the time it is written to the time it is dispensed.
Part V'll. gives the laboratory work which
has been followed with much succe.ss by the
Cleveland School of Pharmacy. A notable
feature of this part is the exercise in equation
writing and in chemical arithmetic that
the work affords.
The volume is well illustrated and will
prove of great value to the practioner and
student.
A Magazine of Merit.
Having rounded out its first five hundred
months of existence with the August number,
LiPPiNCoTT's M.\G.\ziNE Starts out
with September as though it could see a far
longer vista of months and years of life
ahead of ii. And there is no reason why !t
shouldn't, so long as its present high quality
is sustained.
The novelette for September has a sur-

176 THF CHARLOTTE MEDIOAL JOURNAL .
prising plot, and is called "A Bride for A Candid Judge.
Casey." Ella Middleton Tybout stands a Dover lawyer tells a story in which *
,
sponsor for it, and those who have read her figures the Hon. H. L. Dawes, who, it /
books "TheWifeof the Ambassador," etc., seems, in his younger days was an indiffer- 'k
can testify that she knows how to write a gnt speaker. Shortly after his admission to 1
good styry. "Casey" is one of four impe- the bar he had a case which was tried be- 3
cunious young society men living in New fore a North Adams justice of the peace, \
York. In order to acquire the cash neces- and Dawes was opposed by a lawyer whose j
sary to carry out the cherished plans, it is eloquence attracted a large crowd. The «
decided that Casey must marry a rich girl, justice was perspiring in the crowded room
and the others undertake to find him a suit- and evidently fast losing his temper. Finally
able mate. It becomes necessary at one he drew off his coat and, in the midst of the
stage to dispose of the maiden aunt of a eloquent address, burst out:
certain young lady, so they contrive to ship "Mr. Attornev, supposing that you take
her off to Boston until her presence is no a seat and let Mr. Dawes speak. I want to
longer a menace. Her disappearance helps thiu out this crowd."—August Lippincott's.
things along, for charges of robbery, abduc- ___„________________________^^
tion, and murder are promptly brought . . , 7 JTT T- T^^^j
against the quartet by the police.' The end Abstracts of the Leading articles
is unexpected to everybody—and to Casey of the month.
most of all. The characters are splendidly
drawn, even the minor ones, and the whole
tale is invested with an air of
despite the preposteroas plot.
plausibility Acute Necrosis ol Skin.— Coombs in The
British Medical Journal reports the case of
The September short stories are a strong a woman whose illness began with inter-
collection. "What Happened to Father" mittent fever, pain along the course of the :
is an amusing yarn by May Roberts Rine- sciatic nerves, followed after a few days by j
hart, whose books, 'TheMan in Lower the appearance of bullae like those of ecthy- i
Ten" and "The Circular Staircase" have manear the tuber ischii. These bullce formed !
recently brought her fame and fortune, sores which healed in the course of three \
"AuntDianthy," a powerful yet pathetic months. Later a bulla appeared on the
tale of a neglected old woman, is by George inner side of the right knee, and in the 1
Allan England. Other noteworthy stories course of two months the whole skin was :
are "A Question of Honor," by Hornor gone from the right leg. The process j
Cotes; "The Shadow of Molly Kinshlea," usually began by the appearance of serum ;
by Josephine Van Tassel Bruorton; "Be- under the epidermis at the growing point of
,
j
tween Trains" by Thomas L. Masson; "The the narcotic area; the cutis vera died in a j
Death Sentence," by Caroline Ticknor; and few hours; when it was cut off granulations i
"An Unwilling Intrusion," by Percy Wil- were found growing beneath. Eighteen i
son. Thomas L. Masson contributes a after the disease started the whole surface i
blithe sketch called "When to Tell the skinned over. Some six months later the
Parents, " :
i
which will be enjoyed by all fath- skin began to die again, and the patient's i'
ers and mothers, and by some children. temperature was above 'J9 for twenty-five
"A Patchwork Quilt' of Humanity," by weeks, the highest being 104. The treat- ;"
Day Allen Willey, is an interesting special ment consisted in quinine and iron througharticle
on our newest State, Oklahoma, out the illness. Opium was given at night ,::
'Character- Leakage" is the famous nerve and was added to the ointment composed !
specialist who wrote that remarkable little
book "Why Worry?" In the department
"Ways of the Hour" W. Barton Blake disof
lanoline containing tincture of benzoin,
Boric acid in carbolic solution was used at i
first and idoform was added later, and the courses on "The Bigness of Things"; Ellis
O.Jones, on "The Things We Cannot See";
and Phil Cullom, on "The Sin Argument"'
edges of the wound were painted with
peroxide of hydrogen. At the beginning
of the second attack the sorts were ionized,
but it seemed that the hydrogen peroxide
I
'
|
I
,
Walter Pulitzer contributes some "Cogita-
.. ,, . ^. J. and iodoform lotion had a better ettect. i
tions 111 epigrammatic form.
^^^ ^^^^ .^ remarkable because of the per-
There are charming verses by John Ken- gigtance of the high temperature, the ap- |i
drick Bangs, Florence Earle Coates, and pearance and progress of the sore, and the
other well known singers; and to top off fact that the first nurse had to leave because
with ^^'^ them are sixteen pages of brand new ^^"'^^ became infected, suggesting a
jokes, jnigles, and anecdotes. Only a very
captious critic could find fault with the
^-^^^^ ^^ dismissed, as the patient and her ^
children had never shown any tendency
September Lippincott's, suggestive of either.
• ,,„„ •• , , ,
^ ^ , bacterial cause. Syphilis and tuberculosis
j

Prognosis In Tetanus.—Patton in The
Dublin Medical Journal mentions two cases
in which antitetanus serum was used freely
and yet the course of the disease and the
results were quite different. The first case,
a miner, aged 52, with a large fungatiiig
mass on the outer aspect of the left thigh of
two years duration. A large tender swelling
was also found in the hypogastric and
left iliac region. He presented the symptoms
of tetanus, but under the injection of
antitetanus serum and the daily application
of hydrogen jjeroxide the patient improved
and it was possible to amputate the leg.
afler which he recovered. The tetanus
bacilli were found in large numbers in the
epitheliomatous mass. The second case
was a man, aged .18, who presented the
symptoms of tetanus a week after having
sustained an injury to his thumb, dislocating
it at the interphalangeal joint and
breaking the skin so that the head of the
second phalanx protruded through the
aperture. The finger had been steeped in
carbolic solution 1 to 40 for a half hour before
reductipened up, even although there is no apparsnt
necessity to do this. Hydrogen peroxde
is capable of destroying the tetanus
bacillus if the microorganism and the remedy
can be brought into intimate contact,
[t is impossible to say whether the autiteanus
serum was of any value or not in
|hese cases.
Trealmenl oi Tuberculous Peritonitis
^y meaas oi X-rays.— Allaria and Kovere
Arch: de Med. des Unf. ) have treated
even cases of tubercular iierilonitis by
neans of Roentgen rays. Undoubted cure
/as obtained in only one case out of the
even. In one case there was undoubtedly
ABSTRACTS. 177
ease. In some cases there were no bad
effects, even if no benefit resulted. The
treatment caused a slight and inconstant
increase of leukocytosis. The authors believe
that we should be careful in the use of
this means of treatment in tuberculous pe-
ritonitis, since it is unreliable in its effects.
In some cases it is positively curative, not
by destroying the bacilli, but by the stimulation
of the cells of the peritoneum. In
the ascitic form, we tnay hope for benefit
from the rays used moderately and with
great care. The action should be most
carefulh' observed and the treatment stopped
as soon as bad effects are noted.
New Methods oi Treatment ol Gastroenteritis.—
Bouquet ( Bull. Gen. de Ther, )
calls attention to two .systems of diet of exactly
opposite character, both of which are
used in the treatment of gastrointestinal
complications in infants. One is the water
diet, modified l)y the administration of
leguminous or cereal broths, or solutions of
chloride and bicarbonate of soda, the object
of which is to replace the water drained
from the system by the frequent stools, at
the same time that fermentable food materials
are removed from the diet. When
we have initiated the water diet and fermentation
has ceased in the bowels the
question comes up, and is forcibly brought
before us by the mother, how long we can
safely keep the little patient on water alone
without starving him to death. One of the
gruels that is used to give some apparent
food value, slight though it be, is prepared
from potatoes, carrots, turnips, dried peas,
and dried beans, boiled for a long time in a
large amount of water, filtered and salted.
.\nother is made of cereals, wheat, pearl
barley, dried peas, beans and lentils, treated
in the same manner. The diminution in
weight of the child ceases and he stops
vomiting. Other physicians have given to
replace i)ure water a solution of chloride
and bicarbonate of soda. This also prevents
loss of weight when combined with
broths. The ingredients of these broths
seem to have nutritious value, and yet are
not fermentable, and the public accepts
them gladly. Their real value is in lessening
dehydration. Subcutaneous injections
of normal salt solutions, and high saline
injections have the same effect, but the injections
render the bowel irritable after a
time. The dry diet has for its object limitation
of the amount of liquids taken by the
patient. The food consists of eggs, dried
cakes and cheese, with a minimum amount
of li(|uids. Its object is to lessen dyspepsia
due to the taking of a large amount of milk,
in order to obtain a sufficient amount of
lad effect on the generalization of the dis- solids to susiain life. The ingestion of lac-

178 THE CHARLOTTE MEDICAL JOURNAL. i
tic acid bacteria is dependent on their de- has been done and the trouble recurs, it is i
struction of the bacteria of fermentation in not muscle which is found covering the sac; j
the stomach and intestine. They are ad- what is found is merely the fibrous remains !
ministered in the form of bouillon. Intes- of the stretched union, the muscle having |
tinal irrigation is less used than formerly, receded to a point above the level of the •'
The only medication that seems of value is canal. Had the muscle been sound and a
opium, to control vomiting nnd stools, and active, and had it remained in close appo- ,
gelatine. The intestinal antiseptics seem sition to Poupart's ligament, recurrence :<
of little real value. Gelatin causes lessen- would have been impossible. It is there- t
ing of the number of stools; the green color fore clear that to get a permanent result .;
disappears, the bad odor ceases, and the which shall honestly reserve the term "rad- >
acid reaction passes away. It is adrainis- ical cure," a term hitherto much misused,
tered in a warm sterilized solution, with is not by any means so simple as it would
care not to give cold drinks at the same at first sight appear. Bassini's operation,
time. when done early iu the history of a hernia
and followed by sufficiently protracted con-
Inguinal Hernia.- McGavin in The Brit- valescence, is an excellent operation in
ish Medical Journal says that the complete most cases; there are others, however, in
and permanent cure of inguinal hernia de- ^hich it fails to meet the requirements of
pendson: (a) The total abolition of the madern surgery, and these may be said to
peritoneal sac or sacs; and it must be re- ^g the following: 1. Those of inguinal ''
membered that one of these may be thick hernia in elderly subjects. 2. Those in
walled and perfectly obvious, while another ^dult life where the strain of certain occu- '
may be present which is of the most ex- pations is so constant and severe upon the ,
treme tenuity, difficult to find, with a lumen abdominal walls, that it is unreasonable to
only admitting a probe, and yet quite capa- '
expect a cure when treated by the ordinary
bleofenlarging one day to greater capacity, methods. 3. Those in which, although in i
(b) The permanent approximation of the young subjects, the muscular structures of I
muscular structures of the inguinal canal ^^e part are found at time of operation to I
to Poupart's ligament, (c) The mainten- '
^.g t^j,!^ jjadly developed, or stretched and
ance of the histological character of these loose over a large area. 4. Those in which i
'
structures by careful operative technique the hernia has recurred, especiallv if after
and by the subsequent employment of prop- ^ carefully carried out operation followed i
erly regulated physical exercises. And (d) by a primary union. 5. Those in which ;
on the prolongation of convalescence in the the hernia is of such size that the gap can- i
recumbent position for a period much '
be- not be closed without the exercise of such
yond that which is usually accorded to tension as to produce strangulation of the |
these cases. It is easy to see that while the structures within the grip of the sutures—a I
first and fourth of these essentials present condition which is one of the most certain j
no very great difficulty, the second and of all the predisposing causes of recurrence. >
third are not so simply attained. The gap
to be covered may be enormous; the mus- Diphtherias with Invisible Location
culature may be attenuated, friable, and (Crypto-Hiphthcrias).— Abrand (Ann. de
fibrous, and thus it may be that the whole Med. et Cliir. Inf. ) calls our attention to
inguinal canal presents such a wreck that the occurrence of cases of diphtheria
the possibility of a cure seems quite out of which the membrane is not visible, yet
the question. In other cases, although the which have the characteristic diphtheria,
structures may be in fair condition, the syndrome. In these cases the membrane
amount of dissection required to accomplish may exist in the nasopharynx, larynx,
the approximation, especially in old stand- bronchial tubes, trachea, or esophagus,
ing and recurrent cases, and possibly the These locations are quite frequent in cases
tension necessary to keep muscle and liga- of the ordinary diphtheritic angina, but are
ment in accurate contact, are such that, most important when the membrane
within a few weeks of the operation, what not appear on the pharynx and tonsils, the
was muscular is reduced to fibrous tissue, usual locations of membrane. Such caseg
Now the muscle which is brought down is are liable to be diagnosticated late in the'
brought down with a very definite object; disease, after the poison has had a chanc
its purpose is not merely to block the canal to act on the general system, and are liable
passively by its presence (the peritonaeum to paralytic and heart complications as th«
and the abdominal aponeurosis would of first symptom noticed of the action of th(
themselves do that), but by its active con- diphtheritic poison. He calls them crypto
tractions to tighten up the walls of the diphtherias. He describes six cases whid
canal without suffering permanent loss of came under his observation. They shoM
elasticity in doing so. When an operation how important it is to make a careful ex
'.

ABSTRACTS. 179
amination of every obscure case which toms consist of crises of pain in the abdocomes
into a hospital, using the laryngeal
mirror. The admission of such a case to a
men, progressive increase in the size of the
abdomen, diarrhea, tenderness, and ascites,
general ward endangers the other patients, The course of the affection is afebrile,
and ths appropriate serum treatment is not There is often a purulent flow from the
given early enough to prevent serious complications,
even death. The symptoms that
are suspicious are a rapid loss of weight,
vagina. Rectal examination will show the
existence of periuterine, prostatic, or semi-
nal lesions. There may be an umbilical
extreme fatigue, rapid pulse, marked swell- JBstula. The glands are generally involved,
ingof the glands of the neck, with or with- The general condition is very bad, and the
out high fever, polypnea, or dyspnea, that evolution of the disease is toward death,
are inexplicable. Such cases need energetic Nevertheless there are cases that are capaantidiphtheritic
treatment. ble of cure. The ascitic forms are more
The Remedies lor Depopulation.-
^"'^^^le than others.
D'Anfreville (Presse Med.) mentions the Value ol Klnesottaerapy In Uterine
methods of preventing depopulation and its Hemorrhage.— Bloch (Jour, de Med. de
causes. The causes are pathological and Paris) thinks well of kinesotherapy in the
social. The principal causes that are path- treatment of all sorts of uterine hemorological
lie in the sterilization that is pro- rhages, and gives several examples of its
uced by gonorrhea and syphilis, prevent- value. It regularizes the menses, dimining
many married couples from having ishes their duration and the frequency of
Idren. .Another such cause is alcohol- appearance. All menstrual troubles, all
ism, which deteriorates the parents and uterine hemorrhages, from the simplest
causes weakened heredity and bad sur- troubles to symptomatic hemorrhages of
foundings for the children. The social fibroma, salpingitis, retrodeviations, and
causes are the unwillingness of couples to metritis, are benefited by it. It includes
live moderately and to risk being able to massage and gymnastics. The massage
support large families, and the desire to consists of circular movements over the
leave a large property to a single child, abdominal wall. The gymnastic move-
The remedies that have been tried in I'rance ments are for the purpose of lessening conare
various. It has been proposed to make gestion of the pelvic organs, by movements
law taxing the bachelor, and an income of the femoral abductors, given three times
tax which will decrease in amount as the a day. The movements must be executed
number of children increases. The better with great care not to fatigue the patient,
measures to try, and such as have been and should be done under the direction of
already successfully carried out in b'rance, the physician himself. The action is me-
are giving aid to the pregnant woman to chanical and causes reflex action at a disobtain
a support without undue exertion in lance, reacting on the circulation. Circular
the latter months of pregnancy, and chea]) movements exerted over the intestines cause
estaurants where she can obtain good, vasomotor alterations, and increase the acourisliing
food for herself and her children tivity of the circulation. The vessels are
at a minimum cost. Another way of in- hemiparetic in hemorrhagic pelvic condireasing
population is to take care of the tions, and these movements tone them up
young infants, as is done in the consulta- to a normal action. The abductor move-
;io:is for infants and nursing mothers, where
jood milk is supplied, and good counsel
ments crowd back the blood from the en-
gorged territory into the other veins. Among
ven to the mother, the infant being treat- the most valuable means of treatment for
:d when sick, and advice given as to care
'
md feeding when well.
arresting uteroadnexal hemorrhage is kine-
sotherapy. It allows the patients to con-
Tubercular Peritonitis in the Nursling, tinue their ordinary occupations, and is ab-
-Weill and Pehu (Arch, de .Med. des Enf. ) solutely harmless. It should be used care-
,ay that primary peritonitis of tuberculous f^Hy and gently and not prolonged. It is
)rigin is comparatively rare. Tuberculous
)eritonitis occurring in the course of gen-
'"ost valuable to regulate the menses.
Serum Treatment ol Diphtheria Inralized
tuberculosis is not uncommon, but
he primary form is not fretiuent. They
toxicatlon.— Meyer (Berl. klin. W'och.)
describes experiments made on dogs poismblished
two jiersonal observations. Tuber- oned with injections of diphtheria toxin
ulous peritonitis in the nursling is charac- and then treated with antitoxin, as to the
srized pathologically by a marked pre- effect of the serum on tue heart symptoms,
lominance of the caseous form of tubercu- In acute toxemia with heart failure he
, by the generalization of lesions, and found that the serum treatment would pre-
>y a frequent occurrence of infection of the vent the occurrence of heart failure, but
enital organs, male or female. The symp- that when the symptoms had developed it

180 THE CHARLOTTE MEDICAL JOURNAL. ;
had no effect on them, and death ensued, the ansesthetist rather than the surgeon,
These hypertoxic cases required large doses and especially so since at times its appliof
serum by intravenous injections. The cation may fail from various causes and -
best method of treating heart failure attacks necessitate the administration of a general |
was by the use of adrenalin. In cases that anaesthetic. _;
were diagnosticated late and treated after The Need lor More Prompt and Tlior- %
severe attacks had taken place intravenous ough Treatment of Children Suffering
^
injections of serum were beneficial, and f ««" Rheumatism or Chorea—Lees. .'.
large doses were indicated. Heart changes (British Journal of the Diseases of Children ),
in diphtheria were prevented by the use of mentions the great responsibility of the
serum, and post-diphtheritic cachexia was medical man called upon to treat a rheuprevented
or was benefited when it had matic or choreic child. He has the chance
occurred. From these experiments it would to arrest in its earliest stage a morbid proseem
that large doses of serum injected in- cess, which if uncheeked, may be fatal,
travenously were indicated in all severe and if inadequately treated may relapse
casesof diphtheria in man. and again, and irreparably damage the
child's heart. Most of the heart disease,
Spinal Analgesia.— McGavin and Wil- which exists in patients under thirty, is the
liams (Edinburgh Medical Journal ) report result of a rheumatic infection in childhood,
2.50 cases of spinal analgesia by the use of which was either unrecognized or ineffectstovaine
glucose solution. They observe ively treated. Thorough phj'sical examithat
spinal analgesia is a method which has nation should be made and when the cona
definite place and use in modern surgery, dition has been accurately diagnosed thorand
of which the future is no longer in ough treatment will be necessary if the
doubt. Stovaine is admirably suited to the process is to be arrested and lamentable
purposes of spinal analgesia, and is prob- cardiac injury to be avoided. The fate of
ably as safe as any other analgesic at pres- the patient depends upon the action or incut
in use. The risk of infecting the spinal
meninges is, in proper hands and where
action of the physician.
Every child who complains of sore throat
proper precautions are taken, very slight,
The method of spinal analgesia is unsuited
or pains in his joints, muscles or tendinous
structures,—every child who suffers from
to the Trendelenburg position. Failure to malaise, and unexplained pyrexia, whose
reach to reach the spinal theca is usually skin shows spots of erythema or has subcudue
to faulty technique, while failure to taneous nodules on his tendons, or about
obtain sufficiently high analgesia is com- his joints, or who has pains in the chest,
monly due to insufficient d^jsage, and is to or shortness of breath, or marked pallor, or
be met in most cases by a second injection, exhibits slight choreic movements, should
The attempt to push the analgesia to a be put to bed and his heart should be most
higher level than the fourth dorsal area is, carefully examined. The earliest evidence
in the present state of our knowledge, un- of cardiac rheumatism is obtained, not by
wise. The lateral position, although ren- oscultation, but by percussion, for the eardering
the injection rather more difficult liest cardiac rheumatic phenomenon is an
that the sitting position, is less likely to be acute dilatation of the left ventricle. In a
followed by disquieting symptoms, and first attack of rheumatism the duliiess of
commonly gives better results. The great the left ventricle is always increased tomajority
of patients are in favor of the wards the left; almost always to the nipple
method, preferring to retain consciousness line. Along with this evidence of dilataso
long as the area of operation is screened tion there will be a weakened cardial
from their view. In support of this many pulse, a weaker pulse wave in the arteries
patients have elected to have spinal anal- and a shortened and enfeebled first sound
gesia for second operations. The contra- at the apex, and a distict accentuation of
indications hitherto summarized by various
writers must be accepted with reserve.
the pulmonary second sound,
There may be a murmur at the apex,
owing to the lack of detals supplied, and The pulse rate is abnormally frequent, and
the great variety of methods, analgesics, is further increased upon slight exertion,
and doses employed. Sepsis, syphilis, and The acute dilation of the left ventricle is
old age do not appear to influence the re- present even in the mildest attacks of subaction
of the patient to stovaine. The ac- acute rheumatism. Thus the importance|
tion of stovaine is purely one of surface
effect resulting in the blocking of nervous
of complete rest, even in the mildest cases.
He advocates large doses of the salicylate!
impulses, and probably affecting only the of soda and to eeach dose should be added|
anterior and postertor nerve roots. The twice as much of sodium bi-carbonate.
method being but a special branch of the Every case of chorea in childhood ought
science of anaesthetics, its administration to be considered as presumably rheumatici
and investigation should be undertaken by and treated vigorously as for rheumatism.l
i

ABSTRACTS. 181
Opium in the Therapeutics ol Infancy, recent traces of activity on the partof pedi-
—In 'L'Echo Med. du Xord,' Delearde culi vestimenti or body lice. His attention
states that it is the custom to employ very having been called to this phenomenon, he
small doses of the drug to infants. The began to investigate more closely the relafirst
to break with the old traditions is
Borde, of Bordeaux, who has always shown
tion betwixt the scorbutic signs present and
the lesions due to the parasite mentioned,
the tolerance of infants to opium, especially It happened that in a considerable number
in acute gastro-enteritis of infectious origin, of cases, not a few patients were found in
The writer finds the urine increases and the which neither anamnesis nor objective innumber
of stools diminish, without causing vestigation discovered any marked staphyloany
symptoms of retention of toxic material, genie affection of the skin, so that it was
The abdominal tympanitis lessens. It entirely unwarranted in such instances to
should be noted that Pal showed that mor- attribute the development of scorbutus to
phia did not paralyze the intestine, but the debilitating action of such causes or to
regulated its contractions. Vomiting is also the influence of a morbid or predisposed
stopped. The morphia is given in the form constitutional idiosyncrasy, nor could the
of the syrup of morphine (of the French nutritional condition present or any other
Pharmacopoeia) and is made up to 100 c.c. environmental factor elucidate the developin
different strengths for different age-, ment of the scurvy. Thus there was noth-
For example, at the age of one month 2-3 ing else of etiologic valve than the relationgrm.
of the syrup, 3 months 5 grm., 6
months 9 grm., 1 year 13 grm., 18 months
ship l^etween the scurvy and the pediculi,
rendered still more probable by the known
16 grm., 2 years 18 grm. Of this solution fact that the toxic action emanating from
a dessert-spoonful is given every hour, day
and night, till the child falls asleep. On
the parasites is able, by reason of its effect
upon the innervation of blood vessels, to
awakening the treatment may be continued evolve dermal pigmentation and erythema-
The child liecomes much better after twenty- tons and other angio-neurotic phenomena,
four hours, the temperature has fallen, and
the diarrhoea and vomiting, if not ceased. Cardiac Pain.-In the Munchener Med.
have much improved. During this time Wochenschrift Selig describes this subject.
_iilk is stopped, and decoction of cereals 'I'he commonest cardiac sensation is palpigiven
instead. By this metliod the infant tation, due in the healthy to increased enof
3 months is given H centigramme of ergy of contraction. In the large group of
extract of opium. Delearde emplovs the "nervous hearts," psychic conditions befollowing
modification of this method; he come chiefly etiologic, and in nervous pagives
everv three hours a mixture of pare- tients these sensations may develop without
goric elixir of opium with gum acacia and Psychic alterations and frequently at a defiorange
flower water, the elixir being given "'te hour. Another phenomenon is that of
in the doses of .5 grm. jyer vear of age. I'or cardiac anxiety or anguish. All cardiac
example, to an infant of 3 months 1.2.S patients have a fear that something may
grm., and double that quantity to an infant happen to them, but the anxiety is often
of 6 months, and so on. This elixir in 10 dependent upon actual lesions, such as
grm. contains .5 centigrammes of opium ex- sclerosis of the coronary arteries and mj-otract.
The author considers the advantage carditis, and reaches the maximum in
of the opium treatment is the more rapid angina pectoris. The cause of stenocardiac
return toordinary alimentation. Thecontra- states is not always a coronary sclerosis;
indications for opium are—pulmonary af- general nervousness, tobacco, partial or
fectioiis, great wasting, and chronic enter- general spasm of the cutaneous arteries are
itis. Sometimes he adds lime-water to the often factors. Another group of sensations
medicine, and occasionally lactic acid, are educed by disturbances of rhythm and
Opium is also of great value in the spasm retardation of the cardiac impulses. In
accompanying laryngeal affections in the many cases the sensation is attributed to
ifant, and also in whooping-cough, when the heart, though the cause is to be sought
it lessens much the violence of the cough elsewhere. In nervous patients a point
and the accidents resulting from this. located below the breast is often extremely
painful, especially so from energetic palpa-
Scorbutlc Etiolofly.—In the Russische tion. Many cases complain of a cutting,
Zeitschrift fur Ilaut fur Geschlechlskraii- burning or gnawing pain. There may be
keiten Ilalpern. as chief of a hospital in a hyperesthesia of the nipples. The sup-
Russo-Japanese war, iiad the opportunity posed cardiac pain in women is frequently
of observing a number of cases of scurvy in relation with heavy pendant or fatty
in which the angio-neurotic symptoms, sucli mammse. This great weight causing dyspas
erythematous maculae, nodes, etc., were
nvariably accompanied by more or less
nea and various pains in the heart region,
much relieved by the use of a "breast ele-

jg2
THF CHARLOTTE MEDIOAL JOURNAL
vator " sold in the shops and fitted to any curred that there might be some antogonism
corset now in use. Cardiac pain is often between the two organisms, because he
confused with pain in the adjacent bones, noticed that there was a decrease of diphparticularly
where these have gouty deposits theria coincident with the "^crease of cereon
the anterior parts of ribs, in which case, brospinal fever. He then found tha pure
the tincture of iodine renders good service, cultures of meningococci were killed by
Likewise an intercostal neuralgia may cause antidiphtheritic serum He, herefore,
"cardiac" pains Vaso-motor disturbances, treated four cases of cerebrospinal fever by
especially in arterio-sclerotic patients, may antidiphtheritic serum and all recovered,
develop anginoid states (in connection with The success hoped for by this method has,
cold damp weather). Vascular crises play however, not been realized Antipneumoan
important role in the most diverse car- coccal serum seems more likely to be of use
diac sensations, and obstipation, flatulence, than antidiphtheritic, owing to the close
irritation of the walls of the stomach, dis- resemblance of pneumonia to cerebrospinal
nroportion in the size of heart and thorax fever, and of the pneumococcus and meninmav
develop cardiac pains. gococcus to one another. He has used it
once, owing to the presence ot some Gram
The Surgery of Lingual Thyroids.j^j.^.g^iplococci
in the cerebrospinal fluid.
Low, in The Edinburgh Medical Journal.
^^ ^.^^^^ ^^^^^^ followed its use. Jevers
discusses the anatomy of thyroid deposits
^^^ j,^^^^^ however, noted improvement
in this situation and says that as excision
^fter its injection, saving that the patient
of these lingual deposits has been fol owed
^^^^^^ ^^-^^^^ and went to sleep; the tembymvxedema
the surgeon should always
^^.e rapidly fell, followed bv a rise some
consider carefully the question whether or
^-^j^^ j^^j^j. but the patient seemed better and
not in these cases the normal thyroid in the
^^^ ^^^^ stronger. The production of a
neck is sufficiently developed to carry on
^^^^^^ satisfacton^ anti-meniiigococcal se-
itself the thyroid function m the body. In ^.^^^31^0^1^ „ot be long delayed, and to this
case of absence or small size of the cervical ^^ ^^^^ j^ok as being the most rational,
thyroid, one would hesitate to operate ex- ^^^ ^^^ ^^^^^ method of combating this discept
when the size of the lingual deposit ^^^^ jochman produced a serum for which
should prove dangerous to life Enough ^^ claims distinct therapeutic properties;
of the lingual deposit should be left to carry ^.^j^ .^ ^^ ^^.^^ ^^j^ ^^ confer immunitv to
on the thyroid function (m case of cervical ^.^^ a-ainst six times the ordinary lethal
absence) even at the risk of subsequent re- ^^^^ ^^ ^^^ ^^^^. p^^ humans, doses of
currence. He advises the splitting of the ^^ ^ ^ ^^^ required either iutraspinally or
tongue from tip to base, thus permitting g^bcutaneously. Of seventeen patients
thorough eradication. The writer prefers ^^.^^^^j j^^ jj ^^^y 5 qj. 09.4 per cent. died,
this method to that of subhyoid Pliaryng- j^^ pg gerum' he tried on three patients
otomy, for while the latter is admirably ^^^^^^^^ success. Recently Flexner's serum
adapted for the removal of growths at the ^ ^o be giving verv satisfactory reentrance
to the larynx, it has for the re- ^^^^^ ^^^^^ ^^^^^^ ^^^^^ ^^ l^^^.g brought
moval of growths at the base of^the tongue ^^^^;^ ^^^ mortality considerably,
the great disadvantage of opening a communication
between the septic cavity and pyopcricardium in Children.—Poynton
the large cervical wound. Moreover, if the jj^ -j-j^g British Medical Journal says in an
transverse incision is carried any distance analysis of 100 fatal cases of this affection
beyond the hyoid bone, the superior nerve tai-en from the Great Ormond Street Hosmay
be cut, and the larynx is rendered in- pj^-^j ^^^^ other records, notes that S3 per
sensitive, permitting food and discharge to ^^^^^ occurred before the fourth year of life
enter the cavity and expose the patient to ^^^^g completed and two-thirds between t'he
the danger of foreign body pneumonia, ^^^gg ^f one and three years, making it, in
The procedure to be followed after expos- j^^t, almost a disease of infancy. Primary
ure of the growth depends on its size. In- pyopericardium is excessively rare. About
cision with curetting and cauterization may (^q p^j. (,g„t ^.gre associated with empyema,
suffice in some instances, but the author a^j about 40 per cent, were associated with
contends that it is a very much better plan acute pulmonary tuberculosis. ,\bout 20
to extend the operation to an excision of pgj. ^gnt. of the cases ran an acute course
the capsule which, he says, consists of the lasting about four weeks. Fifty per cent,
dilated remains of the thyrolingual duct. ^^^^ subacute, lasting four weeks to six
Cerebrospinal Fevcr.-Larkins, in The months; 17 percent, were chronic, with in-
London Practitioner, mentions the sera used sidious onset lasting from six months to
in the cerebrospinal fever. The use of anti- over a year. In acute cases the symptoms
diphtheritic serum was suggested by Wolf, were abrupt and pneumonic in type. In
of Hartford, Connecticut, to whom it oc- the subacute and chronic cases, cough,

ABSTRACTS 18,5
pleural pain, and wasting were prominent, of recovery. He believes that in infants
In the most chronic cases only gradual fail- even if the pericardium be opened the relief
ure of strength and health was recorded, afforded will be comparatively slight on
The majority of the symptoms are in no account of the difficulty in draining the
sense localizing. Those which attract tenacious exudation and the presence of
especial attention as unusual and not quite multiple associated lesions. Paracentesis
like those which are expected in severe pulmonary
disease are extreme illness with
lividity, panting respiration and excessive
of the pericardium is, of course, required in
these cases, and if there is sufficient evi-
dence of an effusion it is well to proceed at
dyspnea, curious irregular rises of tempera- once to open the pericardium. As to the
ture accompanied by rapid and feeble action exact site for exploration. West has recently
of the heart, orthopnea, and syncopal at- advocated the left lower margin of the cartacks.
The last two are regarded by the diac dulness—that is, in the region of the
author as the most suggestive, if in addi- impulse.
tion the pulse is stiikingly rapid and ex- In uncomplicated cases this is doubtless
cited. the wise procedure. In accordance with
When the diagnosis has been arrived at the conditions present, however, it may be
with confidence one of two events hasprob- wise to introduce the needle into the fourth
ably occurred—either pericardial friction or fifth intercostal space close to the sternum
has been detected or there has supervened or in the left costoxiphoid angle, pressing
large pericardial effusion. In children it inward and upward behind the lower end
both events are exceptional.
When a case of pneumonia or empyema
of the sternum. Inflammatory changes in
the anterior mediastinum and great thickenfirst
comes under observation, if the exact ing of the pericardium itself make it somecondition
of the heart is recorded it is pos- times difficult to tell when the pericardial
sible in some instances to trace out every cavity has been opened.
stage of the development of the effusion.
Among the most important signs are progressive
muffling of the heart sounds, syn-
The Operation ot Cardiolysis.—Poyn-
ton and Trotter, in The Dul)lin Medical
chronous with enlargement of the cardiac Journal, report such an operation in a boy,
area, together with marked percussion dul- sixteen years of age, which was successful.
ness over the pericardium and sometimes They remark that the operation of cardioposteriorly
in the interscapular region, lysis was first suggested in 1902 by Brauer
Tubular breathing or absent breath sounds and put in practice by Peterson. The name
may also be noted in the interscapular cardiolysis is perhaps a little misleading,
region. as it is at any rate more impressive than
A rapid and extensive increase of the the surgically simple procedure to which it
cardiac dulness upward toward the left is given. It was pointed out by Brauer
clavicle.
that in certain cases of adherent pericardium
The pear-shaped outline of a distended where the heart is embarrassed by fixation
pericardium. to the surrounding parts, a considerable
The abrupt transition from the dulness of amount of this overloading of the heart's
fluid to resonant lung tissue.
A wavy and diffuse pulsation to the left
of the sternum.
When there is much fluid round the heart
the pulse becomes rapid, small, and someaction
could be got rid of by rendering the
prsecordial part of the chest wall more flex-
ible than normal by removing its bony and
cartilaginous framework. No extensive
separation of adhesions was suggested, and
times very irregular and almost running in it is obvious that under the circumstances
character.
'
in which the operation has to be done such
As to the clinical distinction between procedure would be very dangerous. In
rheumatic and pneumococcal pericarditis, the first place the circulatory conditions are
the hitter is at its maximum frequency un- very unfavorable for prolonged general
der four years of age, is almost never com- anaesthesia, while the risk of tearing the
plicated by endocarditis, or dilatation, is as left pleura or even the heart wall would
a rule complicated Ijy empyema, pneu- seem to be very great. The operation was
uionia, and pleurisy, exhibits a marked extremely simple and short and the results
tendency toward pus formation, is only ex- were encouraging. Nevertheless, it seems
' ceptionally complicated by joint involve- to have been very little done. A review of
I inents.
In all these respects the rheumatic the subject published in August, 1908, by
I pericarditis differs. Ernst Venus, gives a total of seventeen
The prognosis of suppurative pericarditis cases, three of them being Brauer's. The
in small children is exceedingly grave, article contains a summary of all the cases
Surgical intervention offers the best chance and seems to be founded on a very comof
success and there are some recorded cases plele study of the literature. There is no

184 THE CHARLOTTE MEDICAL JOURNAL.
death recorded as the cosnequence of the to become nasal. This can be easily demoperation,
and the results appear on the onstrated; if nitrous oxide is given by the
whole to be very good. In all the published face piece method, when one is near the end
casesgeneralansestbesiaseems to have been of the administration the face piece is still
used, on the whole without much trouble, kept on, and at the same time the nose is
The operation need not last more than a compressed, unless the palate is of the short
few minutes and no very profound degree variety, it gives rise to obstruction to exof
anaesthesia is necessary, so that if the piration. Besides the condition of the fauces
patient has been kept at rest for some time causing obstruction and giving rise to cyapreviously
there seems no great objection nosis, cyanosis in itself gives rise to obstructo
the use of chloroform. If it were neces- tion of free breathing in the later stages,
sary, however, to do the operation at a time the swelling and falling back of the tongue
when the heart was in an unsatisfactory giving rise to false stertor: he has noticed f
condition there can be little doubt that a that this trouble occurs to a marked degree
local anaesthetic should be preferred. As in patients with receding chins. Cyanosis
is well known, the chest wall can be very causes distension of the large veins of the
satisfactorily infiltrated with eucaine and neck; and, as is well known, a collar or
adrenalin, and one has been able, for ex- piece of tape, which was quite loose at the
ample, to open the pericardium very freely beginning is, if the administration is pushed
under it in a child with purulent pericarditis until the patient jactitates, found to be
without causing pain. The technical de- pressing tightly round the neck, the meas-
tails of the operation are very simple. A urement of the neck having increased J4 in.
horseshoe shaped flap should be marked in circumference. This is clearly due to
out, having its base above at the third rib distention of the superficial veins of the
and its apex at the seventh. The inner neck, as it is not likely that a structure like
edge should be over the sternum and the the cervical fascia can stretch much. In
outer in the region of the nipple line. The cases of oedema or suppuration beneath the
flap is turned up with the pectoralis and all deep cervical fascia, one is struck by the
the structures external to the ribs. The severe dyspncEa that occurs from pressure
fourth and fifth ribs are those most com- beneath this structure without any apparent
monly excised, but the extent of the rib re- general swelling of the neck. If the supersection
will, of course, depend on what is ficial veins external to the cervical fascia
found. A length of at least three or four are compared with the deep veins of the
inches of combined rib and cartilage must neck, one realizes what the pressure in
be removed. The third, the sixth, and these huge veins must be, on the soft tissue,
even the seventh rib must also be dealt with beneath a fixed structure like the cervical
if it appears necessary, and even the left fascia. The parts likely to be affected are
edge of the sternum lias been excised when the laryngeal opening, which may get
the heart was obviously fixed to it. There pressed back against the wall of the phahas
been but one subject of disagreement in rynx, and the space just above the larynx,
the matter of technique, and that is the where the tissue is extremely vascular, and
question of the removal of the costal perios- it is quite easy to imagine how, with the
teum. But it was shown by Koenig that increased tension within the cervical fascia
the anterior periosteum only should be re- occurring in asphyxia, the air way here
moved. The possibility of leaving the peri- may be completely obliterated,
osteum without damaging the usefulness of
the treatment makes the operation still more Prostatic Enlargement.— Herring, in
simple and removes the only serious risk it The Dublin Medical Journal, states that
could be supposed to have. prostatectomy should not be undertaken
The Causes ol Obstruction Producing
Cyanosis During the Nasal Admlnistra-
Hon ot Nitrous Oxide.—Trewby, according
to The London Medical Lancet, has
observed some thousands of nitrous oxide
administrations and states that cyanosis in
unless the symptoms present are definitely
ascertained to arise from that organ, and
from nothing else. Urinary symptoms are
very frequently artributed to the gland when
in fact they come from quite a different
cause. Forinstance—and this, perhaps, is
the most common mistake— a patient comordinary
cases in merely mechanical, being plains of occasional retention, haemorrhage,
mainly due to the size and shape of the
palate and tongue. Whether nitrous oxide
pain, etc.; a rectal examination is made;
the prostate is found to be enlarged and is
is given by the nasal or ordinary methods, straightway accused, without furthersearch,
the fact remains that the oropharyngeal of being the cause of the trouble. What is
aperture is always obliterated before the theresult? During the operation for removnasopharyngeal
aperture is in any way af- ing the offending member a stone is found
fected, and the breathing gradually tends in the bladder, which could easily have

ABSTRACTS. 185
been removed by lithotrity and the patient vocates the giving of tuberculin by the
restored to health in a week, whereas he is mouth in normal saline solution or in fresh
now condemned to pass through au unnec- horse serum. He says that it should be
essarily severe ordeal. In skilful hands given when the stomach is empty and in
the x-rays will nearly always eliminate the morning. He shows by the effects on
such errors, even when the sound has failed the opsonic index that it really acts when
to reveal the true cause. Prostatectomy so used, but the dose required is about doushould
be deferred until after treatment by ble the hypodermic one. He asserts that
catheter has been tried. The patient may benefit is derived from tuberculin even in
recover his power, or he may decide, when very acute stages of phthisis, but this is not
he knows exactly what to expect, to con- altogether confirmed by Dr. Mackenzie,
tinue treatment. No harm can come of a The point of interest is the fact that fresh
delay of a month or more, and in septic horse serum given alone always raised the
cases much good will result, for the patient opsonic index to tubercle without any prewill
improve and be in a better condition to ceding negative phase, and should, therebear
the operation. Afterward, if the ca- fore, be a most useful addition to the treattheter
fails or is found too irksome, recourse ment of acute phthisis. When tuberculin
can be had to operation. When the patient is given in any form, the patient should be
is comparatively young, in good health, kept in bed for at least twenty-four hours,
and has many years of life before him, and the temperature taken every four hours,
operation is ver>' rightly advocated as soon preferably in the rectum, in order to guard
as it is proved that catheter treatment will against ill effects during the negative phase,
not cure. The same may be said of those He considers that Marmorek's serum is
who, owing to their position in life, calling, horse serum containing an unknown amount
or lack of funds, are unable to carry out of tuberculin. This serum was tried some
the few simple details necessary in sterile time ago but did not give such results as to
catheterization. Prostatectomy undoubt- make its use permanetit. Dr. Maguire's
edly is the best treatment when the prostate, method of injecting intravenously every
by its mere size, has largely encroached day 50 c.c. of 1 in 2.000 formic aldehyde in
upon the bladder space, and there is no normal saline solution is difficult, but does
residuum. The urine is clear and free from good in some cases. Cinnamate or hetol
all signs of sepsis, yet the patient has con- injections increase the number of leucocytes
slant and urgent calls to pass water both by in the blood, and thus probably aid the
day night. Pinally, the operation may be phagocytic power,
necessary in certain cases where the prostate
is constantly bleeding and filling the Radloactlvlly and Carcinoma.— Barbladder
with clot which interferes with in- low, in The British Medical Journal, prestrumentation
and endangers the patient's sents his views on radioactivity and carcilife.
noma. The writer shows that certain of
the tissues of the human body show skoto-
PWhlsIs.— Broadbent (London Practi- graphic action (liver, kidney), while certioner)
in speaking of the treatment says tain do not (spleen, lung); that a larger
that in giving tuberculin, the best results amount of this property resides in female
will be obtained, if the opsonic index is tissues that possess it than in male of the
taken a few times first, and the new tuber- same kind; that the amount present in the
culin T. K. injected when the index begins liver increases from infancy to the age of
to fall. After the injection, there will be a fifty-five years, with an unexplained drop
negative phase of a falling opsonic index in both sexes during the age period thirtyfor
about twenty-four hours, followed by a five to forty-five, and that after fifty-five
rise to above the former line. A new injec- while it increases still further in the case of
tion is indicated when the index again be- males, in females it undergoes a sharp
gins to fall, which is usually in seven to diminution. The author demonstrates that
ten days. Headache, rise of temperature, carcinomatous material possesses skotoor
a prolonged negative phase would show graphic power, whether it is primary or
that too large a dose had been given, and secondary, and that female carcinomatous
a feeble opsonic response that the dose was tissue has a higher skotographic value than
toosmall. It is safest to begin with 0.00002 male; and that the existence of a mass of
of a milligramme, slowly increased to 0.0001 carcinoma in a tissue ^modifies its normal
or 0.0002. It is possible to give tuberculin skotographic value. Barlow has found that
without using the opsonic index, if the tem- certain substances commonly supposed to
perature and clinical symptoms of the pa- be causally related to carcinoma possess
tient are very carefully watched, and the the skotographic power to a high degree
quantity injected is very slowly increased (cholesterin, gallstone), while others are
at intervals of ten days. Dr. Latham ad- devoid of it (clay pipe, paraffin). The

]S(,
THE CHARLOTTE MEDICAL JOURNAL.
writer throws some light upon the nature staphylococcus aureus from which a vacof
the skotographic action manifested by cine was prepared and a dose of 25,000,000 ]
animal tissues and certain other substances, staphylococci were administered. In three i
comparingtheir behavior with that of woods days improvement was noticed. Later an- l
in which the action has been regarded as other injection of the patient's own staphydependent
upon the formation of hydrogen lococci were given. The blood withdrawn \
peroxide, and with that of recognized radio- clotted almost immediately and, therefore, ,
active suostances. On this point he ad- one-dram doses of citric acid were adminis- ;
duces evidence showing that the animal tered every four hours for four doses. The j
tissues and other substances under examin- patient made an uneventful recovery, the I
ation cannot, so far as their action upon a only sign of illness left being a dimple on i
photographic plate in the dark is concerned, the left cheek caused by the skin becoming ;
be grouped conclusively with the recognized attached to the mucous membrane of the
radioactive substances or segregated into a cheek just over the opening of Stenson's I
class such as that formed by the woods, and duct.
believed by Russell to affect a photographic i
plate in the dark by means of a purely A Case ol Acute Lupus Erylliematosus. ,
chemical action. They occupy an inter- —McDonagh, in the Glasgow Medical
mediate position and have affinities with Journal, reports such a case occurring in a ;
the woods on the one hand, and with the female, aged fifteen, who was admitted to I
recognized radioactive substances on the the hospital March 12, 1907. She first
other. Lastly, MacCormac has shown that noticed her hands gradually becoming blue i
bacteria may be divided into groups accord- and numb. A few weeks later the feet ;)
ing to their skotographic power, and that likewise became affected. For some years j
the only group which acts in this way with previously she had suffered from chilblains,
j
constancy and to a marked degree is a small On admission to the hospital the fingers i
one, which includes the pyogenetic staphy- and toes were bluish, showed old scars, and j
lococci and the bacilli of tuberculosis and were cold to the touch. There were some j
diphtheria. The bearing of these observa- blotchy red patches on the face. The nos? i
tions upon the question of carcinoma he in- and ears were normal. A few days after
;
tends to treat in his third lecture. admission a red rash appeared all over the
face and on both wrists extending up to the •
A Case ol Severe Facial Carbuncle, forearms, being accompanied by a persist- I
with Ludwig's Angina and Parotilis.— gntly raised temperature. No hemoglobin- i
Walters and Solly, in The London Prac- uria was found. On March 26, the face '
titioner, report such a case successfully became much worse, the nose appeared .j
treated by vaccine, combined with the ad- cyanosed, and albumin appeared in the i
ministration of repeated doses of citric acid, urine. On April 3, the nose became very ',
The patient was a girl of seventeen. A sore and swollen, also the upper lip, and <
pimple was first noticed on the right cheek, the patient breathed almost entirely through ;
which was squeezed but no pus exuded, the mouth. On April 12 the face, the hands, j
Two days later she had a hard indurated and the feet were better, but patches of ery- i
inflammatory mass about the size of a shill- thema appeared on the arms and a papular v
ing on the right cheek adjoining the lip. eruption on the back. On April 23 the face "1
The temperature was 99° F. Soon the upper was diffusely pigmented and erythematous; I
lip on the right side began to swell and pus it was covered all over with scales, some of 'i
discharged by many small holes from its which came off easily, others being adher-
^
under surface and the lower lip began to ent; the latter on removal had those pro- !|
swell. Soon the whole of the right cheek cesses of horny tissue which fitted into if
was dusky in color, with an indurated swell- small depressions on the skin, and which j
ing extending upward from the lip, the eye are typical of lupus erythematosus. On .\
being nearly closed and the groove on the having the hair cut short typical plugs and 'j
side of the nose nearly obliterated. She scarring were found. The scalp, like the ']
was almost unable to open her mouth, there face, was diffusely pigmented anderythem- \
were sordes on the teeth, and her tongue atous. A small papulosquamous eruption |1
was very foul. There was no fluctuation covered the neck and chest. An atrophic ,1
present. The temperature was 103° F., the condition of the skin had spread up the ;f
pulse 140; the patiejit was somewhat drowsy, back of the hands to about the middle, <
semi-delerious, and evidently very ill. A where the scarring was less marked, and t
j
dose of 50,000,000 staphylococci (mixed when present was covered with scales and ji
stock vaccine > was
•'
inoculated. The next surrounded by a zone of erythema. As else-
day there was not much change. On the where, many of the scales on removal pes- jg
day following a culture taken from the sessed the horny processes. Later she was j.1
pustule of the lip gave a pure growth of brought to the hospital with all the signs of j'j
•
'

ABSTRACT. 187
a general peritonitis, and was operated tinal method of entrance is much more rare
upon. Later she developed a purulent peri- than has been supposed, especially since
carditis, necessitating a second operation, milk has been sterilized habitually, and so
which was followed by death. The point much care taken to get it free from tubercle
of great interest in this case is the age of bacilli. It is much more important to conthe
patient. Xo history of tuberculosis in sider the pulmonary or naso-pharyngeal
this case was obtainable. entrance of germs. The principal factor is
always human contagion, often in the
Kyphosis witb Spinal Crest.—Marie
family. To preserve the infant he must be
Nageotle-W.lbouchewitch ( Arch de Med.
^ j^^^ ^„ contagion, separated from his
des hnf.) describes a form of kyphosis
tuberculous parents or relatives, placed in
which IS very rebellious to treatment It
^ s^^^toHum, if necessary, or in the counoccupies
the preferred location of kyphosis
Tuberculosis may be arrested at all
m the adult, the maximum curve oemg at
^^^ latent tuberculosis progresses favthe
sixth or seventh dorsal vertebra, and is
^.^^ly for the infant as soon as he is recharacterized
by prominence of the spinous
^^^.^^ ^^^^^ j^i^ surroundings to the free air
processes of three or four vertebrae, forming
^^^ « ^^^ j^^ i^,,^ ^f jl^^ country.
t>
.
an elongated crest at about the angle ot the
scapula. The vertebrs forming the crest Use and Abuse of Proprietary Foods
aregenerally the sixth, seventh, and eighth, m Inlant-Iccdinfl.-Cantley, in The Lon-
More rarelv the crest is lower down. The don Practitioner, savs that proprietary foods
mobility of the spine at this location is al- are not really necessary in ordinary circumways
less than normal. When the child stances. They are, however, often of very
lies on his stomach the crest does not en- great value, more especially the malted
tirely disappear, and on raising the legs do foodg^ provided that they are used with disnot
form a concavitv, as would be the case crimination as additions to the diet, and not
in the normal child. When pressure is as substitutes for cream or milk. Generally
made on the summit of the crest the neigh- speaking, in the first three months of life,
boring regions become incurved, that is the t^g only permissible proprietary foods are
cervical and dorsal regions become more those made from condensed milk, with or
curved. There is no true ankylosis, for vvithout the addition of cane-sugar, or of a
suspension restores the contour gradually, completely malted flour. These foods are
The crest is the key of an arch, and the also useful, under certain temporary conpoint
of departure of a more extended ditions, in the second three months of life.
kyphosis of the cervicodorsal region. This At this age. too, we can make use of the
kyphosis increases with age and appears completely malted carbohvdrate foods as
very early in .the life of the child, at from a„ addition to the milk mixtdre instead of
three to five years of age. It is believed by sugar; of the more or less malted foods, in
the author to result from a congenital mal- a similar manner, provided that they are
formation of the vertebrx, since the same given in small quantities and do not procondition
is seen in parents and children, duce flatulent distention of the intestines;
The treatment consists of suspension, re- and even of the foods consisting of unspiratory
gymnastics to develop the thorax changed starch, especially those which
and counterbalance the kyphosis, correct
attitude when working, and repose on the
undergo partial conversion in the process of
preparotion, and, at the same time, partially
back.
The Principal Ways ot Tuberculizapeptonize
the milk proteins. In the third
three months of life, mothers constantly
tion in the Young iniant.— Terrien (.Ami- clamor for the addition of some food to the
de .Med. et Chir. Inf.) discusses various milk mixture. Simple barley water, gradumetliods
of entrance of tubercle bacilli into ally thickened, is sufiicient, and will eduthe
organism of the young infant. The cate the child in the digestion of starch.
writer discards as almost negligible the Almost all of the meat preparations consist
theories of hereditary transmission of the of extractives of no nutritive value, perhaps
germs and of the predisposition to tubercu- stimulating to the digestive functions, poslosis.
Tracheobronchial adenopathies are sibly throwing an extra strain on the liver
almost constant in tuberculosis in the child,
and are a common location of early tuberand
kidneys. The high proportion of salts
and extractives is liable to cause thirst and
culosis, whether it be brought from the respiratory
organs or not. Still it cannot be
diarrhea. Diarrhea is especially apt to be
induced by peptone preparations. Some of
regarded as a positive sign of i)ulmonary the meat jellies, though not nutritious, have
entrance of the bacilli. The ways of entrance
of tuberculosis are multiple, includa
pleasant flavor and are comforting to a
feverish infant who refuses food. They are
ing the bronchial, naso-pharyngeal, and still more comforting to the anxious mother
intestinal mucous membranes. The intes- who fears that her child will ttarve and has

188 THE CHARLOTTE MEDICAL JOURNAL.
profound faith in these preparations. In end, the csecostomy or appendicostomy
small quantities.they do no harm. Similarly,
a hot, clean fluid, such as beef-tea, is pleasopening
is easily closed. In chronic ulcerative
colitis the urgency of the symptoms
f
.|
ant to the
digestion.
febrile tongue and disordered is not so great and milder medical measures
As ordinary articles of an in- may be given a prolonged trial. But when
I
'
fant's dietary, these foods must be con- the diarrhcea still continues with the pass- ;
densed. age of blood and mucus, and despite treatment
the patient is progressively losing
The Surgical Treatment ol Colitis.— weight and passing, as they frequently do,
Heaton, according to the Edinburgh Medi- into a neurasthenic condition, an appendi-
|
J
'
cal Journal, says that of the causes of acute costomy with prolonged daily irrigation of
ulcerative colitis we know but little. Some the colon will in many cases effect a cure. ;
authorities, notably RoUeston. include all Many such successful cases have been re-
such cases under the term dysentery, and ported.
maintain that bacteriological examination „ ^ „ .. . ,,. . ^.^ .^
shows them to be identical. But Osier, «^"» Degeneranon ol Uterme Fibroids i
Allchin, and others hold that they are sep- Complicating Pregnancy.- Bland-Sutton ;
arate and distinct disease. Bright's disease in the Edinburgh Medical Journal discusses <
would certainly seem to be a predisposing the influence which pregnancy exerts on j
factor and the disease seems equally com- fibroids. When the walls of the uterus are i
mon in men and women. There is pro- occupied with fibroids and pregnancy en-
;
found diarrhcEa, and blood is almost always sues, the fibroids are often influenced by
j
present in the motions, mixed with a most the altered conditions. They often become j
offensive mucus and pus. There are usu- red or flesh-colored and this has been sup- 1
ally marked abdominal tenderness, rapid posed to be due to an increase in muscular ;
and progressive emaciation and weakness, fiber. Another important change is the !
the patient in some cases lapsing into a onset of pain and tenderness. In early !
typhoid condition. The temperature is stages the reddish change comes in streaks,
irregular, and there may be profuse pers- but as pregnancy advances the whole fibroid \
pirations. Distinct diagnosis has to be mass becomes so affected and the whole
made from abdominal tuberculosis, typhoid fibroid may even soften and become difiiufever,
and malignant ulceration of the lower ent. In these degenerating fibroids no orbowel
with spurious diarrhcEa, and is in ganisms are usually found, but the tissue
some cases a matter of extreme difficulty, is necrotic and refuses to stain. The char- |
A sigmoidoscopic examination should be acteristic redness is found to be due to the
I
.
made whenever practicable in these cases, diffusion of blood pigment through the
|
,i
and will often materially help in arriving necrosed tissues, so that the hardest fibroid
at a right conclusion. The prognosis seems may become of the consistency of soft soap,
'from the reported cases to be a very bad From a large subserous fibroid staphyloone;
intestinal perforation is frequently a coccus pyogenes aureus has been isolated, ,
cause of death. Murrell reported five cases but no organisms have been found in the
treated on purely medical lines with one re- interstitial variety. It is now believed that
!
1
covery and four deaths. Active surgical when a uterus becomes pregnant the fibroids i
treatment is urgently called for in such do not enlarge in consonance with the physicases.
The large bowel must be kept empty ological increase of the normal muscular
and at rest, and yet to starve such patients tissue of the uterus. Some fibroids do en-
:
i
is to kill them, while rectal feeding is out large beyond doubt, but this results froir i
of the question. An artificial opening is interference in circulation in these tumors, ,(
made in the caecum, or the appendix is producing edema and color change due to
fixed to the abdominal wall and opened, hemolysis of blood, not to rapid increase in 'i
The operation can be done in a very few muscular tissue, as has generally been sup-
minutes and with but little or no shock,
Intestinal contents are in this way diverted
posed. The sudden pain and tenderness
produced by the red change may suggest
^
jl
..«
from the ulcerated colon, which is at the rupture of a pregnant tube. If the patient
same time put at rest and under the best is kept in bed the pain and tenderness due
i
i
'
conditions for repair. Through the open- to the red change will generally subside.
ing thus made the inflamed and ulcerated Occasionally surgical intervention is neces- ',>
bowel can be daily irrigated. H. C. Curl sary. During the last nine years twenty ';
has reported eleven such cases, with eight cases have come under the author's personal ;i
recoveries and three deaths. One of the care. Of these ihe symptoms came on in li
deaths occurred in a patient who was al- the first month once, in the second four 1;
ready moribund when operated upon, times, in the third four times, in the fourth :i
Later, when the patient is convalescent and six times, in the fifth, sixth, and seventh )i
the ulcerative processes have come to an once each, and in the puerperium twice. \i
j
j
^
'
j

Of the patients three were spinsters, three
multiparas, and fifteen primiparas. Ages
varied from 28 to 45. Of the operations
done, three were enucleations and seventeen
h^-sterectomies, two of the latter being
total, as the fibroids were in the cervix.
The writer has seen the red change occur
in all thirty-two times. The author says
that he has no opinion as to its cause. The
presence of micro-organisms in the degenerated
tissue is in all probability exceptional.
The thrombus and infarction theories
which have been advanced require
more proof than has thus far been brought
forward. The condition is prone to occur
during pregnancy. Fibroids so changed
are a serious menace to the pregnant state.
lodipin In Syphilis.— Freshwater, in The
British Medical Journal, mentions the advantages
and disadvantages of iodipin. It
is often necessary to give a long course of
iodine to patients who are unwilling to lake
iodide either from its lowering effects or
that they are the subjects of iodism. All
the iodipin injected is used up and must
exert its specific action; an exact dosage is
therefore possible. Injections are painless,
and there is no fear of sepsis if proper precautions
have been taken. Subcutiineously
it does not produce iodism. Patients who
have an idiosyncrasy to potassium iodide
can take it quite well. Patients remain
much longer under the influence of iodine
than when iodine is given in other forms.
After a short course of injections the system
can he kept for a period of four to six
months under the influence of iodine. The
body is under a slow, continuous regular
action of iodine, which is of prophylactic
value. In nearly all cases, after a prolonged
course of potassium iodide, there
are stomach and bowel troubles. This does
not occur with iodipin. It has a specific
action in tertiary syphilis and arterial degeneration.
The disadvantages to the use
of iodipin may be briefly summarized as
follows: In cases of syphilis, when a rapid
therapeutic efifect of iodine is required, iodipin
is of little use, as the absorption of iodipin
is extremely slow, two to ten days elapsing
before the iodine can be definitely demonstrated
in the urine, so that in cases in
which there is a threatened perforation of
the palate, cerebral gumma, etc. .potassium
iodide should be given. lodipin is not a
substitute for potassium iodide when active
lesions are in progress. A further disadvantage
is that only a small amount of iodipin
can be absort)ed per diem, about onethird
what would be given in the ordinary
way by the mouth. This can, however, be
turned to account in various ways. For
example, in tertiary syphilis, after potas-
ABSTRACTS. 189
sium iodide has been administered somewhat
vigorously, a course of iodipin injections
may be given, and the patient may
then be left without medicine for some
months, during which time the physician
knows that iodine is daily passing through
his tissues.
Typboid Bacilli in tlie Blood of Patients
Not SIcl{ witli Typlioid.— Busse
(Muencb. Med. Wchschr.) says that the
difficulty experienced in the early diagnosis
of typhoid fever led many clinicians to endeavor
to discover new methods and new
symptoms which should be pathognomonic
iu the early stages of typhoid fe\er, and
distinguish it from similar infectious diseases,
especially from miliary tuberculosis.
Xo reaction and no symptom has as yet
been discovered which would absolutely be
proof for or against the diagnosis of typhoid.
The receut demonstratioti of typhoid germs
in the blood of typhoid fever patients in the
early days of the disease caused many investigators
to believe that this method had
but one meaning—the diagnosis of typhoid
fever. This would be the case if the Eberth
bacilli could only be found in the blood of
typhoid fever patients. The author reports
the clinical history of four patients. Two
of these had miliary tuberculosis, another
phthisis, with intestinal affection, and one
case of typical lobar pneumonia with diarrhoea.
In all four cases typhoid bacilli
were demonstrated in the blood in the Hygienic
Institute of Posen. In the first two
cases typhoid was suspected, but the autopsy
revealed no typhoid lesions. The third case,
with pulmonary tuberculosis, was under
medical treatment for months without typhoid
symptoms. The autopsy revealed
no typhoid changes. The typical course of
pneumonia in the fourth case excluded t^'phoid
entirely. The cases indicate that the
finding of typhoid bacilli in the blood of
patients does not necessarily mean that the
I)atient is sick with typhoid, on the contrary,
it demonstrates that typhoid bacilli
present in the intestines of patients sick
with some other serious malady and with
intestinal affections, may pass from the intestines
into the blood without causing
typhoid fever. As these four cases occurred
in the course of a year without having systematically
made examinations for typhoid
bacilli, it has the appearance as if it were
not an infrequent occurrence. In making
the diagnosis, this fact must be taken in
consideration. Typhoid bacilli in the blood
of suspected typhoid patients- do not absolutely
mean that typhoid fever is present.
Complications oi Suppuration in Air
Sinuses.—Turner (Edinburgh Med. Jour.)
iu speaking of the treatment, says that we

190 THE CHARLOTTE MEDICAL JOURNAL. I
have to consider whether the onset of orbit- minal muscles covering an active gastric or ;<
al complications should be made an indica- duodenal ulcer will be found to be rigid,
tion for opening the affected frontal and and this rigidity is quite localized. The
ethmoidal sinuses by an external operation, hardness of the upper part of the right rec-'
Notwithstanding the fact that a number of tus overlying an active pyloric or duodenal
cases have been recorded-iu which inflam- ulcer is therefore an important sign. A
matory cedema of the eyelids complicating tumor. A tender nodule or an indefinite
an acute inflammation of these sinuses have induration, especially in the neighborhood
been completely cured by endonasal treat- of the pylorus, with a history of long standment,
he is of the opinion that the external ing stomach trouble, are characteristic of
operation is the wiser procedure. It is often chronic ulcer, and furnish its most importimpossible
to say whether the orbital swell- ant sign. A considerable tumor may be
ing is merely due to cEdema, or whether caused by inflammatory exudation and in-
pus has already formed within the cavity duration round a chronic ulcer, but this is '
of the orbit. Early evacuation of an ab- rare. A definite movable tumor suggests a'
scess in this situation is essential, not only cancerous rather than a chronic ulcer. The ]
for the preservation of the function of the symptoms which distinguish a chronic gas- '
eye, but in order to prevent the risk of trie from a chronic duodenal ulcer related •
secondary intracranial complications. In chiefly; 1. To pain. To the time at which !
cases of chronic sinus suppuration, in which pain occurs after taking food, that is, soon ;
an abscess forms in the orbit, there is in all in gastric, later in duodenal ulcer. The in- ,
probability, caries and destruction of a part iluence of food upon the pain; solid food j
of the bony wall of the sinus contiguous increasing gastric, but relieving duodenal j
with the orbit; consecjuently an external pain. The effect of rest in bed on the pain; j
operation is the only possible procedure, rest relieving gastric, but producirg no good I
The incision should be made immediately effect on duodenal pain. 2. To the charbelow
the eyebrow, and great care should acter of the vomiting. Its close relation-
be taken to detach the periosteum from the ship to food and pain; its involuntary char-
inner and upper wall of the orbit without acter in gastric, and its voluntary appear- !
injuring it, and exposing the orbital fat. ance in cases of duodenal ulcer. 3. To the ;j
As a rule, the pus is found between the form of hsematemesis. Recurrent, and in i
periosteum and the bone. The ethmoidal relatively small quantities in gastric, over-
cells can then be freely opened by the re- whelming and followed by meleena in duod- .
moval of the lamina papyracea, and the enal cases. The diagnosis of stricture in I
frontal sinus can be explored by removal the neighborhood of the pylorus is so easy j
of the inner portion of the roof of the orbit that no excuse can be offered for mistakes. ,<
which forms the floor of the sinus. The With the history of a chronic gastric or i
sinuses may then be dealt with according duodenal ulcer some years back, and peri- i
to the condition and size of the cavity. In ods of remission of the symptoms, each re- :
the ethmoidal cells it will probably sufBce mission being followed by a less perfect re- 1
to establish a large communication with the covery until the evidences of stomach dila- '^
nasal cavity, while the orbital wound is tation are complete—with such history the M
lightly packed, the skin incision being left diagnosis of cicatricial stricture as a conse- i
unsutured for a few days. The nasal drain- quence of the ulcer is unmistakable. This ]
age is assisted by the removal of the middle is fortunate, as these cases demand opera-

ABSTRACTS. 191
—minimal dazzling, best visual acuity, and cancer incurs grave responsibility.
best field; cosmetic advantage of a round 8. Treatment of symptoms without a
pupil; ease of reposition of the iris; minimal physical examination is unjustifiable.
dafiger of incarceration of capsule in the 9. Early cancerous ulceis should not be
wound; infrequency of prolapse of vitreous; treateM with caustic; their appearance begreater
protection of deeper parts of the eye comes masked, and valuable time is lost.
from infection; absence of pain and bleed- 10. It is an error to wait and observe in
ing from cutting the iris. The chief dis- order to arrive at a diagnosis.
advantages of simple extraction are: Risks 11. In doubtful cases a diagnosis must
of prolapse of the iris; less efficient treat- and can be made in a few days.
ment of the anterior capsule; greater diflS- 12. To examine, to diagnosis, and then
culty in expression of the nucleus; greater to treat, should be the rule in all cases.
difficulty in removal of soft lens matter;
greater danger of ring synechia and
Fatal Case of Pernicious Vomiting ol
second
ary glaucoma if iritis should occur. The
Pregnancy.— Maxwell (Journal of Obstet-
r'Story of severe vomiting at home, unasiris;
diminished risk of secondary glaucoma.
l^o^vever, vvith marked wasting
The chief disadvantages are; Greater com- f^^'^^^'^'.
^l^e toxic nature of the case did not reveal
plexity of the operation, including especiitself
in any characteristic alteration of the
ally need of more instruments and of the
urine; there
introduction of more
was no albuminuria; the only
instruments into the
ominous signs on admission were drowsi-
eye, and greater duration of the operation;
"ess and a very rapid weak pulse; there
optical and cosmetic disadvantages; greater
danger of incarceration of iris and capsule ^^^^ "" jaundice. Pa lent passed success-
jvely through stages of restlessness, dehrin
the wound; greater danger of postoperative
glaucoma; pain and bleeding from the '"'"; 7,^"'^a
""T^- T^^^ '^'
. . " ^ "
vealed hyaline degeneration and necrosis
Uterine Cancer.
of the central cells of the hepatic lobules.
— 'I'he Edinburgh Medi- the kidneys also showing a severe parencal
Journal calls attention to the special
committee of British Medical Association,
chymatous nephritis; sections of both tissues
weie shown under the microscope. The
in regard lo appeal issued by the chainnan, diagnosis of this distinctly atypical case
and says; vvas uncertain during life, and was based
We cordially commend the whole to the finally on the pathological investigation
consideration of all. It is the experience post-mortem.
of all operating surgeons that few opera- ^.^gy Treatment ol Ringworm ol tbe
tions for cancer are so successful as that of scalp.-Macleod, iiiThe London Medical
early hysterectomy for carcinoma, and it is
j^ancet says that the x-ray treatment of
the lament of all that too often they only ringworm bv the single dosage method with
see the cases when it is too late to operate.
(1,^ dosage regulated by the pastille is prac-
1. Cancer of the uterus is at first a local
^jcally safe and harmless. It is a method
disease. .
(,f treatment of such delicacy that even in
2. Cancer of the uterus is often a curable
the hands of an experienced operator an
disease.
accident such as an over exposure might
^. Operation is the only satisfactory meth- happen, but such accidents should be of
od of treatment. ^^ph extreme rarity as not to discredit a
4. The earlier the disease is recognized
^^^^^^ ^^ treatment possessing such obvious
the more hopeful are the prospects of treatadvantages.
Severe dermatitis followed by
'"ent. permanent baldness is the result of an over
.5. The risk of operation in early cases is exposure or is due to some accident such as
slight, and the chance of permanent cure is the exposing of an area, the resistance of
good. which has been lowered by the previous
6. The recognition of early cancer is not application of strong irritants before the
usually difficult, and the disease should not inflammation has entirely subsided, the use
be overlooked by the medical attendant. of wrong or inaccurately standardized pas-
7, A medical practitioner who fails to tilles, or from overlapping. Permanent
make a physical examination of a patient baldness or delayed hair growth without
exhibiting any of the symptoms of uterine marked dermatitis is the result of over ex-

192 THE CHARLOTTE MEDICAL JOURNAL.
posure, but it might in rare instances be rayed areas. In practice the dosage works
due to some idiosyncrasy on the part of the out so nicely that every part receives an
patient in the same way as the occurrence equal amount and depilation is total and
of alopecia areata after ringworm. He has complete, without anywhere a sign of over
been unable to obtain any definite evidence or under exposure. In theory, according
of injury to the brain by this method of to the well known laws that the quantity of
treatment from his own cases, from the rays received at any point exposed varies
literature on the subject, or from any one (l) inversely with the square of the distance
with experience of this treatment whom he from the source; and (2) directly with the
has asked. Adamson remarks that depila- size of the angle of incidence, the dose retion
by means of the x-rays is now fully ceived by any part of the scalp is found to
established as the most satisfactory method be with mathemalhical accuracy, one pasof
treatment for ringworm of the scalp, tille dose.
Briefl}', the treatment consists in temporarily
depilating the affected area or areas, A Case ol Tuberculous Meningitis
each by a single measured dose of x-rays, -without Tubercles.— lliggs, in The Edinand
thus, mechanically, and without actu- burgh Medical Journal, reports such a case,
ally killing the fungus, eradicating it from the unusual features of which are: 1. The
the areas exposed. By the introduction of presence of tuberculous meningitis with
the pastille of Sabouraud and Noire as a much fibrinopurulent exudate at the base
means of measurement of dosage, in trained of the brain without any miliary tubercle
hands, the dangers of the treatment have formation: 2, the absence of miliary tuberdisappeared.
One disadvantage it still has, culosis of the lungs and other organs; and
namely, the length of time occupied Ijy the 3, the great predominance of polj^morphoactual
exposures to the rays, and any means nuclear leucocytes over lymphocytes in the
of shortening this period must be welcomed cerebrospinal fluid. The child only lived
by all who have many such cases to treat, two days after admission to the hospital,
more especially in hospital or institution but a diagnosis of tuberculous meningitis
work. In a large majority of cases it is was made from the history and physical
found necessary to irradiate the whole scalp, signs. At the necropsy, however, doubt
By Sabouraud and Noire's well known was thrown on this diagnosis, as, although
method with circular localizers from ten to there was an actively caseating bronchial
twelve exposures are necessary in order to gland to serve as a primary focus, there
x-ray the whole scalp, and reckoning only was no generalized miliary tuberculosis and
fifteen minutes for each exposure and a no tubercles in the meninges, which, morecertain
time for adjusting the localizers for over, showed much thick fibrinopurulent
each area, the time occupied in x-raying exudate, mainly posterior basal in distributhe
whole scalp is from three and a half to tion. On the other hand, the general
four hours. By another method, that of "stickiness" of the meninges and the presdividing
the scalp into rectangular areas ence of some exudate around the vessels in
and irradiating each area, surrounded by a the Sjivian fissures favored the diagnosis
lead foil shield, in succession, the time may of tuberculous meningitis. The doubt as
be reduced to from two and a half to two to the diagnosis was accentuated by the
hours. The author reduces the number of cytological examination of the cerebroexposures
to five, so that it is possible to spinal fluid. With regard to the reason
irradiate the whole scalp in one and one- why tuberculous granulations are not alhalf
hours. Its essential features are that ways found in cases of generalized tuberno
cylindrical nor lead foil localizers are culosis, it may be considered that while
used, but that adjacent x-ray applications general tuberculosis infection usually takes
are made in such a manner that at those the form of a pysemia it may occasionally
parts where overlapping does occur the in- be only a septicemia, ond that the primary
cideuce of the rays is so oblique and so tuberculous focus in the first case dismuch
further from their source that no ex- charges into the circulation clumps of bacessive
dose is given. It is important to cilli with tissue debris, and that these
make the irradiation at right angles to the clumps, becoming impacted in the smallest
direction of the irradiation of adjacent areas, arterioles, cause the formation of miliary
and to aim not at a point in the centre of tuberculous granulations or "tuberculous
the vertex of the lower occiput, or of the pysemic abscesses" around the blocked vessides
of the scalp, but toward the outer sels, but that in the second case separate
margin of these areas, so that half the dose bacilli only are discharged into the circulagoes
on to the scalp and half on to the shield tion in considerable numbers, and that
protecting the face and neck. If these pre- these isolated bacilli do not get lodged in
cautions are taken there is no risk of over the small vessels. The difluse leucocytic
exposure at the overlapping margins of the infiltration of the cerebral cortex and the

'
ABSTRACTS. • 193
cellulofibrinous inflammation of the men- tion as is possible in
inges may be explained as being the result men.
this world of mortal
of the irritation of the toxines, and of the
The Condition oi the Heart and Lungs
bacilli, which have found their wav from
alter Abdominal Operations.— T.ichten-
the blood vessels into the cortical substance
^erg (Munch. Med. Woch.) has tabulated
and into the cellular tissues of the menmges,
t^e findings by repeated examination of the
these parts especially easily reacting to the
^^^^^ ^^^ j^^^^^ -^ ^ ^^^-^^ ^^ jOO p^^i^^^^^
tubercle bacillus.
^^f^^^ ^^^ ^fj^^ abdominal operation. The
The Fate ol Damaged Jolnts.-Warren
^^^er draws the following important conin
The London Medical Lancet reports "^
,®'°"f
^- ^liat post-operative lung complica-
cases of injury, principallv fractures, in- .
tions are extremely
volving joints, treated in the massage
common: that they may
department
of the London Hospital. From "" ^heir course entirely unnoticed (on ac-
a
continuous series of nearly 400 cases taken
count of insignificance of symptoms), and
for a period of about eighteen months, he ^^^^ slight rises of temperature of short
duration m the first days of the aseptic
concludes that, on the whole, the results
operations are generally
are not bad, though
due to such lung
certainly admitting of
considerable improvement. If modern treat- comphcations.
2- These post-operative changes cannot
ment be carried out. the outlook for frac- ,
tures involving joints is less gloomy than
^^ post-operative pneumonias m
'f ^^'^J.^^^
the ordmai^' sense.
some would have them
They form rather the
believe. Unless cases
'jackground
are made to come and show
upon which pneumonia may
themselves
^^^^'^^OP'
after treatment has ceased, one gets ^"^ a false
^^'1'"^ this they may disapperspeclive
of the results; one sees cases ^ ^^"^ ^^^^^ ^^'^^°^t ^'""'"'^ '^^"^
^'^^\'l
coming up week after week and month "'^V!^''*°" . • . r .
^-
after month with
^^e great majority of post-operative
verv little signs of im- ,
lung complications anse iminediately after
provement. Cases doing well slip awav,
the opera .on and are recognizable on the
Their treatment is shorter, and they leave
impression on the mind than do °"^' /^^'.''^ ^"^ ^°"''
tliose stiff, '^
^f "^^^V } '"^
°f anesthesia has nothing to do with "f'^?^ the
squab, edematous, and utterly dreadful-
"umber of lung complications,
looking ankles, as after Pott's fracture,
'^^ ^^rcos^s pneumonias are rare^ The
which are constant visitors. With patience
and perseverance, however, these latter as- ^'^^' "^^Jon y of conditions must be con-
^'^^'^^'^ ^^''o^"^
sume something '"
of their normal
°"g'"- '^ ^^^^ ^'^
proportions ^^P""
and are, at any rate in the majority of the
cases, exceedingly useful and serviceable , . ^ ^ ^, t . i i- u^
meansof progression. lie has found to his ^^^^ important part than relatively slight
surprise the after-results much better than ^^^^.S^' '» ^1^^ vascular system and myohe
expected. From the cases discussed the ^araium.
value of early movement and massage will 6. Important information as to the existbe
readily seen in improving and accelerat- ence of an ocult lung complication may be
ing recovery of function. Massage and obtained by testing the inovability of the
movement alone are not suitable from all Ltases of the lungs (in front),
fractures, though serviceable for a great '. By following the curve of blood pressmany
more than is commonly supposed, "re, and having reference to other factors,
Certain fractures, e.g.. Pott's fracture, must information about the condition of the cirhave
some retentive apparatus to avoid dis- culation may be obtained which is of value
placement, not to produce immobility of the for the regulation of stimulation by drugs,
limb. In the treatment of fractures and ^ is a striking fact that /3 of the 100
allied injuries, as in a verv large number of cases showed after operation signs of conmedical
and surgical cases, two great and solidation or of bronchitis, but that not a
apparently opposing principles are used, single death was attnbuted to either of these
viz., rest and exercise. In the past too conditions.
static.
5. Well-marked heart lesions seem to play
much stress has been laid on the import- The Antisepsis ol Abortion.—Champion"
ance of rest in cases of injury, and it is
largely to the French school that the credit
is due of accentuating the importance of the
other factors in treatment, movement, and
iiiere (Ann. de Gyn. et d'Ost.) says that
we may consider a normal labor as a fresh
wound, a labor after contact with hands
and instruments as a dirty wound which
exercise, bor movement leads to power of will often become infected. lie puts us on
function, and it is by proper appreciation our guard against wounding the uterus by
of the importance of each of these princi curettings which produce a site for the enples
and by correlating their application in trance of infection. Intrauterine injections
practice that one could attain such perfec- continue these abusive measures. Lastly,

194 . THE CHARLOTTB MEDICAL JOURNA).
the uterus is left distended with tampons of albuminuria is an abnormal molecular diuiodoform
or sterilized gauze. All this is de- resis, a hyperactivity of the epithelial tissues
fective and often causes infection. His of the kidneys, an exaggerated permeability
treatment consists in the injection into the of the kidneys. Such infants are poorly
uterus of a few cubic centimeters of strong developed, under-weight, have vascular'
carbolized solution, in cleansing the vagina aplasia, small hearts, and low arterial tenthoroughly
with speculum in place, and sion. They are subject to nervous sympallowing
no injection. Abortion should be toms, spasmodic cyanosis of the extremities,
treated in the same way. Injections are of and cold feet. There may be an incomvalue
neither before nor after abortion, plete development of the kidney epithelium.
The writer detaches the ovum with hisfinger, First, in changing to the uptight position
makes the same small injection of a strong there is vascular anemia of the glomerular
solution, and allows no injection. This tissue; then a rapid alHux of blood to the
procedure is possible only when the case kidney; lastly an excessive filtration of
has not been much handled. Infection urinary substances from the blocd. He excaused
by abortive measures should not be amined 750 children from the Children's
confounded with puerperal fever. When Clinic at Florence experimenting with the
there is infection already present with a re- position of lordosis. The author considers
tained ovum or only debris, we must first that orthostatic albuminuria is caused by
cleanse the uterus through the speculum hypotonia of the vessels in and neuroarwith
a small tampon soaked in carbolic acid thritic subjects, or in times of development
solution. Chloroform should be given for and circulatory disturbance. It is indethis
cleansing to allow of thoroughness and pendent of any renal lesion,
that dilation may be practised'. We may .
use both carbolic and peroxide of hydrogen
on small tampons, pushed up to the fundus.
Having made your cavity antiseptic, remove
Miscellaneous.
all debris with the nail. There is generally A Superior Laxative. |
no need of curetting. When infection /s j j,^^,^ ^^^^ Abbott's Saline Laxative \
present curetage sulBcient to remove debris, ^^^ ^^^-^^^^ -^ ^^ ^^ superior to any laxative
but not to wound the uterus is necessary,
i have ever tried. The more I use it the
Then cleanse the cavity with carbolic or
^^^^^^ j jjj.^ -^ -^
^j i^^^^ ^^^ ij
peroxide on a sound: next push up to the
,endid, claiming that it does not gripe 1
fundus a small tampon soaked m creasote ^^^^ ^^^^ j^^ ^^^^^ ^^-^^^^^ annovance j
'
and glycerine, 2 to S per cent. This cau- ^^ ^^^ feeling.
terizes but leaves no slough that will putre- j^ -^y Cobb M D '
fy. Use no other tampon or injection, and '
have nothing in the vagina. Creasote is an
admirable, nontoxic antiseptic.
'
Pe'rrv Mich '
Samples of Abbotts Salines with complete i
i
literature may be obtained free on applies-
Functional Albuminuria in the Infant.- ^ion to the Abbott Alkaloidal Company, ,
Mori
Chicago, 111.
(Riv. di Clin. Fed.) has investigated
i
,
many types of functional albuminuria in Dr. Givens' Sanitarium for nervous and 'i
the infant. Alimentary albuminuria is the mental diseases at Stamford, Conn., has a I
most important. It frequently occurs with '

ABSTRACTS. 195
George Lincoln Walton, M.D., has just and at autopsy there is hyperemia of the
completed an important series of three pa- brain, effusion into the serious cavities,
pers, entitled "Those Nerves," for Lippin- infarctions in the lung, and a flabby heart,
cotfs Magazine. In them he discusses va- Cases of chronic intoxication have also
rious phases of nervous disorders, real and been described, and there are several inimaginary.
The papers will bear the subtitles,
"The Human Sensitive-Plant,"
stances on record where benzine was in-
haled purposely, since it gave rise to pleas-
"Sidetractibility," and "Character- Leak- ant dreams. In one case there were such
age," the first of which will be found in permanent lesions as retrobulbar neuritis,
the July number. Dr. Walton's unique and
helpful little book, "Why Worry?" has
with central scotoma for red and green,
Treatment of acute poisoning calls for
gone though several editions and proved a gastric lavage, if the benzine were swallowboon
to thousands of readers. ed. Cardiac and respiratory stimulants
should be used freely. It is probable that
Out of the Ordinary. benzine is not excreted through the urine,
,
' ^ but solely through the lungs.—Muench.
Abbott's Saline Laxative has two features
which distinguish it from the common
i^j^^j Woch.
"
run of saline cathartics: First, when taken Noninfectious Disease of the Adnexa.
in cool (not cold) water immediately or
nsn,g. It acts once m an hour or two (a
clean, satisfying fllush) and usuallv no
^_^ ^^^u^,,i states that nonh.fectious
disease of the adnexa is deserving of greater
,. .• ,, • n t f w^^
,-''',. ,. 1 " .1 attention than is usually given to it. We
more; whereas ordinary salines keep the •
, i .i i j •• a
. , 11 ' J ,
i^i have under tins head active and passive
patient busy all daylong. The annovance ^. j, u i '? .,„4„
,. , -. " , - congestions, adhesions, hemorrhages, cysts,
J.
of this when one is awav from home or ^ , ' , • r , ,•»• fi, \ /„„^L
, , • • . '
•
r>
1 .1 scleroses, and painful conditions tliat cause
busv in business is great. Besides, there •
. i 'rt, t ti,^^,. ,
J , J r f -1 .1 great suffering. The causes ot these condoes
not seem to be any failure in the 5.^. • r j 1 »u ^^ n « „^,;
-
r
., . ,. ,
J ,. ditions are found by the author in the pen-
action of this sabne when used contin-
„,Hc congestions to which these organs are
uously for long penods-no habit forming
^^.^jected the displacements of which the
necessitating increase of dose, but rather
^J^^ .^ susceptible, and the metritis and
the reverse. ... . - ,. . 1 salpingitis that occur aside from infectious
In one case a physician reports that he / n . a-,- t f^ ,„.,„i^„;

.
196 THE CHARLOTTE MEDICAL JOURNAL |
Jobann Holl's Malt with Iron. obscure. Fine, well-nourished children,
(PEPTONATES OF IRON AND MANGANESE) without any previous digestive troubles, are ;
ITS RELATION TO ASSIMILATION
Suddenly seized with appendicitis. Heredity,
lamily predisposition, lymphatism and ar-
,i
.,
The continued presence of iron and man- thritisra are incriminated in such cases. In ;|
ganese in the blood—the cause of health others there may be adenoids, tonsillitis,
and strength—is due, not so much to the otiti.s media, cervical adenitis, gastroenter- ;
amount ingested, as to the form, the main itis or mucomembranous enterocolitis, i
condition being that enough is absorbed. Among infectious diseases influenza plays i
As to the form, we are told by Fraenkel an important role in the aetiology. Typhoid :
(Arzneimittel-Synthese), thatthepeptonate fever comes next, and then scarlet fever, ,
is to be preferred if we would avoid the un- measles, mumps, varicella and, generally \
pleasant effects of iron. The case is the speaking, all the specific or non-specific in- ;
same with respect to manganese. Both are fections which in the child more than in the i
essential; both in the organic form, follow adult cause an overgrowth of the lymphoid !
scientific precept strictly, and afford the tissue. The symptoms are variable and j
largest amount of their material to the complexr Cyclical or periodic vomiting, ;
blood. with oi without acetonuria, in most cases \
is a symptom of chronic appendicitis. The )
•
Undializable Constituents of the Urine
In Pregnant Women in Normal and
prognosis should be guarded. It is impossible
to count on a spontaneous cure. Surj
Pathological Conditions. • gical intervention is required in most cases.
M.Savare has examined the undializable The paper ends with a brief summary of .
residue of the urine, which
cases.-Bntish Journal of
is in consider- 3,°^,;""^y"^^i''^
Children s D'seases.
able quantity in normal and pathological |
conditions in pregnant women, and has in-
Treatment of Syphilis ol the Upper Re- \
jected the residue into animals to ascertain spiratory Tract.
whether it has toxic properties. He finds .^^.. ,. ,.i -r r
Dr. Livien discusses the identification
that there are contained in the urine of
of -
women who af e in a pathological condition ^^^ spirochEeta palhda and the detection of ,
specific antibodies in the serum of people .
while pregnant, especiallv when attacked
bv eclampsia elements that are markedly ^"fected with syphilis. No serum thera- ,
toxic to the experiment animals, causing
Peutic treatment had been found effective. !
them to have stupor and convulsions, and Mercury and iodides remain the chief reme- j
killing
^'^s. two out of ten animals He states that mercury is best ad- |
injected,
mi»istered by injection or inunction, and .
The relation to the causation of eclampsia
of these toxic elements is not as vet cleariv ^^^^ ^^°^>''' ?'''^" defined, but should be further studied, since
1"
efficient doses, has .
proved experimentally to produce similar i
it may prove a fruitful field of observation.
—Annali di Obstetrica e Ginecologia.
'^"^ '^. dangerous to the optic nerve.
if'^^^l\
^^^ diagnosis should be certain before
treatment is started. Spirochseta shoulb
,
^
i
Dyspnea Following Nasal
ol Menthol Oil.
Instillation de found, or time given for the serum-test,
^^ ^^^ appearance of the roseola. In most
\
i
A. Delille. in a paper read before the of the cases where inunctions and injections l
Societe de Pediatric in Paris repor'ed the
^^^ employed local treatment is unneces- ,
case ot an infant in whom a nasal instillla- '
,, . , , , ,,, ,
tion of menthol oil, 1 per
^^^^^ Mercurial plaster
cent., was immeshould
be used to J
diately followed by violent spasm of the cover chancres on the lips or face. Noso- ,i
glottis. After fifteen minutes the child re- phen is a good dusting-powder, and ortho- j
covered. Guinon had observed several form may be used in painful cases. Malig- |
similar cases. Marfan had never seen one. „„,.tf„^.,^ f fi,„ ^- „ , i j i * „ 1
n^,^u,r »u nant forms ot the 1 . 1 t ^ disease responded . best to ,\
Lomby thought 1 per cent, was too strong. ... ^ , , , . . i]
He used menthol oil 1-300.—The British '"Jections of calomel. When inunctions are \{
Journal of Children's Diseases. used baths of soap and sulphur may be use- «
fully added. The iodides are most useful I
Chronic Appendicitis in Children. in the tertiary lesions, but act well in vege- [*j
Comby (Bull, et mem. de la Soc. med. tating secondary patches in the nose or !i
desHop. de Paris). Appendicitis is very ,'
throat. lodism may be removed bv daily
rare m infancy, but becomes more and j •
i ^ ^- c ic r i 'i. -i- I
,•,,,,,-» fr^^„^„t „ «i 1 u ij J administration of 15 grains of sulphanilic I
more trequent as the child grows older, and i
is common after five years. It is essentially ^^^^ '" -^ ounces of water. In sensitive cases \
a chronic disease, in which the ^cute form iodipin is a useful substitute.— British Wedi
is only an episode. The aetiology is often cal Journal.
'
,

AD8VRTISBMBNTS. 197

198 THE CHARLOTTB MEDICAL JOORNA).
Disappearance ol a Tumor (Sarcoma?) sparingly. Alcohol, strong- tea and coffee
Following Injections ol Coley's Fluid.— must be avoided. Rest in bed is essential.
Ashdowne, according to The London Medi- From the first attack of angina the patient
cal Lancet, reports such a case in a woman, should be sent to bed as if he had an aneur^
forty-five years of age. She had a fusiform ism, so as to reduce the work of the heart
swelling of regular outline and well defined as much as possible. The pressure should
limits in connection with the lower part of be reduced as low as consistent with health
the right humerus with no suspicion of by vaso-dilators, in cooperation with the
fluctuation or egg shell crackling about it, measures just described. The value of the
the skill and muscles were not implicated, nitrites in reducing aortic pressure is well
but the superficial veins were a little promi- known, and although their action in this
nent and there was an enlarged gland in the resjiect is transient, it seems beneficient to
right axilla. The arm was wasted and the reduce tension even for short periods, and
muscles were weaker than those of the op- so give the heart a chance to recover. Osier
posite side; the movements of the elbow urges the use of large doses of nitrites, and
joint were unimpaired. Pain was only com- has given as much as 3U minim doses of
plained of when using the arm or on apply- liquor trinitrini three times daily. Sir W.
ing firm pressure. No other bone abnorm- Gowers thinks that the prolonged use of the
ality could be made out. There was no nitrites has a "steadying effect on the vasohistory
of injury or of fracture, and the motor centre. " The value of the iodides
question of syphilis was carefully gone into, in arterial diseases, arterio-sclerosis, aneurbut
no evidence of it could be obtained, ism, and angina pectoris is well recognised.
Treatment with Coley's fluid was given.
The author began with half minim doeses
andiiicreasedthemby quarter, half, and one
minim until a maximum of nine minims
They should be given in doses of 3 to 5
grains thrice daily, unless there be a defi-
nite syphilitic history, when larger dose is
required, 15 to 20 grains. This should be
was reached; the first injections were given continued for six months, with such tempointo
the arm outside the limits of the growth,
but the later ones were injected into it, and
rary suspension as any intolerance of the
patient may indicate. In the paliation of
twenty-three injections in all were given,
They were followed by pain and swelling
the attacks the nitrates are the chief remedy.
To block the reflex by which the heart
at seat of injection, with general malaise, is inhibited he uses atropin continuously
headache, nausea, vomiting, and pains in until the liability to an attack seems to
the limbs and joints followed by the appear- have vanished. As tolerance is established
ance of subcutaneous haemorrhages resem- the dose must be increased accordingly,
bling bruises, but with only slight rise of Morphia also probably blocks the dangertemperature
and increase of pulse
These after effects were unpleasant.
rate,
The
ous reflex path, and should be used in doses
of not less than one quarter of a grain hyswelling
disappeared and the structure and podermically, or if there be any hesitation
outline of the bone resumed its normal ap- about giving this dose, one-sixth ef a grain
•
pearance.
can be given, and this repeated in about ten
minutes.
Treatment of Angina Pectoris.— Allbutt
(Folia Therapeutica) believes that of all Male Characteristics Developing in a i
the dangerous maladies this is the most Girl.— In The Med. Press, London, Thumamenable
to treatment. There are three ^ni reported the case of a girl, aged 17
objects to be attained in treatment : First, years, who first menstruated at the age of
if possible to mitigate the lesion of the at- fifteen, but not again. At that period
tack; second, to reduce the stresses; and luxuriant beard began to develop; hair als
thirdly, to block the inhibitory influence on grew on the breast and on the linea alba,
ihe heart. To combat the local condition and the voice became deeper, but the figure
directly we may use antidotes, such as sali- remained feminine. The external genitals
cylates if there be rheumatic condition; were those of a female, the uterus was nor-s;
iodides and mercury if syphilitic; also spe- nially developed, and the ovaries could bej
cific treatment for gout, if that be present, plainly felt under an anaesthetic as smallj
The toxins of other diseases, such as influ- liard substances. The girl died from sepsis
enza, cannot be directly neutralized. To commencing in a panaritium. The autopsy
reduce the tension, gentle and frequent mer- showed well-developed maminse, female
curials, such as calomel, with laxative min- genitals and a feminine pelvis. The ovaeral
waters, calomel, salicylates, iodides, ries were small and hard without any trace
and strict diet may be employed. Flatu- of ovulation. The right supra-renal body
lence and catarrhal states of the stomach contained two brown nodules, and the left
must be relieved. Meals must be restricted was converted into into a tumor as a large
in quantity, carbohydrates must be used as a man's fist, which proved to be a struma

ABSTRACTS.
juprarenalis. The thyroid was enlarged, •sj«€««€€Se*S€e!$S*r$-$;5SSS:'$i$S$S*$i$,
3Ut the hypophyses were not. The case %
yas Iherefore, one of atrophv of the germ ^"^ J; cj t ^'--'^ T T » « ;!;
jlands ds with witl: hypertrophy of those of the 4 1 Ollet ^^^-^OyP^ieniC %
I'ascular system
Urachal Cyst Simulating Appendicu.
| ANTl^PPTir^^ *
ar Abscess; Arrested Development ol 4
|
/».i ^ II ttOl^X 1 IVO
[Genital Tract.— Doran, in The London 'k . a,-. . • il
,» r J 1 T i i- »i r ;!; H;:trrra After trvinE: various aeents -P
iMed.cal Lancet, mentions the case of a pa- * feai recommended for the hygiene of |
:ient, a girl of l/'j years, who complained /fi ~!?H.| the toilet without satisfactory
)f pain in the right stde of the abdomen for % S:5^=3j results, give Tyree's Powder a *
)ne month previously. On examination a ^^m i» chance. Try a twenty five cent ^
ii- r '
I J 1 »i • i_^ r .1 W r DOS. It has tfle Dlehest indorse- 'ft
arge swelling was found to the right of the * ments from ^cient.s-s ai:d practitioners. |
nediuin line; there was no fever. The va- g who have used it tor a great many years %
jina was only two inches in depth and a * witu unfailicg results in Leocorrhea, Gon- \t
small opening leading to a canal was dis. | ""'^ff- Y?^'°''^?; P'^'itus, etc.. as well as %
1 . ., J ,1 t 1 . 1 S> Prickly Heat, Ulcers, Poison Oak, Tender cK
:overed at the upper end, through which % ^^^^^ ^offensive Perspiration, Hi^es, Ec- %
he menstrual flow was seen to come. At j}> zema, Old Sores, and Catarrhal Conditicas *
jperation the mass was found to be a cvst «t> °^ ^^^ Nose and Throat. ^
)f the urachus containing clear fluid. The %, ^\ neither pains or stains. Is odorless jj>
^ J 1 .1 1 1 1 1 I ? ana economical, without the all pervaomji "i
:yst was connected to the bladder by means vj/
^^1, jaie odor of Carbolic, Iodoform, eic. ^ t.
)f a cord and the upper end lay just beiieatli ^ Be sure you get Tyree's Powder. A 3/
he umbilicus. In addition the uterus was ^K sample and booklet containing its compo- #
•oundtobebicornate, both horns lying be- «> sition bacteriological and clinical poten- a>
J ,. . » .1 » i, %-i »•/ cies furnished the profession free upon w
ow and ad.iacent to the cyst vvallr 1 he «> appij^ation. >'?
;yst lining was removed and the cavity was % . _ „„„„„ -,, • i m v » n n (!i
>losed by buried sutures: the patient made * J- S. TYREE, CliemiSt; WaSniDgtOD, D. C. |
m uneventful recovery.
Doran reviews the pathogenesis of those
:ysts. The epithelial lining of the urachus. always causes more or less cardiac weakeniccordiiig
to Wutz, grows steadily up to the ing, and this may sometimes become spe-
>.5th year, and in about one-third of the ciallv manifest. '
The erroneous idea as to
:ases cystic dilatations of the canal are the effect of sodium salicylate on the heart
sresent. The writer found that the vesical has led to its being given oiilv in small
)rifice of the urachus is guarded by a trans- doses. The addition of double the quantity
rerse valvular fold. Others have found of sodium bicarbonate is an effectual means
hat in a considerable number of cases, the of diminishing side-effects, and the unpleasipper
wall of the bladder presents a diver- ant taste may be covered bv glycerine and
iculuin of varying depth, sometimes even peppermint water or chloroform water.
is far as the umbilicus. A urachal mesen- -f ijjg combination should be given in freery
is not uncommon. Cysts of the urachus quent and increasing doses until the occursresent
themselves in four different types: rence of any unpleasant side effect is ob-
.1 ) with fistukee: ( 2 ) primary cystic fistukx; served. The paper gives full details of the
rommunicaling with either the bladder or treatment of acute and subacute rlieumahe
umbilicus: (.ij pure urachal cysts; (4) tism by this means.
lecondarv cystic fistula;, deleloped from —:, _ „,.
mre cysts whieh have acquired communi-
Toxicity ol Mother's Milk.
:ations with the bladder or the umbilicus. Raymond Francois believes that he has
The author guards against the temptation «een cases in which the milk of its own
o call all cysts in the neighborhood be- mother has been an evident poison to an
ween the bladder and the umbilicus, ura- infant, while it would thrive on the milk of
:lial cvsts. .Many of these are merely cases wet nurse or on artificiol feeding. He be-
•f encysted peritonitis, tubercular or other- I'eves that there are conditions in which
yise. the human milk has a toxic effect on the
infant. This poison is evidently in the
Sodium Salicylate in Rheumatism.— xnWV, and is due in general to some form of
.«es: (Proc. Royal Soc. Med.) says that intoxication in the mother, the poison of
odium salicylate, when given to a rheu- which is carried over into the milk. It has
natic patient, does not cause any weaken- been shown that coloring and other matters,
ng of the cardiac action. The idea that it diphtheria antitoxin, etc., are carried over
S a depressant probably arose from the i„to the milk. Menstruation, dyspepsia,
nresence of impurities in the drug during constipation, and similar conditions may
ts early apijlication; these are now rarely produce this poison.—Journal de Medecine
net with. But rheumatic taxsemia itself de Paris,

THE CHARLOTTE MEDICAL JOURNAL.
In Summer Complaints
ALKARHEIN
THI THIINfC OI
OF USE
IN INDIGESTION.
We do not claim that it will cure all cases of dyspepsia, but it will be sur-
prising how useful it will prove in very many derangements of the gastro-iutesti-
ual tract.
COMPOSITION--With Physiological Action.
Rhubarb A superior laxative because it does not impair but
2 1-2 Crams improves the digestion—Is a tonic, also astringent.
Golden Seal (with the acrid resin removed)—The great tonic
I 1-4 Crams and corrector of the mucous surfaces.
Potassium Bicarbonate
2 1-2 Grains
Pancreatin
Antacid. Increases Alkalinity of the blood and the
oxidation and excretion of effete matters.
Promotes intestinal digestion, converts starch into
I Grain sugar and dextrose; proteids into peptones; emulsi-
fies fats, digests the casein of milk.
Ceylon Cinnamon Valuable in atonic conditions of the intestinal mu-
1-4 Grains
cous membranes, with flatulence and diarrhea.
Spirit of Peppermint and a minimum of Simple Elixir is a menstruum that
will commend itself to physicians.
Think of Alkarhein in acid dyspepsias, flatulent colic, infantile colic, cholera
infantum, cholera morbus, diarrhea and all abnormal acid conditions of the ali-
mentary tract. Think of Alkarhein in these cases and prescribe it as thousands
of physicians have been doing for many years with the confidence boni of ex-
perience.
ORIGINAL WITH AND PREPARED BY
The Wm. S. Merrell Chemical Company
Manufacturing Chemists.
c:;iiNCHNrN/\Ti

TABLE OF CONTENTS FOR SEPTEMBER.
Table of Contents for September^ 1909.
Original Commanications.
VntilDxiu or Serum Thera'.v
in the Treatn ent of
Wh('0|jiiijr Cougrh, Measles
and Scarlet Fever, by
Sleplieii Harnsberger, M.
D.. I'atlett. Va.,
I'he Husint-ss Methods of
the rrofessioD.bv Dr. Edwin
C. Moore, Elm City,
X. V
Prophylaxis in Typhoid
Fevir. by W. P. Ilorton,
M.D., North Wilkesboro,
K. (•
rV Ca'^e of Osteomalacia, by
J. St'!ven Brown, M. I).,
A N-w'Theoiy Concerning
til,! Etiology of Adenoids,
Beii/.oate o! Soda
Alabama Medical Examiners,
Ostmipaths Succeed in
Ccorgia
Viiginia Medical Kxarain-
• ' Hoard,
.
Rex Hospital 163
Geriatrics, 164
Typhoid Problems, Iti-l
A Pathognomonic Sign of
Appendicitis 165
Editorial News Items 166
Marriages, 167
1^8 Deaths 167
Review of Southern Medical Literature,
169
Book Notices.
Manual of Therapeutics.
Parke, Davis ,S: Company,
Detroit Mich 174
The American Pocket Medical
Dictionary, edited by
W. A. Newman Dorland,
M. D 174
Tuberculosis: A Preventable
and Curable Disease,
by Adolphus S. Knopf,
M. D 174
Atlas and Epitome of Ophthalmoscopy
and Ophthalmoscopic
Diagnosis,
by Professor Dr. O. Haab,
of Zurich 175
Principles of Pharmacy, by
The Principal Way.s of Tuberculization
in theYoung
Infant, 187
Use and Abuse of Proprietary
Foods in Infant-feeding,
187
The Surgical Treatment of
Colitis, 188
Red Degeneration of Uterine
Fibroids Complicating
Pregnancy, i88
lodipin in Syphilis, 189
Typhoid Bacilli in the
Blood of Patients not Sick
with Typhoid 189
Complications of Suppuration
in Air Sinuses, 189
1
.
;
Chronic Gastric and Duode-
llendersonville, N. C.,. .
Amoebic Dysentery with
Abscess r Liver—Confirmed
at Autopsy, by
\Vm. Allan, M. D., CharloLte,
N. C,
The Apparent Divorce of
Modern Medicine and
Surfjery. and Some of its
Consequences, by J. Allison
Hodges, M. D., liich-
II, on,!, Va
of Post Oporative
by Henry Norrig,
i;uthorfordlon,N.C.
hric AK-cess— Repu;
I uf Two Cases, by T.
E. W. lirown, M.U..Asheviile.
N.C.,
Eczema, by Albert D. Parrolt.
M.D., Kinston, N.C.
lUr^ery and Surgical Literature
of the Kighteenth
Century, by T. E. W.
Brown, M. D., Asheville,
N.C.
Editorial.
The Physician.-* National
Boanl of Regents,
Dr. Ciiiis Duffy,
X-Uav Burns
Merlianiiul Vibration
nal Ulcer,
190
Methods of Cataract Extraction
190
Uterine Cancer,
191
Fatal Case of Pernicious
Vomiting of Pregnancy, 191
X-Rav Treatment of Uingworm
of the Scalp
191
A Caseof Tuberculous Meningitis
without Tubercles 192
The Fate of Damaged Joints 193
The Condition of the Heart
Henry V. Arny, Ph. G., and Lungs after Abdomin-
Ph. D.,
175 al Operations,
193
A Magazine of Merit, 175 The Antisepsis of Abortion 19.3
A Candid Judge 1T6 Functional Albuminuria in
the Infanl 194
Abatracte.
Acute Necrosis of Skin, 176
Opium in the Therapeutics Prognosis in Tetanus 177
of Infancy, 181 Treatment of Tuberculous
Scorbutic Etiology, LSI Peritonitis by Means of
Cardiac Pain 181 X-rays,
177
The Surgery of Lingual Now Methods of Treatment
Thyroids 182 of Gastroenteritis
177
Cerebrospinal Fever 1(

202 THF CHARLOTTE MEDIOAL JOURNAL
Treatment ol Cerebro-Splnal Mentngl- hemorrhage, to which the patient sue- ;
tis with Ficxncr's Scrum. -In the Edin- cumbed. The abscess had apparently emp- ,i
burjjh Medical Journal Ker describes his tied itself through the auditory meatus, as i
experiences of this treatment in a series of no more pus was noted later on; but, neverthirty-three
cases during a recent epidemic theless, the venous wall became eroded ^^
of cerebro-spinal meningitis in Edinburgh, through the abscess, which infected the re- j
The normal dose adopted for children was suiting hematona. ]
30 c.c. if possible, but if much less fluid
than this amount was obtained on lumbar
OP

ion ceosed rather abruptly above at the
evel of the ductus arteriosus. Considerable
jnd-arteritis was present, with nodular
hickeningsof the iutima, but without ulcerition.
About an inch above the aortic
)rifice the inner and middle coats had been
cm by a transvere rent, extending almost
lompleti-ly round the vessel. From the
nular rent, a second rent proceeded in an
ipward vertical direction in the posterior
part of the vessel. Towards the pulmonary
irtery this ruptured part of aorta was seen
;o be eovered by a recent clot, and a dissectng
aneurysm, the size of a small walnut,
lad formed in this situation, burrowing into
he sheath which is common to the twn
vessels. There was a small hole in the
iheath of the dissecting aneurysm indicating
;he rupture into the pericardium. The
meurysra was not manifestly due either U>
;ongeiiital syphilis or to the action of niicr..
jrganisms. The dissecting aneurysm prol
ibly originated at tlie time of the onset c;
pain in the chest, which was fourteen d;n -
jefore death.
Treatment of Chronic Degenerative
Lesions oi tlie Heart and Aorta.
James Harr says that the ultimate causes
ot theses degenerative lesions are frequently
set down to toxins in the blood, but he has
^ihown that at least in a large number
of these cases there is an increase in
the eiTete material iu the blood as evidenced
l)y tlic lower freezing point. Of all toxic
coTiilitions perhaps syphilis is the disease
most frequently associated with these
ch;niL;es, and Ur. Bramwell thinks that it
acts through the vasa vasoruni, thus impairing;
the nutrition of the vessel. Among
the other toxic agents he mentions typhoid
j
ABSTRACTS
you can depend upon it that the cardiac
muscle is still fairly healty and the aorta
fairly elastic. You should therefore lessen
their work by devoting your attention to the
periphrey. Vasomotor relaxants are here
of not much value except as temporary expedients.
If the patient have gouty kidneys,
the purin bodies and other nitrogenous
elements of food should be cut down
and there should be a free administration
of the bonzoates. If there is too much lime
fever, intestinal toxins, septicemia, influenza,
gout, myxedma, diabetes, lead, ergot,
and other pressor agents, as caffeine, theobromide,
digitalis, adrenalin, purin bodies.
The general opinion would seem to be that
in the system, all milk foods and jellies
should be eliminated from the diet, and de-
these toxic agents act directly on the walls calcifying agents should be freely used.
of the aorta, producing the 'degenerative The action of the skin should be encour-
lesif)ns, but it is his opinion that they act aged and graduated exercises should be
indirectly by raising and maintaining the taken. With high systolic and moderate
blood -pressure at a higli level, thusdestroy-
,ing the elasticity' and imijairing the nutrition
of the vessel walls. Were it otherwise
the iiulmonary artery would be affected as
or low disastolic pressure the elasticity of
the aorta is becoming impaired. When there
is a difference of mm. of mercury it is high
time to think of effecting repairs. The pa-
the aorta, which is not the case. The detient should be kept on a light, dry, nonpendent
arteries of the lower extremities stimulating diet, with little or no salt. De-
have a higher blood-pressure than in the calcifying agents as a rule are useful and
upper extremities, and the former are usually
much more affected with sclerotic changes
moderate catharsis should be produced.
When there is a high systolic and a low
• than the latter. He then considers how this disastolic pressure, a dilated heart, and high
'high blood-pressure in the aorto is main- intraventricular disastolic pressure, the diet
tained. If the systolic and disastolic pres- should be dry and nitrogenous if the kid-
Isures be both high, with a geutle gradient, neys are healthy; the bowels should be kept

204 THE CHARLOTTE MEDICAL JOURNAL. |
open and a course of digttalis, squills, and of origin of this condition; it may begin in
num vomica or srrychnine is beneficial, the glands and extend to the lungs, or vice i
These are not the cases for mountain climb- versa. Age is an important factor in de- i
ing, but for moderate exercise on the level, termining its origin. Unilateral adenopa-
{
When there ia high systolic and low dias- thies are found in children from two to five I
tolic pressure, with aortic regurgitation, the years of age. Tuberculosis of the apex is (
result is largely influenced by the amount found in children between six and ten years i
of elasticity left in the aorta. The diet of age. Bilaterial gland enlargement also (
should be light, dry, and nitrogenous, and occnrs at the same ages. Cure of these <
the exercise should be moderate. A course glandular enlargements before the lungs (
of phosphorous acid and strychnine often have been affected is qnite easy if the child |
answers well. When the systolic pressure is sent to live at the seashore for a consid- j
is failing, with a relatively high diastolic
pressure, the cardiac muscle is getting much
erable time. A short sojourn only produces
a cessation of the process for a short period,
j
impaired. In these cases the question of
the free calcium ions in the blood must be
and it recurs again. Radioscopy is very
useful in making the diagnosis between tu-
(
i
considered. In such cases small doses of berculosis of the glands and that of the
glycerophosphateof calcium and large doses apex. The germs enter by way of the lungs
of phosphoric acid are of benefit. When and upper respiratory tract to general,
!
i
j
the systolic and diasiolic pressares are fail- Rarely they enter from the intestines or •
ing and there is edema of the extremities, a descend from the rhinopharyngeal region.
temporary rest is highly beneficial. The —Archives de Medicine des Infants.
^
.
diet should be light, dry, and nutritious,
and nitrogenous if the kidneys be fairly Hydrotherapy in Hospitals. )
healthy. Sodium chloeide should be elim- According to Schaper, who has recently J
inated and a course of cardiac tonics pre- made a tour of Norway, Sweden and Den- i
scribed. In many cases of myocarditis the mark, all the larger hospitals of those conn- i
right coronary artery is much more affected tries are provided with a special pavilion i
than the left. A good cardiac tonic in such equipped for the giving of all kinds of <
cases consists of glycerophosphate of cal baths. The same may be said of many of 'j
cium, strychnine, and phoephoric acid. the leading German hospitals. i
A few of the hospitals in this country (
The Lower Segment of the Uterus. have introduced hydriatic measures, but in i
Cyrille Jeannin distinguishes the inferior
"^ost of the leading hospitals of the United i
segment of the uterus as the isthmus, or States there is still a sad lack of appliances lower third of the fundus. It is of great ^°^ ^^^ ^^e of water and other physiologic
importance pathologically and normally measures.
in When visiting a large Eastern
pregnancy. Its walls are much thinner
liospital recently, the editor made inquiry
than those '^^'th of other portions of the uterus,
reference to provision for the use of
In front it is thinner than behind. Its lower
water, and was told that the leading physilimit
is the ^'^^^
internal os. Its thinness pre- "^^^ 1^'^^ enthusiastic about hydrodisposes
to rupture of the uterus. Its form
therapy a few years ago, but his ardor had
^
1
r
1
a
ii
i
-i
varies with the presentation of the fetus, cooled off, and he had recently said nothing t
During pregnancy it lends itself to the de- *^°"^ '^- ^" f^^^- t^e opinion was enter- .,j
velopment of the fetus by stretching. By tained that hydrotherapy was one of those i
some it is supposed to be the cause of the
Passing fads which would soon be no more r
talked about than the sulphurreted hydro- i
beginning of labor. Its dilation by rubber
balloon is a most efficient means of indue- S^" method of treating tuberculosis, or any i
ing labor. In the early part of labor
other of the medical fancies which seem to f;
it
confracts, but later remains inert. During ^^^^ possession of a certain portion of the ^
medical profession from time to time. I
pregnancy the implantation of the ovum on
this segment is a frequent cause of abortion '^^'^ is a great mistake. Hydrotherapy lij
and of hemorrhage in
is placenta previa,
here to stay. It is not a new thing; it is ,*
During labor the adhesion of the ovum to not a fad. It is as old as the earth, and |
this segment is a cause of very slow though it
dilata- has been greatly neglected, will ^
tioti of the cervix.—La Presse Medicale.
gradually win its way to increasing recog- «
nition. Water is unquestionably the most j^
'
Tracheobronchial
Powerful, the most versatile, the most uni-
Adenopathies in Their
versal of all therapeutic agents.
Relations to Chronic Pulmonary
To be
sure, water itself is not curative.
Tuberculosis The same
in Children.
maybe said of every other remedy. The ifl
Charles Leroux, as a result of the treat- remedy does not cure. The cu.ative power !»i
ment of many cases of tracheobronchial resides wholly in the body. It is the blood j »i
tuberculosis, states that there are two modes that heals. The same forces are required Hi

to heal the sick man as to maintain the
well man in a state of health. The reparative
forces of the body are identical with
those forces which maintain the growth and
nutritive equilibrium. The curative powers
of the body can be most readily stimulafed
into activity and modified as necessary
by those natural aids to recovery which are
classed under the g^eneral head of physiologic
therapy.—Good Health.
Dr. Woods Huthison in his article on
measles states; "The very mildest and
most insignificant attacks may be followed
through carelessness or exposure by a fatal
bronchitis. Indeed in view of the distressing
which our histories of tuberculosis in
children the words, "came on after measles,"
it is highly advisable to watch carefully
every child as regards abundant feeding,
avoidance of overwork or overstrain,
and of all unnecessary exposure of infection,
wonder wet for two months after the
attack."
Waterbury's Metabolized Cod Liver Oil
Compound with Creosote and Guaiacol will
be found a remedy par excellent for the
cough following measles, and will assist
nature in her fight against the toxins.
Interpretation of the Porro uterus In
Relation to tbe TlUrd Stage ol Labor.—
Hart, in the ICdinburg Medical Journal, says:
When Porro, in lS7n, performed Ca.'sarean
section accordingto his well known method.
he not only made the first distinct advance in
the perfecting of that operation, but gave
obstetricians specimens on which the phenomena
of the third stage could be studied
in a way no other natural experiment has
since afforded.
Since 1SS6, when Barbour published the
most oustanding and able paper on such
specimens, the whole question of the third
stage mechanism has beeu debated without
any final agreement as to its nature,
and, indeed, at present an apathy on this
subject has come over ti.ie profession
over both investigator and practical obstetrician.
The real reason of this blight on investigation
has been that the question has
usually been investigated on the supposition
that the separation must take place
in such a way as to check heemorrhage,
i. e., during pain, and any view as to
its occurrence by any other mechanism,
after a pain, for instance, has been viewed
with the greatest suspicion, especially by
the general practitioner, to whom the
"relaxation after a pain" is anathema,
and "uterus like a cricket ball," the only
safe and satisfactory descriptive term.
Matthews Duncan held strongly that the
—
.
Sulpho-
Lythin
HEXAMETHrLENAMINE
u. s. p.
'Tablet No.6"
Cbolagogue, Biliary and
Urinary Antiseptic.
Effective in all conditions produced by
Hepatic InsufiBciency.
Effective in arresting, preventing and counteracting
bacterial invasion of the gallbladder.
Hence it is indicated in
Cbolangitis, Cbolecystitls and
Ctaolelitbiasis.
Effective in Typhoid Fever, as a preventive
and curative agent, being an Intestinal
Antiseptic.
Effective also in Toxemia of Pregnancy.
Sample, literature and clinical reports upon request
LAINE CHEMICAL CO.
Manufacturing Chemists.
NEW YORK.
placenta separated from shrinkage of the
I^lacental site, and when confronted with
the fact fact ascertained by Barbour—that
a shrinkage from 7 ins.x7 ins. to 4 ins.
x4 ins. did not bring about separation
merely remarked in the well-deserved eulogy
he gave Barbour, that he had no doubt
tlie placenta separated at a lower shrinkage
area.
After some leagth treating the pros and
cons, the doctor points out the following
faults:
1. The placenta is separated, or an attempt
is made to separate it, during the
pains—the wrong mechanism of separation,
I hold.
2. The uterus does not get the necessary
rest between its contractions, and thus inertia
is brought on.
3. When partially separated, the expression
may tear off the bulk of the placenta
or membranes from an unseparated
portion
The seeond method is to keep the hand
permanently on the uterus, wait for pains,
and not to compress the uterus unless there
are indications for it, the main one being
haemorrhage. The size of the uterus should
be noted, and only when its bulk markedly
diminishes, indicating separation,
should gentle expression of the uretus or
—

206 THE CHARLOTTE MEDICAL JOURNAL.
WE ARE MAKING
MUCH ADO
ABOUT
SOMETHING.
And that something is a tasteless preparation of Cod Liver Oil
Which does contain in its entirety Pure Norwegian Cod Liver Oil
Waterbury^s Metabolised
COD LIVER OIL COMPOUND
(Plain or with Creosote and Cuaiacof,.)
Is what its name implies, Metabolized or Changed Oil. Obtained by
the action of animal fat splitting ferments under normal conditions of
temperature. By using this preparation you avoid all objections to the
plain oil, and at the same time get its entire medicinal and food properties
in a form that will be tolerated by the most delicate stomach, and you can
rel}' on immediate assimilation. Waterbury's Metabolized Cod Liver Oil
Compound can be used wherever a general builder and reconstructive tonic
is indicated.
Supplied by all Druggists in full pint
unlettered bottles.
Literature covering process and samples furnished Physicians on
application.
WATERBURY CHEMICAL COMPANY.
No. 37 Pearl St., Home Offce, Toronto,
New York City. Des Moines, la. Canada.

THE
ADVERTISEMENTS.
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Corner West 7th & Church Sts, Charlotte, N. C.
D. A. Tompkins. President. E. C. Register
W. D. Witherbee. M. D.. Secretary.
M. D.. Vice-President.
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SPECIAL EQUIPMENT
The most Improved hydrotherapeulic apparatus, Complete Electrical Equipment,
Sun parlors, two Surgical Operating Rooms, Electric Elevators, Vacuum Cleaning
System and Rooms with Private Phones.
The Training School for Nurses consists of a Superintendant and Corps of forty
nurses.
CHIEFS OF THE DIFFERENT DEPARTMENTS
Medicine Surgery
EDWD. C. REGISTER, M. D. G. W. PRESSLY, M, D.
Nervous Diseases
J. P. MUNROE. M. D.
Diseases of Digestion
C. M. STRONG, M. D.
Eye, Ear, Nose und Throat
E. R. RUSSELL, M. D.
W. 0. NISBET, M. D.
A. M. WHISNANT, M. D.
J. C. MONTGOMERY, M. D.
For- F"iJth^r Infor-matlon Address E. B. C Re-gistet-, IW. D.
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W. D. WITHERBEE, M. D.
Genito-Urinary and Rectal Diseases
A. J. CROWELL, M. D.
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for board, milk, eggs and medical services. Best of references. Address
DR. MARY F. LAPHAM,
Highlands, North Carolina

208 THE CHARLOTTE MEDICAL JOURNAL.
pressure in the suprapubic region, accord- and animals is now universally admitted,
iiig as the placenta is in the lower uterine but it is not sufficiently perceived that the
segment or in the vagina, be employed, doctrine of evolution is applicable to many
This method goes on the theory that other sciences than biology. Recent rethe
placenta is separated after the pain, searches have indicated that in matter itthat
hand pressure will not separate it self there has been an evolution of elements,
safely at the time, and that the safe time with the ultimate survival of those which
to use hand grasping is after the placenta could endure the conditions of their envilias
separated. ronment.
Tge time for the third stage varies from n is, however, in the realm of pathology
20 minutes to an hour, and the practi- that the importance of evolution is of the
tioner who gives the proper time and fol- greatest interest to us. In the never-ending
lows this plan with the necessary patience struggle between an animal and the para-
Nature demands, will have the reward she gitic micio-organisms invading it, forms
always gives to those who understand and are slowly evolved which have greater and
obey her. greater power of resistance to the microbic
»» - .- , .. "
J „ .i.„i„„„ attacks, and thus in time a racial immunity
Darwin, Evolution and Pstbology. . ' , t. j t^i
of greater or less power is reached. This
The recent celebrations at Cambridge of jg well exhibited, for example, in the case
the centenary of the birth of Charles Dar- of measles. Through centuries measles has
win and of the fiftieth anniversary of the existed as an epidemic disease in this counpublication
of the "Origin of Species" were try, and by a selective removal of those in
remarkable not only for the wide area from whom the disease was of special severity a
which those taking part in the celebration race has arisen in whom measles is cornwere
drawn, but also, and even more, for paratively mild, though even at present
the unanimity with which the importance some 13,000 die yearly from the disease in
of Darwin's teaching was appreciated. England and V^ales. That this diminu-
The meeting at Cambridge emphasized the tion of the severity of measles is in no way
fact that the few who seem to claim that the result of a weakening of the virus is
Darwinism has been superseded are either conclusively shown by the result of the inthemselves
misunderstood or are not fully troduction of the disease to a race to which
acquainted with what Darwin really taught, the disease is ne^, when an appallingmor-
Those who know his teaching best are best lality rate will occur, as was terribly exemable
to appreciate how widely his ideas plified in the Fiji Islands some thirty-five
have penetrated into every science and how years ago.
adaptable in many directions those ideas
during the proceedings in honor of Darwere
and are so that it is extremely diffl-
^j,, ^^ Cambridge, Professor Metchnikoff
cult to say of any work done since his era
referred to the evolution of resistant strains
that it is directly antagonistic to his theo-
^f bacteria. In the lower organisms which
^'^^•,
.
, , , _ . , . possess to a high degree the power of rapid
The central and general idea of evolution
multiplication we are able to see ourselves
is very old, but until Darwin arose no simjj^^
evolutionary process at work. To the
pie or reasonable explanation had been
bacterium which passes through hundreds
given of the method by which this evoluof
generations in a day, that day is as a
tion might be brought about. Many had thousand years to higher organisms, and a
recognized the apparently progressive
bacterium'may undergo changes in a few
change in organic forms, so that there was ^ours by which its qualities are absolutely
an almost continuous slope from the lowest
^jodified. Its virulence as an agent of dislorms
to the highest but it was hardly de-
^^g^ ^^^, be enormously increased or profinitely
recognized that all these organisms
foundly 'diminished. The attenuation of a
might be part of a true genealogical tree,
virus, while passing through the body of a
Darwin was perfectly original in pointing
resistant host, is probably only another exout
that while change m organic forms de-
^j„ j^ ^f rapid evolutionary changes in mipended
on the variations and peculiarities
croorganisms.
present in every organism, the persistence . • ^ ,
i i j.jr ^ •
i
of these changes was dependent
^uch widely diilenng topics as racial
upyn their
powerof
addiction to alcohol and structural modifi-
agreement with the conditions in
cation in parasites
which
can be discussed from
the organisms were placed. The
question
^^^''
whether
Darwinian side but we have said
the variations are great
and immediate or slow and little is on an- f."°""b
to show that by a correct apprecia-
tion of evolution
other plane; the main
and he doctrine of the
doctrine depends on
^''''''''^^
the survival of those forms which are best
°^ '^^ ^"^^^ ^^'^ "^^'^''^^^ "^^" '^
adapted to the circumstances in which they enabled to penetrate more deeply into the
find themselves. The evolution of plants mechanism of morbic processes, and to un-

**<
I
mi
ADVERTISEMENTS.
To obtain the best results in
Anaemia, Neurasthenia,
Bronchitis, Influenza, Pulmonary
Tuberculosis,
and during Convalescence after
exhausting diseases employ
fellows' Syrup
of
Rypopbospbiies
Contains—Hypophosphites of Iron,
Quinine, Strychnine, Lime,
Manganese, Potash.
Each fluid drachm contains the
equivalent of
Special Note.—
( -64th grain of
pure strychnine.
Fellows' Hypophosphites
is Never Bold in Bulk.
Medical letters may be addressed to
The Fellows Company of New York,
26 Christopher St., New York.

210
THE'CHARLOTTE MEDICAL JOURNAL.
derstand more fully the complexities of im- pure, crystalline form from the seeds of
munity which pievail in the animal world. Strophanthusgratus. This gratus-strophan-
—London Medical Lancet.
thin Thorns, manufactured by Merclc, was
^ employed in 3>2 patients bv P. Fleischmann
The dose given for
.
strophanthin is usually h to 1 Mgm:, but
Francesco Fulci, after going over the
^^^j^ ^^^ p^^.^^ cr>'stalline preparation no
literature with reference to the possible oc- i.^
^^^^ ^^^^^^ Mgm. should be injected,
currence of tuberculous endocarditis, sums
^j^^ j-gg^^g gf a„ injection are very evident;
up by saying thai the opinions of authors
ygj-y soon the pulse will slow, 'the pulse
are still at variance as to the possibility of
amplitude rise, and within three hours
Tuberculous Endocarditis. and H Wjasmensky .
its occurrence. Perhaps these lesions are
(jj^^jegis begins. The lowest pulse-rate is
merely toxic, not caused by the actual
^^^^^^^ between six to eight minutes up to
presence of tubercle bacilli. This theory
ggveral hours after the injection. The durais
supported by the absence of specific bac-
^j^^^ ^f a^lion varies with the ease: someterial
lesions and of speciffc histological
^^^^^ j^ j^ ^jg^ desirable to give digitalis or
formations. Lesions of the same kind can
^^^^^ j^^^j.^ ionics. The best results are
be produced in dogs by injection of emulalways
seen in cardiac decompensation; less
sion of bacillus of Koch into the carotid
gjjgj,^ jg evident in pneumonia, scarlet, and
artery, after ligature of the ureter made the
^^^^^ infections, while the tarchycardia of
day before the injection. The result is spepj^t^isis,
carcinoma, etc., is usually not re-
cific granulations disseminated over the in-
'
^^^^^] l^^ ,5,,^ ^ase of Basedow's disease
ternal surface of the left ventricle and au-
^^^ p^j^^ ^^,^^^ increased in frequency. Unricle,
the aorta, and ventricular surface of
^Q^aj-d effects are seen very rarely, but the
the aortic valves. This tuberculosis may
^^^^ should not be too high in cachexia,
be produced without any trauma of the
Cumulative effects should be guarded
heart, either by direct injection of the speagainst,
particularly if the patient has been
cific bacilli into the heart, or by carotid injoking
digitalis.—Deutsch. med. Woch.
jeclion after suppression of the kidney . .
function. The examination of the lesions Etbylmorpliine Iodide in Opbttaalmology
showed necrotic, inflammatory, and reactethylmorphine
hydro-
,ve phenomena. The bacteriological ex-
^Me, has earned a well-established place
amiiiation showed few bacilh in the supe^^
ophthalmology, and quite recently the
fical fibrinous deposits vvhen the germs
^^^J^^^^^- j^^^ide has been recommendwere
injected into the blood. The author
^^^ ^,^,^^^^ diseases. F. R. v. Arlt
sums up two groupsof experiments on an-
[ ^^ ^^^ ^^^
imals made by himself thus: he dissents
^oes not dissolve quite as readily as dionin.
from the opinions expressed by others m
,,^^ of g^'u in the tears is importthat
he obtained no granules that were un- ^ P
J^
^^ ^^^ ^^,^_
doubtedly tuberculous: he never succeeaed
g'^'^^^^^ ^igg^i^e more readily in a salt soluby
endovenous injection 111 producing un^ ^
^^ ^^ ^.^^^ ^^ introduced
doubted inflammatory alterations of the
j^^o the eye with some salt, the pain' will
valves: Marchiafava after years of obser-
^, j^g, ^,\ked than with dionin alone. As
vat.ou never encountered specific endocar^
therapeutic activity is concerned, the
dial lesions in tuberculous subjects.-ll
.^^.^^ .^ skid to be equally as valuable as
i-oliclinico.
dionin, and is perhaps to be preferred for
Stropbantbin in Pure Form. children.—Therap, u. Hygiene.
The desire to standardize accurately
potent heart tonics, such as digitalis, has
led to the introduction of the term "'frogunit."
This refers to the amount necessary
Dyspepsia in Malarial Subjects.
V. Raymond and L. Salignat have had
under treatment at Vichy many cases of
to cause systolic rest within thirty minutes
of the heart of rana temporaria, weighing
chronic malaria contracted in tropical
countries, in which they have found chronic
30 to 40 Gm. Since the various prepara- dyspepsia to exist. In thirty of these cases
tions are not, however, ab.sorbed equally they have made accurate determinations of
fast from the lymph-sacs of the frog, it is the stomach contents and gastric chemistry.
a much better plan to employ principles They found that in 53 per cent, there was
known to be chemically pure. Strophan- hyperchlorhydia, in 33 per cent, normal
thin has latterly been employed for intra- chemism, and in 13 per cent, hypochlorhyvenous
use, where quick action is desired, dria. These troubles are found in recent
Most specimens of this glucoside are im- as well as chronic cases of malarial poisonpure
and amorphous, but recently Thorns ing, and are the results of various stages of
has succeeded in isolating the principle in the disease. The liver and spleen are also

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212 THE CHARLOTTE MEDICAL JOURNAL. f
In TREATING BRONCHITIS there is need for a remedy )
that will lubricate and exert a sedative influence upon the
mucous surfaces ; relieve the dry, hacking cough; promote
expectoration ; allay constriction and rawness of throat and
chest ; assist the inflamed membranes to return to their nor- •
mal condition and to resist future attack—and do all this
without upsetting digestion. .^
Angler's Petroleum Emulsion
will accomplish these results more surely and pleasantly ll
than any other remedy. j
Samples sent upon request. ANGIER CHEMICAL COMPANY, BOSTON, MASS. J
'
affected. There is hypertension and then produced by the same cells which formed
hypotension of the portal circulation, and it.—Archivio per le Science Mediche.
^
relaxation of the suspensory ligaments of
liver and spleen. All sorts of symptoms Landry's Paralysis. J
are presented in gastric dyspepsia of mala- c. H. Cattle recently reported a case of |
rial origin. In the beginning there is ex- Landry's paralysis. The patient was a col- J
citation of sensibility of the stomach, of lierv banksman, aged twenty-three, and had J
secretion, and of motility. Later succeeds taken alcohol to excess, as well as sat in
j
a period of depression, with dimunition of ^,et clothes a week previous to the onset of
j
secretion. Later succeeds a period of de- the disease. This began with muscular J
pression, with diminution of secretion. In pains, then he turned cold, sick, and dizzy, J
most cases there is more or less pronounced ^^d complained of numbness at the tips of
J
anemia. Treatment should include the use "
the fingers of both hands. The arms were
of quinine and hydrotherapeutic measures next affected, and after them the legs and
—Rivue de Me Jecine. trunk. Then the eyelids and mouth mus-
Hlstological Observations in Human Os- cles became weak; there was a little head-
leomalacia. ache and a slight cough. The pupils were
Gino Baggio has examined histologically normal and the temperature practically '
the bones of four victims of osteomalacia, normal throughout. The muscles were found ';
one man, and two women who died of in- to be weak or paralyzed in whole groups, ^
tercurrent affections in advanced life, though not wasted. There was no reaction '
There were found only islands of calcified of degeneration, the reflexes were abolished,
bone substance. The osseous trabeculae but everywhere sensation was normal. The 1
were traversed by canals filled with fibrous muscles were extremely tender when grasp- |
substance rich in vessels. There were three ed, and passive movements of the limbs .1
types of medulla, lymphoid, fibrous, and were very painful. The bladder and rec-'.^
fatty; of these the fibrous predominated, tum were not affected, and no bedsores oc- i!
The bone corpuscles found in the ossified curred, although he was in bed continuous- Ij
portions showed elongation toward the peri- ly for six months. For a time the intercos- ;
phery of the islands, their shape being pre- tal muscles were entirely paralyzed, so that -',
served only at the center. In the uucalci- there was imminent danger of respiratory jj
fied portions the structure consisted of failure.
fibrous tissue in large parallel bundles. Treatment resolved itself into strychnine^;
The corpuscles in the osteoid zones were and belladonna internally, and then strych-'^large
and with dilated, short prolongations, nine alternately with sodium salicylate. !
When the process of osteomalacic alteration Eventually he recovered sufficiently to be
is in progress the limits between soteoid moved to an infirmary, where he could get ,
and calcffiod tissues are changed coutin- about pretty comfortably with the aid of a '
ally by a dissolving of the calcerous salts wheeled chair.—British Med. Jour. 1
'-
'
\
I
i
'

ADVERTISEMENTS.
St. Luke's Hospital
1000 WEST GRACE STREET,
= RICHMOND, VA.
ISA.A.C Al. 'rA.'V^L.rOR,
Both
Owned and personallyconducted
by Dr. Stuart McGuire for the exclusive
use of his private patients.
Building erected for the purpose
to which it is devoted, and combines
the comforts of a home with the
conveniences of a modern sanatorium.
Location in residential section
convenient to all parts of the city
by means of the street car service.
Capacity for sixty patients, single
and double bed rooms, No wards.
Designed especially for surgical
and gynecological cases. No contagious
diseases, insane or colored
patients received.
Cost of bed, board and general
nursing from 114 to |i8 per week
For further information, address
the Secretary.
BROADOAKS
SANATORIUM
Morganton,
North drolina.
A Private Hospital for the
Treatment of Nervous and Mental
Diseases, Inebriety and DruE
Habits
A home for the Permanent
of SELECTED CASES
CHRONIC NERVOUS
MENTAL DISEASE.
OF
AND
JVX. I>.
Medical Officers reside in the SANATORIUM and devote their
whole time to its service. New addition just completed admits
of thorough classification of patients, and gives better faci-
lities for the care of all. Billiards, Tennis and other diverting
amusements.
Complete equipment for Hydrotherapy now being installed.
Correspondence with physicians solicited.
1

XXII THE CHARLOTTE MEDICAL JOURNAL. 1
A Convenient Cblorolorm Package. a condition absolutely essential in the
treatment of rheumatism. In short, the 1
Much interest is being manifested in the
value of salol ni rheumatic conditions ,s
chloroform dropper- ampoule marketed bv so
Parke, Davis & Co., and which, in the ^^ understood and appreciated that
opinion of a good many physicians and ^^^her comment is unnecessary. The 1
surgeons,is the most convenient and practi- statements of Professors Hare and Gutt- j
cal chloroform package that has ever been >"^"" ^""e
f ^^^^ k"°J» ^"d to the point J
introduced to the profession. The nevv
^"^^ have been verified so often, that the
device is at once a hermeticallv sealed con- "^^s of Antikamnia & Salol Tablets'
""'^
tainer and a perfect dropping-bottle that
«* ""^^ apparent. Each of these tablets
contains
can be carried about in the emergency bag
two and one-^half grains of anti-
at all times in readiness for immediate use. ^^am-ua and two and one-half grains of j
'
'
^^'o^-.
It supplies inportable form enough
The proper proportion of the ingred-
of the
anesthetic for one service-about thirty '^"^^ '« evidenced by the popularity of the
tablets in all rheumatic con ditions.
grammes. The desirability of such an
j
,
individual package and its superiority over . ^. . „ .. . ^ ^
the ordinary amber, cork-stoppered bottle « A*^"*" «* Sanmetto In Gonorrheaheretofore
supplied is appreciated when one The philosophy of the action of sanmetto
]
' |
remembers that chloroform ill broken pack- in gonorrhea maj' be explained in this ^
ages rapidlv deteriorates under the influence way; Sanmetto has no direct germicidal
of air and light and becomes contaminated action in the treatment of membranous
with chlorine decomposition products. conditions due to the invasion of the gono-
The dropper- ampoule is, furthermore, a coccus. It should be borne in mind that
very economical package, as loss by
evaporation, spilling of contents, and detersanmetto
does not directly destroy gono-
cocci. Whatever may be its direct action
ioration are practically eliminated. The upon these germs, it is certain that it does
chloroform may be dropped directly upon not have any such directly germicidal inthe
mask with ease and accuracy. The fluence. What it probably does is to set
anesthetist lias perfect control of the out- up in the mucous membrane a reaction to
£
I
J
-t
flow and is enabled to regulate at his dis- the inflammation or a nutritive toning up '
'
cretion the intervals between drops. of the parts, which brings to the parts a •'
Physicians desiring further information sufficient reinforcement of leucocytes to
relative to the dropper- ampoule are advised over^vhlm the germs—the gonococci.
to write to Parke, Davis & Co. for their This view of the action of sanmetto exillustrated
circular descriptive of the new plains the a; parent aggravation which
J
i
package, addressing them either at their sometimes is set up in the treatment of ;
main laboratories, Detroit, Mich., or any chronic inflammation of the bladder and ;i
of their branches. urethra, and a consequent sloughing off -'
. of shreds and purulent matter, causing the J
AntlpyreHc, Analgesic and Antiseptic
patient to think the sanmetto has made his j
Powder. case worse, but which really is but the "!
smoke of the battle in which sanmetto is
In speaking of the treatment of articular to be the victor and the gonococci the
rheumatism, Hobart A. Hare, M. D., Pro- vanquished,
fessor of Therapeutics in the Jefferson Medi
cal College and Editor of 77ie Therapeutic
Kelene (Pare Cblorlde of Etiiyl).
6^a~f/'/t', says: "Any substance possessing In pathological laboratory work. Dr.
strong antipyretic power must be of value writes: "I have discarded altogether the
under such circumstances." He further use of CO2 and ether as mediums for
notes that the analgesic power of the coal-tar freezing specimens in making sections. I
products "must exert a powerful influence use the ordinary microtome and place a
for good." The lowering of the fever, small section of the tissue to be examined
no doubt, quiets the system and removes the on a block used for that purpose, which is
delirium which accompanies the hyperpyre- placed in position for cutting in the microxia,
while freedom from pain saves an tome. I then throw a fine spray of Kelene
immense amount of wear, and places the (Ethyl Chloride) on the tissue, which is
patient in a better condition for recovery,
The researches of Guttmann show conclufrozen
in two seconds hard enough to get a
beautiful section. The whole procedure
sively that these products possess a direct does not take over two minutes and but a
anti-rheumatic influence, and among those
remedies, antikamnia stands pre-eminent
very small amount of Ethyl Chloride,
"It is much more rapid, and no additional
as an analgesic and antipyretic. Hare, microtome is required, as in the usual
in his Practical Therapeutics: says "Salol case."
renders the intestinal canal antiseptic," Glass Automatic Spraying Tubes avoid
'
f

UNpT. il
ADVERTISEMENTS.
Aseptinol Manufadaring Company,
'Baltimore^J^d.
LIBER'' L SAMPLE TO PHYS/C/ANS A NO NURSES.
LAXOL
A PURE CASTOR OIL
Rendered by a new and improved
process, which retains all the valuable
medicinal properties of the ordinary
oil, without its nauseous taste. Made
palate-appealing by the' addition of
fbvorlng agents.
"SWEET AS HONEY"
Laxol Is suited to all ages and is re-
tained by the most delicate stomach.
Samples and literature, upon request. 4
LAXOL T
168 Dtune Street NEW YORK i
1
Pine Ridge Sanitorium.
A Modem and Most
Tliorouehly
f^"''''''Ke
Treiitmciit of Lar\-n(!eal
and Pulmonary Tubercu-
"Dcar Doctor: If you
are coing to send your
Tubercular Pntienla to
the best climate in tlie
world. "Tlie Sunny
South." W(
advantages
SAL HEPATICA
For preparing an
EFFERVESCING ARTIFICIAL
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Superior to the Natural,
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i.axaUve Salts of the most celebrated
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irCAIIIifimTIVtl
WiHUNlUWIUl.
luiACIDSOLVii
BRISTOL - IITERS CO.
377-370 Greene Avenue,
BBOOKLYN - NEW YORK,

XXIV THE CHARLOTTB MBDICAI. JODRNAL
'
all waste of material and insure absolute a dressing for ulcers, wounds, skin diseases,
purity. etc., it has no equal, and is universally both
"Kelene" requires no steam valve for recommended and used by America's most
discharge. Simply press the lever and the prominent surgeons and physicians. As a
automatic sprayer will do the rest. Glass general surgical antiseptic, it not only intubes
alone insure absolute purity.—Fries hibits but destroys bacterial growth. Cam-
Bros., New York. pho-Phenique should be a permanent fixture
•
•me Earliest Symplom ol Enlarged
Prostate.
to all medicine cases.
^^^^, inquiry for a sample, addressed to
the Campho-Pheniqne Co., St. Louis, Mo.,
Increased urinary frequency, chiefly noc- will receive immediate and courteous conturnal
in character, is the earliest and most sideration.
frequently encountered symptom of enlarged
prostate. Many cases of hypertrophied The Modern Treatment ol Hay Fever.
prostate might never develop beyond this Whatever be the accepted views as to the
point if sanmetto was administered as a pathology and etiology of hay fever, there is
prophylactic, and the discomfort of rising little difference of opinion concerning itsimtwo
or three times at night to urinate, to portanee and the severity of its symptoms,
say nothing of entering upon a catheter An agent that is capable of controlling the
life, might be avoided.
- catarrhal inflammation, allaying the violent
It is especially in the chronic prostatic paroxysms of sneezing and the abundant
hyperplasia which we find in old men, alwaysassociated
with chronic vesical catarrh,
lacrimation, cutting short the asthmatic
attack wnen it becomes a part of the clinical
that sanmetto gives the most brilliant re- ensemble, and. finally, sustaining the heart
suits. Number of cases can be recited in and thus preventing the great depression
which the use of sanmetto alone has not that usually accompanies or follows the
only relieved the vesical irritability, but attack—in short, an agent that is capable
has seemingly reduced the hypertrophy of of meeting the principal indications—must
the prostate and enabled the patient to dis- prove invaluable in the treatment of this by
pense with catheterization and micturate no means tractable disease,
unassisted for the first time in years. In the opinion of many physicians, the
most serviceable agent is Adrenalin. While
Painstaking doctors whose experience not a specific in the strict meaning of the
and skill are recognized by the consulting word. Adrenalin meets the condition very
medical specialist are frequently called upon effectually and secures for the patient a posito
exercise judgment in the selection of live degree of comfort. It controls catarrhal
antiseptics, whether for the treatment of- inflammations as perhaps no other astrininflammatorv'
affections or for general use. gent can. It allays violent paroxysms of
It is therefore quite natural that under such sneezing and profuse lacrimation by blanchcircumstances
they would be anxious to ing the turbinal tissues and soothing the
select a non-poisonous antiseptic, the use of irritation of the nasal mucosa which gives
which would reflect credit upon their ex- rise to those symptoms. It reduces the seperience
and judgment.. The recommenda- verity of the asthmatic seizure, in many
tions of leading hospital practitioners based instances
on the very highest clinical tests, form one relief.
affording complete and lasting
of the best guides in such cases. In select- There are four forms in which Adrenalin
ing Tyree's Antiseptic Powder, they will is very successfully used in the treatment
merit the commendation of both the phy- of hay fever: Solution Adrenalin Chloride,
sician and the patient, as the Tyree Powder Adrenalin Inhalant, Adrenalin Ointment,
is free from all the objections found in other and Adrenalin and Chloretone Ointment,
antiseptics. Tyree's Powder has stood the The solution, first mentioned, should be dimost
exhaustive clinical tests and is used luted with four to ten times its volume of
and recommended by many of the leading physiological salt solution and sprayed into
physicians and hospitals of America and the nares and pharynx. The inhalant is
Europe. Exhaustive chemical and bacterio- used in the same manner, except that it
logical analysis together with a box of requires no dilution. The ointments are
Tyree's Powder will be mailed free of supplied in collapsible tubes with elongated
charge to any physician by the manufac- nozzles, which render administration very
turer, J. S. Tyree, Washington, D. C. simple and easy.
It is perhaps pertinent to mention in this
Campho-Pbenlque.
connection that Messrs. Parke, Davis & Co.
As an antiseptic, as also an anaesthetic, have issued a very useful booklet on the
Campho-Phenique, for the past 25 years, sabject of hay fever, containing practical
lias fully demonstrated its superiority. As chapterson the disease, indications for treat-

ADVERTISEMENTS.
^^^2ZSi^^
aohannfoj
MALT
REPRESENTS THE MOST
VALUABLE COMBINATION
OF TONiC AND RESTORATIVE
KNOV/N TO MEDICINE
EACH WINeCLASSFUL CONTAINS ONE GRAMME
OF THE PEPTONATES OF MANGANESE AND IRON
EISNER- MENDELSON CO., New York
University College of Medicine.
Tlir Sl.tc Eiaminina Board Slalislics For GradualB of 1908 Show
Virginia leads adjoining States— North. South and West ReCOrd, 94..5%
U niversity College of Medicine leads Virginia. Record, 97.7'/
Also leads all medical schools in Virginia, on fitteen year period, Record, 91.8'^
SIMILAR RESULTS IN DEPARTMENTS OF DENTISTRY AND PHARMACY.
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every advantage. For catalogue and other information apply to
CHAR1.BS F. BE\/J\N. in. D., DBAIN,
Cor. Calvrert and Saratoga Sts., Baltimore, ma.
|

THE CHARLOTTB MEDICAL JOURNAL.
ment, preventive measures, etc. Physicians
will do well to write for this pamphlet, addressing
the company at its home offices in
Detroit or any of its numerous branches.
Treatment of Gonorrbea.
Hand injections are not popular in France,
and most cases of gonorrhea are treated
either according to the method of Fournier
or Janet. The former simply gives bicarbonate
of soda with flaxseed tea during the
acute stage, and has the organ washed off
frequently, or applies a wet dressing. After
about fourteen days a small amount of copaiba
or cubebs is prescribed.
The more popular method of Janet calls
for irrigations of the entire urethra by means
of a weak solution of potassium permanganate.
Though the gonococci are directly
carried into the posterior urethra, a urethritis
is a very rare complication here.
During the acute stage, when the secretion
is purulent, oxycyanate of mercury, 1 :4000,
or albargin, 1:1000, is superior to the permanganate.
The abortive treatment is only
rarely employed. The following is an excellent
method, if the discharge has not persisted
for more than three days and is more
sero-mucinous in character; The first day,
a few cubic centimeters of a 1 to 2 percent,
solution of silver nitrate are instilled into
the anterior urethra; a few hours later, the
anterior urethra is irrigated with a 1:2000
permanganate solution. This is repeated
on the second day, and on the second sitting
of the same day a 0.5 per cent, cocaine
solution is injected, and the irrigation repeated
into the bladder. Two irrigations
daily are given for five to six days, then
one irrigation daily. The strength of the
permanganate is later diminished to 1 :4000.
Complications are rare, and a cure generally
sets in from two to four weeks. Where
there are no gonococci, but a pronounced
mixed infection, some prefer bichloride,
1:20,000. In chronic gonorrhea, all the
glands must be carefully examined, especially
by palpation and massage. The treatment
consists in massage and irrigations of
permanganate, 1:3000. For involvement of
the anterior glands, massage may also be
practiced, or the glands are emptied by
means of a Kollman dilator. For infiltrations
in the anterior canal, sounds are in
place, or electricity is recommended, while
softening ointments or injections are only
rarely employed.—Muench. med. Woch.
Epsom Salts In tbe Treatment of Warts.
J. B. Ridley recently had under observation
two cases of verruca plana of the hands
and face, one of which has been successfully
treated by Epsom salts. The first case
was that of a girl, aged twenty years, who
presented herself at the skin hospital on Feb.
3 of this year suffering from warts of six
years' duration. Upon inspection the dorsal
surface of both hands was covered with
warts of considerable size, while in addition
there were a few scattered ones on the
neck and around the mouth. She was put
on Epsom salts in dram doses thrice daily,
no external application was given, and by
March 24 the warts had entirely disappeared.
The second case was a little boy, aged
four years, seen on April 21, suffering from
warts of seven months' duration. The dorsal
surface of both hands was much affected
with them and a few were also to be seen
about the mouth. He was treated with
Epsom salts in dram doses twice daily, but
as he had only been under treatment for a
short period there was no marked effect at
the time of the report, but the author had
no hesitation in saying that in the course
of a few weeks more they will have entirely
disappeared.
Some fifteen years ago he treated a little
girl, aged ten years, for extensive warts of
the face and body. He gave her Epsom
salts in dram doses twice daily for over
three months; at the end of this time the
whole of the warts had entirely vanished.
None of these cases ever complained of any
unpleasant symptoms.—The I^ondou Medical
Lancet.
Typhoid Bacilli In Sputum. !
Lung complications of severity during |
typhoid fever are not very common; nevertheless
they occur with sufficient frequency
to make them of decided clinical importance.
Their bacteriology has been investigated
by Dr. Stefanelli, in I'lorence, and he
finds that out of fifteen patients suffering
from typhoid fever and from intercurrent
lung trouble, as follows:—Severe diffuse
bronchitis, 2 cases; broncho-pneumonia, 10
cases; lobar pneumonia, 3 cases, the sputum ;
contained the Diplococczus pneumontBm. every
instance, and the Bacillus typhosus in six
out of the fifteen. The importance of this
from the point of view of the spread of the
disease is obvious— it must be dangerous to
have a case of typhoidal pneumonia coughing
in proximity to another patient's bed.
It is also of importance from the point of
view of treatment; for the vaccine treatment
of pneumonia requires a precise knowledge
of the bacteriology of the lung trouble in
each individual case. It is hardly possible,
if both pneumococci and typhoid bacilli are
present in the same sputum, to say for certain
which is causing the bronchitis or the
pneumonia; but the diplococcus is very
common as an ingredient of normal sputum,
.

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tHYMOlINE
CATARRHAL
CONblTIONS
and Utero=Vaginal
Kress

XXVIII
THF CHARLOTTE MEDIOAL JOURNAL
whereas the typhoid bacillus is not likely the coma of opium poisoning and that from
to be adventitious. The point needs further zerebral hemorrhage.
investigation, but it seems likely that in a
ease where sputum contains both pneumococci
and typhoid bacilli, the latter are the
cause of the lung trouble, and a pneumococoal
vaccine would be unlikely to do
much good.—The Journal of Clinical Research.
State Board Examination Questions of
Itae Illinois State Board of Examiners.
AN.\TOMY.
MATERIA MEDICA AFD THERAPEUTICS.
1
.
Write a prescription for an alterative,
and give indications for its use.
2. Write a prescription for a cardiac
stimulant and another for a cardiac depressant,
and give the indications and dangers
of each.
3. Name the preparations, therapeutic
indications, doses, and dangers of belladonna.
4. To what class of remedies does nux
1. What are the Graafian follicles? vomica belong ? Give preparations, doses,
What is the discus proligerus? therapeutic indications, and dangers.
2. With what bones does the inferior 5. Define antiperiodic, and give examturbinate
bone articulate ? pie with dose and indications for ure.
3. Give origin, insertion, action, and 6. Name one or more internal autisepnerve
supply of the brachialis anticus mus- tics, and give dose, mode of action, and
cle. uses.
4. What is the commencement of the 7. Define antipyretic, and give two exinnominate
artery? What is its length? amples, with dose, mode of action, and uses
Where and into what does it bifurcate? of each.
5. In the adult, which is the smallest 8. Define diuretic. Give two examples.
and which is the largest branch of the celiac Explain the physiological action of one,
axis artery ? with indications for use.
6. In ''Pott's fracture" you will find 9. Define oxytocic. Give ezample with
the foot everted. What muscle produces dose and use.
the eversion ? 10. Name one diaphoretic, and give phys-
7. Name the openings in the diaphragm, iological action in detail.
What nerves supply the diaphragm ?
CHEMISTRY.
8. How many pairs of cranial, and how
many pairs of spinal nerves are there? 1- Describe a process for the manufac-
9. Briefly describe the ventricles of the ture of sodium carbonate or soda, as combrain.
monly called.
10. Name the muscles attached to the 2. What do the following formulae rep-
lower end of the femur.
resent?
PHYSIOLOGY.
KNO2; KjCrOi; K>Cr207; KMn04; HCN.
3. Complete the following equation.
1. Discuss sleep.
Give name of compounds and resultant
2. Trace the blood from the time it en-
compounds:
ters the heart from the veua cava until it
leaves by NaN02-|-H2S04 =
the aorta.
4. Describe chloroform, giving its formula
and the preparation on the large scale.
5. Briefly discuss chemical action in
general.
3. Define reflex action. Describe a reflex
arc.
4. Name the important centers in the
medulla.
5. How would digestion be affected by
obstruction of the ductus choledochus communis
?
6. Explain why the gastric mucous
ETIOLOGY AND HYGIENE.
1. Give etiology of neurasthenia.
2. Give etiology of mitral incompetency.
membrane is not digested by the gastric
juice, Give the constituents of gastric
3.
4.
,
Give etiology of angina pectoris.
Discuss the prophylaxis of malarial
juice.
^i
7. ,. Describe ^......ethe the How are impurities in water classi-
disturbances of function ^
of the digestive system produced by excess- "^^ '^^"/hey be detected and why
^^fj '«
ive use of alcohol.
*^ presence of organic material m drinkg
water considered deleterious?
NEUROLOGY.
1. Give diagnosis and
PHYSICAL DIAGNOSIS.
treatment of
chorea
1. Give the etiology, pathology, and
2. From what artery is cerebral hemor- symptoms of spastic paraplegia.
rhage most likely to occur ? 2. Differentiate incipient phthisis from
3. Give differential diagnosis between bronchitis.

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3. Give the etiology, symptoms, and
pathology of tabes dorsalis.
4. Give the etiology, pathology, and
symptoms of edema of the glottis.
5. Differentiate between herpes goster
and prurigo.
OPHTHALMOLOGY AND OTOLOGY.
1. Give treatment of chronic otitismedia.
2. Give the symptoms, etiology, and
treatment of optic neuritis
THE CHARLOTTE MEDICAL JOURNAl .
7. Give the etiology, symptoms and signs,
and treatment of lobar pneumonia.
8. Give the diagnosis and treatment of
chronic nephritis, late stage.
9. Give the cause, symptoms, and treatment
of ascites.
10. Give the treatment of chronic fiirun-
culosis.
OBSTETRICS.
Describe the chief differences between
3. Give your treatment of contused jj^^ fg^j^j^lg P^l^ig .,„^^ ^l^e jjjale pelv
wounds of the eyeball
Give the various diameters of the in-
PEDIATRICS.
let and outlet of the pelvis.
1. Give the dose of the following drugs
3. Give a full description of the uterus.
for an infant three months old: tinct. acon-
4. Describe the treatment of a lacerated
ite, phenacetin, strychnine, morphine, anti-
perineum. When v.'ould you institute the
febrin, quinine.
treatment?
2. Give the symptoms and treatment of
5. What changes take place in the ovum
diphtheria.
PATHOLOGY.
1 Give a description of progressive mus-
after fecundation?
6. Describe the placental circulation.
7. Discuss the management of brow presentations.
8. Discuss briefly dystocia due to the
cular atrophy, with its pathology.
2. What pathological changes take place
in urinary stricture from a prostatic enlargement?
3. What tissue changes characterize in-
terstitial nephritis?
4. Define the term general anasarca.
and give the pathology of the leison which
most frequently gives rise to it.
5. Discuss the pathology of cirrhosis of
the liver.
foetus.
9. What is the uteroplacental souffle?
What is the funic souffle?
10. Describe in detail the contents of a
well equipped obstetric bag.
SURGERY.
1 Describe and give the varieties of pus.
What are the symptoms of suppuration?
2. BACTERIOLOGY.
Describe traumatic gangrene, and give
1 Give a method for staining the gono- treatment of same.
cocci. How do they appear under the mi- 3. Give the means and agents for the
production of local anesthesia?
croscope?
2. Describe and give characteristics of 4. Give the symptoms, diagnosis, and
bacteria especially connected with pneu- treatment of intracapsular fracture of the
monia.
femur.
3. What is the method of staining the 5. Give the symptoms of strangulated in-
bacillus of tuberculosis:
guinal hernia. Describe in detail hernioto-
-r. DescribTthe com.ua bacillus, and give my by the method you prefer,
manner of its introduction into the system. 6 Describe the sutures most commonly
5. Describe the microorganism associated used, jivmg the preparation
7. Enumerate the symptoms of cerebral
with malarial fever
compression, and outline proper treatment,
PRACTICE.
8. Give the etiology and symptoms of
1 Should you be called to attend a case
-
^
1^,^^^^^
of diphihena. dipl: and find that other children ^^^^ r^„.„:u. ,v,. „ffi„.;..„o ..f
Describe the affections of the skin due I
in the family have been thoroughly ex
oynhilis philis. j
posed, state fully what you would do for ,° ^^f, __ V
10 Give the etiology of anei-iysm. 5
the patient, the other children, and to pro-
GYNECOLOGY.
tect the public.
j|
''
2. Suppose you are called to see a case of 1. What is vicarious menstruation.
valvular disease of the heart with broken 2. How may vaginisms be recognized, '1
compensation, what would you do, what and what is the treatment? ,
would you give, and why? 3. Discuss the treatment of tumors of the': I
'
3. Give the etiology, symptoms, and mammary glands. !
treatment of peripheral neuritis. 4. Describe fully the two varieties oi| «i
4. Outline the management and treat- ovaritis. ;.''
ment of chronic constipation. 5. Give the etiology and treatment of kB| ';
5. Give the etiology, symptoms and treat- acute general cystitis. i
ment of cystitis. 6. Discuss the advantages and disadvan- I
I
^
6. Give the symptoms, diagnosis, and tages of the vagina as compared with thCj
treatment of hyperchlorhydria. abdominal routes in surgical operations, I
.

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physiologi-
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correct
food.
ADVERTISEMENTS.
Mellin's Foodwith fresh
milk is physiologically a
correct food for infants.
It contains the necessary
nutritive elements,
comhining" them in the
right proportions to give
baby fii'm, sound flesh,
and vitality.
There is no better way
of modifying fresh milk
than by using
Mellin's Food
The Sarah Leigh Hospital.
NORFOLK, VIRGINIA.
Offers many advantages to those patients
desiring a quiet, homelike institution combined
with every modern facility and equipment.
A private hospital, delightfully situated,
bright, well ventilated, amid attractive and
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Correspondence with physicians solicited
Southgate Leigh, M. D.,
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James H. Culpepper M. D.,
Associate Physician and Pathologist.
Stanley H. Graves, M. D.,
Associate Surgeon.
Miss M. A. Newton,
Superintendent.

THE CHARLOTTE MEDICAL JOURNAL.
LARYNGOLOGY AND RHiNOLOGY. was followed by scvere abdominal pain,
1 Give the appearance and effects of the tympanitis, and vomiting; temperature,
destructive action of syphilis on the larynx. 103.2 pulse 120; vagm.tis; condylomata;
'Toive the patholoS of acute rhinitis. ^^:^^^^-i±Z T. T.T/. 'l
MEDICAL JURISPRUDENCE
rupturing the membranes, and at this time
Whir postrn^ortem changes occur in the amnjotic fluid was found to be greenish
yellow, but the delivery was spontaneous
the tissues.
d easy. A few hours after delivery the
2. Describe rigo^morte.
^^^^^^ ^.^^ ^^^ ^^^^.^^^ ^^^^^^^^ p^^.^^
Saiodin in the Treatment In Sypbilis. jj^ig combined with right sided parametritis,
Benassi (Gazz. degli. Osped.) has been fibrinous pleuritis and septic spleen. In
testing the value of sajodin in the treatment the utenne wall a diffuse phlegmon was
of secondary and tertiary syphilitic leisons. found extending. nto the right parametrium.
Streptococci abundant. In commenting
It was tried in about fifty cases, but it was
only possible to watch the effect for any upon the case the author calls attention to
len-lh of time in twenty-two cases (eight the great likelihood of gonorrhceal infection
tertiary and fourteen secondary). Thedrug in the last weeks of pregnancy; the existis
a compound of iodine (24.5 per cent.) ence of a parametric abscess even before
and calcium (4.1 percent.). It is an abso- labor with intact membranes and closed
lutelv odorless and tasteless powder, and cervix; the rapid occurrence of peritonitis,
insoluble in water. The usual dose is 1 gm., from the parametritis; the rapid dehvery
given in a cachet. The author found sajo- although the uterus and its vessels were:
din a good substitute for potassium iodide diffusely invaded with streptococci. Thei
and the alkaline iodides. It acts quite as case also exemplifies the occurrence of in-,
well, and in some cases even better, than faction before labor ot cases dying within
iodide of potassium, and can be tolerated a day or two after delivery.— Zentralbl. f.
in larger doses; no iodism was observed even Gyn.
in patients suffering from gastric disorder
Diabetes Insipidus.
and under large doses. It may be used ^ , r i t .•
where one usually prescribes the iodide. It Engel reports some careful observations
is best tolerated when given at or just after on cases of genuine diabetes insipidus and •
a meal.-British Medical Journal. polyuria from other causes desigied to I
demonstrate the theory of Tallquist, Meyer 5
Advisability ol Lactation Daring Acute and others, that the primary symptom in r
Illnesses ol tbe Motbcr. tiijg disease is a polyuria, dependent on a ii
G. Guidi, fiom an experience of thirty characteristic disturbance of water metab- «
years in practice, together with experiments olism, which may be called a loss of the
on animals, gives it as his conblusion that Power of concentration on the part of the
in many acute diseases of the mother it is kiddey-an inability to secrete any but a
advisable to continue lactation. Stopping very dilute urine. In such a condition ft
it injures mother and child. The patient water would be withdrawn from the tissues H
should be carefully watched, fed so as to in proportion to the urinary solids to be ex- i
give the necessary amount of nutritive ma- creted and irrespective of the water intake, x
terial, and kept under the best possible hy- and thirst and polydypsia would be second
^
gienic conditions. As to the danger of in- ary. The urine would vary in amount ir »
fection of the child, it is slight. Either the close proportion to the intake of solids to b« I
milk has antitoxic properties, or the child excreted by the kidneys, and the concentra
j
is capable of producing antitoxic substan- tion would be nearly constant. In polyuru |
ces that protect it against the disease. The from other causes, the amount of urim ,
varies quite directly with the water intake ,
passage of bacteria into the milk does not
produce infection of the infant. The child and is largely independent of the amount c
could not be kept in the room with the solids, so that variations in quantity ar,
mother except when being dursed. Clini- usually less marked, while the concentra
cal observation and experimental study tion shows wide fluctuations.
agree in showing that the germs not infect Seven cases are described— four of dia
the child.-Rivfsta di Clini'ca Pediatrica. betes insipidus, and three of polyuria fron
other causes. In all of them careiul record
Acute Peritonitis Preceding Labor. ^^^.^ ^^^^ ^f quantity and concentratio:;
G. Leopold, (Dresden), reports a fatal of urine under different experimental con
case, rather rare, but yet instructive since ditions—varying diets, administration c
j
it displays the possibility of a fatal termin- such salts as sodium chlorid, withholdin ]
ation from infection before labor. A preg- water, etc. Concentration was determine \
nant woman was admitted to the clinic two by the lowering of the freezing point. [
days after having had the first child. This The four cases of diabetes insipidus ga\ j
1,

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XXXIV
—
THE CHARLOTTE MEDICAL JOURNAL.
results corresponding in every way to the the growth of the B. Coli. Others believe
theory There were wide variations in that lactic acid and Us salts and possibly
quantity of urine, but the concentration some other products of the lactic acidbacilli,
changed little and was always much below have this action, even after the germs have
normal Givin^-salt and withholding water been killed by heat; while a third group becaused
extreme discomfort, soon becoming lieves that the effects are due wholly to the
unbearable- the refractive index of the stimulus given to the digestive processes by
blood was much increased, but the urine the acid milk. Von Kern's experiments
concentration was practically unchanged, were directed to the question whether the
In the other group of cases there was no B. Bulgarus has any real inhibiting action
sign of constancy of urine concentration, on the growth of B. Coh, in vivo and in
and the patients could nearly always volun- vitro. His experiments on the living per-
tarily refrain from drinking to the point son consisted in counting the colonies ot B.
where the concentration was practically Coli in a givrn amount of fecal matter with
normal Moreover, drugs which ordinarily and wilhout the administration of sourmilk.
diminish the water diu.esis or increase the He found them always much diminished in
molecular diuresis had little or no effect in number under sour milk, In vitro, he tried
the diabetes cases, while on the other hand the addition of the toxins of B. Bulgarus
after a sin'rle incxestion of a large amount to cultures of B. Coll. In the first two cases
of water the resulting dilution of the urine the inhibiting action of B. Bulgans was
was less than normaC and appeared later, evident, but not very marked, while the
That the inability of the kidneys to excrete effect ot the toxins was very decided. He
concentrated urine was not absolute was concludes that sour milk, especially when
demonstrated in one case by the elimina- prepared with B. Bulgarus, the most active
tion of urine of normal concentration dur- of the lactic acid group, is distinctly indiing
an intercurrent fever, and in two others cated in acute and chronic intestinal disbv
a moderate increase in concentration turbances with fermentation, in diseases of
after prolonged withholding of water or the stomach with insufficient secretion, and
administration of salt. Drugs, such as the accompanying intestinal disorders, and f
strychnin, atropin, and antipyrin were found especially the "achylic" diarrheas.— Zeituseless
in these cases. schr. f. Klin. Med.
•
The etiology of the condition is still obscure
Auto^ies have demonstrated t^e
*
«--'|y-„^« .--re"n^- CV^. l^n^
absence of anatomical changes m the kia-
Pathological Conditions.
nev The ordinary cause of polyuria
. , , j- i. ui
namely, hydremia resulting from excessive M. Sav-are has examined the undializable .,
drinking, "does not exist here, as the poly- residue of the unne, which is m coiiSideruria
is primary and hydremia does not able quantity m normal and patho og.cal
occur the blood being, 'oil the contrary, conditions in pregnant women, and has inneorly
alwavsconcenlrated. Engel inclines jected the residue into animals to ascertain
to the theory that the polyuria is the result whether it has toxic properties. He finds
of a continual nervous stimulus originating that there are contained m the urine of
in the cord and acting upon the kidney, women who are in a pathological condition
and cites cases of disease of brain or cord while pregnant, especially when attacked
in which precisely similar symptoms liave bv eclampsia, elements that are markedly
been observed.-Zeitschr. f. Rlin. Med. toxic to the experunent annua s. causing
them to have stupor and convulsions, ana
Eilect of the "Yoghurt" Bacillus on killing two out of ten animals injected. The
B- Coll.
relation to the causation of eclampsia ol
Von Kern reviews the liierature regard- these toxic elements is not as yet clearly
ing the laclic acid bacilli as intestinal anti- defined, but should be further studied, smc«
septics ( r sliuiulaiits to digestion. It is it nuiv prove a fruitful field of observation
generally admitted, and apparently proved — Annali di OsleU-icia^ Ginecologia.
"
experimentally, that certain animals thrive
better under the administration of sour The discomforts of Hay Fever will sooi
milk, and that the constituents of the urine have to be contended with. The mos
resulting from intestinal putrefaction are satisfactory remedy is Suprarenalin in «,:
distinctly diminished.
various forms— solution, ointment, mhalaii'
There' are three main theories as to the and triturates. Suprarenalin is preventive
reason for this. Metchnikoff and his school in some cases and palliative mothers,
ascribe the results observed to a direct in- Where anesthetic effect is required wj l<
hibiling action of the living lactic acid or- suggest Eucapren solution; a combinatioi u
ganisms, especially the "Yoghurt" bacillus of 1% B. Eucain Lactate and 1:dOOO supra ijj
(B. Bulgarus) and B. Paralacticus, upon renalin.

ADVERTISEMENTS
The Success of Listerine is based upon Merit
The manufacturers of Listerine are proud of Listerine—because
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This measure of success has been largely due to the happy
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and that of the mild, non-irritating boric acid radical of Listerine.
Pharmacal elegance, strict uniformity in constituents and
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—

XXXVI THE CHARI,OTTE MEDICAL JOURNAL.
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SOUTHERN MEDICAL SOCIETIES,
MISSISSIPPI VALLEY MED. ASSOCIATION.
res., J- A. Witherspoon, M.D., Nashville,
;
,
Tenn. Vice Pres. Louis Frank, M. D.,
Louisville, Ky. Second Vice Pres.,
A. E. Sterne, M. D., Indianapolis, Ind.
Secy., Henry Enos TuUey, M. D.,
Louisville, Ky.
reas. S. C. Stanton, M. D. Chicago, 111.
ext Meeting St. Louis, Mo,. Oct. 12, 13,
and 14th 1909.
)OTHERW SURGICAL and GYNECOLOGICAL
ASSOCIATION.
nnual meeting at Hot Springs, Va., Oct.
5-6, 1909.
W. D. Haggard. M. D., Sec,
Nashville, Tenn.
Stuart McGuire, M. D., Pres.,
Richmond, Va.
SOUTHERN MEDICAL ASSOCIATION.
nnual meeting at New Orleans, La. Nov.
9-10-11-12, "09.
fScarDowling, M. D., Sec. Shreveport, La.
Giles C. Savage, M. D., Pres.
Nashville, Tenn.
BDICAL ASSOCIATION OF THE SOUTHWEST.
nnual meeting at San Antonio, Texas,
October, 1909.
. H. Clark, M. D., Sec, El Reno, Okla.
Jabez N. Jackson, M. D. Pres.,
Kansas City, Mo.
U-STATB MEDICAL ASSOCIATION OF THE
CAROLINAS AND VIRGINIA.
nnual meeting at Richmond, Va., Feb. 8,
1910.
i
I LeGrand
J Howell Way, M. D., Sec,
Waynesville, N.C.
Guerry, M. D., Pres.,
Columbia, S. C.
BDICAL ASSOCIATION OF THE STATE OF
ALABAMA.
nnual meeting at Birmingham, Ala., 1909.
J. N. Baker, M. D., Sec.,
Montgomery, Ala.
1 B. L. Wyman, M. D., Pres.
I Birmingham, Ala.
1 FLORIDA MEDICAL ASSOCIATION.
nnual meeting at Pensacola, Fla., April
7-9, 1909.
J. D. Fernandez, D. D., Sec,
Jacksonville, Fla.
J. F. McKinstry, Jr., M. D., Pres.,
Gainesville, Fla.
MEDICAL ASSOCIATION OF GEORGIA.
nnual meeting at Macon, Ga., April 21,
1909.
laude A. Smith, M. D., Sec. Atlanta, Ga.
Thos. D. Coleman. M. D., Pres.,
Augusta, Ga.
KENTUCKY STATE MEDICAL ASSOCIATION.
Annual meeting at Winchester, Ky., Oct.
1909.
A. T. McCormack, M. D., Sec,
Bowling Green, Ky.
Jonn G. Cecil, M. D., Pres.,
Louisville, Ky.
LODISANA STATE MEDICAL SOCIETY.
Annual meeting at New Orleans, La., May,
4-6, 1909.
E. M. Hummel, M. D., Sec,
141 Elk Place, New Orleans, La.
E. Denegre Martin, M. D., Pres.,
New Orleans, La.
MISSISSIPPI STATE MEDICAL ASSOCIATION.
Annual meeting at Jackson, Miss., April
13, 1909,
E. F. Howard, M. D., Sec,
Vicksburg, Miss.
J. W. Gray, M. D., Pres.,
Clarksdale, Miss.
MEDICAL SOCIETY OF THE STATE OF NORTH
CAROLINA.
Annual meeting at Wrightsville, N. C,
June 21, 1910.
D. A. Stanton, M. D., Sec,
High Point, N. C.
Jas. A. Burroughs, M. D., Pres.,
Asheville, N. C.
NEW MEXICO MEDICAL SOCIETY.
Dr. G. K. Angle, Silver City, N. H. Pres.
Dr. G. S. McLandress, Albuquerque, N. M.
Secretary.
Dr. C. G. Duncan, Socorro, N. M. Treas.
Next meeting at Roswell, N. M., in the
fall of 1909, the date to be announce later.
SOUTH CAROLINA MEDICAL ASSOCIATION.
Annual meeting at Summerville, S. C,
April 21, 1909.
Walter Cheyne, M. D., Sec,
Sumter, S. C.
S. C. Baker, M. D., Pres.
Sumter, S. C.
TENNESSEE STATE MEDICAL ASSOCIATION.
Annual meeting at Nashville, Tenn.,
April. 13-15 1909.
Geo. H. Price, M. D., Sec,
146 8th. Ave., N., Nashville, Tenn.
B. D. Bosworth, M. D., Pres.,
Knoxville, Tenn.
MEDICAL SOCIETY OF VIRGINIA.
Annual meeting at Roanoke, Va., fall of
1909.
Landon B. Edwards, M. D., Sec,
Richmond, Va.
' Richmond.
Stuart McGuire, M D., Pres.,
Va.

Late Researches in
Diphtheria Therapy
Investigations by Fritz Meyer (Berlitur Klinisthe Wochenschri/i, June
28, 1909; editorial comment, Medieal Record, July 31, 1909) on the
effect of diphtheria toxin and antitoxin upon the heart, demonstrate:
1. "Antitoxin, if administered early in sufficient doses,
absolutely prevents the fall of blood-pressure."
2. "if given later, but before the fail has occurred, it
delays the onset ; but
?. " If given after the pressure has once fallen, it is quite
without effect."
4. " Antitoxin given early in sufficient dose prevents myocarditis
after the injection of toxin in any amount."
Meyer states that large doses of Antitoxin given early will eliminate
cardiac complications and postdiphtheritic oaobexla. He recommends
5000 units as first injection, and when this is not promptly
effective, 20,000 to 50,000 units at a dose.
These doses conform with those of McCollum and other competent
observers, who, recognizing the danger in giving too small doses to
neutralize the toxins, advocate 5000 to 40,000 units.
A CONSERVATIVE RULE IS:
Administer 1000 units for immunizing.
No therapeutic dose should be less than 3000 to 5000 units.
in laryngeal, postnasal, severe or neglected cases, 10,000
units.
if marked improvement is not noted within eight hours,
double the initial dose or give at least 10,000 units.
Mulford's Antitoxin is a thoroughly reliable product. Its
record is unsurpassed. You do not experiment in specifying
our brand. Valuable literature mailed upon request.
H. K. MULFORD COMPANY
PHILADELPHIA

ADVERTISEMENTS.
In TREATING BRONCHITIS there is need for a remedy
that will lubricate and exert a sedative influence upon the
mucous surfaces; relieve the dry, hacking cough; promote
expectoration ; allay constriction and rawness of throat and
chest; assist the inflamed membranes to return to their nor-
mal condition aud to resist future attack— and do all this
without upsetting digestion.
Angier's Petroleum Emulsion
will accomplish these results more surely and pleasantly
than any other remedy.
Samples seni upon requesi. ANGIER CHEMICAL COMPANY, BOSTON, MASS.

j.
I .
THE CHARLOTTK MEDICAL JOURNAL.
K SANmC i TO GENITOURINARY DISEASES, .i
A Scientific Blending of True Santal and Saw Palmetto with Soothing Demulcents 4
in a Pleasant Aromati c Vehicle
A Vitalizing Tonic to the Reproductive System.
SPECIALLY VALUAL EIN
PROSTATIC TROUBLES OF OLD MEr!-IRRITABLE BLADDCR-
CYSTITIS-URETHRITIS- ''E-SENILITY.
O0SE:-On9 TeaspoonJul Four Times a Daj. CD C. IM. CO., NEW YORK,
CAMPHO-PIiENIQUi:

c
ADVERTISEMENTS.
BOVmiNE
Reconstructive Food
and Tonic
BOVININE represents the most valuable combination of
Food and Tonic elements known to the medical profession.
BOVININE has proven clinically to be most valuable in
all forms of Tuberculosis.
BOVININE enables the nerve cell to assimilate its specific
elements, which it fully supplies.
BOVININE promotes the metabolism',of fat'and albumin
in muscle aud blood, thereby restoring the bodily
health, strength and normal powers of resistance.
BOVININE supplies full and complete nutrition through
its Food and Tonic properties.
THE BOVININE COMPANY
73 IVcst Houston St.. New York City
The Standard of Therapeutic Efficiency.
NOT ONLY FOR THE LAST VI-LAR BUT FOR THE LAST QUARTER
Ol' A CENTURY HAS HAYDEX'S VIBURNUM COMPOUND GIVEN
DI'I'ICNDABLE RESULTS IN TIIIv TREATMENT OF
Dysmenorrhea, Amenorrhea, Menorrhagia, Metrorrhagia
and other diseases ol the Uterus and Its appendages.
Tliere has been no necessity for any change in the formula of H. V. C. because
its therapeutic efficiency has made it "Standard" and so recognized by the^most
'""
painstaking therapeutists and gynecologists from the time of Sims.*
r>.--
I'nscrupulous manufacturers and druggists trade upon the reputation of Hayden's
Viburnum Compound, and to assure of therapeutic results insist that the genuine
H. V. C. oii/y is dispensed to your patients.
SAMPLES AND LITERATURE UPON REQUEST
NEW YORK PHARMACEUTICAL CO. l^lZll^T^i'
i'DLNS URIC SOLVKNT >
, Goul and other

THE CHARLOTTE MEDICAL JOURNAL.
WHAT A DOCTOR PRESCRIBES
Hatchechubbee, Ala.,
April 30, 1908.
The Rock Hill Buogv Co,.
RockHili, S. C
Gentlemen:—
The wheels to my bugrgy
reached here about the same time as your
letter, and I waited long- enough to take
several rides before replying to your letter.
Am delighted with the job in every respect,
and shall be glad to advise anyone who
is looking for style, comfort, and perfection
in workmanship, to invest in a "Rock Hill"
bugg\'. Yours truly,
R. A. White, M. U.
%
No 17 Doctor's Buggy
Further comment on the above letter is hardly necessary for
Dr. White has evidently used enough buggies in his practice to
make his opinion worth something.
We are willing to guarantee that you will be just as well pleased |
as Dr. White, if you will use a No. 17 Doctor's Buggy.
RockHili Buggy Co., Rock Hill, S.
"A Little HigKer in Price, But—*'
C.
m^^^^smmeim0m^0^mmmemmmmmme sm^mmm^^m.^^^^4mem ^##€»^
fe.
FEVERS
pond'sHtract
As a simple yet effective means of keeping a skin normallj
active throughout a protracted fever. Pond's Extract has nc
superior. Applied liberally every few hours, it not only exerti
a pronounced refrigerant influence, but also imparts a desirable
tone to the dermal structures and glands.
Ilrely
PAI ITION'^« toiic dangers of adulterated subsUiutesmayi be em
\^nKJ ll\Jl^.
^^gjj^j J, prescribing PONDS EXTRACT ezclus}
POND'S EXTRACT CO., New York and London.

ADVERTISEMENTS.
Does not cause
the injurious effects on the stomach,
or the other disturbances of
salicylism produced by the
sodium salicylate made from coal-tar.
Furthermore the uniformly good results
fromTongalirie are secured largely by the
thorough and constant absorption of the
salicylic acid it contains because this is
made from the natural oil of wintergreen.
Samples by Express prepaid -Mellier Drug Company. St Louis.
lIKAMNIA & SALOL i _L1_ „
Hare says "Snlol renders the intestinal canal antiseptic and is the most
valued dru^ in intcstmal affections." The anodyne properties of antiUamnia in
connection with salol render this tablet very useful in dysentery, indigestion,
cholera morbus, diarchcea, colic, and all conditions due to intestinal fermeutation.
ANTIKAMNIA & CODEINE TABLETS
Especially useful in dysmenorrhoca, utero-ovarian pain, and pain in general
caused by suppressed or irregular menses. This tablet controls the pains
of these disorders in the shortest time and by the most natural and economic
method. The synergelic action of these drugs is ideal, for not only are their
sedative and analgesic properties unsurpassed, but they are followed by no unpleasant
effects.
The efficacy of this tablet in all neuroses of the larynx is also well know.n.
In coughs and colds, coryza and la grippe they will always be found of inestimable
value.
THE ANTIKAMNIA CHEMICAU GOMRiiaNnC^
ST. LOUIS. V. S. A.

:he charlotte medical journal.
GOING SOME—
^ S Americans are upholding America's reputation for progress on the firing
Jine oi aerial na\i!jatiun, so Abbott's Saline Laxative 'simply purified magnesium
sulphate, 60%, in non-nieilicinal, effervescent combination), typifving therapeutic prop;ress, holds all
records for efEciency, parity and popularity, other effervescent salines (mostly secret unbalanced com-
pounds) being but inferior imitations.
poctor, if you will pnecify Abbott's Saline Laxative for general use, and Salithia (the same with
_
colchicine and lithium added) for rheumatism, vou will be more than pleased and vour patients will
rise up and call you blessed. If your druggist is not in stock we will suppiv vou.
generous sizes) : $2.00, $4.00 and $8.00. Samples on request.
THE MBBOT-r MI_K.nLOmHI- CO/VlF»rtIS-V
Home OHIce and Laborslorlos: RAVENSWOOD, CHICAGO
'
NEW YORK S- .^TTLE
'
Per dozen (three
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EMBLEM
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George Heil, motorcyclist of 30 days' experience,
makes perfect score in F. A. M. Endurance Contest, i
THE KIND OF MACHINE FOR THE
ORDINARY KIND OF MAN TO BUY
Emblem Mfg. Co.
Angola. N. Y„ U. S. A.
DISTPIBUTORS. -Manufacturers Supply Co., 418 Arch St ,
Philadelphia, Pa., for Delaware, Marvlandn
and Southern New Jer.sey; John T. Bill & Co., Los Augeles, Cal , for Southern California; B'aIIon|l|
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:
1

lDVERTISEMENTS
Is physiologically adapted to relieve gastro-
intestinal indigestion, caused by deficiency of
acid, enzymes, or disturbance or impairment of
function.
Elixir Lactopeptine covers and disguises the
disagreeable taste of Bromides, Iodides, Salicylates,
etc., prevents stomachic irritation and
constitutional disturbance.
It is also an efficient peptonizing agent.
"o"- Illustration of "Graduated Kelene" Tube, Price $1.60
GENERAA L AN/ESTHESIA
th "GRADUATED KE-LENE;" Also as a Preliminary to ETHER
Q \
No STEAM VALVE required for
discharge.
Simply Press the Lever and the
/\utomatio Sprayer
Will do the Rest
For Literature and Clinical Reports, Address
FRIES BROS., ^r^^rsxI^T''''' NEW YORK

THE CHARLOTTE MEDICAL JODRNAL.
[II
Hj^ortlx Oaroliio^a ^^dCedioal College
Cti£»rlotte, IV. i^.
OLDEST MEDICAL COLLEGE IN THE STATE
SESSION OF 1908-1909 BEGINS SEPTEMBER 15, 1908.
W. O. NISBET, M. D.
Professor of Diseases of
the Digestive System and
Dean of the Faculty.
JOHN P. MUNROE, M. D.
Professor of Neurology and
Practice of Medicine.
I. W. FAISON, M. D.
Professor of Pediatrics and
Clinical Medicine.
E. C. REGISTER, M. D.
Professor of the Principles
and Practice of Medicine.
B. C. NALLE, M. D.
Professor of Physical Diagnosis
and Clinical Medicine.
R. I.. GIBBON, M. D.
Professor of Practice of
Surgery.
G. W. PRESSLY, M. D.
Professor of Principles of
Surgery.
A. J. CROWELL, M. D.
Professor of Rectal Diseases
and Genito-Urinary Surgery
and Secretary and Treasurer
of Faculty
For Catalogue address
FACUjjJFS
E. R. RUSSELIv, M. D.
Professor of Diseases of the
Eye, Ear, Nose, and Throat
W.D.WITHERBEE, >4.D.
Professor of Dermatology,
and Materia Medica.
C. M. STRONG, M. D.
Professor of Gynaecology.
C. H. C. MILLS, M.D.
Professor of Obstetrics and
Clinical Gynaecology.
C. N. PEELER, M. D.
Professor of Anatomy and
Superintendent of Dispensary.
R. H. LAFFERTY, M. D.
Registrar and Professor of
Chemistry and Physiology.
L. B. NEWELL, M. D.
Professor of Pathology.
\VM. ALLEN, M. D,
Professor of Bacteriology ,
and Assistant in Pediatrics.
C. A. MISENHEIMER,M.D.
Clinical Professor of Surgery
J. P. MATHESON, M. D.
Clinical Professor of Diseases
of the Eye, Ear, Nose and
Throat and Professor of
Yygiene.
.
DR. PARKS KING
Assistant in Surgery.
DR. WM STRONG
Assistant in Gynaecology.
DR. C. S. MCLAUGHLIN
Assistant in Anatomy.
DR. MYERS HUNTER
Assistant in Obstetrics and
Clinical Gyanaecology.
Dr. E. C. BOYETTE
Assistant in Medicine.
HAMILTON McKAY, A.B.
Assistant in Anatomy.
BENJAMIN TEAM, A. B.
Assistant in Chemistry.
S. A. HARDING
Assistant in Bacteriology.
C. M. LENTZ.
Assistant in Genito-Urinary
Diseases.
CALDWELIv WOODRUFF.
Assistant in Histology.
H. B. MALONE
Assistant in Clinical Microscopy
and Pathology.
A. J. CROWELL, M. D., Charlotte, N. C.!
In. y. rosx graduate I
* JW&dliceil School and Hospital W
S Second Av/enue and T\A/entieth Street, INeiA/ "Vork City. X
courses for the genev
and eomparalive coi
training through the
actitiouers. Teaching wholly clin
y. -JioBeds in the Hospitol; 350 oi
d others adapted to the specialist
irrying the students with indiridua
and the operating room. Similar con
therapeutics, ti'opical

ADVERTISEMENTS, IX
PANOPEPTON
Considered Qinically
Cjiitiiiued clinical experience with Pauopepton shows a net gain from
ts use far beyond the original anticipations which are so thoroughly well
justified by the nature of the food itself.
There are records to show that in cases of extreme intolerance of food,
Pauopepton is often retained after ever}^ other form of nourishment has
seen rejected:
In persistent nausea, it renders truly remarkable service in allaying
rotation and preventing exhaustion. And under all conditions where
!uch a foDd is indicated, it acts promptly as a restorative, not only by pro-
/iding nutrition without taxing energy, but by the directly stimulating
effects of its savory and nitrogenous constituents.
Panopepton is a wholly absorbable food; leaves no debris to cause
:omplications due to putrefactive changes, and herein the patient derives
aeuefits, obvious and potential, that are beyond chemical and caloric esti-
mation.
FAIRCHHILD BROS. & FOSTER
New York
STAFFORD WATER
Noted (or It* Remarkable Remedial Properties In
PARENCHYMATOUS NEPHRITIS,
ACUTE NEPHRITIS, ALBUMINURIA,
and Its Therapeutic Value and Efficiency in
Diabetis. Chronic Interstitial
Nephritis and Cystitis.
For Sale: THEO. P. KLUTZ & Co., Salisbury, N. C.
For Literature write
S. M. PURCELL, Salisbury, N. C.
liURWELL & DUNN CO., Charlotte, N. C.
U. t^. FRIERSON, Charleston, S. C.
PATRICK MCINTYRE, AsheviUe, N. C.
MURRAY DRUG CO., Columbia, S. C.
COLBURN, MORGAN 6l CO.. lessees.
VOSSFUJRG, -------- MISS.

THE CHARLOTTB MEDICAL JOURNAL.
COCOEMULSION.LILLY

^ Peak's
\ Supporter
ADVERTISEMENTS.
For after operations of
APPENDICITIS.
HERNIA, Etc.
. 2 Net to rhysiciaiis - - $i
Wocher's Surgeons
operating Outfit No.
Set ol Three Pieces,
$28.50.
No. 1004 Combination Nebulizing
and .Atomizing Outfit, Oxidized Steel
Tank, 3 Bottle Nebulizer, Atouii/.ers
and Lever Pump, complete.
Special price, - - - $.00,00
i:^
TAULBEE'S LATEST OPERATING SCISSORS, don't pinch, 8 inches
long, made in straight-sharp, curved-sharp, or curved-blunt, each
52. oO; set of 3 f6.oo.
Cincinnati Heat Ray Therapeutic Lamp, THE CINCINNATI OPERATINGlROOM.
with special .m> c. p. heat
*
generating lamp
and removable condensing hoo 1 $- 50: new We Make All Kinds of Hospital Furniture.
100 c. p. Therapeutic Lamp, fi.s 00.
NeiA/ Hospital Eciulpment List Sent Upon Request.
Surgical Instrument Makers. Ortbopedic Apparatus, Trusses. ElasSic Stockings
19-21-23 W. Sixth St. Cincinnati, Ohio

THE CHARLOTTE MEDICAL JOURNAL.
NEURILLA FOR NERVE DISORDERS NEURILLA
'
If Patient suffers fromTHE BLUES (Nerve ExhausHon).
Nervous Insomnia, Nervous Headache, irritabitity or
General Nervousness, ,?ive four times a day one
^ feaspoonful NEURILLA •--*§
_ Prepared from Scutellaria l^ateriflora.
Passi flora Iricamatn and Aromatlcs.
DAD CHEMICAL COMPANY. NEW YORK and PARIS.
Just Published
GENITOURINARY DISEASES
ANo SYPHILIS
By EDGAR G. BALLENGER, M. D.
LECTURER ON GENITO -URINARY DISEASES, SYPHILIS AND URINALYSIS. ATLANTA SCHOOL OF
MEDICINE; EDITOR JOURNAL-RECORD OF MEDICINE; GENITO- URINARY SURGEON
TO PRESBYTERIAN HOSPITAL, ATLANTA, GA.
"Barely a page of this work can be read without finding at least one
instructive and interesting point. The experienced teacher, the skilled
genitourologist, and the learned syphilographer, is revealed in every line."
Medical Record, New York.
With 86 Illustrations. 276 Pages.
F*raotical, Concise
I=»rlce *3.00, Carrying Charges F«repalcl
E. W. Allen & Co., Publishers
ATLANTA, GA.
TENT COTTAGES WITH OPEN FIRE PLACES
FOR TUBERCULAR PATIENTS
In the midst of the forests of the beautiful Blue Ridge Mountains of North Carolina
seventy-five miles south of Asheville, at an altitude of 3,8,50 feet. Climate unsurpassed.
The fall season being long and sunny and the winters agreeably mild and equable.
Tents supplied with electric bells; our own water works system with baths, toilets,
etc. Completely equipped Laboratory, X-Ray machine, etc. Graduate Nurse in charge.
Terms, $60.00 a month for board, milk, eggs and medical services. Best of references.
Address
Highlands,
DR. MARY E. LAPHAM,
..- = = = . North Carolina
—
\

ADVERTISEMENTS.
BUFFALO LITHIA
SPRINGS
Do^^i^'K^P*'^
^P BRIQHTS DISEASE
PREGNANCY AND SCARLET FEVER
WATER
DR. JOS MOLT. a/AVrr Orleans Ex-President of the State Board of Health
..««,says. of Louis-
Ihavepreprescribed BUFFALO LITHIA WATER in affectLf of he
particularly in Gouty subjects, in
frntrbllolnv^'T r'lT.!i Albuminunr, and .rr table condition i^
of the Bladder and Urethra in females. The results satisfy
extraordinary me of its
value in a large class of cases most difficult to treat "
DR. GEORGE BEN JOHNSTON, ^/./....^, Va. Ex-President Southern Surgical and
(,y., oology and Abdonnnal Surgery, Medical College of Virginia: "it is
value
an agent of
HI the
ereat
treatment of the Albuminuria of Pregnancy. •'
^
?^^"^SON. m.DNe-u' Orleans, La, Ex-President, 'laJ^r^} Ne.v Orleans Surgical
^"^•^•'^' >-^"« prescribed ' \viifi' u Tk 'T- J ^^'V"' BUFFALO LITHIA
':
rel e,^n Jail trr^r " "' ^'''\'^'^'''^.'^''S it to be drunk ad libitum, ..ith the
.rehevingall
effect XV of
traces of Albumin in the urine, and have found it equallv efficacious in
lenialdiseasesrequinngtheuseof alkaline y
eracacious in
water."
^'^ ^"'^->'
^v''Sv'^^i.^y^''ur•°••>.^r"'':'',
vll
^ood results
\r?uf{f^^^^^^^^^
BUF-
' !,"^''''''^'''^°'^^^^''''Gout,
Vei/.n.Ji , /r Rheumatism, Albuminuria of
I resi.ancy, Scarlet I^ever diseases of Women, Renal and Vesical Calculi,
ad
and Cystitis
mmany '^jsmis,
instances with signal benefit/-
Medical Testimony on request. For Sale by Druaglst generally.
BUFFALO LITHIA SPRINGS. VIRGINIA.
BUFFALO L IT HIA SPRfNGS WATER CO .
DiagnosticHviethods
Chemical, Bacteriological g Microscopical
By Ralph W. Webster, M. D., Ph.D.,
Assistant Professor of Pharmacologicjil Therapeutics and
Instructor in Medicine in Rush Medical College,
University of Chicago; Pathological Chemist
at Cook County Hospital, Chicago.
Octavo, xxxlv 641 Pages With 37 Colored Plates and 164 Other Illustrations.
Publishers,
Cloth, $6.00, Net; Hall Morocco, $7.50, Net, Postpaid.
P. BLAKISTON'S SON & CO.,
Philadelphia

THE CHARLOTTE MEDICAL JOURNAL.
'^he niGKSMITH HOSPITAL
(Incorporated)
Fayetteville, NortH Carolina.
Centrally located, facing on Green Street, extending entire block from Hay Street
Old Street. Modern in construction and splendidly equipped, affording excellent facilit
for the treatment of all surgical and medical cases. Otis Hydraulic elevator to all
the Hospital—front and rear entrances— Rooms single or in suite—Private baths. Capac
of hospital 70 patients. Operating room not surpassed. Special attention given to scien
fie laboratory methods of diagnosis— Resident physician always in the hospital. Usuaj
rates— Descriptive booklet on application. J, F. HIQHSMITH, M. D.
WailAMS' PinVftTE SflNITARIUM
A PRIVATE HOME EXCLUSIVELY FOR
Alcoholic, iyiorphine and Drug Habitues and
All Forms of Neurasthenia
Lo~cat«d tit 1 020'W. M'ai
B. B. WILLIAMS. M. D. GREENSBORO. N.C.
JACKSON SPRINGS SANITORIUM.
A new and modernly arranged building including modern diagnostic
apparatuses and various electrical appliances for the treatment of noncontagious
diseases. Special attention given to renal, hepatic, digestive
and nervous diseases.
Patients have free access to the celebrated Jackson Springs mineral
watsr which took second prize at the St. Louis World's Fair. This
water is especially indicated in above named diseases.
Centrally located in Moore County, N. C, amid the sand hills and
long leaf pines. Elevation 700 feet above sea level. Rates reasonable.
For further information, address
M. M. yncDONMLD, /Vl. D.
Ow/ne-t- and /WanagetsJacUson
Springs, IN, C.
j

——
ADVERTISEMNTS.
I PROF ESSIONAL CARDS I
t
DR. GEORGE W. PRESSLY
JOHN P. MUNROE, M. D.
^ SPECIALIST IN NERVOUS DISEASES.
I
^
(;hai!loite. N. ( .
'KACTICK r.IMllED T(l SiKOK.I:-*.
DR. W. O, NISBET
Diseases of Digestion
* Offices: 9 North Iryon Street
* I'hones: Office, 21. Residence, 1196.
ijtTice Hours: 8:00 to 10:00 llff
a. m., 11:00 a, u
(h to I :oo p. 111.; 3:00 to 5:00.
.Special Hours by .Appointment
^
DR. JOHN R. IRWIN.
Ch.\ri,otte. N. C.
•> lal alteiition f^iveii to .Vbdomiiial
Surgery and Diseases of Women.
-ANDREW J. CROWELL. .W. D.
Chaklottk, X. C.
Practice Limited To Cjcnito-l'rinary and
Rectal Diseases.
Hours: 8. .30 A..M, to 12. M.
4 to 6 PM. Sunday by appointment.
DR. A. M. WHISNANT.
18 S. Tryou St., Ch.\rlotte N.C.
Office Hours:
8:30 a.m. to 1 p. ra., and 3 to 6 p.m.
Sundays hy appointment. Practice
limited to lyye. E ar, Xoseand Throat.
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J. P. MATHESON. M. D.
221 S. Tryon Street, C .^klottk, .\. C.
Hours: 9 a. m. to i p. m., and 4 to 5 p. m.
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THE CHARLOTTE MEDICAL JOURNAL.
f ^ENTRATED PROMPT POWERFUL |
I
Rheumatism and Kidney Remedy
FORMULA-Colchicum, Hyoscyamus, Rhus Tox Chirette GauUberia,
^c-a^s

The Charlotte Medical Journal
Vol. LX CHARLOTTE, N. C, OCTOBER, 1909. No. 4
A Pica lor the Early and Tborougb •
Re- famiHar tr, all K„t th^.
moval 'amiliar
ol
to all, Tonsils and Adenoids but there is
In
an anatomic
Cblldren.* torination above each faucial tonsil, which
By Dunbar Roy, M. D., Atlanta, Georgia. '" ^^^ ^^^^ ^^^^ years has received much at-
1. Anatomical— *^"^'°" o" account
Position
of its
and Structure
pathologic import-
'
2. Phvsiologic '" being
Function.
probably the starting point
f"'^^'
*°''
3. Pathologic
^'anous infections in
I^unction
and about the ton-
4.
^''^' Remote Effects
^^Pecially of peritonsillar
( 1 ) by Pathologic abscesses.
Ir-
Killian
voh'ement, (.2) by Mechanical
was one of the first
Obstruction.
men to call
attention
5. Rational
to this
Treatment.
anatomic formation from
the My only excuse
examination of
for bringing
105
a time-worn
anatomic preparations
subject and like this before our
100 living persons.
Medical Assoc
He found
ation is the fact of its importance to the \ '1 ^ immediately below the
,^'''f
specialist and ^°^^ of
general mucous
practitioner membrane,
alike which
^^"^'^""f
and also that I wish
^^^ upper part of the
to
tonsil
put myself on in front,
record ^°r'^
as favoring an early operation for tonsils ^ ^^P^^'°" >»^k
«[ This is the openand
adenoids, and this too onlv under a H^ '"'° f «lative y arge cavity lying in
general anesthetic. In the last few vears u^ ^"^f "^^'^^ *°"?'' '^'^"='^ '^ concealed by
the deleterious effect of enlarged or diseased ?^ ^of palate. Examination with a probe
tonsils and adenoids upon the general con- f °'^^ ^''^^^^'' P'^^'^^ ^^^ ^ '^e"^ ^^P^^ of
stitution of the individual has been univers- ,V"" / ^^^"^ was called by His
^.'t "f,"^
ally
^natonist,
recognized,
the
and supra-tonsillar
ils importance is in- ]^^ fossa and
creasing with every year of our medical L.l '11,^'"'' ''
'f"'^ \'' '^f''^"^^
advancement. It is impossible for me, in ^"'^Y •
^^ Prolonged down-
f ? f T^ the limited time at my disposal, to go t hor- '
f'^'" ^"' "l \^^, .^°"f °^ '' ^^y ^e
oughly into
^'-^J'^hedoutvvard
every
behind the
detail
palato-g
of this subject,
ossus
but
I shall try as far as possible to present some ^"!f/'fn T f , "r"" ^'^'-
possible to present "' some
''^'
crypt of the tonsil but a space above l'
important facts^as a practical
this
contribution
organ.
to the Enough
subject
has been
in question.
written to show
that it The has a distinct
anatomical anatomical
position
entity
and and
relationship
possesses
of
clinical
the faucial
significance. It
tonsils and adenoid may be-
tissure in
the nasopharynx
come
is no doubt j"""*! the \'"^ seat of suppuration which may
too familiar
to need
very imperfect
discussion, although manner and in
I shall speak
this way later on
give rise to
this point when
continuous throat irri-
discussing the obtation.structive
Patterson has
influence
found pyogenic or-
of these structures to
ganisms in
proper
great abundance
ventilation
in this
of the nose
space
and ears.
The
and believes it is
lymphoid
the point
ring
where the
in the throat now
ma-
has a
jority of tonsillar
definite infections arise. meaning to nearly My every own
physician,
observations
embracing
correspond
as
with this
it does
state-
the circle of Ivmphoid ment. In fact,
tissue
Killian known has
as
given
adenoid, up the
faucial, and lin-
ordinary incision
gual through the
tonsils.
soft
All of
palate in
this ring of tissue is
cases of peritonsillar
histologically abscess
the same,
d
being
opens
what
knowii
'^'"^ through the
as
supratonsillar
lymphoid fossa
tissue. On
by
account of
the prominem position and ease oframin If^ L?'.!.?'°^!l '"^.f^f„""^ .'"'^ *l^ ^^
scess ^'-cao
ation by uy this mis route.
fli(» fQii^i.,! juuie. t. „..;io i; f i
1 he question as to the
r'.^e^J^ m:^l Sl^nUon^lha^^ d^' th; Sjh^^^^L^y^t t^n^" ^iS adenoid T 'Z:"" T
tissue in the naso-pharvnx and the '! ^/'^°"sji a
'
, , T ) ,
of
lymphoid
.experimental work tissue has been
at the base of the tongue f^^V^^^.f. This, furthermore, was justifiable becfuse '"'' '^^ -'^'^
^.^^^ ' T'^^^.tT"''' r
the faucial tonsil, do produce more svstemic "' '^"^ °P1"'°."'
HZ T S
disturbances than '''''
possiblv do the rema Id r Ivmnhadc ti su'e Ch'i T''"""'"' l'
of the lymphoid ring, and for this reason L^ fP^'A". _''''"^,'^°*^ " '^^. "^so-pharynx
has receh-«f'^r/'r.^' r
their
"^ !"' '''?
nas "^T" bu^mo;resp;;i;n7;he"fauci;rt7„rir.'
received more attention from physiolo- tv.^ „.,, , r , .,
[""^t-"
-;K.a-d before the
'» t^^^ 'ght of the present day
n,eeti„g of the Georgia M...,cat
Association in Macon, Georgia, April "^"owledge, is still
20, 21, veiled m some obscurity.
"' '^^'
'
' It is for this reason that I shall speak for a

214
THE CHARLOTTE MEDICAI, JOURNAL.
moment on the present theories in regard to closely resembling Pe5'ers' patches of the
these organs. In 1907 E. Barth published
in the Deutsch. Med. Woch. a very exsmall
intestine.
2. None of the theories thus far advanced
haustive article on this subject, and I shall to explain the functions of the tonsils are
take the liberty of quoting from the same conclusive.
as the most recent exhaustive contribution 3. The tonsils produce no physiologic
to the subject. Histologically the tonsils
consist of adenoid tissue, the same structure
secretion
4. The tonsils are not absorbing organs,
as exists in the naso pharynx and it must contrary to the later views as expressed by
be concluded that their function is similar
to the lymph glands. It is for this reason
Barth.
5. Tubercular tonsillitis is an uncommon
that they show a close resemblance to the condition.
Peyers' patches and solitary glands in the 6. There is no evidence to show that pulintestine.
monary tuberculosis ever results from ab-
The tonsils being placed in a superficial sorption of the tubercle bacilli from the
position at the level of the mucous mem- mouth through the tonsils,
brane at the beginning of the air and food 7. Rarefaction of the epithelium of the
passages, have been shown to have a con- tonsils affords a ready explanation of the
stant emigration of
mucous membrane.
leucocytes on to the
The presence, howway
in which the contagion of diphtheria
may gain entrance to the general circulaever,
of opening in the epithelium through tion in this disease.
which the lymphocytes might migrate, have Goodale of Boston, and Kayser of Bresnot
been entirely substantiated. One pe- lau, both have experimented and shown
culiarity about the tonsils is the presence of that the absorptive power of the tonsils is
fissures and folds, crypts, and lacuns.
The theory that the tonsils have some
very limited. Although a study of these
physiologic experiments shows many conpower
to aid the digestion and absorption flicting statements as to the function of the
of carbohydrates, has not yet been estab- tonsils, in fact leaving it an open question
lished. Some clinical investigations by as to whether or not they have any special
Lichtwitz and Sabrazes have shown an improvement
in the condition of the blood
function, the fact is nevertheless true that
clinical observation has shown many reafter
removal of hypertrophied tonsils. The lationships existing between diseases of the
theory of the protective action of the tonsils tonsils and other pathologic conditions of
is opposed by the fact that they are especi- the human body. Many clinical observers
ally liable to inflammation in consequence have reported authentic cases where varied
of infection and are often the source of a diseased conditions of the body had their
general infection. Barth says that inflam- origin through the portals of the tonsils and
mation of the tonsils is only in rare cases adenoid tissue in the nasopharynx. Tonsils
the result of an infection of the surface of which give rise to these various systemic
the tonsil, but arise more frequently by a conditions, or at least apparently so, are
secondary infection which reaches them seemingly just as active whether normal or
through the lymph channels. He illustrates abnormal in their appearance. Certainly
them by referring to a tonsillitis which the large flabby tonsil with numerous large
some times follows an operation in the secreting lacunae, or even the small friable
nasal cavities, even after the most thorough and degenerated tonsil, would be looked
asepsis, and this I have myself noted. The upon more as the starting point of various
infection here arises not from the surface of systemic aff'ection than those of a more
the tonsil, but from the wound in the nose healthful appearance.
through lymph channels. It seems, therefore, The importance of the faucial tonsils and
that the tonsils have the power of excreting adenoid tissue in the naso-pharynx as the
foreign substances which are brought to it gate of infection for chronic tubercular disby
the lymph stream, besides having some ease, has excited marked attention during
secreting powers of their own. There is a the last few years. While the results of the
great diversity of opinion among investi- various investigators in the field differ as to
gators as to the physiological and patho- the frequency of various forms of systemic
logical function of the tonsil; At variance tubercular trouble originating through this
to some of the views above expressed, is
the summary given by Hodenpyl at the
source, the possibility of such an occurrence
must certainly be considered. Clinical facts
close of his most exhaustive article published
a few vears ago on the physiological
t ^. r li. i •, rx , , .
function of the tonsil. He says that his
cannot always be substantiated by labora-
^^''y investigations and for this reason w&
must consider both sides of the question,
^^^j,,^ ,^^ j^^, f,,^ y^^,, laryngologistsj
investigations lead him to conclude: especially have noted the relationship bei
1. The tonsils are lymphoid structures tween the enlarged glands of the neck and
i

ORIGINAL COMMUNICATIONS. 215
a diseased faucial tonsil, and the brilliant evidence of a tubercular nature have also
results obtained in the complete disappear- been obtained by McBride and Turner of
ance of these glandular enlargements after Edinburgh, Milligeu of Manchester, and
the thorough removal of the tonsils, cannot
but impress upon all the relationship of
cause and effect. The question as to what
Brieger of Germany.
An interesting observation was that of
Riethi, who found tubercle bacilli in six
are enlarged and diseased tonsils will prob- out of a hundred hypertrophied tonsils reably
never be settled as long as there remains
so many different ideas on this submoved
from
tuberculosis.
persons showing no signs of
He believes that all hyperject
among physicians. Lennox Browne trophied tonsils should be removed as early
says that all tonsils which project beyond
the faucial pillows and many of those which
as possible. Goodale of Boston, who has
done more experimental work on the faucial
do not, are foreign bodies in the throat and
should be removed. This probably is extreme,
and yet in my own mind I think
tonsils and nasopharyngeal adenoids than
perhaps any other one man in this country,
besides being an exceedingly capable and
Browne is nearly correct. Logan Turner conservative laryugologist, sums up what
says that the presence of enlarged cervical would probably be accepted by most larynglands
should make the removal of hyper- gologists as the present status of this untrophied
tonsils imperative. G. B. Wood certain question. lie does not believe that
has done considerable experimental work a cervical adenitis of tuberculous nature
along this line and he concludes that the can be removed by the removal of the tonsil,
tubercle bacilli not only produce a tuberculous
condition of the tonsil itself, but that
because the tubercle bacilli have already
penetrated into the lymph glands. What
pass through the structure into the should be done under these circumstances
According to this observer is to prevent further penetration of more
lymphatic drainage of the faucial ton- bacilli into the lymph glands by extirpation
1 they
I lymphatics.
I "the
I sils runs directly to the upper deep cervical of the tonsils and adenoids. In many in-
1 glands,
and these glands by a rich system stances there is enlargement of the glands
of anastomosis, are connected by afferents I
and efferents with practically all the lymph
of a non-tuberculous nature in which re-
moval of the tonsils brings a relief to the
glands of the neck and head. The tonsillar glands.
lymph gland just below posterior belly of Briefly summarized, it may be stated that
the digastric muscle where it crosses the primary tuberculosis of the tonsils and adeauterior
border of the sterno-cleido mastoid, noid tissne in the nasopharynx is rare, but
Topographically this spot is located just as portals for the entrance of the tubercle
behind and below the angle of the jaw." bacilli into the general system, especially
According to this observer, nearly all tuber- into the cervical lymphatic glands, is a
cular adenitis of the neck have their origin question which as yet remains unsettled,
through the tonsils. Cases pro and con have been reported which
Strassman, Demochowski, Kruckmann would lead us to believe that the tonsils
and others, have demonstrated the exist- play no unimportant role in general sysence
of tubercle in the faucial tonsils, and
their observations have been confirmed,
Hugh Walsham has examined the faucial
temic tuberculosis. During the last few
years much has been written in reference to
the relationship between rheumatism and
tonsils removed postmortem from ,54 cases faucial tonsils. Such a relationship is all
of tuberculosis and found them tubercular most universally recognized, a fact which
it). In his examination of tonsils re- shows that the internist and the laryngoloved
from living persons his result was ogist must work together. Such accurate
negative. Gourc examined'201 cases both clinical observers as Osier, Thayer, Solismicroscopically
and by inoculation, and he Cohen recognize this relationship and many
also could find no trace of tubercle. On cases have been reported where the removathe
other hand, a most positive result has of the disea&ed and degenerated tonsils
been found by other observers. Fillet found have absolutely cured rheumatic conditions
evidences of tubercle in 7, hjc in naso- of the severest character. Ingalls says that
pharyngeal adenoids. Lemoyez has published
two cases where the adenoid tissue
he is compelled to recognize the relation-
ship existing between the two diseases,
removed was almost entirely tubercular, since in examining the redords of 100 cases
Dieulafoy, after inoculating guinea pigs of tonsillitis without selection, he found
with portions of adenoid tissue from 3.S that 45% had, were having, or had immepatients,
obtained tubercle in 20%, and diately following, an attack of rheumatism,
histological examination by the same ob- Melville Hardie thus summarizes the pres-
iserver revealed evidence of tubercle in 5, ent status as to our knowledge of the re-
7%. Brindel obtained positive evidence in lationship between rheumatism and tonsil-
12.5%, and Gottstein in 12%. Positive lar affections, and from my own knowledge

216
THE CHARLOTTE MEDICAL JOURNAL.
of the literature on this subject, I think his appendix from the throat through the dideductions
are quite correct: gestive tract and he further observes that
1. It is undoubted that a certain number the micro-organisms which especially excite
of cases of acute rheumatism are preceded appendicitis, viz.: the influenza bacillus,
by angina, the proportion varying from .30 and the streptococci, are frequently the
to 80 per cent. cause of angina. This is certainly an in-
2. Both rheumatism and angina have teresting observation, and 1 trust that phymany
etiologic points in common, season sicians and surgeons will bear in mind the
of the year, cold, wet, fatigue, depression, possibility of such a relationship and that
vitiated air. all such authentic cases may be reported.
3. The connection of angina and rheum- I have myself known of several cases where
atism, though undoubted in a number of the removal of an appendix has been folcases,
is not yet clearly explained. lowed by a cessation in attacks of tonsillitis
4. The tonsil may be the port of entry of which previously had been quite frequent,
the rheumatism virus, and this even through As a resume of these important points I
the naked eye appearance of the throat can do no better than to give the conclugives
no indication of its being affected. sions of Uhlman published in 1901. These
5. The particular affection of the throat are:
which is associated with rheumatism has 1. That the normal tonsil has a physionot
yet been established. Apparently it is logic function, probably protective to the
not peritonsillar abscess. organism. (This is true if we knew what
6. Peritonsillar inflammation does not was the normal tonsil) but unfortunately
seem to be arrested by the administration this is far from being decided.
of anti-rheumatic remedies. Many cases 2. That being in itself diseased, the
of parenchymatous and lacunse tonsillitis physiologic function of the tonsil is im- |j
on the other hand are considerably benefited paired, and that instead of being protective ;
by the administration of salicine or the sali- it is the nidus for the grow'th and distribu-j
cylate of soda. That this action proves tion of pathogenic organisms and their pois-j
the rheumatic nature of the disease cannot onous products in the system. ]
yet be accepted. 3. That many grave and fatal general in- '
7. The question requires research in two fections have their origin in the tonsils,
directions: One is the differentiation of the 4. That if the exanthemata, particularly
various forms of angina, and ascertaining scarlatina, are of bacterial origin the tonsil
which one is associated with rheumatism; acts in part as a port of entry.
the other in further research to discover the 5. That acute articular rheumatism and
true nature of rheumatism. the diseases often associated with it, endo-
Besides tuberculosis and rheumatism, carditis and chorea in a great majority of
which seem to bear some decided relation- cases are due to the action of attenuated
ship to the tonsillar structure, other condi- bacteria, their toxins or both entering the
tions have been reported which also show system through a diseased tonsil,
some similarity. For instance, numerous 6. That in those rare cases of typhoid
cases have been reported where a diseased fever in which no intestinal lesions can be
condition of the tonsil has either produced demonstrated the similarity of the tonsillar
a septic infection or has been the gateway tissue and Pyers' patches suggest the tonsil
for the entrance of such septic organisms, as the portal of entry of the Eberth
Froelich has reported an interesting case bacillus,
in which a severe attack of follicular ton- 7. That scrofulosis is often associated
sillitis was followed by peritonitis and with diseased tonsillar tissue and that the
death. tubercle baccillus often enters the system
Jessen of Hamburg, has reported three via the tonsils,
very interesting cases where the general 8. That the tonsil is too little examined
history of the cases and bacteriological ex- at autopsy and as much light might be shed
amination showed almost with certainty on fevers of uncertain origin by its bacterithat
the infection entered the body through ologic aud histologic examination,
the tonsils. W. Lubinski records four cases It is unnecessary to speak of the relationwhere
there was an acute inflammation of ship existing between the lymph tissue in
the thyroid gland following an acute tonsil- the throat and the acute infectious diseases,
litis, and has been able to find only one such as measles, scarlet fever and diphother
case similar to these and this one by theria. The first symptoms of these dis-
Quervain. eases as manifested by some form of amyg-
H. Weber has found two cases where an dalitis is familiar to all, and needs no furangina
tonsillitis was followed by appendi- ther comment. The fact is certainly obvi-
citis. The author's explanation of this as- ous to all that enlarged and diseased tonsils
sociation is, that the irritant reaches the and adenoids add much to the gravity of

ORIGINAL COMMUNICATIONS, 217
any of these diseases and frequently pro- no idle fancy, but it is confirmed by the exlong
a more speedy convalescence. perieuce of all clinical observers.
I wish now to speak but a few minutes Having shown you some, not all, of the
in reference to the obstructive influence of injurious effects upon the general system
this lymphoid tissue upon the respiratory by the presence of adenoids and enlarged
and aural development of the individuai. and degenerated faucial tonsils, I wish to
The development of any chest, the ex- close with a plea for an early and radical
pansion of any lung, which is one of its operation upon these structures. The rephysiological
functions and thus indirectly suits of such an operation, when properly
the oxygenation of the blood for the purifi- done, is simply marvelous upon the general
cation of the whole body, is absolutely de- constitution of the child and in the majority
pendent upon free and unobstructive respir- of cases will make such an individual much
ation through the nose and mouth. A child more able to contend with the physical viciswith
enlarged tonsils and even more so with situdes of life. When should such an operaa
naso-pharynx filled with adenoids, has tion be performed? Preferably between the
but a feeble constitution to withstand the ages of three and six, but even earlier
numerous ailments which seem to be the should the tonsils and adenoids be found
heritage of the young. The two conditions, giving trouble. Should all faucial tonsils
adenoids in the naso-pharynx and enlarged be removed? My own opinion is that if the
tonsils, are usually associated together, al- adenoids require removal that the tonsils
though I have frequently seen a large should be removed at the same time, especamount
of adenoid vegetations without a ially if there has been a previous tonsillitis
corresponding enlargement of the tonsils, or the tonsils are enlarged enough to project
Both conditions are obstructive to free res- beyond the faucial pillars. I believe with
pirations, and in many cases enlarged ton- Lennox Browne that the tonsils are foreign
sils are just as serious offenders as a bunch bodies in the throat and as such are better
of adenoids, for they extend high up be- out than in. I know there will be strong
neath the palatal folds and can materially adverse criticism to such a position, but it
narrow and diminish tne size of the naso- has been reached only after years of experipharynx.
ence and the observing of conditions later
This leads me now to the consideration in life which could have been remedied had
of the second point, and that is the indirect the management of the same been along
influence upon the ears of this obstruction these lines earlier in life. Why wait to
to free nasal respiration. The eustachian operate later in life, or perhaps not at all,
tube acts as a chimney, and in order for it and allow abscesses and discharging ears
to be freely ventilated and likewise the to fasten themselves upon the individual
middle ear, there must be an unobstructive with all their direful consequences? Why
passage of air continuously over its mouth allow peritonsillar abscesses and enlarged
which terminates in the nasopharynx, cervical glajids to undermine the constitu-
Breathing through the mouth is absolutely tional integrity of the individual? Why
useless in exerting any influence on the allow these constant coughs every winter
middle ear, because the air cannot possibly and those recurring ear-aches in the very
reach the opening of the tube. This lack young? As Dr. Goodale says, the removal
of ventilation in the middle ear, produced of the tonsils will not always remove the
by the presence of adenoid vegetations and enlarged cervical glands after they have
enlarged tonsils, is most usually the start- become infected through the tonsils, but
ing point of the so called dry catarrhal you can frequently prevent such a condideafness
which in after years is so difliicult tion by the early and thorough removal of
to remedy, and which probdbly could have adenoid vegetations and faucial tonsils bebeen
arrested in the early years of life by fore the infection has taken place. If ademore
radical treatmetit. Both of these con- noids are present in a child afflicted with
ditions, but especially adenoids, are the hot discharging ears, you cannot heal this conbeds
for tiie production of that catarrhal dition until the adenoids and tonsils are restate
manifested in the very young by fre- moved, or if they do heal, under local treatquent
ear-aches during the winter and a ment, there will likely be a return of the
constant nasal discharge. Abscesses of the discharges with each succeeding cold,
middle ear with the possibility of the ex- In regard to the operation. The day has
tension of this pathological process to the passed when a thorough tonsil and adenoid
mastoid, jugular vein and cranical cavitv, operation should be undertaken in the office,
with
because it not only does the patient injustice
all its serious consequences, and in
.
, , . but likewise the physician. 1 he operation
. ^ , many cases be traced an infection from the
^jj^uld be considered a major one, to bepernaso-pharyiix,
engendered by the presence formed in a hospital where the necessary
of adenoids. This, fellow practitioners, is technique may be used and where the sur-
(

218
THE CHARLOTTE MEDICAL JOURNAL.
geon is able to meet any emergency, should One other remark in regard to this opera- !
such occur. It has always been my en- tion, and that is to say that results will al- i
deavor to impress upon the laity, and the ways be better when the same is performed I
profession also, that this is not a simple during warm weather. In fact, I think
operation if done thoroughly, but requires that only operations of urgency should be i
the greatest skill and manipulative ability, performed on the nose and throat in cold I
I have frequently heard other larj'iigologists weather, if we desire the best results. i
of prominence and ability say that they In conclusion, allow me to express my- 1
considered the dissection and removal of self again by saying that this operation is
the faucial tonsils one of the most diflScult the most beneficial of all in the domain of
operations which they were called upon to pediatrics, and if performed early and thorperform.
oughly will make the majority of children
If the operation is done early, when the strong and healthy for all future life. '•
child is young, the one great danger, that Grand Opera House. |
of hemorrhage, either primar>' or secondary, , |
is obviated, for almost without an excep- Accuracy In the Diagnosis ol Diseases \
tion those cases of severe or even fatal *** **•* Chest.* i
hemorrhage, which have been reported as By Lewis M. Gaines, B S., M. D., Atlanta, Ga., j
following the removal of the tonsils, have '^'^-^:^^-^^::^Xi^n^-'' '
occurred m adult patients. We must ex- pjtai; chief Medical Clinic Atlanta
cept in this statement those cases of hemor- School of Medicine; Associate Di-
rhagic diathesis.
rector Peachtree Heights Sana-
Only a few words in reference to the
torium for Treatment of
-.
. , r Tuberculosis. I
operation itself. . ,.•
, c
I prefer that this be done in a hospital Accuracy is one of the essentials of suewhere
the nurses and assistants know your cess in every calling. To the physician its I
methods, and where proper illumination value is beyond estimation, both for his own j
can be had for the field of work. This, of sake and that of his patients. Accuracy ,
course, can be done at home, and in cases presupposes both knowledge and skill, for
't is
of adenoids alone is quite as satisfactory,
a trait impossible of attainment by the
I always desire the patient to be placed ignorant and unskilled. But, alas! the
thoroughly under the anesthetic, and pref- possession of knowledge and skill by no i
ercbly ether, as the records show that it is means implies the attainment of accuracy 1
the safer. One must have good illumina- but necessitates the virtues of honesty and ]
tion, so as to see exactly what you are do- patience. A hasty examination because ':
ing. A mouth gag is used, and I prefer the waiting-room is full, a diagnosis based |
on conjecture rather than accurately ascer- \\
one of the Murdock varietv. I prefer the
patient on his or her back, although some Gained facts—these are temptations and j|
of the best operators prefer the patient in
faults which account for many failures, and .!
the upright position. The assistant stands which too often react upon the patient to ;,
^''^ detriment. Such failures are far less
j
on the left side, ready with sponging and
the tongue depressor. The tonsils are dis- excusable than those of honest ignorance. ;,
sected from the anterior and posterior pillars. Aside from ethical considerations, how-
pulled out of their beds with the tonsil for- ever, I desire to urge the importance of j
ceps, a snare or tonsilHtome passed over the accuracy m the diagnosis of chest diseases ;
latter, and the tonsil in this way thoroughly ^or the following reasons:
removed. If any remnants of the tonsil 1- Because of the frequency of diseases i
should be left on accoudt of its being soft of the chest. A far larger percentage of the j
and friable these can be removed by means fiuman race die directly or indirectly of :,
of the Hartmans' tonsillar punch. The l^^art and lung diseases than of diseases of
child is now turned so that the face hangs any other portion of the body. All honor
oyer the left side of the table and all bleed- to surgery and the magic advances she has
ing allowed to cease, which it usually does ^lade in the past half century, but except I
in a very few minutes, after which the ade- "i comparatively rare instances surgery is :
noids are then removed. I prefer the powerless to influence in the slightest de- j
Brandegee forceps followed by the curette, g'^e those affections of the chest which j
and finally with my finger wrapped with carry off such a very large proportion of !
sterile gauze. After all bleeding has ceased mankind. It is from the physician rather .j
the child is put to bed on its abdomen with than from the surgeon that aid must come
its head turned on one side, so as to allow and it can only come through the portal of the escape of blood and mucous. In twentyil
a correct and early diagnosis. j
|
four hours, if there is no fever, the child 2. Perha ps the most potent reason for
may be taken home. *Read before the Georgia state Medical Associa-
Liquid diet is ordered for thirty-six hours, tion at Macon, Ga., April 22, 1909.
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ORIGINAL COMMUNICATION. 2l9
accuracy is that it is the surest way of ar- ent he has tuberculosis or heart disease,
riving at an earh' and correct diagnosis. He must know what inroads the disease
This is a matter of the first importance in has made, how much lung tissue is itivolvtuberculosis,
the early stages of which are ed, the degree of hypertrophy of the heart,
overlooked in a large percentage of cases, and the stage his alJection has reached
It is needless to reiterate that a delayed that is he must know what his chances are,
diagnosis in consumption usually means a as nearly as they can b« estimated. It is
hastened end, whereas 7(J% to 90% of the true that such questions are often impossiearly
cases will get well under the best care, ble to answer. Nevertheless, accurate ex-
On the other hand, tuberculosis should not aminations will go far toward diminishing
be hastily diagnosed. A boy of 14 was pro- the number unanswered or wrongly announced
by several physicians to be in a swered.
hopeless stage of consumption. He drifted 5. As a rreans of determining the most
into my hands, and repeated and painstak- effective treatment, the importance of diaging
examinations revealed a large abscess nosis prior to treatment would seem to be
in the upper part of the right lower lobe, bepond controversy. Vet it is a continual
This diagnosis was later confirmed by a temptation to treat symptomatically, and
surgeon. Dr. Willis Jones, of Atlanta, who not lay the axe at the root of the tree. As
saw the case with me. In many diseases therapy is becoming more scientifically exof
the heart a correct diagnosis cannot be act, the necessity for accurate diagnosis is
reached except by an accurate and i)ro- becoming more and more imperative. Far
longed examination. And correct diag- be it from me to decry the efforts and
nosis of heart lesions means much more achievements of our predecessors, but the
than a scientific refinement. It means prog- general methods and shotgun prescriptions
nosis and treatment based on something of former times can no longer prevail,
definite; it frequently means prolongation Though far from the goal of our dreams,
of life. In this connection, I desire to refer we now recognize certain definite proced-
.
to life insurance examinations. A few ures will be productive of certain results in
few years ago I heard a leading physician certain cases. Hence the key to the door
publicly refer to insurance examinations as lo relief and recovery lies in the accurate
"casual," meaning it
should be so regarded.
was proper they diagnosis. Here again I beg to cite the
I am convinced by early diagnosis of tuberculosis as the chief
many personal experiences that the chest hopeof the victims of that prevalent scourge,
examination for insurance is eminently in- 6. Finally, I venture to urge the value of
accurate. Six months ago I found a man well kept case records ''hich are invaluable
to be in the second stage of pulmonary personal assets to every physician. The
tuberculosis, who had been passed the week very taking and keeping of such records
before by an examiner for a prominent com- fosters accuracy. FL-rthermore, such recpany.
The man died a few months later, ords are of great value for their own sake.
Do not examiners owe their companies the and if compiled and edited would contribmost
accurate chest examinations they are ute their quota to our knowledge. It has
capable of making? long seemed to me that the physicians of
.5. The progress or decline of many chest the South should contribute far more largely
affections can only be intelligently followed than they do to the medical literature of our
by accurate examinations at regular intervals.
This is particularly true of pulmoncountry.
How may accuracy be attained, seeing
ary tuberculosis. In many of these tuber- it is so important? First, by obtaining carecular
cases the symptoms do not accurately ful case histories. The getting of a firstcorrespond
with the real condition of affairs class history is almost a fine art in many
in the lungs. A patient may have gained instances. Often it takes time and patience,
his full quota of weight, and have most of and such skillful interrogation as a lawyer
his symptoms disappear. Yet on careful might well envy. The object is to have the
examination an area of moisture may be patient state only essential facts bearing on
found, indicating an active process, and his malady without asking him leading
the necessity for the utmost caution, the questions. This is often very difficult, and
lack of whicli will often result in relapse, yet a history so taken is of the highest value.
This is no fanciful statement, but is based as the first correct step,
on personal experience. So, also, in many Second.—Accuracy is to be attained by a
forms of heart disease, from the patient's painstaking physical examination which
Standpoint the greatest value attaches to does not stop short of any procedure of
repeated accurate examinations. demonstrable value necessary to clear reas-
4. The question of prognosis can only be onable doubts in the mind of the examiner.
answered honesily after an accurate exam- I am satisfied that the results of the examination.
It is not enough to inform a pati- ination should be charted. My own method
—

220
THE CHARLOTTE MEDICAL JOURNAl.
is to stamp a skeleton chart on the history summit. Hence the closest scrutiny should
sheet and by a system of easily remembered be directed to the supra-scapular region,
symbols fill in the findings. Thus the out- rather than to the clavicular regions, which
line of the heart as determined by inspec- are invaded secondarily as a rule. In maktion
and percussion is drawn to correspond ing the examination by far the greatest
to its relative size and position. If mur- value attaches to stethoscopic auscultation,
murs are present their location, intensity straining the ears to detect fine moist rales
and transmission are appropriately shown, at the end of inspiration, or variations from
So, for the lungs, the exact areas of dul- the normal characteristics of the oreath
ness, the location and character of rales, sounds. I would call particular attention
the character of the breath sounds, and to the value of causing the patient to cough
other data can and should always be filled just prior to a moderately deep inspiration.
in. In no other way can an accurate ex- I have frequently elicited a shower of fine
amination be recorded and at the same time crackling rales by this method when none
be so quicklv available for reference. could be heard otherwise. And the detec-
There are certain points in the techuic of tion of such rales persisting after two or
examinations which I have been led to be- three full respirations is diagnostic of a
lieve by observation, are frequently imper- tubercular deposit in the vast majority of
fectly observed or neglected. To a few of cases,
these points I beg to call brief attention. In a large majority of cases these fine
1. Examination for arterial changes as- rales will be overlooked unless sought foi
sociated with high blood pressure, hyper- with extreme diligence. By diligence I
trophy of the heart, and accentuated aortic mean having the patient stripped to the
second sound. It is loo frequently true in skin, and in the case of women stiff starched
physical examinations, especially for life underclothing removed, as I have found
insurance, that the examiner is satisfied if more than once that the distant rustling of
there are no heart murmurs, and if no these garments on deep respirations proirregularities
or increased rate of the pulse duced a sound almost exactly similar to
is apparent. It is a significant fact that rales. By diligence I also mean time-takthe
statistics of one of the largest insurance idg and painstaking systematic going over
companies show that nearly 22% of the every square inch of surface with a stetho-
first year mortality of passed applicants are scope. Regardless of what may be said to
due to cardio-vascular disease. Accuracy the contrary, I believe it to be impossible
should be insured by diligent examination for any living man to hear as perfectly,
for arterial thickening, estimation of blood locate as accurately, and make as few mispressure
by the sphygmomanometer, care- takes with his unassisted ear as with a
ful auscultation of the second sound at the stethoscope. One must remember, however,
base of the heart, and estimation of the size that the stethoscope, like other instruments
of that organ. oi precision, requires constant practice in
2. The true valuation of heart murmurs, order that proficiency in its use may be
In dealing with heart murmurs accuracy is gained. Furthermore, one gets accustomed
often difficult of attainment, and yet very to his own instrument, which yields him a
necessary for correct diagnosis, prognosis satisfaction superior to any other. One
and treatment. The first distinction to be should borrow or lend a stethoscope with
drawn is between functional and organic about the same compunction he would a
murmurs. I have been led to believe that toothbrush. It has been from the infremistakes
here are very frequent. The sec- quent use of an unsuitable or borrowed inond
point in the valuation is the accurate strument that all slander of stethoscopes
determination of the valve affected, while have arisen that I have heard.
the last to be remembered is that frequently A further point in technic which I believe
the murmur is of less value in diagnosis to be of real value is the frequent auscultathan
many other features of the examina- tion of this primary area following the
tion, such as the ascertaining of the size of hypodermic administration of Koch's old
the heart, the characteristics of the pulse tuberculin for diagnostic purposes. Even
and of the heart sounds, and variations in in the absence of marked febrile reaction a
the duration of the pauses between the beats, local hypercemia with resulting slight exu-
lt is sometimes true that the silences of the date often takes place at the focus of infecheart
are more instructive than its sounds, tion, and resulting fine moist rales occur.
3. The mode of examination fortheearli- If there is a slight rise of temperature or re-
est evidences of tuberculosis. It is import- action at the site of injection, the proof is
ant to know that the primary site of tuber- all the more convincing,
culosis deposits in adults, in the vast ma- I should like to emphasize, also, the fact
jority of cases, is in the posterior portion of that the appearance of tubercle bacilli in
the apex of the lung about an inch from its the sputum is now regarded as a late sign

ORIGINIAL COMMUNICATIONS. 221
of an early stage at best, and that their ab- and daughters. Physicians throughout the
sence, even if continued, is of no value South, especially . should study school probwhatever
in ruling out the disease.
Finally, I would urge the necessity of
lems and put themselves in a position to
regulate many abuses that now exist At
continual study and practice as a requisite least one well qualified physician should be
,
for attaining accuracy in diagnosis. Xor- on every school board in the South,.and it
mal chests should be constantly studied and is not suflncient that these physicians should
results kept clearly in mind, in order that inspect regularly the schools under their
the slightest variations may be detected separate jurisdictions. Full histories should
when the presence of disease is suspected, be obtained and recorded of every pupil's
Candler Building. physicial condition at the beginning and
. close of ever^' scholastic year. These histo-
Thc Influence of Modern Education on ries should be recorded by the card index
tbe Physical Development ol Woman.* system and should be very complete, show-
BvD.L. Wilkinson,.\.B.,M. I), Montevallo, Ala. i"g "ot only the pupil's past history, but
^ also his family history. There should be
, ,
For the past eleven years have been
^g^orded then 'the pupil's present physical
studying the educational problem from the
condition, the number of studies he is carstandpoint
o Its immediate and remote
rying, etc. Notes should be made and pereffects
upon the development of our women, ^^^^^j inspections made of the pupil's home
During these years I have been physician
surroundings. The teacher should be refor
nearly .50UU college women between the
p^^j^^ ^pon as to his or her physical condiages
of 14 and 21. I have now oyer oOO
^-^^^ temperament, habits, cleanliness, etc;
under my care. .Many of these girls have ^ I ^^p^^^ ^f ^^^-^ ^.-^^ ,,,ou,(j read about as
I been measured and weighed, their family
foUo^^g. ^^ry Doe, ?ged l.S, residence 218
land past personal histories obtained, thnr
Blank Street; mother died from tuberculosis,
sight and hearing tested, their menstrual
^j^^y j^^^ ^^^ measles, scarlet fever and
histories recorded, and their own observawhooping
cough; adenoids, enlarged tonsils,
I
lions noted as to their physical condition
i
gstignatic, undersized, pallid, anaetic heart
(before and after beginning college work,
j^urmurs, muscles flabby; home surround-
1 In addition to this I have largely culled the j^^^ unsanitary, sleeps with three others in
I literature,swapped
t
reports with other college
^-^^^^ room, meals sufficient in quantity, but
physicians, etc. I can only conclude that as
poorly prepared. Teacher aduised as to
1 at present conducted, modern educational
^j,^ number of studies and hours of recita"
methodsarerepletewithmistakes.periucious ^j^,,. parents advised as to necessity for
to well rounded physical development, the
removal of adenoids and tonsils, the wearhighest
mental attainment and a stable
j^^ ^f glasses, and the improvement of
nervous equitibrium. It also adds its (luo'.a
^^^^^ conditions; teacher, healthy, of cleanto
occular disease, consumption, gynecic
j^ habits, but peevish and not alive to the
troubles, sterility and marital unhappiness.
importance of properly caring for the health
The greatest economic mistake of the age
^f ^^^ pupils. The school inspector should
consists in permitting a continuation of
^^p^rt on not only every thing relating to
neuroses, physical defects and stigmata of
jjj^ schools sanitary condition, but also
degeneracy, where possible to prevent
everything any where near the school buildi^^^-
ing that may in any way affect the health-
,
If education is To fit us for complete livfulness
of the pupils. He should insist uping",
as Tillotson has defined, its object
on the correlation of physical development
can not be the accumulation of usele.5S
and education without regard to the accomknowledge,
but it must meaJi storing away pHshingof a maximum mental work. Inotnof
knowledge that finds its greatest use.
gr words a maximum is not desirable for an
What greater use can knowledge find than
average— as our teachers seem to demand,
the knowledge of how to live? This means
-phese histories and such other information
Ithat we must know some anatomy, much ^g ^jjj readily suggest itself should be tabphysiology,
and a great deal of hygiene,
ulated so that at any time any information
sanitations, preventiee medicine and chemdesired
concerning any school or pupil may
'Stry.
In these particulars, our schools and colleges
are sadly deficient. We, ourselves,
largely responsible for this state of affairs.
We have been too busy with the
treatment of diseased conditions to sufficiently
consider the education of our sons
be readily accessitale to either parent, pupil,
teacher, physician, health officer or super-
intendant of education. Some such forward
^^^^ supplemented by regular lectures on
^j^^ ^^re of the body, hygiene; sanitation,
preventive medicine, and kindred subjects,
^ould soon bring about a much better physi"
•Read before the Southern Medical Association, cal condition and a higher citizenship,
AOanta, Georgia, last Fall. especially if the inspectors are given the

222 THE CHARLOTTE MEDICAL JOURNAL.
authority to enforce their recommendations, of our schools require) at least an equal
This ought not to be diiScult as parents, time to prepare for these recitations and in
and educators will consent, I believe, to addition, add art, elocution and music as
any change that we can prove is whole- many of our girls have, you will readily see
some, practical and of far reaching conse- that they are over-crowded— exercise is cut
quence in racial progress. In many of the down to '2 hour twice a week and this
cities and in many of our schools we have grudgingly given. The result is that effete
already demonstrated the very great value products accumulate, toxaemsias result, the
of medical inspections. If this is trne any- brain becomes sluggish and inactive, the
where, it is especially true in the South and kidneys are overworked, the nervous system
in our colleges for women. When woman suffers a tremendous shock, physical develloses
the college opportunity for physical opment is interfered with, the most importdevelopment
she loses her final opportunity, ant function in woman's after life becomes
Woman is the greaer factor in heredity, altered, and she suffers from ihe conseqen-
Her ultimate function, and in normal wo- ces of a disordered uterine function—either
man, her greatest desire, is legitimate, menorrhagia, dysmenorrhoea or amenorhealthful
motherhood. If her health fails rhoea. Xo wonder that we reap the whirl- j
her in college, she enters life handicapped, wind: irritable temperaments, flabby mus-
The general changes in the anatomic and cles, infantile uteri and sterility; idiosyn-
j
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physiologic functions of young women are crasies, perversions, hysterias, choreas,
too well known to need reiteration here, but neurasthenias, anaemias, digestive disorin
the South we have been too largely inclined
to accept deductions made in the
ders. and so on through the category of diseased
conditious. The desire of woman
East without regard to the earlier maturity to put herself in an earning capacity and
of our women and the possible effects of an her unwillingness to admit the influence of
efforced
We must
education
make our
at
own
an
observations
earlier period,
and
her menstrual life upon her physical
being is largely responsible for the crowdjwellj
follow
largely
our
accomplished
own deductions.
before the
Education
menstrual
ing in educational work, and
much to lose her the cooperation
it has
she
done j
demolimen
begins, and education forced dur- serves. Very vnfortunately onr women
ing the years of puterbal changes exert a are taught but very little about themselves
vastly different influence on the human and this they are compelled to get as best I
economy. Our girls become sedentary, they may. I have personally known girls
dignified and retiring much earlier than who were in absolute ignorance of the men-
Northern girls. We contend with the en- strual function until its first appearance,
nervating effects of a much warmer climate
and more of our women suffer from obscure
and diverse troubles like the anaemias,
and they were much alarmed thereby until
informed that it was a natural function.
I have known society women to tell girls to
chlorosis, unciniarisis, etc. Our women take cold baths to stop the discharge if fhey
mature so rapidly that it is impossible often- wanted to go to a ball. Amenorrhoea' dys-
|
times for the mental and nervous systems menorrhoea and menorrhagia, in the order I
to meet the rapid changes going on in the named, are much more frequent among col- |
osseous and muscular systems. The result lege women and more unamenable to treat- '
in seen in neuroses and pyschoses. Unfort- ment than in women out of school. My I
unately our women have inherited ihe notion statistics differ here frem investigators in |
that it is unladylike toromp and play; that the East; Dysmenorrhoea seems to be more i
a lad}' should idle and not work. My sta- prevalent there: amenorrhoea, here. Among {
tistics show that puberty occurs in the aver- 1200 girls, 7r>'/c suffered from amenorrhoea, ^
age woman in Alabama at the tender age of while 90% suffered from some trouble of <
13 years and 9 months. The problem with menstrual origin. We have been enabled?
us is to make our girls take the exercise they to reduce this percentage considerably under I
need for full physical and symmetrical de- hygienic measures. Drugs are practically I
velopment and at the same time to distrib- useless, unless the menstrual disturbance is 1
ute the educational effort so as not to over- secondary to some other disturbance. Me- I
crowd them. It must not be forgotten that norrhagia is most difficult to relieve. In
pubertal changes are not accomplished all most of our schools we have cases of men- 1
at once, but are distributed over several orrhagia going on from term to term until 1
years. During this time there is a tremen- the general health is broken down and even i
dous increase in the number of broken down life itself endangered. One of my worst j
cells in the body, consequently there should cases of this nature was a physician's j
be a corresponding increase in the amount daughter. In spite of many letters and my 1!
of exercise. Unfortunately the reverse is urgent advice to remove her from school for |
true. If you add to this indisposition upon purposes of an operation, do you know he |
their part, 6 hours for recitations (as most forced her continuance, and the teachers,*

ORIGINAL COMMUNICATIONS. 223
in spite of protests, forced her attendance a most deleterious effect upon the health of
upon her recitations until the close of school, the individual, then are we indeed in need
She left school one of the most chloric of eve possible preventive measure for we
women I have ever seen. When physi- are fast becoming a race of mjopics. Right
cians set such examples, do you wonder here let me say, some of onr colleges are
why parents do not rise up in righteous in- making a very serious mistake in allowing
dignation? Speaking generally, there are traveling opticians to do the refracting
several defects of school life that are espe- work of their pupils. The medical profescially
reprehensible. Theendeavor to accom- sion should protest against this in no un:
'
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I
plish a maximum of work in a minimum measured terms. Practically all of the disof
time; the classification—the weak must orders of young women are increased durkeep
up with the strong—the dullard with ing college years. A word as to self abusethose
mentally bright: the lack of instruc- I have tried in every way to ascertain
tion along practical lines and a know-ledge
of one's own functions; the fact that no
whether this was a prevalent habit, as some
authorities have claimed; I have only been
leniency is shown during the menstrual enabled to learn of one case in nearly 5000
period; the cram of examinations; grading young women, and this was a paranoiac
according to per centages; inadequately who was later sent to an asylum, hence I
equipped gymnasiums; the absence of regu- conclude most emphatically, self abuse does
lar, daily systematic exercises, etc. Most of
our colleges for women are now insisting
not existin the average normal Southern girl
of mature years. I have said nothing, purupon
high curriculums. There can be no posely, about the evils of dress, the natural
objections provided education and physical imprudence of women, their neglect of
development are properly corrrelated. While themselves, etc., believing that these condimost
of the teachers in our colleges for tions can be remedied by a sufBcient num.women
are women, I have found more of
them unamenable to reason than men—not
ber of heart to heart talks with the girls
themselves. The infrequency of marriage,
because they do not believe these truths, late marriage and the sterility of college
ibut because, they say; "Well, I had to un- women, I believe to be largely due to higher
dergo the same thing, and I've gotten along ideals among our college bred women. It
! alright. '
' Xine
out of ten of these women are is more difiBcult for them to secure mates of
iirrascible, peevish, snappish old maids and similar ideals. Their sterility is due to no
!to any fair minded man or woman thei-' unwillingness to bear children, but the un-
'pitiable condition appeals for sympathy, fortunate lack of development which seems
In the "teens" is woman's great time for to be concomitant with higher education.
(Storing up force, nerve energy, and cellular
jactivity— nature's most strenuous elTort is
Ibeing put forth. If the cells are poorly
As wifehood and motherhood are the true
ends of womanhood, we should see that our
women are developed to their fullest extent
nourished, if nerve energy is wasted, if physically, then there will be no evil results
vital force is exhausted, ill health is inevit- from the highest mental development. Eduable,
sterility results, or in later life there cational efforts should be directed more to-
I
il is a weakened progeny. The only person wards woman's ultimate end in life
||who can remedy this is the physician and and every woman should have as a part of
'he can only do it by a careful study of each her training in life a knowledge of herself
Ipupil. The college physician then is a ne- and a knowledge of ihe processes of gesta-
'cessity, and the necessity for the medical tion. If left to her, I am sure she had
inspection of all schools can be as readily rather be taught how properly to clothe,
.proven. Observations extended over sev- care for and feed her offspring than to cogieral
years show that 3.S% of our girls are tate over differential calculus or to meditate
received in college already suffering from over the religious beliefs of the ancients,
some chronic trouble. That this is due She should at least be taught hygiene, sanilargely
to defects in the public and high tation, physiology, biology, botany, zoolo-
'Schools, there can be no doul)t—probably gy, domestic science, scientific cooking,
unsanitary conditions and indulgences at nursing and infant feeding. They should
home are in part to blame, but this can not be taught more largely out of doors. All
account entirely for the increase of digest- colleges and high schools should be equip-
'ive disorders, anaemias, etc. The past year, ped with good gymnasiums, and physical
on entering college, 7,S out of 2.Si) girls ex- culture exercises should'be regular and sysamined,
gave a history of marked menstrual tematic, under well trained instructresses,
disturbances, i. e. ,50%. 10% gave a his- Possibly I .should apologize to you for not
•or\ of antecedent tubercular history. IdO quoting from Christopher, McDonald, Hall,
s'irls out of the last .300 examined, or Kelly. Goodell, Playfair, or from some of
i.'^ 1 .^/?, showed defective vision. If Gould the recent writers before the American
is right in his contention that eye strain has Academy of Medicine, but no one of these

224 THE CHARLOTTE MEDICAL JOURNAL-
has considered the subject from a Southern the typical pupilary glare of the insane. ^
standpoint. I am reluctant too, to conclude She subsequently improved under relief
that in their deductions they are invariably from worry, and at home finally regained |
correct. I want us to investigate this subject an apparent normal condition.
j
for ourselves. From a considerable number Now there are several points to be con- |
of histories at my disposal, I select a few for sidered about these histories: Probably 4
rehearsal, and 1 have concluded. none of these girls should have been accept- j
Miss C, aged IS, family history nega- ed by any school until they had shown that J
tive, except that a younger brother was they were physically qualilied to do college
idiotic, very bright, led her classes until the work, but having accepted them, the school
spring term of the Junior year, broke down, or college should have provided every safehad
to leave college, married at 20, has guard to preserve what little health they
been married 10 years, no children, has did have. Here we encounter the system
been an invalid since breaking down at of classification, and the fact that they
college. Cause: Nervous temperament, must keep up with their classes or drop behard
work, no exercise, ozoena, chronic hind. When they are thrown in lowei
indigestion and constipation. classes, then a "howl" is raised at home.
Miss R.. blonde, entered college at 14, It is impossible to enforce cooperation upon
family history excellent very close hard a faculty unless we have parental approval
student, suffered from amenorrhoea, took at home and this, without an educational
exercise only when compelled— that was ,'2 campaign, it seems almost impossible tc
hour twice a week. Went from bad to obtain. The only alternative that seemi
worse, graduated at 17, but died 8 months feasible to the writer is that the
later from tuberculosis. physician should have supreme power-
Miss B., brunette, aged 20, mother died even power over and above that of president;
from tuberculosis, physical health good or teachers. To secure this we must again
upon entering college, very hard student, educate the public to the extent that boards
but learned with difficulty, could not keep of trustees will give to their physicians unup
with her classes, went to bed 3 months limited and unrestricted power in all matafter
entering worrying over recitations, ters appertaining to the hygiene and sani
spent most of the next 60 days in bed, was tation of our schools and colleges, as well
then sent home; has been suffering from as in all matters of classification, physical
nervous prostration since leaving school, culture and out of door exercise. Here, the
Cause: Compelled to do work beyond her diet is an important consideration an^
strength. should be constantly watched, altered auj
Miss P., blonde, aged 18, entered college changed according to individual require
suffering from menorrhagia, refused opera- ments.
tion, continued work in spite of condition. One word more: A school should never
family history good, went home at end of have a physician under the power of either
session, with haemoglobin percentage of a president or a faculty. Personal preju- j
60 and in a state of chronic invalidism. dices play too important a part? A college
Miss B.. blonde, aged 16, tuberculosis in that has a physician only tor purposes of
family, developed broncho-pneumonia, re- treating the sick had prebably better not;
fused to go home after recovery, but con- have any regular attendant at al'
tinned her studies. Soon after her return any school operating without a physicia
to work had return of cough and microscop- ought to be tabooed by parents general^
ical examination of sputum showed tuber- having the welfare of their sons and daughj
cle bacilli. ers at heart.
Miss J., aged 17, family history good,
broke down during year from over work, Carbuncles.*
but continued studies in a desultory way. By J. G. Johnston, M. D., Chester, S C.
In February developed broncho- pneumonia, ^ Carbuncle is a circumscribed inflai
fo owed by empyaema which vvas in turn
^^^^ extending through the skin into
followed by pyaema, after 101 days in bed,
^^u^i^, ^i,,^^, beneath, and due, in n
recovered, bu was for months compelled to
,^ ,^^ Staphvlococcus.
be wheeled ";^>erever she went
, ^ It may occur in any part of the body, bu,
Miss S., blonde family history bad,
seems to have certain points of predilection.,
mother insane, hard student, or
^
4 months
^^^ ^^.^ ,^^^„„ ^j ^^,^^^^ -^ ^^^ back ofi
after matriculation couldn't sleep at night,
^^^ ^^^^ j^ g^g,„, t„ „,^^, wherever therei
became very melancholic was sent home
j, ^„^ irritation of the skin, and it may b«
in unbalanced mental condition. As illns-
^^at "the constant rubbing of the collar on
tration ot condition when she left school 5
would pace the floor all night in that long *Read before recent meeting of the Tri-Stati
restless stride of mania and at times had Medical Society, Charleston, S C.
,

ORIGINAL COMMUNICATIONS. 225
i
the back of the neck is responsible for their he lives. If, in this operation, you do not
being- found there most commonly. get all of each division, you are likely to
One of the first symptoms of a carbuncle, have further trouble and a spread of the
is a slight redness and swelling of the part, infectious process. Now, I do not propose
accompanied, usually, by pains radiating to criticise these modes of treatment and
from the point in various directions. If it stop there, but 1 hope to be able to present
happens to be on the back of the neck there something that will materially help the
is a stiffness of the muscles and pain runhing
up into the head more noticably than
doctor in dealing with these painful affec-
tions. To be brief, the plan I have found
^Isewhere.
Tha patient thinks little of it—thinks he
best is to treat them with a high power in-
candescent electric light. This plan of
has a little boil on his neck and very likely treatment softens the mass around the imbqueezes
it or gels some friend to squeeze it mediate infection, stops the infectious protor
him. This usually does more harm cess, and almost entirely relieves the pain,
than good for it bruises the underlying and They will almost invariably get well in a
adjacent tissues, making infection of them much shorter time under this than any
much more easy. This state of affairs may other plan of treatment I have ever tried.
Continue for a few days with pain and
bwelling gradually getting worse. He then
buts a poultice on it—thinking thus to soften
The light has a decided influence on the
spread of the infection, rendering it more
circumscribed. The most wonderful part
the core and get rid of it. In this he is usu- of the whole thing to me, is that the parts
ally mistaken, for instead of getting better are so nearly anesthetized that you can do
[t continues to grow worse and larger. By what little cutting is necessary or what
he time he consults a jjhysician it has gotten squeezing is necessary to force the pus out
ucli a firm hold thatnothing can prevent it. with very little pain to the patient. I use
The physician then finds a large circumscri- a 500 candle power incandescent light with
)ed mass with two or more openings in it, a parabolic reflector over it, focussing the
vith pus oozing from tliem and an infiltra- light rays on the desired spot; at the same
ion of the surrounding tissues, so much so, time drawing down the lamp as near the
hat the hardness sometimes extends several patient as he can stand. It gets hot alright,
nches on all sides of the openings, Those
)n the back of the neck p oduce such inolerable
pain in the head that nothing
but the relief from pain is so great that they
are willing for you to make it hot for them,
I have treated a number of cases in this
hort of Morphine hypodermically will way, the number of treatments varying
elieveit. This infiltrated skin has a dusky from one to twelve— giving one treatment
ed ajjpearance and is very hard to the each day. I will not go into details with
ouch. 'JMie temperature ranges from 99 these cases, but will only say that witli
i5 degrees. The bowels are constipa- about an equal number treated in the old
ed, the urine high-colored, and in many way with poultices, lancing, cjkc, and those
>atients some sugar is found, as it is gen- with the light—that the ftirmer took about
rally known that a man who has many as long again to recover and suffered three
arbuncles is in a pretty good road to be: or four times as much as the latter. One
ome a Diabetic. thing I wish to mention is this—that the
However this paper has nothing to do time reciuired to complete the cure after the
t'ith that, only dealing with the carbuncle cores have been removed is also very matelone,
Now as to treatment: Almost everything
rially shortened.
In conclusion, I only wish to say that I
u the medical alphabet has been used and think the advantages of the light treatment
)raised by some one. However there are a
w things that all agree are among the
are briefly these:
1. Less danger to the patient,
lest things to be done. Many advise mak- 2. The pain is much less,
iig two deep cross incisions through it and 3. Recovery much more rapid,
uretting out the contents. Some advocate 4. Much smaller scar.
lie injection of carbolic acid into them to I am sure that if you will give it a thortop
the infectious process. I suijpose the ough trial on even one patient, that you will
tost common practice in all cases is to never go back to the old way of treating
nesthetize the patient and cut out the them again.
rhole infected area. This usually relieves peripheral Operation lor Tic-Doulourex;
le pain, but it is very seldom that you will Report ol Case.
nd a patient who is willing to undergo the By Dr. A. IC. DakL-r, Cliarleston.S. C, Gynecologist,
nesthetic until he finds there is absolutely l'"!"-''' Hospital Polyclinic Medical School
o other way out of his trouble. This also Of all diseases that are not fatal, probably
as the disadvantage of making a large facial neuralgia is one of the most distresscar,
that stays with the patient as Igng as iug and one of the most difficult to cure.

226 THE CHARLOTTE MEDICAL JOURNAL
The external treatment of this disease has
been almost as varied as the internal; all
manner of application of heat, cold, drugs,
liniments and lotions, have their testimonials
of cure. Electricity is employed in
the form of electrolysis and high frequency
current. The X-Ray has been used as well
as thorium and radium.
The number of surgical and semi-surgical
methods for the relief of this trouble are
probably greater than that ever advanced
for the cure of any other disease.
Owing to the mortality of operations on
the Gasserian Ganglion, which is at least
10 per cent, and the fact that at first we
may be unable to differentiate between a
major and a minor neuralgia, the peripheral
operation on individual nerves should first
be tried, provided all, or a large number of
the nerve, are not involved.
To obtain the best and most lasting results
from peripheral operations the nerve
should be removed as far centrally as possible.
The branches of the 5th nerve show a
very strong tendency to regeneration leading
to recurrence of the neuralgia after neurectomy,
especially those branches which
occupy a boney canal.
In mentioning some of the operations
which have been devised, the strecthing of
the nerve was done as early as 1748; it gave
some little relief, the method has been abandoned.
The division of the nerve was but
little better, in that the nerve reunited so
quickly.
Resections of portion of the nerve gave
relief from 6 months to 2 years, at which
time the nerve had succeeding in reproducing
itself.
J, Ewing Mears recommended the removal
of the Gasserian Ganglion in 1884, and this
was first done by Dr. Rose in 1890.
Dr. Abbe, 13 years ago, advocated the
intra-cranial inplantation of rubber tissue
to cover the foramen of exit of the various
branches of the trigeminal after their resection.
This effectually prevented the regeneration
or reunion of the nerves, and a further
report was made in 1903, showing permanency
of cure. Shortly after this original
work of Dr. Abbe's, Dr. C. H. Mayo,
accepting the idea of interposing mechanical
difficulties to the nerve union, devised
his operation, which is based on the different
function of the motor nerves from that
of the sensory nerves, namely: that the
motor nerves require a favorable opportunity
for reunion, while it is a most difficult
matter to prevent the regenation and return
of function of the sensory nerves.
The impulse of the motor nerves being
from the center outward, the peripheral end
degenerates. The function of the sensory
nerve fibers are just the opposite, which is !
'
from the periphery to the center.
Ilis method is to remove as much of the !
nerve as possible, by resecting it out of the :
foramen by Thiersch's method, then plug
the foramen with a silver screw, the screw ,
1
'
being sufficiently large as to be forced in ij
the foramen by means of a screw- driver,
thereby making it impossible for this screw
to become dislodged; such being true, the ;
j
nerve can never grow back through this
foramen to reunite itself with its peripheral'j
end. 1
Report of Case.
Capt. E., aged 65. Suffered 9 years with
j
|
I
I
;
I
facial neuralgia, having intervals of a few
months rest from pain.
As usual, he had every imaginable treatmeut
rendered him but with no permanent
results.
Finally his sufferings became so intense I
that he could not talk or eat without severe •!
i
I
I
sufferings. Also he could not sleep except
under the influence of morphine.
Life under such circumstances he felt I
could not last long, therefore, he accepted
the operation which had been offered him j
several times before.
The operation consisted in dissecting the
infra- orbital nerve from the foramen and
with a hemorrstatic forcep caught the nerve
]
close to the foramen and winding the nerve I
on the forcep by Thiersch's method, which
enabled me to remove at least 2 inches of
|
the nerve. j
With a Mayo's silver screw, the same be- !
ing Yi, inch long and a /:; inch thick, by \
means of a screw-driver, placed this most '
firmly in the foramen, thereby making it i
impossible for it to ever become dislodged. \
This being true, the nerve will be prevented !
in its efforts to reunite itself with the peri-
j
pheral end. j
It has been one year and a half since this
operation and the patient has been entirely I
free from any symptoms of the old neural- !
gic pains. Quoting his words "l am now '
a well man."
The Potency ol Medication in Serious
Cardiac Disease.
By Alexander G. Brown, Jr., M.D., Professor of
Theory and Practice of Medicine, University
College of Medicine; Physician to Virginia
Hospital, etc., Richmond, Va.
In no department of medicine has therapeutic
pessimism been more emphatically
checked than in the recent studies and treatment
of cardiac disease. This signal reaction
in the use of drugs for the amelioration
of the distressed, the prevention of the
premature termination in degenerative disease
processes, and the cure of disease itself
is nowhere more clearly evident than in this
I
'\
|
'

ORIGINAL CO.MMUNICATIONS. 227
branch of medicine; and this remarkable ation of the circulation, as revealed in
fact, in which all physicians must rejoice, secretory functions, in certain viscera, notais
to he explained upon a two-fold basis: bly the kidneys, intestines, liver, lungs, and
notably, the new and clarifying additions so on.
to our knowledge of the phenomena often The potency of the therapy of serious
characterizing pathologic conditions of the cardiac conditions might be discussed in
heart and, secondly, a coincident enlighten- several ways, but I desire to present the
meut upon the value and therapeutic appli- subject from the view point of drugs comcalion
of remedies used in these conditions, monly used in heart maladies.
When we reflect upon the pictures present- Digitalis.—This is the great cardiac stiming
clinically in some cases of heart dis- ulant. It has its definite field of therapeutic
ease, as that of failing heart with dropsy, application. It has its peculiarities that
dyspucEa, insomnia, discomfort and many makes it dangerous and harmful to the
others, or of angina pectoris with its great heart under some conditions. It is toxic
pain, alarm, and so on, or some functional from cumulative effect or from over-dose,
syndrome with its tachycardia or brady- producing incoordination and disassociacardia,
and see these groups of heart mala- tion of auricular and ventricular systole.
dies yield to therapeutic agents and be He who gives digitalis to slow the heart in
removed from conditions of gravest danger paroxysmal tachycardia, in cases of fever,
I
to those of comparative comfort and security in cases of associated acute nephritis, in
against premature and sudden end, we pleural effusion, in cases of extensive and
can very readily understand the renewed late degeneration of the myocardium with
interest and enthusiasm exhibited in the arteriosclerosis, in pneumonia, in rheumatic
consideration of this subject. The former fever, will meet failure in its use. In these
conception that heart murmurs were the conditions digitalis is impotent. Not only
only diagnostic symptoms of supreme im- the nature of the heart lesion has an effect
portance; that the lesion back of such mur- upon the efficiency of its action, but also
murs, of structural origin, represented ir- the kind of preparation has a decided inremediable
conditions in which effort should fluence upon the results secured. Therebe
limited to the comfort of the case; that fore, it is important in administering this
the heart should not be considered thera- drug to know that you are working with
peutically until these murmurs were as- a physiologically standardized preparasociated
with pronounced symptoms of a tion. This subject has recently been
more or less distressing kind, is giving way thoroughly investigated by Edmunds and
to the view that heart murmurs give but Hale (Bulletin No. 48 Public Health and
little valuable information in connection Marine Hospital Service of the United
with the matters of greatest importance in States). The action of digitalis upon the
the treatment of cardiac diseases, that val- heart may be divided into three elements,
vular disease is really of far less imi^ortance It slows the pulse by prolonging the diasthan
the behavior of the myocardium and tole through stimulation of the vagus. It
that the early management of beginning effects greater tonicity in the heart muscle
derangement in cardiac action is of the and thus produces a stronger and more
greatest importance, and that upon these complete systole. It acts to produce conconditions
deoend therapeutic success. striction upon the splanchnic arterial vesf\nother
more recent consideration of this sels and dilatation of the peripheral and
subject is to take a broader range as we cerebral arterioles, due, it is thought, to the
tudy cardiac problems. No longer do increased pressure in the internal arteries,
clinicians deal with heart pevse. The vas- (. Miller, J. A. M. A., Vol. II, No. 21, citcular
system has to be considered at the ing Gottlieb and Magnus). Having the
same time. The newer views of arterio- standardized drug and administering it in
[sclerosis have added much to the success- the selected cases in which it is useful the
jlful management of cases with prominent clinician has to watch the effect of the diug
Icardiac disease. The mere fact that palp- upon the heart very carefully. Sometimes
lable arteries seem not involved in sclerosis brilliant results will be forestalled by the
does not preclude the likelihood of serious too persistent use of it; sometimes the retvascular
disease:— not infrequently a con- suits will be delayed by the insufficient
Mition in which the crux to the distressing dosage. The careful study of the pulse, an
I;ymptoms
are to l)e found. Internal and accurate observation of the daily secretion
ocal arteriosclerosis, with or without high of the urine nre essential as a guide
irterial blood pressure, often sustain a most in its use. The fir^t good effect to be
mportant relationship to the cardiac em- noted in the use of digitalis will be the in-
)arrassnient. luirther, the value of medi- crease of urine; this usually appears in
ration in cardiac diseases depends upon an about forty-eight hours. The pulse is
idequate understanding of the proper oper- slow^ed, has more precision and more vol-

22S
THE CHARI,OTTE MEDICAL JOURNAL.
ume When these physiologic conditions achievement in this affection, even to the
are accomplished the drug must be reduced point of passive congestion and dropsy.
in dosage and under such circumstances In cases of stenosis at the aortic or mitral
can be continued for a longer time, modify- orifice the use of digitalis is not indicated
ing the frequency of the dose to meet the and will do serious harm unless certain
conditions, without the fear of toxic phe- complicating factors exist that demand the
nomena. The administration of digitalis temporary use of it, such as secondary,
can be by mouth, intravenously, or by dilatation of the right ventricle and passive
rectum The usual method, unless there is eougestion of the liver and dropsy. In
decided gastrointestinal irritation from its these conditions digitalis should be used to
use should naturally be bv the mouth; restore tone to the right ventricle; when
especially so in office and general practice, this is accomplished other remedies must
The chief affections of the heart respond- be relied upon to maintain the equilibrium,
ing to the use of digitalis are those that show There is a class of cases in which the use
dilatation of the heart with comparatively of di-italis can be of advantage only in
healthy muscle. In cases with a weak and certain stages, and that is those cases withinsufficient
systole, this drug, properly used, out valvular lesion showing arterial scle-
effects most satisfactory results. In old rosis with symptoms of cardiac distress. .
rheumatic cases, with weakness of ventri- This cardiac condition, following upon the
cular action, with symptoms of failing com- obstruction to the circulation m the aorta,
pensation, with passive hypereemia of ven- kidneys, and splanchnics, due to sclerobis,
ous circuits, this remedy accomplishes bril- may show a tachy-arythmia, may show
liant results. Cloetta (cited by W. His, rapid auricular systole and slow ventricular
Therapie der Gegenwart, Berlin, XLIX, action, may give signs of dilatation of the
No. 10, p. 433) states that the administra- left ventricle, or secondary relative regurgition
of digitalis in recent valvular trouble tation of the mitral valve, and later with
will restrict the compensating hypertrophy oedema of the lungs with dilatation of right •
and dilatation to a minimum. Inthesecases ventricle and venous pulse,
its continuous use in the period of conva- In this class of cases, now so often seen,
lescence following acute endocarditis the digitalis can have no place m the therapy,
drug has been most useful in my experi- except in the most unusual syndrome, until
ence, and I believe has forestalled grave the late signs of lower blood pressure precardiac
terminations in several cases that vails in arterials and the heart labors under
showed a tendency to sudden cardiac fail- the bane of broken compensation. In these
ure. The administration of digitalis in later stiCges its careful and skilful use, in
aortic regurgitation has been a question of connection with elimination of toxic agents
dispute. In these cases effectual good can and unburdening the splanchnic and renal
be done if the case is one uncomplicated by circulation, good results can be gotten here.
great sclerosis of the arteries; with high Strophanthus, squills, apocynum, and adoniblood
pressure the administration of digi- diyi belong to this group of remedies. The
talis is not only not indicated but it is de- use of squills, apocynum and adonidin (this
cidedly harmful. But in cases of aortic last remedy is said to have a dilating effect
regurgitation, with hypertrophy and dila- upon the coronaries) areemployed very little
tation, relative mitral regurgitation, the use on account of their irritating qualities in the
of digitalis is very good in its results. gastro-intestinal tract. Slrophanthus, for-
In mitral regurgitation digitalis is most merly thought to have no constricting effect
efficacious. Especially when the disease upon the internal arteries, but latterly be- i
process begins to show or has already lieved to possess this quality, although to a
reached broken compensation. Some ob- less degree than digitalis, is much like digiservers,
as Bayet and Wood (cited, A.J. talis in action. It differs from it m being
M. Sc, Vol. CXXXVI, No. 5. p. 661) dis- less powerful as a tonic to the heart muscle
claim for it any signigcant usefulness upon but in its use the cumulative toxic elfecl
the right ventricle and therefore they claim has not been observed to any marked dein
failing compensation of mitral regurgita- gree.
tion when the right ventricle shows dilata- But the potency of cardiac tonic remedies
tion this drug could not be relied upon to depends also upon associated therapeutic
tone up the muscle of that chamber. How- measures. Digitalis alone will often fail in
ever, the clinical experience of other ob- cases that seem to be ideal for its use beservers
substantiates the view that digitalis, cause of the absence of certain co-incideiU
or some member of the group, effects both therapeutic agents directed to assist in the
ventricles, restoring tone and vigor to in- solution of the disease problem. Often the
ervated muscle and re-establishing the equi- use of spartein sulphate in large doses will
jibrium of the circulation. It is conceded effect happy results in the restoration of the
jhat this drug is capable of excellent secretion of the kidneys. In some cases
1

ORIGINAL COMMUNICATIONS. 229
where great nervousness prevails and cer- in a state of delirium. To these remedies,
tain alarm obtains the use of morphine sul- mainly digitalis, he has been restored to
phate and atropine sulphate will be most activity and is now living a very comfortuseful
in reducing this strain upon the cir- able life with a fixed mitral and aortic reculation.
The removal of dropsical effusion gurgitation. He knows he has this heart
is an important consideration in these cases malady. He is a cardiopath. The heart
and it is a condition which the digitalis can- muscle must be protected. If protected he
not re!mve promptly without material as- may live comfortably to old age. He repsistance.
Under such circumstance the use resents a large class who appeal for mediof
astrongcliolagogue,ascalomel,elaterium, cal guidance and treatment.
orelaterin, is advantageous. Excessiveliquid
diet should he supplanted by dry diet. In my The Violet and X-Ray Cbarms.
hands theinterdic'.ion of salt in the diet has By Robert Gray, M.D., Pichucalco, (,'maga.s,
been helpful in the reduction of the dropsical Mexico,
effusion. Under certain conditions the use
of vasodilator drugs are necessary to relieve Electricity, the medical magic, the light
the constricting effect upon the splanchnic of the world, the breath of the invisible, the
arteries and to assist in lifting the burden life of man, is a theme that elevates medifrom
an overtaxed heart muscle. Some- tation to lofty realms.
times it is imperative to maintain reft of the You people, practitioners, who see and
body in recumbent position. Anv muscu- hear its marvels at all hours of the day and
lar exertion but adds to the problem in night, in material servitude, where science
some cases. I recall a case referred bv Dr. has basely harnessed it in slavish work, do
J. W. Henson of Richmcmd, in which the not pause to contemplate its sublime merits
only change recommended to that already and render it that homage you should pay
practiced by him was to keep the patient with fear and trembling. Were you where
in the house for two weeks and that in an 1 am, in wild, remote, sequestered haunts
even temperature. This patient showed of primeval nature, with no electric contact
improvement and has been able to return other than the medical employment of the
to his usual duties. The gastrointestinal vitalizing current, you would enshrine it m
digestion should receive the constant atten- loftiest niche of the temple of fame, as I
tion of every clinician in his treatment of long have done and do now.
cardiopaths. The early elimination of the Why, every country physician should
toxic accumulation of acetone bodies or the have the violet and x ray portable coils and
indol agents. The clothing in winter should batteries, now both cheap and practicable
be warm and capable of maintaining an enough for a poor doctor to be their poseven
temperature upon the peripheral circu- sessor, as they frequently pay for themselves
latiou under all ordinary changes of weather several times in a year and render the phyand
climatic conditions. The success in sician far more secure in his practice. Were
the treatment of cardiac disease rests upon the profession free from prejudicial legisanother
factor. It depends upon the dos- lative shackles, and able to devote the time
age of the remedies used. In this class of wasted with the nonsense of State Boards
disease conditions where the endeavor is to to electricity and its scientific medical apre-establish
function the dosage must de- plication, it would certainly be a precious
pend, not upon the ordinary rules, but upon boon for suffering humanity. If your legisthe
physiologic effect of the remedv. Hav- lature could hear read in thunder tones the
ing a clear cut idea of the pathologic phe- bushels of letters that come down here to
nomena and the svmptom-complex to be me from collegiate practitioners ten to
dealt with, the remedv must be applied for forty years in harness and successful practhe
removal of such conditions as form the tice, unable to answer many useless quesproblem.
Watch must be kept up for the tions, the laws would certainly be modified,
earliest phvsiologic effects and the strictest W^e are merely in the embryonic electric
lookout must be maintained for the earliest question, new wonders even being in preptoxic
effect of the drugs. aration to surprise us. 1 here are electric
In all these cases the tonic treatment scientists who do not believe in electric imshould
be continued for such period as is possibility short of immortality on earth,
required to restore the functions of the heart. No one, as yet, probably ever speculates as
In conclusion, I recall a case of a boy, to the how of such eventuality and other
fourteen years old, who has had within the yet minor features not now in popular
last four years five attacks of broken com- dreams. . , .,
, j
pensation following rheumatic seizures. In But the every day practical, easily learned
this case dropsy occurred until the youngster and readily applied processes of clinical
was greatly increased over normal size, the electricity are what should engage the solicidyspnoea
was distressing and the heart was tude of every physician who has no porta-

230 THK CHAKi^OTTK MKDiCAL JOUKNAL.
ble mechanism and is ignorant of the appli- newer immunizing agents, both because o{
cation in a country practice. its more extensive and common use, and
I have found that most electric charms of also because of the longer period of time
clinical application are verifiable, and that over which its administration becomes necone
may do sterling work out of the actual essary, I wish, though, to emphasize at
beaten track indicated as practical by the this point, that what I will have to say reprofessors
who instruct doctors by book garding dose graduation in tuberculin will
lessons, which are mere finger boards to the be equally applicable to all biologic products,"
intelligent practitioner, who will advance the object of which is the increasing of tisbeyond
in the strange new field of scientific sue immunity,
enchantment. The plan of dosage of tuberculin quite!
In the narrow sp'^ce of a medical journal universally followed is in brief as follows
contribution it is impossible to do more Treatment is begun by a minimum dose,
than assure practitioners that electricity is the exact amount of which depends; first,
a medical necessity, if one would do some upon the condition of the patient; secondly, '-i
of the best paying practice that cannot be upon the particular variety of tuberculin
in dreams without the majestic current. I used. The initial dose is increased, at first,
did not find it a difficult lesson; but I began very gradually, and the interval between
experimenting with the old back number, the injections is comparatively short. Later
almost worthless batteries, and have fol- on, larger and larger amounts of tuberculin
lowed it up right along to this high degree are given with a corresponding increase of
progressive epoch, where lessons are clearlj' the interval. Finally, there comes a time
practical, much valuable instruction regu- when no further increase of dose can be
larly appearing in current medical journal tolerated. This dose of tolerance is a most
literature, written by physicians in active variable one, and depends upon many con- I
practice, not by collegiate theorists, just the ditions, the details of which cannot here be
aid the country doctor needs to guide him entered into. The one danger-signal to the
aright. physician who is giving this powerful drug '
1 am forty-three years in this fearful field is the reaction,—truly the "red-flag" to the
of tropical fevers, in the sickliest belts of administrator of tuberculin,
the Continent, without one day of vacation,
that has taught me some valuable lessons
To show the far-reaching harmful effects,
of faulty dosage, one has only to recall the'
all along the line of clinical emergencies,
being still in harness beyond my four score
history of the use of this same medicinal
agent. Shortly following the announceyears
of life; and electricity is' the future
that most interests me and is my study and
my desire, that absorb my else idle meditament
by Koch, that he believed that in
tuberculin we possessed a most valuable
remedy for the treatment of tuberculosis, its
tion in long rides over a broken, roadless administration was commenced by physiccountry
and midnight watches beside fever- ians all over the world, with the natural
ish cots; and I wish all readers hereof would and inevitable result of doing vastly more
take the same interest in the grand medical harm than good. Non-selection of cases,
mystery. over- dosage, and the too rapid increase of
the dose given, were responsible for that
Tuberculin Administration: A Perfect
memorable swing of the pendulum of popu
System ol Dose Gradnation.
,^^ disapproval, started by none other than
By Lucius B. Morse, :\I. D., Physician-in-Charge, Virchow, the extent of which has perhaps
Dr. Morse's Sanatorium, Chimney Rock, N. C.
^^^^.^^ ^^^^^ equalled itl the annals of medi-
In the administration of any powerful cine. It was over fifteen years before the
drug, the matter of dose is obviously an medical profession at large recovered from
important one. With most of the older its over-dose of this drug. The patient and
drugs the range of dosage is not very great, doctor alike experienced a reaction against
and, except in rare instances, it is not nee- tuberculin.
essary or desirable to gradually increase the The medical mind, however, of recent
amount of any medicament given; indeed years has changed its attitude. Ourpresent
the reverse almost always holds—the efforts knowledge of the nature and dosage of tuof
the physician being directed toward a berculin, of its indications and contra-indidiminution,
rather than an increase of dos- cations, is infinitely greater than was that
age. An exception to this general rule, of those who attempted its administration
though, obtains in the use of certain bio- in the early nineties. Not a few staunch
logic products. I refer to the increasing believers in the value of tuberculin, though,
number of such products as are given for are fearful that we are possiblv approachimmunizing
purposes. ing another similar reaction against this
My remarks will be limited to the use of agent;—less pronounced, perhaps, but none
tuberculin as the most representative of the the less certain. It is thought, now that
'

ORIGINAL COMMUNICATIONS. 231
the drug is being given by thousands of to be desired. It would also seem as though
physicians, that many harmful effects will such an uneven method of administration
inevitably result, particularly in the hands would certainly increase the likelihood of
of those whose experience in the use of producing reactions. Now this is exactly
vaccine products in general is of a very what happens. Every one who has had
limited sort. experience with the use of tuberculin knows
OXIM.\TE

.
232 THK CHAKLOITE MKDICaU JOURNAL.
strength, before advancing to the next charlatan in nature and did very little to
stronger solution, he is only to proceed by introduce to the world any correct surgical
two points instead of one, and the rate of method for the relief of squint. The first
increase, instead of being 29.1 per cent., practical operation is described in 1838 by
would be double that, or .58.2 per cent., Strotneyer. This grew out of the theory
which would likely never be exceeded. that the contracting muscle was shorter and
Such a dose scale should be of benefit thicker, and the first authentic operation
alike to the specialist and to the general was similar to the one of the present day
practitioner. It is to the latter that I can
see a very positive advantage. The number
of persons during the year to whom he
for tenotomy,
After this the pendulum swung rapidly
aud operations were indiscriminately made,
administers tuberculin, are necessarily few.
The danger lies in the reaction,—not the
with, of course, frequent bad results.
Von Graefe, in the fifties, demanded
slight evanescent ones, whether local, focal more conservative policy. Then came
or systemic, but in the severer grades. Such Bonders, with his theory of strabismus bea
dose scale as the above will reduce to a ing due to errors of refraction, arising from
minimum the dangers attending the thera- disturbed relationship between the accompeutic
administration of this drug. modation and oonvergence.
Co)iclusio7is
I- That strabismus convergens is de-
pendent upon hyperopia.
ist. The immunizing effects of tuberculin
are best brought about by an even gradua-
n. That strabismus divergens is de-
pendent upon myopia.
tion of dose-increase.
2nd. The present method of increase by . Bo"ders theory was readily accepted and
is
volume is most uneven and is attended
adhered to
by
by many today, though theoreti-
""^^^"^
greater danger of producing reactions.
^" practically shown to be inaccu-
^^^e.
3rd. A system of dosage based
tor a time previous to this all squmt-
on a uninig
eyes
form ratio-increase, such as I have formuwere
operated upon. Fhe reaction
°f tlie
lated, is most in keeping
pendu um swung rapidly back and
with the theory of
the production of immunitv, and constitutes "^^^^^^^^ almost as harmful advice,-to
^ }^
wait until the child
the safest mode of administering
had outgrown the detuberculin,
^^_^_^^
formity.
Squint and the Importance ol Its Early There are two forms of strabismus, the
Correction.* paralytic and concomitant variety. The
By Dr. Hugh M. Lokey, Atlanta, Ga.
method of determining the paralytic from
^j^^ concomitant is as follows:
iStrabismus was mentioned in the earliest I" the paralytic form the axes of the
medical writings, but was regarded as a ^^ed and the deviating eye do not mainpermanent
deformity. Hippocrates in his taiu the same relationship when the eye
writings twenty-two centuries ago refers to moves from side to side, while m the conit
as a distortion, and recognized its inher- comitant the same relationship of the axes
itance. Celus in the first century of our is maintained in all positions. According
era, refers to it, but at this time it was not to Bonders' theory, strabismus and hetecoiisidered
ameliorable to treatment. Pau- rophoria are produced by the same causes
lus Aginetta in the seventeenth century and are confused by some,
recommends the wearing of a mask extend- Worth's view is that squmt is due to deing
below the nose, with openings for each ficiency in the development of the fusion
eve, to induce the eves to assume their prop- faculty: (this is frequently inherited) acer
position. Pare, in 1561 to '77 describes counting for the frequent occurrence of
squint eve as an inequal vision caused bv children of squiting parents possessing the
the cradle being placed so that the child same defect. Breslau states that 2:S per
sees the light from one side, thus causing cent, give this history.
the eves to divert towards the light. Many Fritz Kehr, in (Wachenschrift fur The-
|
still adhere to Pare's etiology, and many of rapie und Hygiene des Auges, Becember
the laitv now, as well as some of the pro- S, 1904,) divides the authors of the several
fession, attribute deviation to the fault of theories into three classes.
the cradle, a lock of hair hanging over the 1st: Those who believe amblyopia is the
temple, &c. result of strabismus: A. Von Graefe, Bou-
In 1737, or before, John Taylor announced ders, Javal, Grunfeld.
an operation bv which he could straighten 2nd; Those who believe that it is partly
crossed eyes. His practice was to a degree the cause and partly the result of strabis-
-— -—
, „ . mus: Alfred Graefe, Schweigger, Silex.
*Read before Georgia btate Medical Association, -, i . T:„h,. iiinicplf
at Macon, Georgia, April 21,
-^^y^' ^^'^^' ^^'mseil.
s t' 22, 23. J 1909.
^
. , y y
^jjg ^|.gj ^^^Q believe it can be improved,
tStevtns but Kehr believes it is the result of ambly-
i

1 fraction
ORIGINAL COMMUNICATIONS. 233
opia, and that the amblyopic eye cannot be such. Results cannot be obtained after the
improved. seventh year.
Le tirange and Moreau in "Archives Herman Cohn, in ( Wachenschrift for
d'Ophtalniologie' ' in 1907, reports his find- Therapie nd Hygiene des Auges, October,
ings of 562 cases of concomitant squint. 6; 1904) outlined his treatment of two thou-
In 81 per cent, refractive error was the chief sand cases of squint, covering a period of
cause, and in 38 per cent, refractive error forty years, in which were 700 operations,
was the sole cause of the strabismus. 43 First: Until the fourth year bandage the
per cent, of the refractive errors were com- better eye for a few hours each day.
plicated; 19 per cent, had uo error of re- Second: In the fifth year he corrects
fraction, and were referred to a strabismus with glasses and stereoscopic exercises,
diathesis. The inheritance is due to the Third: He constantly corrects the total
pathological condition of the nerve centers hj'peropia.
and consequent degeneration of the fusion Fourth: He operates only for strabismus
sense. In 1.50 per cent, it was of muscular of the highest grade in the 6th year, otherorigin,
wise, he waits until the tenth.
A Baker, Cleveland; in the Journal of the Fifth: He promises betterment of posi-
American Medical Association, July. 1907, tion, but never binocular vision,
says that squint comes on slowly; at first it Sixth: In strabismus of high grade he
is intermittent, then alternating, finally per- advances the external retcus.
sistent, with deterioration of the sight in the D. B. St. John Roosa, iu the Medical
deviating eye. He says 75 per cent, of Record, September 1905, reports two cases:
S(iuints develop before the fourth year. Re- one, convergent strabismus followed by
should be corrected at the end of amblyopia exonopsia, cured by the use of
the first year, atropiziiig both eyes at the glasses and the exclusion of the good eye
earliest stage, and in connection with this at intervals and the use of stereoscopic extraining
the fusion faculty. If not correct- ercises.
ed by the tenth year he operates. He con- Second, Case of amblyopia, which had
siders the retinascope the most reliable increased when seen the second time, was
method of refracting young children. afterwards relieved by the exercise of the
Dr. de Schweinitz gives as the cause of eye.
strabismus, Iu stationary convergent strabismus,
iMrst: Disturbance of relation between Foster' in the Colorado Medical Journal,
the accommodation and the convergence by July, 1907, orders glasses the second year,
an error of refraction. or as early as squint is observed, using
Second: Disparity in the length, thick- atropine in the fixing eye and exercises
iiess and tension of opposing muscles. with the Worth's amblyoscope. If this does
liird: Inequality in the vision of the not relieve the condition he operates,
two eyes, or amblyopia of one eye, which
removes the natural stimulus (of diplopia
Froehlich in (in Wiener Mcdizinische
Presse, May 11, 1907,) gives for treatment
to exact convergence). of strabismus, atropine in the fixing eye.
I"ourlh: Disturbance or innervation and
defective development of the fusion facul-
A. .-V. Bradburne, Southport, England,
for over three years with Dr. Worth, who is
ty. conceded authority on squint, in ''Opthal'
I'uchs says the natural development of mology", July, 1908, says there are two
squint is accom])lished by the reduction in varieties of squint, viz: paralytic and conthe
visual acuity of one eye. Strabismus comitant. In concomitant the eye can be
is the result of combined action of two fac- moved freely in every direction; in paralytic
tors: diminution of the visual power of one
eye and preexisting disturbance in the
muscular equilibrium. In strabismus conthe
movement is limited by the paralyzed
muscle. He gives as the causes for squint,
First: A difference in the refraction of
vergeus >4 are hyperopic. In strabismus two eyes.
i-ergens -3 are myopic.
Wendell Reber, in the New York Medi-
Second; Deficiency in the fusion faculty,
and in addition there is nearly always
cal Journal, November 1904, states that found,
squintis likely to appear aboutthethirdyear. Third: Defective vision of one eye.
He believes that amblyopia of the scjuint amounting to the loss of useful vision,
'eye is due to non-use; that it is curative Fourth: Inability to Vjring the deviating
ithout operation if taken before the 5th
»r>i . .1 , 1 . 1 •
year. That the amblyopic eye can be imeye
to bear directly on an object.
Many "'

234 THP; CHARLOTTE MEDICAL JOORNAL
the presence of fusion faculty. The fusion tion causes an abnormal static convergence
faculty can seldom be awakened after the and squint is caused. !
sixth year. The recovery of the vision of The proper method of examination is,
j
the deviating eye is seldom accomplished First: Get the history of the case, whether -j
after the sixth year. A delay means a loss or not there are any other members of the j
of valuable time, most squint beginning by family, parents, brothers, or sisters, who '
or before the age of three. have squinting eyes; nature of the squint; |
There are three indications which require the state of central fixation; the movement j
attention. of each eye separately; visual acuity and ]
First; To prevent the vision of the de- the refraction of each eye. 5
viating eye from deteriorating. To determine the squint eye, place a card I
Second: To remove the cause by train- over one eye, having the patient look at a *
ing the defective fusion faculty, distant object. If there is no movement of •'
Third: Remove the disfigurement: the uncovered eye, it is the fixing eye
The means of correction are the removal Quickly move the card to the other eye, if
of the refractive error, the complete occlu- there is a movement, it will be the squintsion
of the fixing eye; training patient to ing eye. A more satisfactory test and the
use the deviatiag eye. This can be done one best applied with children, is with the
by using atropine in the fixing eye and light reflected upon the cornea. Place the
trainingthefusionfaculty by developing the child before you with the light at its back
brain centers; training the muscles of the and with the retinascope or opthalmoscope
eyes when defects exist, and operating when reflect the light upon one cornea. This atthe
above fails. tracts the child's attention. If the reflec-
*Two essential conditions are present in tion is in the center of the pupil, this is the
every case of concomitant squint. fixing eye. Shift the light to the other eye
First; Abnormal convergence of the vis- and if the reflex is not central, the eye is 1
ual axis. squinting, and by the position upon the ^
Second: Defective fusion faculty. Other cornea that you have the reflex, you can j
conditions may also be found. The vision determine the degree of deviation. ;
of the eye which is not being used for fixa- Reviewing the various theories, we must ^
tion is almost invariably suppressed. come to the conclusion that while, according i
Third: There is in rather rare instances, to Donders' theory, errors of refraction are |
more or less congenitial amblyopia. responsible for a certain per cent, of squint, |
Fourth: There is ver>' often acquired we can but accept Worth's theory, based j
amblyopia in the deviating eye as the result upon clinical experience, that the lack of j
of neglect or improper treatment. fusion power is the principal cause for ,
Fifth: There is usually a refractive error concomitant squint. While most divergent .
commonly hyperopia or hyperopic astigma- squints are myopic and convergent are ;
tism. hyperopic, and also where squint is perma-
In the normal eye with normal fusion nent, the squinting eye has a greater error '
faculty there is a desire for binocular vision, of refraction than the fixing eye; yet we find I
Binocular vision is formed by rays of light a certain degree of amblyopia in this eye •
falling upon corresponding sensual centers with an inability to fuse objects with the ;
of the retinue. Wlien the two eyes have fellow eye. ;
not the visual axis binocular vision is im- We can but give some credence to Don- •
possible and there is confusion of objects, ders' theory, as it is essential to correct all
with a tendency to diplopia. The most in" refractive errors, or we would not get re- I
distinct object is suppressed by the brain suits from our fusion training. To substan- i
centers and this produces an amblyopia tiate this theory, in most cases where stra- |
exanopsia. Where the hyperopia is greater bismus is present in eyes with a total loss
in one eye than the other, the retinal im- of sight or where corneal opacities exist,
pression is less distinct in the eye with a there is a tendency to divergent squint,
higher degree and there is required an extra This brings us to the line of treatment
tension in the effort to accommodate, which which should be followed up for correction,
increases the convergence with confusion of I. The correction of all refractive errors |
images. Tbe indistinct impression upon and in connection with this, the training of
the retina allows this abnormal dynamic of the fusion sense,
force to exert itself and renders the eye freer II. There are some cases in which we
to swing in, hence we have squint as a re- have binocular vision where eyes are brought
suit. Squint in these cases is at first occa- to the same focal axis and in these case
sional, but if the refraction is not corrected,
the excessive exercise of the dynamic functhe
correction of refractive error, allows the
muscles of co-ordination through relief from
extra stimulus of the accommodative ceu-
*Worth. ters, to keep the focal axis adjusted.
j

ORIGINAL COMMUNICATIONS. 235
But there are those cases which have the operation the anaesthetizer remarked upon
power of binocular vision and whicli will the large amount of chloroform necessary
require the fusion training of the defective to keep the patient asleep. Patient was reej'e.
turned to the ward in excellent condition
A number of methods are used for this — and reacted nicely from the operation,
example: At 4.30 p. m. he became nauseated and
1; Worth's amblyoscope. vomited a small amount of a brown fluid,
2: Stereoscopic charts, etc. again at 7.30 p. m. he vomited a similar
31 Also by atropizing the fixing eye and fluid, also at 8 p. m. After each attack of
forcing the use of the squinting eye, the emesis he complained of great burning in
vision is developed and binocular vision his stomach and throat. At 8.30 p. m. he
can be cultivated after the fusion sense has was given hypodermically morphia, gr. }(,
been developed. and atropine gr. 1-150, as a result he rested
Unless these amblyopic eyes are trained, well until 4 a. m. when his nausea returned
we will have a complete, or almost com- and vomiting of acid fluid every half hour
plete, amblyopia exanopsia. or so during the day, otherwise his coudition
was excellent, abdomen flat, no signs
Acidosis Following Chloroform Narcosis: of any surgical complications whatever.
—Report of a Fatal Case. During the day his pulse varied from 88 to
. „ ,. ^ ,. , ,. ^ 110, temperature remained around 100° F.
By J. P. Patterson, M. D.. New Bern, N. C.
An attempt was made to give powders of cal-
By reporting this case of Acidosis follow- cined magnesia, grs. 10, and charcoal grs.
ing chloroform anresthesia I hope to im- 20 every two hours, none were retained, in
press upon the Medical Profession one of the fact water was regurgitated as soon as swaldangers
of chloroform as an anesthetic, a lowed.
danger which is often overlooked and dis- August 6th. Condition practically the
regarded, for many cases of post-operative same as that of day before— incessant naudealhs
are due to this condition and not to sea, vomitus however contained coffeeother
causes as supposed. ground particles. Abdomen flat, no signs
History— L. L., a strong sturdy lad of of peritonitis nor obstruction. Wound was
nineteen years, was seen upon the morning examined and found to be healthy, draiuof
July 3Ist, with the history of having been age was removed. Pulse and temperature
taken sick the night before with abdominal about the same as the day before. Conpain
followed shortly by nausea and vomit- junctiva slightly yellow—calomel, gr. 10,
ing. When seen he presented all the symp- was given and retained by being preceded
toms of catarrhal appendicitis, temperature by a hypodermic of morphia, gr: )i, and
100° I'., pulse 90. He was placed upon the atropine, gr. 1-150; at 7 p. m. a low soap-
Ochsner treatment—by night all the symp- sud enema was given and followed by extoms
were milder and the attack appeared cellent result.
to be resolving. The following morning, August 7th. Patient markedly jaundiced
August 1st, unknown to any one, he arose and restless; at times delirious; regurgitafrom
l)ed, walked to a restaurant and ate a tion every few minutes of a blackish fluid
plate of broth. In a few hours he was again which seemed to contain blood. Petechiae
taken sick with abdcmiinal pain followed by noticed upon his back— pulse in the mornnausea
and vomiting; when seen the local ing varied from 118 to 130. At 11 a. m.
symptoms of appendicitis were marked, stomach was washed out with a bicarbontemperalure
101° 1'., pulse 94. Me was re- ate of soda solution. A soapsud enema was
moved to the Hospital for a section but this followed in a few minutes by a large evacuawas
postponed for the reason that his symp- tion. Inhalations of oxygen were given
toms ameliorated markedly in a few hours for fifteen minutes of every hour. Abdoand
an interval operation was decided upon, men flat and no local abdominal symptoms.
The Ochsner treatment was continued. During the day his pulse increased in fre-
From this date until August 3rd he was quency, coma became more marked until 2
free from temperature and pain—but on the p. m. when he commenced to have tonic
morning of the ,3rd a mass about 6 C. M. convulsions every few minutes. At 4 p. m.
in diameter was detected in the region of seven hundred C. C. of blood were removed
the appendix. Prejiarations were made for from the left median basilic vein, while an
operation the following morning. infusion of a sodium bicarbonate solution,
Operation performed at 1 1 a. m. August 1 dram to 500 CC of normal salt solution
4th, Chloroform Anesthesia. Appendix was made into the right median basilic vein,
was found greatly thickened and bound For a time his convulsions were controlled,
down by stnnig adhesiinis, however it was however his pulse increased in frequency,
removed with little difficulty. Wound was temperature rose until just before death,
drained with gauze. Several times during the which occurred at 6.30 p. m., when his

236 THE CHARLOTTE MEDICAL JOURNAL.
pulse was 160 and temperature 105 3-5° F. records two cases where the condition oc-
Urinalysis. Specimens of urine obtained curred in operations for torsion of the pediafter
operation were dark in color, high in cle of ovarian cysts, and two cases of stran-
specific gravity, acid, and showed the pres- gulated hernia of the omentum. His stateence
albumin, acetone, diacetic acid and ment is not sustained by facts.
bile, with granular casts. Syinpioms. The onset usually arises from
Acidosis following Chloroform Narcosis twenty-four to forty-eight hours after anes-
is the result of a perverted metabolism, due thesia, in my case the onset was within five
to a lack of oxidation of the fats and pro- hours, which was unusually early. Willteids,
resulting in the accumulation of an iams and Becker" report a case in which
abnormal amount of the acetone bodies; symptoms commenced on the fourth day,
viz: B-Oxybuturic acid, diacetic acid and and Hysett' one, one hundred and fifty
acetone in the blood. This excess of acid hours after operation.
bodies is due mainly to an excess produc- The first symptom noticed is a feeling oft
tion and only partly to diminished excre- distress followed shortly by burning" in i
tion. The symptoms do not depend so much stomach and throat, incessant nausea""and I;
upon the acetone as its precursors. In nor- emesis every half hour or so. The vomitus '
mal mjtabjlisiu B oxybuturic, by oxida- at first being clear and yellowish, later contion,
is changed into diacetic acid and the taining blood in the form of coffee-ground 1'
latter into acetone. particles. Jaundice usually appears on the
B-oxybuturic acid: CHo -CHOfI - CH., second day, first noticed on the conjunc- ,
i
-COOH. tivae, later the skin and usually becomes
Diacetic acid j CMCO - CH, -COOH intense. About the second day nervous 5
Acetone : CHu -CO CH>. symptoms appear and become pronounced;
But as a result of the perversion of meta- great restlessness, twitching of muscles of
holism there is not the complete change of face, delirium, stupor and coma. And iu
B-ovybuturic acid and diacetic acid into the fatal cases, just before death, convulacetone.
sions—the "Epilepsia Acetonica'of Von.'
Why chloroform should cause this acido- Jackson\
sis there is a^great difference of opinion.
Van Noorden' does not believe it to be due
to the chloroform but to the withdrawal of
The pulse is increased in frequency and
in severe cases becomes as rapid as i60 to
170 per minute.
carbo-hydrate diet before operation, and he
states that acidosis only occurs in those
cases which have been upon a starvation
diet free from carbo-hydrate for several
days previous to operation. This, while
true in my case is hardly tenable for the
reason that it is not true in all of the cases
reported, and again if it was true, this aci-
The temperature usually remains around ,
100° F. until just before death when it
reaches 105° F. and often higher,
The urine is scanty in amount, dark in
color, of a high^specific gravity. acid in reac-
tion, and contains acetone, diacetic acid,
B-oxybuturic acid, albumen, ibile and gran-
ular casts.
dosis should follow all forms of anesthesia
and not chloroform alone. He bases his
statement upon the experiments of fiirchfield-
who found tliat in healthy and fasting
subjects the appearance of acetone bodies
in the urine was due to the removal of carbohydrate
ftom the diet. While this may be
the cause of other varieties of acidosis it is
not of that which follows chloroform anesthesia.
It however is a contributory cause
undoubtedly.
Young and Williams'* believe the acido-
Patholosry. Howland and Richards'' in
their experiments on dogs, found that the
first changes are fatty ones in the interme-
diary zones of the liver followed by a ne-
crosis: which also extend to the center of
the lobules, so that all the cells of the liver
become necrotic. They also found hemor-
rhage extravasation in the liver substance,
The omentum and mesentery also showed
fat necrosis. The raucous membranes of
the gastro-intestinal tract were congested as
also was the serous membranes,
sis to be due to some disturbance of the Wells'" in the autopsy of his case found ^
gastro-entenc tract or sepsis. the liver to be reduced in size, flabby and i
The most satisfactory explanation is that yellow. Microscopically the centres of the
of Well in which he states that chlor6form lobules showed necrosis, the periphery fatty '
has a peculiar affinity for the protoplasm of degeneration. Williams and Becker' ''found
the hver cells, destroying the oxidizing the same liver changes—there being no
enzynesof the liver cells and not inhibiting pathological lesions in the kidneys, "panthe
autoly tic enzymes and lipase of the creas, adrenals or spleen.
*^^|i?- rrealmcnt. The treatment of this condi"
bippel seems to think the condition to tion can be discussed under the usual heads
be due to toxines which results from altered of prophylactic and curative,
circulation, and to support his statement The prophylactic methods are the import-
I

.
ORIGINAL COMMUNICATIONS.
ant ones for the curative are usually futile. The physician should, and usually does,
Ptophylaclic. Never employ chloroform try to get his patient well at the earliest
as an anesthetic in a case which has been possible moment. If this is his ambition,
deprived of carbo-hyduates for several davs then he will take kindly to the hypodermic
previous to operation. This covers the method.
present day Ochsner treatment for appeu- In our Southland alaria predominates.
I
dicitis.
believe that more time is lost from busi-
Always give carbo-hydrates some ness as a result of malaria than from any
form the day before chloroform anesthesia.
Beddard-- advises dextrose by mouth, or a
rectal enema of a ten to twenty per cent,
solution. I should prefer to give oat meal
one disease in the lower South. If we employ
the method I shall describe, this condition
will cease to exist.
In the lower South the countn,' doctor
will appreciate the advantages of this
per mouth
The lavage of stomach with a method, for it is he who sees and treats the
Curative
"
most virulent forms of malaria. Unfortun-
solution of sodium bi-carbonate. Carbo
ately the time of gathering the cotton crop
hydrate diet. Intra vneous infusions of
solutFon of"carbonate of soda 3.5 gm. to 1 is the scene of our most strenuous efforts.
liter of water. Inhalations of oxvgen. Malaria takes this time to strike the laborer
Conclmious. Acidosis following chloro- on the plantation. Their sickness means a
form Narcosis is due to fatty and necrotic loss of money to themselves as well as the
chan-es in the liver cells, with resulting landlord. Cotton is king indeed and waits
perve'^rsion of metabolism. for no man." If we can save the fever-
That chloroform is a dangerous anesthetic stricken laborer three days, or even one, in
and should never be the one of choice: and shortening his sickness, then we have paid
only should be used in cases which contra- three debts, to the patient, the planter, and
indicts the other anesthetics.
the world that deals m cotton.
That chloroform should never be given We may expect the following from the
to any patient in whose urine there is dia- hypodermic treatment: CD lime. 1 ati-
^"'^ '^^'^
cetic acid
return to work and the physician to
That in'everv case in which chloroform his office to rest; for he needs it during the
is to be used, it is the duty of the surgeon busy season. (2) If commenced early in
to see that the patient the dav before opera- the disease there is no danger of his losing
;„cr«tprl rarhn-hvdrates ill some his patient. (3) An absence of tinitus
tion has ingested carbo-hydrates in some
iim and otiier nervous symptoms. C4j
form.
Elks Temple, Rooms 201-204.
References:
1. Disorders of Metabolism and Nulrition
Arch. Exp. Path.
Hoston Medical Journal,
6.
l-23-l')ii9.
Archives of Int. Medicine, July, l'»n'
aun
No disturbance of the stomach, a thing to
be considered in the old way, especially if
the patient is a child or a very old person.
(,5) Worry. No danger of a return of the
original infection.
A great many physicians admire this
treatment, but are afraid of it on account
of the "terrible" abscess that sometimes
Arch, fur Gvnaekologie, Berlin. follows an injection of quinine. With the
Journal, A. M. A., May 8th, IVOV tablets of quinine that can be gotten from
Proceedings Michigan State Medical any reliable drug house, combined with
' '
"'
Society, 1909.
fair knowledge of sterilization, there ""
is no
8. Arch. f. Kinderheikunde.
excuse for an abscess.
9. Journal of Exp. Med. New York.
I treated last shmmer fifty-two cases of
10. Archive of Internal' Medicine, Chi- malaria by this method. Some of these
cago.
were given one and two hypodermics a
11. Proceedings Rochester Path., Soc, day, and out of over a hundred injections
February l.Hth, 1909.
I was afflicted with three abscesses. I de-
12. Lancet, London, March 14th. served every one of them. That you may
profit by my ignorance I state the cause.
The Hypodermic Treatment ol Malaria.
The first abscess was due to inserting the
By George K. Koniegay, M U., Clevelaiul, Mi.ss,
needle between the layers of the skin.
The hvi.odermic treatment of malaria is Given in this manner the quinine acts as a
so simple and gets such brilliant results powerful irritant and will always produce
that I cannot understand why it is so sel- an abscess. In the second case I used
dom used. (Juinine is pre-eminently the
p^^p water and in the third I tried to bring
treatment for malaria, and to get the most
(,^0 goimjon fifteen grains of quinine in the
satisfactory results is to give it in a way . * „f .„„ c,rr;„crA T Imrl a soluthat
it will do the most good in the quickest Au.d contents of my syringe. I 1^^^
^J^^
time-the hypodermic way. tion of a ropy consistency that was not ab-

138 THE CHARLOTTE MKDICAL JOURNAL.
sorbed and produced the ugliest abscess I and two hours before the next chill. In not
hav-eev^r seen giving further treatment (antimalarial) mv
It IS folly to attempt to dissolve over ten motive was to determine the effectiveness of
grains of qunnne in the amount of water the hvpodermic treatment. Ten grains -iven
that the ordinary syringe will hold. To during the decline of the first chilK hvpoderattempt
a larger amount means a ropy solu- mically) has always in my cases prevented a
tion that IS hard to inject and too irritating, return of malaria on the next chill dav but
I am using the method described below, it may appear later. If a second hvpobince
Its adoption I have escaped the qui- dermic is given on the next chill day an
nine abscess. hour before the expected chill there is little
U ) Clean the part selected for injection chance of the patient having a paroxysm
with soap and water. Do not hesitate to if at all it will be of little severity. In those
scrub well, you will be suprised to find how cases where I have given it during the first
much dirt you will get off of the most aris- attack I have not had to repeat the iniectocratic
arm. Follow this with alcohol and tion, neither has the patient had a return
instruct your patient to keep his hands off of any symptom of malaria While I am
of the place you have sterilized. Some enthusiastic over this treatment, I do not
patients seemingly cannot resist the tempta- wish to be understood as savin"- that after
tion of rubbing the place in spite of your a hypodermic injection he is free or imdirections.
Cover with a piece of gauze and mune from malaria the balance of his life
It will save you lots of time. (2) Cleanse not at all; but I honestly believe that he is
your syringe by filling with alcohol and free from the original infection, if after the
then with sterile water. Wipe the needle second injection he misses the second chill
with a cloth saturated with alcohol and let The patient is of course susceptible to anthe
needle remain m this cloth while you other attack, but it will not be from the
are preparing your quinine solution. (3) original malarial plasmodia, and must be
Clean the yes.sel you are to use for holding bitten by another malaria-infected mosquito
solution with alcohol and sterile water. In the treatment of the Aestivo-autumnai
rut in the "umber of tablets you have de- type I usually give two hypodermics a dav
cided upon. I- ill syringe two thirds full of one when the fever is at its highest and
water (sterile) and spray tablets several vice versa. In givingit while thefeverislow
times until they are entirely in solution. If we are able to prevent a troublesome hvperit
IS convenient heat solution until perfectly pyrexia and destroy numbers of plasmodia
clear. Alter expelling air from the syringe I think the greatest benefit is seen when
wipe the needle with alcohol and sterile given during the decline of the paroxysm,
water. I would suggest especial care here, Quinine is described in the text-books as
as any of the quinine solution on the needle having some antipyretic action, thouoh
will act as an irritant to the wound the feeble compared with the coal tar product's
needle makes m passing through the skin. This is not true when given hypodermic-
K^) i usually give the hypodermic iujec- ally. You will be pleased with the rapidity
tion .11 the posterior part of the arm, the with which the fever leaves the patient after
place does not matter so much as the tech- a hypodermic of quinine. I know the -reatnique.
Lift the skin well and let the fluid e.st destruction of plasmodia results when
flow under ,t. Do not inject into muscle, but given at this stage(decliiie of paroxvsmlfor
deeply under the,skin. Allow theneedle tore- they are more susceptible to the action of
main a tew seconds and be sure that the con- quinine. In this class of malaria 10 to 15
tentsotthesyniigehavebeenexpelled. Then grains should be given twice a dav Tlie
exert a little pressure at the point of punc- addition of one-eighth to one-fourth of a
lire and withdraw the needle gently. Do grain of morphine aids in the comfort of
this and you will not through suction bring your patient.
any fluid with the needle, thus lessening I am reminded of two cases which I think
tlie chance of the solution irritating the skin tested the value of this method. The first
the
LT u \, ^ffl
puncture with iodo- case was that of a negro woman
form
who was
collodion (10% iodoform). suffering with the Aestivo- autumnal type
Lxpenencehastaughtmethattheverybest (the so-called swamp fever or slow fever)
time to give an injection is during the de- She gave a history of two weeks of fever
"1 ''"'^•"°,^ ^' °,\ ^ °"" ^'^""S^t ^^^thout
f
a chill. A blood examination re
when the fever is at its highest. In several vealed crescents. Patient had been takiir.
li'-'ve had an opportunity to ad- twenty to twenty-five grains of quinine sul-
l^t^L7
m oxvs,Wl""' "h "", ""• "^ "'" P^^^^ ' ^^y
'^'f''' ^y mouth for two leeks and
,'"''';
^^^« ""^'^le to
^f.J?H,i
continue
t'^^?,^"''^^"''^''^''^"''- the treatment on
account of nausea. Other patients at this
his r"^ ;^T"•^^^'1'^'^'''^^°"^
'f/^e^'dedly better to in- time 1
ltr,^'.t T f; ? prevented me from seeing her but once
structpatieuttotakelOgramsofquiniuefour a day. The fever was at its highest in the

ORIGINAL COMMUNICATIONS, 239
afternoon, hence I decided upon that time who had tried the oral administration in
for my visit. I gave her a hypodermic heroic doses without success, and each time
Monday, temperature at this time 105° F. a hypodermic of quinine always caused a
Each da}' at or about the same time this rapid improvement.
treatment was given and I noticed that the The method of upsetting a patient's stomfever
was lower at each visit and on Friday acli with a conglomeration of capsules,
of the same week she was entirely free of tablets and tasteless preparations of quifever
and has not had a return. No anti- nine, complicated with the uncertainty of
malarial treatment was given other than action, must eventually pass away. Aledithat
described, neither has any form of ma- cine is getting on a scientific basis, and it
larial treatment been given since and she is certainly the opposite of science to dehas
been free from malaria. I have exam- pend upon the capsules and tablets in a
ined her blood several times and have been weakened condition of the gastric juices,
unable to find a single Plasmodia. The tablet or capsule may not be dissolved,
The second case is one of a series of two or if we are so fortunate as to bring them
cases of comatose malaria that I have into solution we do not know how much is
treated. The first case died after thirty- absorbed, besides the patient is in a posi-
j
;
six hours. (At that time I was not familiar tion to infect other mosquitoes, thereby inwith
the hypodermic treatment). I had creasing the disease.
been treating the patient's children and was With the hypodermic method we know
giving one of them a hypodermic when he just exactly how much quinine we are getsuggested
that I had better give him one ting into the blood. We can, at a few mintoo.
Not having any more tablets with me utes' notice, throw as many grains of qui-
I promised to give him an injection the nine into the blood as we desire; on the
next morning when I returned. I was other hand if we employ the old way, first
called at an unearthly hour the next morn- we must wait until the calomel has
ing to see the patient. His wife explained acted before the quinine is given, and of
to me that he liad been having two chills a course the malaria plasmodia "makes hay
day, and that soon after I left the house he while the sun is shining" and produces a
had one chill after another, five in all, fin few million plasmodia. To destroy the
ally becoming unconscious. I immediately
gave fifteen grains of

-"•0 THF CHARLOTTE MEDIOAL JOUKNAL
financially or the givin.a; up of life-long chlorate, three grains to the ounce of water
habits. In order that he be willing to make The local anesthesia is not so great as tha
this sacrifice, he must fully realize the grav- from cocaine, but it is sufficient to last sev
ity of his condition. Of course, tact must eral hours.
be used in bringing this knowledge to him Because of the fact that people who ai
so as to, as much as possible, reduce the over-fed usually have sluggish bowel movt
mental shock. I have not seen any patient ments, it is well to have occasional doses o:
who was made worse on being told he had castor oil or senna to empty the colon It
tuberculosis. those who are habitually constipated, th«
Given an obedient patient, in moderate proper remedies must be used. In case ol
or good circumstances, who has gotten over low stomach motility, it may be necessarj
the first fright of the knowledge of his con- to use lavage or massage once a day in'
dition, I think it is probable that he can be order to remove material left over from the •
treated to better advantage in his own com- day before. In case there is diarrhea it;
fortable home than almost anywhere else, must, of course, be controlled. This cau*\
believing, as I do, that climate is almost a usually be accomplished by the regulationii
negligible factor in the case of the patient of diet and the occasional use of hio-h^i'
who will do as he is told. enemata.
"
'''i
He should have a room, preferably a large Fczr/- and C/u7/s.—As the high tempera- "J
one, with several windows through which ture in consumption is due to the absorp--i
the sun may shine at least several hours a tion of toxic materials from the local lesion
day; or better, he should sleep on the porch and as exercise increases the amount of this i
or veranda, or in a shack in the grounds of absorption, it is, of course, plain that in \
his home. His waking hours should be fevering cases the exercise should be liiuspent
in the open air, indulging in moder- iled, and, if necessary, the patient put to I
ate exercises; or when this is not advisable, bed and kept there until the fe\ er lessens '
because of high temperature or rapid pulse. Also, as it is a daily observation that hi-h '
he should be on the veranda or in the yard temperature in consumptives is preceded by !
on a reclining chair or cot. If he spends chills, it is necessary to eliminate or reduce
his nights m his room, the windows, of these chills. This chill or chilly sensation I
course, must be kept wide open. appears in the maiority of patients at a j
While, as I said before, the majority of fairly definite time of day. This time should
consumptives are as well, or better off, in be noted when found; the patient should be i
their own homes than elsewhere, there are put to bed and covered up to the neck, with '
a few individuals who either will not or can one or more hot-water bags at his feet I
not follow directions at home. These it is, This should be done about an hour before i
ot course, best to send to a resort for con- the expected arrival of the chill and the .
sumptive:? where they will have example as patient kept so until about an hour after ,
well as precept, and will be away from the the chill should have passed. In case the i
influences which at home prevented them fever is not lessened by the rest in bed and I
from following out the treatment as it should the relief of the chilly sensation, recourse i
have been amst be had to cold or tepid baths and aiiti- i
jMei As to diet I, personally, believe pyretics. The least harmful of this latter
that It should be mixed"; that is, of such is probably pvramidon. This may be oiven
food as comes on the table of the ordinarily just before or about the time that the "fever
well-to-do, rather than a preponderance of usually rises, in doses of two or three grain i
any one variety of food, such as milk and capsules, repeated once or twice if neces- <
eggs. At the same time, I think the pati- sary.
ent should use milk to wash down his food Mg-/a Sz.rah—As in the vast majority '
instead of water or coffee, because the milk, of cases that have night sweats they are preot
course, has a large caloric value, while ceded by fever, it is evident that in order to I
water and coffee have practically none, cure them the fever must be relieved This
'
Kaw eggs should, I think, be kept as a re- can usually be done by the measures out- |
serve. I'or instance, if by reason of lack lined above. As a temporary remedy cam- i
ot appetite the patient has not been able to phoric acid is probably the best because the j
chew and swallow what he knows to be a least harmful—40 to 50 grains to be oiven |
sulhcientmeal, he may take two or three in 5 or 10 grain capsules between six" and i
'
eggs to finish out because they readily slip nine in the evening. This usually relieves
down without being chewed. n,„ ^.. „ * j u -j •
Tn il,oce ^,=»c 1- ^"- the
, ,. ^ sweats and,. besides, is a ,
In those good
cases
general
which are complicated by .^„- , . a , ,'.
' '^ ^^^"^^ lasting in most cases
tuberculous laryngitis of such degree that
deglutition is painful, the pain^may ^s
be
long as 24 hours.
greatly relieved by spraying the throat be- If the sweat has been severe, the patient
fore meals with a solution of heroin hydro- should change his wet for dry night clothes,
'
'

ORIGINIAL COMMUNICATIONS. 74 J
first having been well rubbed preferably there is a little water, and these are to be
by some one other than himself. cleansed daily with boilin

242
the; charlotte medical journal.
or two days after a hemorrhage the amount believe in rabies, some others who are nc
of the patient's rational food, or,
the fluids.
at least, yet fully convinced that vaccination is us«
ful as a preventive of small pox, and man
;
Pleurisy.—Pleurisy may usually be con- of us were very slow in taking up the us
trolled by putting the patient to bed and of diphtheria antitoxin.
applying heat. Sometimes, it may be nee- ^^
essary to limit the excursions of the lungs Treatment of Severe Bums.— Pels- Leui
by applications of adhesive strips. These den ( Deutsche Med. Wochenscrift) believe
should be placed over the lower part of the it important to disinfect the burned area al
lung of the side affected, extending from thoruughly as in preparing for an asepti|
the lower part of the sternum to the back operation. In burns of small extent thiSJ
bone. There are occasional cases in which may he done under local anesthesia: in those
it is necessary to use a hypodermic of mor- covering a large surface, under spinal anall
phia. gesia or ether. Blebs are to be removed an^
Ciclture Products.—A remedy, which we the burned part and its surroundings cleans;
can reasonably hope will be of benefit in ed for ten minutes with hot water, soap and
the treatment of a given disease, should, brush, and then washed for another tw«!
we will all agree, be given a full and fair minutes with alcohol and sublimate or sub(
trial. In consumption , culture products is lamin solution, 1;1,000. It is then covered
such a remedy. The fact that it does in- with a guaze compress and an abundanc'.|
crease natural resistance to tuberculosis of absorbent cotton, over which is placed
and, at least, gives a partial immunity anotherlayer of non-absorbent cotton. Paiii
against it, seems to me so well established is to be relieved with morphin, although thil
that a multiplication of reference is un- is rarely necessary under the use of such
necessary. dressing. As soon as the cotton become
In this country, most of the private sani- saturated with serum it should be removei
tariums have been using it for years, and
claim that their results are many times betand
renewed, the gauze being left in place
and this is to be under the strictest asepsis
ter than before they commenced its use, In the course of ten to fourteen days thj
notably the Winyah Sanitarium at Ashe- dressings, including the gauze compress!
ville, N. C, and the Pottenger Sanitarium will become detached of their own accorc|
at Los Angeles, California. Many of the and in burns of the second degree epiderm]
State and city institutions also, such as the zation will take place rapidly and complete;
Henry Phipps Institute and its branches ly. The application of iodoform gauz;
and the Saranac Lake Sanitarium. directly to an extensive burned surface j
In the August, 1906, number of the Jour- dangerous, on account of the risk of absorn
nal of the American Medical Sciences, Dr. tion. This method, which was originatel
Trudeau states that he has used culture pro- by Tschmarke, has only the drawback th:]
ducts continuously since 1891. His tabu- because of its painfulness it requires to t
lated results show that in from 3 to 13 years carried out under anesthesia, but this i
after discharge, 2.5 per cent, more of his more than compensated for by the rapij
tuberculin-treated cases were alive and well curative results.
than those treated during the same period ^^^ Bactericidal Power oi Uving CellJ
with tuberculin.
In England, many favorable reports have A. Albergo-Berretta, after experiments c I
been published, notably those of Wright, animals by injections of emulsions of bact i
with which you are all familiar. ria to ascertain the power of the living eel
In Germanv, out of nearly 100 institutes to destroy bacterial life, gives us the follo\ •
;
i
i
:
^
for the treatment of tuberculosis, I am told ing conclusions: That the uninjured tissu i
that there are only two which do not use as long as they preserve their vital prope
culture products. ties are able to destroy all microorganisr
When we remember that these institutes that come immediately in contact with thei
are practically kept bv patients sent to them The microorganisms only find a conditii
by the industrial insurance companies, we adapted to their action in the presence
must think that the remedy is useful, be- injuries to the tissues, or in conditions i
cnuse these insurance companies have found which their vitality is lowered. In tl
out that by having their tuberculous risks destruction the phagocytes take an impc
treated with culture products they have been taut part, but they are not the only fact
j
saving many dollars. in this destruction of germs. There are sii
j
Those who wish to make a trial of cul- stances already contained in the protoplas I
•
ture products must not be deterred from so of the tissues which kill the germs, and ;
doing because many of the leading men in cells have the power of elaborating su !
tuberculosis work are not using it; for there substances when they are needed.— La Si i
are some reputable physicians who do not rimentale.
! '
j

Charlotte of t^^e Medical problem Journal than European sanitarians
were a quarter of a century ago.
Published Montbly. Not for one moment would we seem to
EDWARD C. REGISTER, M. D., EDITOR express our disbelief in the existence of
CHARLOTTE, N. Cpellagrra
in the Southern States. We know
_ it is here and we believe likewise that it
PEULAGR^ A^D PEUbAGRAPHOBifl ^^^ ^^^" prevalent for a number of years.
I' "rthermore, '
Ti,o T^ c, . o we are
. r rr
satisfied that , ,
the dis-
The Tennessee State Board of Health, at ease is uniformly fatal, and that great sufa
recent meeting n. Nashvdle. I deeded to fering results to the victim in many cases
,order the isolation of all cases of pellagra before death comes. Let it be said here and
inow existing or that may be discovered in now, however, that the diagnosis is by no
the future. I 1 he cities or counties in which means always quite easily made, since there
;such cases are found inust meet the expense are other diseases which i>ear a more or less
.of such isolation. 1 his Board ,s reported close similarity. In our desire to discover
to have expressed the opinion that the dis- cases there is doubtless too oTeat a tendency
lease is communicable In the above re- to jump at conclusions without due con
port we have yet another evidence of the sideration. In other words, our enthusiasm
length to which man is swayed by that is apt to obscure our judgment. It is not
which IS novel and bizarre We do not with any intention of questioning the abiliwish
to be misunderstood in this matter, but ties of our brother doctors that these things
It IS not difficult to see that in the case of are written, but merely to sound a note of
pellagra there is manifest the world-old warning: it isn't that we would attempt to
tendency of humanity to fly to extremes, throw an obstacle in the way of progress.
Doubtless It IS to the credit of the medical but we would plead for a somewhat saner
protess.on--perhaps It is not—that so wide- attitude. Xo one would attempt to dispute
spread and profouna a sensation has been the proposition that other diseases like tvstirred
up throughout the length and breadth phoid fever and tuberculosis have produced
ot this land of ours. Perhaps, also, he who are producing and potentially will produce
tias the temerity to raise a protesting voice infinitely more suffering and loss, both
•vill be branded as iconoclastic and cynical, financial and vital, than pellagra does. In
lutit IS a fact, and we believe that success- any one community there are probably
ul contradiction is improbable, that the scores of cases of tuberculosis whose outmpression
made upon the minds of the laity look is quite as hopeless as that of any
lasreally created, and added to the already pellagrin, notwithstanding the fact that
ong list, a new phobia. The writer has science seems to have found a remedy for
ecentlv observed with considerable curios- the former. And in the case of typhoid fever
ty the frequency with which pellagra be- —a disease that is always with us, poten-
•omes a subject of conversation whenever tially if not in fact—the people who suffer
wo or more people come together and talk and die outnumber many times the victims
s possible. Invariably the discussion turns of pellagra. In the case of both typhoid
this disease and one hears expressions fever and tuberculosis, lhecau.se and pathovbici.
111 some cases, amount to evidences genesis of the diseases are— one might alt
absolute terror. It is a fear having its most say— well understood. Preventive
rigin in ignorance, and while no one can treatment, at least, is entirely possible in
e blamed because of the ignorance, still it both and a fair amount of success is promoes
seem so unnecessary, so fruitless, and ised, so far as curative measures are conne
might even venture to si^y. so pernic- cerned. Yet practically no space is devoted
3US that such sensationalism has been per- by the lay papers to jopular or sensational
iitted to develop m regard to a disease discussions concerning these diseases. They
'hich, at worst, is comparatively rare, even are far too common, we have made our bed
1 the South. As we have said above, it is with them for too many years for us longer
ery probably our ignorance concerning the to feel any fear. Our souls are not thrilled
ause and nature of the disease, and our with horror at the bare mention of the dispparent
entire helplessness so far as cura- ease" one does not hear them discussed in
ve measures are concerned, that have every social gathering—from bridge whist
roused the emotional side of the people, parties to public receptions. On the other
omplete knowledge of the pathogenesis of hand one rarely looks through the columns
|»e malady and a consequent knowledge of of a daily or weekly paper published anvliat
to do for the patient would lead to a where in the counlrv that something isn't
ilm and sane attitude of mind, and breed found about pellagra. Apparently every
teeling of security which ignorance makes doctor who thinks himself the discoverer of
ipossible. However, we do not at present a pellagrin, or who signs the death certifipear
to have drawn any nearer a solution cat? of a pellagra patient finds himself

244 THE CHARLOTTE MEDICAL JOURNAL. 1
locally notable because of his connection vestigation and, all to no purpose, scares
with the case. For some reason he willingly people within an inch of their lives.
or unwiUino-lv becomes a party to the spread- In thus giving vent to our pent up beliefs
ins abroad of the news that such and such in a live subject we do so knowing and ex- ,
1
a patient is suffering with or has died of the pecting to be disagreed with. 1 here would,
dread disease "with which medical science however, be no occasion for expressing!
finds itself utterly unable to cope, since no these opinions if all were agreed, if all be- i
known remedy has so far been found which lieved as we believe. A cool consideration
seems to do those sick with the malady any of what has been said in this article should I
eood " Not satisfied with a simple account appeal to our readers, and our sincerest de- ;
of so'unusual an incident the reporter in sire is that it may bear fruit. There are
|
many cases takes occasion to reiterate the other things which might be said relating
j
available statistics concerning local cases, to the economic side of the question, but li
probably calls attention to its widespread we deem it sufficient to have made our ap-
prevalence, takes advantage of the oppor- peal briefly and to the point. X. .
tunity to rehash the various theories of its ^^^ rbcord or the rouRTH op JUbV. I
etioloey and perhaps adds the cautiously . r , »u ^^ I
expressed theory of the eminent doctor The annual haryes of death resulting
whose case is reported, or calls to mind the from l-'ourth of July mjunes is a ways a
Tssay of some other local authority on the fruitful source of inspiration for the vital
subject In addition one sees occasionally statistician. It also is a matter which gives
the brazen statement that the doctors of a very serious food for though at the carecertain
city have deliberately set about dis-
. ] ',
less waste of human life m this land o .
cov-erigthecauseofpellagra. Withsound- the free." During September the Journa ,
ingb assand blare of trumpets to herald A. M. A. published the seventh annual
hf wonderful news, case after case is found compi ation of deaths and injuries resuUing
ln7Sieories galore are published abroad^ l^^^l^^T::^'.^'''^::::^^'^ll^s
thTgTea drsc;.;nenn th; worid of To us of the South these figures do not;
science have been made by the quiet work- mean so much, because of tl e fact that
those who were content to work and there ,s little part.cpa ion „i the methods.
S^do^^t;X^it;astoM:' of celebration which have persi^ for.:
All these things, we contend, do no good, long m more northern States, ^e^erhebut
on the contrary, exert an influence less it is no less appalling when we read o
whch is inimical both to the lay mind in the fearful sacrifice of human life wh ch
j
Aat it tends to and actually does produce ^^^^^^^ ^^"'^
f^^^^^^^y
^^.^.^VT.Tl come i
pellagraphobia-if it is permitted to coin a horrible manner m which death comeH
S-m for the occasion, and to the successful makes one shudder at the very thought.
•
ny^tigation of the pathogenesis of the There were l.-,0 tetanus cases th,s yea
disease in that the constant iteration and ahnost double the record ;
^^^^^^ f^'-; Jf
reiteration of ignorance and inability on '^ cases were repo ted. This is the la^^^^^^^
the part of the doctor cheapens his work number since 190o when there were 41.
and produces a skepticism in the popular cases. It ,s significant to "o^e that th,
mind as to the work of the profession, number of blank carttidge wounds corre
People do not like to think they are being pondmgly increased from M6 last yea ,
experimented upon; the very minute they 1,09.-, this year, and that he States ha^l.; ,
come to believe thev are being made the the largest numbers of blank cartridge n ,
subject of experiment their confidence van- Junes have also the largest number of tela ,
ishes and another man gets the job of treat- "US cases.
ing them. People can be fooled, told they Tetanus cases occurred m 2-> differe.
^
have something^lse, but it is absolutely States, or m ^^^^^^'^'^^^'^f^^^^^^^^^^
Utopian to hope to obtain the consent of the same as m 1906. For the fifth conseci
iff„„„ i
mor"^ than a very few to submit to a proper tive year Illinois -ports the largest nun .
investigation of the disease so long as the ber having cases tins ear 12 each .
]
knowledge is spread abroad day after dav 1908 and 190/, 16 in 1906 and 20 m ua
thatthedoctor'^andonothing.'^ Again we In 190,^ and 1904 P^"->'ly^"- ;Xc^
desire to make our position clear. It is not the highest numbers. For the fourth co
that we advocate deliberate attempts to de- secutive year New Jersey reports the ie>
ceive people. When it is discove.ed that a h'gbest number, having 19 cases lis ye
patient has pellagra he should be told, or 10 last year, 8 iii 90/ and 10 m 190,, 01
at least those nearly related should be told; reports 12 cases this year. Michiga a
but it is not necessary, for the sake of a ^ew York each had 11 cases and 1 enns)
little cheap advertising, to foster by public vania 10.
announcement a public distrust and lack of Besides the 125 deaths due to tetanus
confidence which handicaps scientific in- persons were killed by various lorms of far
^
;

works, making a total of 21n deaths, an in- glycogen. Glycogen can also be formed
"^' '''^" ^'""^ '^'
,, T.K,r i°"''' \ """f n' T'^ Pteids of the food;
n and
1906. Seventeen were
uTder
kdled outright certain circumstances sugar can
this year by
be
firearms
directlv
U, were killed by ex- formed from the body proteids
plosions of
In
powder,
hea h
7 by giant firecrackers, the amount of glucose in the circulating
- L!Z K,""? """"^ '-^^ "^'"^' ^^°°d
I^"?"'
^^"ges between 0.1
such
and
as blood
0.2 per cent
poiso„,ng,_ by sky-rockets. If it were not for the reservoir
chem.ca action of the
s, etc while 3. were literally liver and muscles in storing
burned up the
to death
excess
by fire from fireworks, of carbohydrates after a meal as many of which were
"h-co'eT
caused by the so-called we would have more than 0.2
harmless percent of
vaneties of fireworks. glucose in the blood, a hyperc.lycaem°a
,,"°"" nijuries this would occur and a glvcosur'a e^is'^e.
veJr or^rTf;
''f'
In
^^''^ l^^^lth the glycogen is
were U neon ^^ ^T }Ta'^'ureconvertedwere
into glu-
1(, people totally bhnded this year, cose, which is distributed to the
benig.morethan
muscles bv
last year, but 9 less than the circulating blood and there
the highest
burnt
number
up
inl90.S. There were producing heat and energy.
o6 who
The man^e^
lost one eye each, 41 who lost legs, in which this final combustion is effected
' '"'"" '"'' °"^
Tm^r^ "°^ been known.
or more CohnSS
fingers nngers.
'
published '^^t^'^'^^.^^ his researches in 1903 and
Peniisylvania
1904
holds the blackest record and threw much light on the subject. By
rnduiU^S.r? r'' Yk" T,?''^'"'"'",^'''^- " ^P^'^'^^y constructed press
ond
he
uuh obtained
S9,S, followed by Ilino.s with 547, the juice from the pancreas
New and muscles of
Jersey wuh 4,S,S and Massachusetts dogs and cats. Each juice added hide-
pendently to solutions of glucose was inert.
ri ^ -1 -I-, r ,_
I he responsibility for the vast majority When, however, the pancreatic juice
of hese was
injuries rests with the city govern- added to a mixture of muscle juice
mentsand,
and Jlu^
as the Journal says, this annual cose there was rapid breaking up of the
ou Ivf '^°"lV""'\"e«« be prevented with- latter into alcohol and carbonic acid.
outCohn- e.xtreme difficulty. There is evident a heim holds that this remarkable effect is
tendency m various parts o the countrv to analogous to Pavlow's observation
ns
that
nu e measures which will lead to saner trypsinogen is only made active for proteid
aiidsafermethodsofcelebratingournational digestion by being converted into trvpsiu
holulay Several arge cities, notably Balti- by the "enterokinase" of the succus enieri-
^^"'^S:o and Washington cus. w!' V^? He believes
J""^'
that the muscles
have
produce
adopted prohib.tor>' or restrictive ordi- a proenzyme which is onlv made active for
nances which have already shown their carbohydrate combustion bv the action of
beneficence either by the total absence of another substance produced in the pancreas
accidents or by the occurrence of only a and conveyed to the muscles by the
very
blood
few serious injuries. stream. He showed that the glvcolytic
c;\RBoriYDK,^TB MBT/\BouiSM AND substance produced bv the pancreas is not
Di'^BBTES.
,, a true ferment but a bodv closelv related in
, Many theories have been advanced to its characteristics with other well known
account tor the common disease diabetes, constituentsof internal secretions, as adren-
None, perhaps, are al)le to account for all alin and iodothyrin. He also found that
:ases tor the very good reason that in all when too large a quantitv of the juice of the
proDabiiity no one cause or set of causes pancreas is used carbohydrate combustion
•ould be found to be active in all cases, is retarded or even stopped. The pancreas
Jur Ignorance of the metabolic disturb- juice is supposed to supply the amboceptors
uices m diabetes has been largely due to and the muscle juice the complement. The
ae tact that we have not known how the retarding action of an excess of pancreas
:arlx)liydrates are eventually disposed of in juice is believed to be due to an over-abun-
Ue body 111 health. Normally the carbo- dance of amboceptors. According to these
lydrates of the food are stored in the liver researches the carbohydrates normally are
ina muscles as glycogen. Pavy held that burnt up in the muscles, producing heat
part ot the injected carbohydrates is con- and energy by the combined action of two
erted by the villi of the intestinal mucosa glycolytic bodies, one produced in the musito
tat and carried thence by the lacteals cles and the other in the pancreas. As said
> the blood. Hy a splitting off process an- above, when an excess of glucose (over 0.2
tner portion is incorporated with iiitro- per cent. ) occurs in the circulating blood a
enous matter and carried away in the form glycosuria occurs. Theoretically this may
I proteid. He thinks that only a portion be produced as follows: By functional or
the carbohydrates reaches the liver as organic disease of the islands of Langer-
Ilucose,
where the hepatic cells convert haus in the pancreas. The islands of cells
us monosaccharid iulo the polysaccharid probably produce a glycolytic ferment which

-,^^
THE CHARLOTTE MEDICAL JOURNAL.
carbohydrates independently, or as Cohn present "a^^ >
heim believes, is necessary to render act ve t.cular^
'^f^^L blood vessels within the
a proferment wh:ch,smanufactnied,n the P.-^^^^S.^;';;^ constUnents needed in the
muscle cells.
formation of bile, and thus, by a descend-
BTiOLOGY OF GfKUi. STONES. i„g infection, enters the gall bladder. These
The vast amount of attention that has organisms are capable of producing an inbeJn
devoted to the subject of gall sto.ies flammation nf the bihary passages, mild or
durhiethl past decade has resulted in the severe, of an acute or chronic na ure, and
flue dat on of manv problems regarding the the acute cholecystitis, m particular, is be-
So-^enesis as well as the treatment of i„g recognized as a by no means infrequent
?hSaS It s generally admitted that complication of typhoid fever. According
sevS factors are concernedly^ forma- to Naunyn, the bacteria multiply m the
tfon of *all s'ones The most important of stagnant bile and cause an inflammation of
these afeLmmerated bv Fitz: Thev are the mucous membrane, the cellular product
suTnatL oHhebile, infection of the bile from which contains the cholesterin and
Dassatesand unknown disturbances of lime of which the calcuh are composed m
metabolism ncluded under the term pre- addition to the pigment derived from the
TisposSr No one of these factors seems bile. The milder the inflammatory process
sXe t but the combination of at least and the longer its continuance, te larger
^ passages by
two is essential. The importance of the or more numerous are the calculi likely to ,
fiTst twoT i-enerallv accepted, while the become, but for the formation of the cal-
Siiificance of the third is doubtful, the cuius a preceding inflammation of the bile ,
'
Smpredsposition being perhaps more a passages is necessary. Gall stones th-
form of speech than a demonstrated process, may arise m the bile
P^f^^f^^ henat^J
The importance of stagnant bile is to be without the hver.m the ^o"^° P^^^, •
"^
Jf
reco-nized from the fact that infection with- or cystic duct, but especially withm the
out "stagnation is less likely to be a fore- gall bladder.
runner of gall stones than when combined Experiments on anima s ^^o"" ^^^^ ^^^
^^th stagnation. Gall stones are more culi may be produced m the gall bladder by ,
Ike y o be found in those in whom the flow obstructing the flow of bile and nitroducing
of Me is r^ore likely to be impeded. Sev- bacteria into it, while the admission of bace«ty-si4
per cent, of the Mayos' cases are teria without an associated obstruction to
wometin whom the stagnation is attribut- the flow of bile 1^-, "° -'^'^^^JfbilSy'
able to the habit of lacing, and to repeated bacteria may be admitted to the bUiary
p?e' nancies which lead after parturition to tract through the ^^'^'^'^'}^''',\f^'^^^fl^,
Sion of the cystic duct from prolapse of by inoculating the
^f-'^tlvViUo the Ra^l
the liver and during pregnancy to pressure they may be injected directly into the gall,
d^^tlv^pontSegJ^^ladder. In the obese bladder or bile duct, '^^-e experimented
and in those of sedentary habits of either are of interest also as s^Sge^^^^^jlie rapid ,
Jexs agnation is more likely to occur for ity with which gall stones may be formed
;
obviouf reasons. In the aged, because of Concretions as large as a frain of whe^^^^
the exposure throughout a longer life to bave thus been produced wihiix weeks ,
variousinfectiveprocesses, and also because others, of the size of a pea withm tour,
of the g eral muscular enfeeblement from months. Our definite knowledge hovveve,
degeneration and disuse, the flow of the bile of the rapidity of the ».o"
fo'^^^f
"f .^^
fsSardedinthebile passages. Most im- stones in the 1--^" .^^
f^, , "„tm "nsj
oortant of all however, is infection of the from the operations of Kehr and oHomansj
bUe carrying apparatus. Naunyn first di- who found at a subsequent operation upor.
rected special attention to this factor. the patient that gall stones had formeCj
Infectious organisms, especially the colon
^^^^^^^ ^^^ ligature in the gallbladder
bacillus, the typhoid and paratyphoid
^^^^ .^^ ^.^^^ months in Kehr'si
^:^:^^!i::::rLTt^'^::i ....... Lmans emptied the gallblad^!
with greater or less frequency in the gall of stones in April, 189... bymptoms of ga
bladder. Although human bile is usually gtones returned in December, 1896; the galj
sterile under normal conditions, it is claimed
j^jg^jj^ej- ^as re-opened in Jauuar^^ 1897!
that if a sufficient quantity be examined the
^^^^^^ were found to hav!
colon bacillus may constantly be found.
ana sev
It g
'
n^ature
is an excellent culture medium, and if the formed around the ligature.
.

DR. ll^o^^'OK COOK, DISCOVERER, lieve, that he would become a ravinj, maniac
Doubtless this Journal is not alone in feel- were he to be discredited bv the world In
ing great elation over the fact that the first some respects he has already shown himself
human being to have actually reached the far from being a normally 'balanced iudi-
Koal of three hundred years of human en- vidual. There can be no doubt however
deavor was a plain every-day medical man. that so far Cook has the best of the aro-u-
\et we do not mean that, for Dr. Cook is ment. He has refused to retaliate, he has
more than a plain, ordinary being. There conducted himself in a dignified and couris
something extraordinary about the man teous manner, and he has only to prove
who was able to do so wonderful and, till that he has been there. On the other hand
that time, unique a stunt as was accom- Peary has acted the part of a small, spoiled
phshed by this Brooklyn doctor in reaching child, he has shown how puerile and selfish
theXorth Pole. We should, of course,— is his spirit, and not only must prove that
and we do—find greatest pride in the fact Dr. Cook has not been there, but he must
that Dr. Cook is an .-Vmerican, but next to at the same time adduce evidence to prove
the patriotism which thrills our liearts, with that he—the great Pearv— "nailed the
that of millions of other loyal Americans, Stars and Stripes to the North Pole." We
because the stars and stripes were the first do not for a moment wish to attempt to deto
flutter in the polar breezes, comes the cide the controversy. It is perfectly possipride
that Doctor Cook is a medical man. ble that both men reached the Pole,' but our
It isn't that the penetration of the mystery purpose is merely to witness to our great
which hitherto has kept the Pole shrouded admiration of Frederick Cook, the physicfrom
man s prying instincts means anything ian, the gentleman, the explorer, the greatto
us in a medical way; but it simply adds est discoverer since Columbus
a whole laurel vvreath to a profession which «oM«rER-s method or art.p.c.au
has too long been content to strive for rbspir^tion
achiev-ement within the restricted bounds The Silvester method of artificial respirao
medical science. Dr. Cook's discovery tion has doubtless been more widely taught
of the Big Xa.l is but another evidence of and employed than any other. It is neces-
Amencan grit, perseverance and determm- sary only to mention. t that one shall be
ation t was a test of human endurance perfectly understood. Another method was
to withstand the hardships and privations, taught by Marshall Hall, and still another,
which to us are well-nigh unthinkable, which is likewise better known in this
Enough, however, has been said and IS still country, is the method introduced and
being said, and, perhaps, for months will demonstrated by Benjamin Howard. A
be said, in praise and wonder over the man newer method has recently been advowho
first found a way to the North Pole, cated by Schafer, and those who have em-
His name has been inscribed among the ployed it report that its simplicity and the
names of those whose fame is undimmed by ease with which it is put in practice render
the passing years, and no amount of petty it the best method vet devised,
jealousy, niud slinging and disparagement Schafer's method differs from Howard's
has succeeded, or will succeed, in dimming i„ that it depends entirely on the fact that
the lustre of his imperishable name. i„ ordinary tranquil respiration the dia-
The attitude of Commander Peary has phragm sinks with inspiration, and as it
justly received the stamp of mean and sinks pushes forward the epigastrium. If,
small-souled by the whole world. There therefore, this portion of the belly be cornremains
little that could be said in regard pressed it pushes the viscera back against
to his actions and utterances throughout the diaphragm, drives it upwards, and exthe
whole affair. The majority of lay pels air from the lungs. Schafer insists on
papers of the whole country have, we be- this principle, and has no desire to comlieve,
shown a tendency to side with Dr. press the thorax at all, though practically
Cook in the controversy, and all because he the thorax is to some extent compressed,
has consistently acted the part of a gentle- He has shown that compression of this part
man toward the other side. Peary seems of the abdomen causes a large exchange of
to have an idea that no one but himself had air, larger, he thinks, than can be obtained
any right to find the North Pole: because he by other methods, including Silvester's.
had made numerous attempts and failed he Professor Keith and others, however, doubt
apparently had conceived the notion that he this latter conclusion.
had a monopoly on the wliole Polar region In brief Howard's method was to put a
and that all who dared tresspass should be large pad under the shoulders, and bend
looked upon as poaching on his preserves, the head back until it was at right angles
This ambition to be the first man to reach to the trunk: in this position the trunk is
the North Pole amounted to an obssesion drawn forwards, and the glottis is necesin
the case of Peary to the extent we be- sarily open. Then he got astride of the

248
THE CHARLOTTE MEDICAL JOURNAL.
patient and forcibly compressed the thorax, is to be found in the mamma-hormone, dis-
He grasped the lower ribs, and by so doing covered by the above named investigator,
to some extent made pressure on the ab- It is known that from the very commeiicedominal
viscera and pushed them against ment of pregnancy there occurs a constant
the diaphragm.
" and increasing growth of the manimse, which
Professsr Shafer also at first advised a continues right up to term. Starling has
pad under the shoulders, but he afterwards been able to adduce proof that this enlargeabandoned
it as not only unnecessary, but ment is caused by a substance produced in
positively injurious. He places the patient the growing embryo, as by means of the
prone with his face turned to one side, and, injection of extracts of such embryo he snckneeling
either at the side of him or astride ceeded in causing enlargement of the
—astride is very much better—he places the mammee of virgin rabbits, such as would
palms of the hands on the loins as low down correspond to the early stages of gestation,
as possible: the thumbs should be parallel Zuelzer now infers that a similar specific
on either side of the spine. The palms of hormone may also exist for tlie function of
the hands should not touch, but be placed intestinal-peristalsis—in other words that
just above the iliac crests: the fingers just normal peristalsis is set up by a special
reach the lowest ribs. All that need be hormone. On the analogy of physiological
done by the operator is to press and relax experience, as, for example, the secretory
alternately by leaning forward on to the conditions of the pancreas and of Brunner's
outstretched anus, waiting a couple of sec- glands, it appeared very probable to him
onds, and then without removing the hands that the seat of this hormone might be in
throwing the body back on to his haunches, the mucous membrane of the stomach, and,
This pressure causes the expiration that in fact, he was able to demonstrate the exwould
normally be produced by the natural istenceof a peristalsis-hormone in that situresilience
of the abdominal wall. It must ation. A necessar\' proviso for obtaining
be noted that in an apparently drovvfned this hormone is that the stomach of the aniperson
(or one actually dead ) the abdomi- mal shall be at the height of digestion; from
nal wall is much less elastic and resilient the fasting stomach the hormone which
than in normal individuals. When the stimulates peristalsis cannot be produced,
weight of the body is thus thrown on to the This hormone, in like manner to all others,
arms, a pressure of forty, fifty, or sixty exerts its effects by way of the blood stream,
pounds is exerted, which is quite enough: When the peristaltic hormone is injected
this is much less likely to do any harm than intravenously into a rabbit there occurs,
is the Howard method, after the lapse of a few seconds, an ener-j
As Dent, from whose article in The Hos- getic peristalsis beginning at the duodenur
pital \\& quote at length, remarks, every and reaching to the rectum. By floating
new method introduced upon the medical the intestinal coils of a chloralized experi-1
stage seems to pass through certain definite mental rabbit in saline solution, the fecal
vicissitudes. At the outset full of promise, contents may be seen to be driven from i
it embarks

EDITORIAL. 249
of a tetanic nature. Briigsch, from whoe^ danger an increasing one. Is our race to
article in Folia Tlurapeiitica we are in- be allowed to deteriorate, or will we take
debted, remarks that there can be no doubt measures that will not only stop itsdeteriorthat
these observations of Zuelzer will bios- ation, but will tend to improve our children
som out into fine therapeutic results in the and those who come after them,
treatment of constipation, and that our We liave raised the world over the double
present teaching on the subject will have to line red cross flag against tuberculosis.
undergo some modification necessitated by Let us all get together, physicians, clergythe
discovery of the peristalsis hormone, men, and the laity, and everybody regard-
Manizer draws attention to the fact that in less of race, color, creed, or walk in life,
laparotomies performed under lumbar anes- and raise the white cross flag— I suggest a
thesia, when adrenalin was used in the white cross, signifying purity in all things,
anesthetic, a very considerable increase of on a field of light blue—against immorality
peristalsis was frequently observed, where- and its attendant evils. And the sooner
by a more rapid evacuation of the feces the better for all of the human race the
was brought about; the intestinal contrac- whole world over.
tions. however, were similar to those pro- In this great, grand, and noble work let
duced by physostigmine, z.^"., they were of America lead; and what better place to start
a specific nature. such a crusade than in the South, noted for
,„„„„^, ,^^
its chivaly to and its respect for its womaiihood.
Even physician, nurse, and yes, even the
laity have heard of the great fight now be-
rex mospital,
gept. 2Sth was set apart by the trustees
mg made aga.nst the great W hite Plague.
^f ^^^ Hospital, Raleigh, X. C, as a day
Prom the largest city unto the smallest for receiving gifts for the almost completed
hamlet m our own country has the battle ^^^^, j, j^^l building which is soon to be
cry of the human race aga.nst tuberculosis dedicated. On that dav the hospital was
been heard. On all sides there are notices,
^i^^^^.,,, ^^ ^^^ ^b^ ^,,^ ^,^^5^^,^ -^^
lectures, pamphlets, and educational exhi- ^^eat numbers thronged the wards from
b.t.ons, tending to increase the general ^.^^^^ ^^^ ^ Contributions of all kinds
kno-.vledge of this dread disease and the ^^^^^ received in the shape of money, linen
prevention of it All of which is very com- f^,^ ^^^^^ ^^^^_ chinaware, kitchen utensils.
niendable and of great value in the protec
furniture, and pantry supplies. The Raleigh
tion of the human life against this death- citizens, to whom this institution has meant
dealing enemy. But against the greatest ^^ ^.^^,j ^^^^ ^^j^ ;„ ^^^ f^^^^^ ^^g^,, j,^,
destroyer of our health, our happiness, our measurably more, responded most liberally.
homes, and our lives, against the arch The new superintendent, Miss Orchard.and
enemy of the ).roper healthy proiiagation of ^ ^ ^f capable nurses were on hand to
our race what is being done? This arch pHot visitors about the building.
enemy is Immorality, with Us attendant ^^ ^^^ dedication of the hospital, which
staff of syphilis and gonorrhea.
^^iH ^^me a little later on, after the equip-
Were it possible to obtain accurate and ^^^^^ -^ complete, it is expected to have Dr.
exact statistics of what it is directly andm- q^-^.^^ p j^^^ ^j Philadelphia, a nephew
directly the cause of. the death rate even of ^f the late Mr. John Rex, and several other
It would astound one, whereas the record „je,„bers of the Rex familv from Pennsylof
the suffering and uuhappiness caused by ^,^,,i^ .|.,,g j^^gj. ^^^^ ^jf^g ^^j^i^,,, ^^^^^g
It would be so great and overshadowing ^^^ ho.spital an actuality. At the dedicathat
It would eclipse all the records of all
^j^^j jj^^^e ^^jH ^e appropriate religious and
the other diseases put together in this re- juugjcal services.
gard, and stagger the most vivid imagination
to exaggerate it, or the greatest mind st. josbpivs iiNriRMftRY.
to properly comprehend it all. Yet again Plans for the new St. Joseph's Infirmary,
the question, "Wliat are we doing agairst which will shortly be erected in Atlanta,
it?" And a loud echo answers from all (}a., have been approved. The new hosover
our great land "Practically nothing," pjtal will cost $150,000 and when completed
while the devil smiles and is glad to see will be one of the handsomest and decidedly
how unconcerned, and in fact, how will- one of the most modern structures of its
ingly. our younger generation is handed kind in Atlanta. The plans include every
over to lives of suffering and sin. modern and convenient device which can
Is it not time now and at once to wake contribute toward making a hospital up-toup
to this arch enemy and take immediate date and thoroughly complete. It will be
steps to stop its ravages against our race? located at the corner of Courtlaiid and Baker
Every physician knows that what is said streets. All the old building with the exhere
is true and that every year sees the ce^tiou of the Spaulding wing will be torn

250 THE CHARLOTTE MEDICAL JOURNAL.
down to make way for the new. When Harper, Assistant Demonstrator of Clinical
ready for occupancy there will be accommo- Pathology,
dation for one hundred patients.
EDITORIAL NEWS ITEMS.
The Medical Department of Wake Forest
College opened for the session 1909-1910
with twenty-seven students. Dr. J as. B.
Powers, dean of the Medical School and
Dr. II. A. Royster was recently elected
professor of Bacteriology and Pathology,
President of the Raleigh Chamber of Com- succeeded Dr. W. S. Rankin in this posimerce
and Industry^ tion. Dr. Edgar E. Stuart is Professor of
Anatomy and Physiology.
The Medical Department of the University
of Alabama, located at Mobile, opened its
r^ , ., r^ , ,, ,
1909-1910 session, Sept. 22. A large attendbattle
6c Company, the well known
ance of students is assured.
chemists' corporation of St. Louis, have
only recently issued ISo. 10 of their hand-
^ ^, , „ ^ , ^, ^ some Dislocation Chart Series. Thev an-
Dr. Beverley R. Tucker announces that
^^^^^^^ ^^^^ ^^^^ ^iU send all back numafter
September he first 1909, his offices
^^^^ ^^ ^^^ ^^^ ^^^^ ^^ ^^ ^^ phvsicians,
will be a his residence, 208 Franklin St.,
^^ .^.j.^^^ ^j^^^^^ ^^^ j^ ^^j.
East Richmond, \irginia.
^^^^ ^^^^^ ^f ^1^^ ^.^^-^^^ dislocations, and
„,,,,_. r ^ ^ , are both valuable and ornamental. Address
Dr. John M. Faison, or Faison, Duplm B\ttle & Co
county, N. C, is being urged by his friends
2001 Locust St
to become a candidate for nomination on
St. Louis
the Democratic ticket to represent the Third
Congressional District in the next U. S. Among the additions to the faculty of the
Congress. Medical College of Tulane University is L
S. Kliener, M. D., Ph. D., of Yale. Dr.
The new operating room on the fifth floor Kliener will be the first assistant in physioof
the Delgado Memorial, one of the Charity logical chemistry. F"or two years he has
Hospital buildings of Xew Orleans, was been connected with the Sheffield Scientific
formally opened Sept. 17th, by Dr. Ernest School of Vale University, under such men
S. Lewis, one of New Orleans' most hon- of world-wide influence as Profs. Chittenored
veteran surgeons, after whom the room den and Mendle.
has been named. W^hile at Tulane as demonstrator and
lecturer, he will continue his research work
The regular monthly meeting of the in physiological chemistry.
Wayne County Medical Society was held
Sept. 7th, in Goldsboro, N. C. Dr. E. T. The following announcement has recently
Dickinson, of Wilson, addressed the society been received by the Journal:
on "The Advantages of Organization." "Dr. Benjamin B. Steedly announces to
Major-Surgeon Paul C. Hutton, U. S. Army, the medical profession that after the first of
also spoke on "The Mosquito Pest and its September, nineteen hundred and nine, he
Prevention." will confine his practice exclusively to
Abdominal Surgery, Diseases of Women
The Atlanta School of Medicine opened and Consultation Work. Private Hospital
with favorable prospects for a successful Corner Main and Liberty Streets, Spartanyear
on Sept. 21. An opening address was burg. South Carolina."
made by Dr. T. J. Mc^rthur, of Cordele, Dr. Steedly is already well known to the
Ga., who is president of the Georgia Medi- profession. He therefore needs no word of
cal Association. Other addresses were made commendation at our hands.
by ex-Governor W. J. Xorthen and Bishop •
C. K. Nelson, who are trustees of the The Medical College of Virginia begun
school. its 1909-' 10 session Sept. 14, with a large
numberof students already registered. This
The Medical Department of the University school has raised its entrance requirements
of North Carolina begun its eighth annual so that all students must now take an exsession
Sept. 8th, simultaneously with the amination equivalent to four years in a high
other departments of the University. The school or present a certificate satisfactory to
Raleigh school opened most auspiciously the secretary of the State Board of Educawith
increased attendance of students and tion, who will also look over and pass upon
enlarged faculty. New members of the entrance papers of those who take the exteaching
force are Dr. Jno. S. McKee, amination after reaching Richmond. This |
Demonstrator of Obstetrics, and Mr. J. M. applies only to those studying for the degree ;i

EDITORIAL. T-<
^^:hjS^^' ->^'- - S-hS;- men
degree in dentistry
s^nsJii:?;.--
The Louisiana Anti-Tuberculosis League the WeTter llfsStl r:^r' ^^-^^-^^
hasestablisheditsfreeclinicatUOOTulf" MorgL ttn X 2^he d ' ''
Ave New Sent tt'"' Orleans. With a.Visiting nurse n.tendent r'eported th
employed and
n'utber
a sanitarium camp ^fUSs
in St on -\u

252
THE CHARLOTTE MEDICAL JOURNAL.
Dr. P. L. Hagler, of Birming-batn, Ala,, prietor of the Pastime Social Club, which
was shot, September .ird, and seriously was organized in that city about the time
wounded by the husband of a woman pa- statewide prohibition became effective in
tient on whom the physician was accused Tennessee. Mayor Crabtree officially deof
having performed a criminal operation, manded the resignation of Dr. Shafer on
r. , », 1 Sept. 9th.
The Salvation Army m Selma, Ala., took
charge of the City Infirmary on Selma Street At a meeting of the Tidewater Medical
in that city on Sept. 15th, and is operating Society, which was held in Urbanna, Va.,
that institution for the charity patients of September the 20th, the following^ officers
thecity. were elected: President, Dr. \V. T. Jones-
Vice-Presidents, Drs. J.W. D. Haynes, J.
Gov. Noel, of Mississippi, has appointed ^ DeShazo, A. C. Palmer, Clavbrook
Dr. J.J. Mathis, of Orwood, Miss., a mem- pauntleroy; Secretary and Treasurer, Dr.
berof the State Board of Health from the q .^^ Brown. Papers were read by Dr.
second Congressional District, in place of ^ g Christian, and Dr. C. D. Marchant.
Dr. R. A. Seale, who recently resigned the ^^^ ^^^^^ meeting of the society will be held
position. in Saluda, June 12, 1910.
Dr. J. H. White in charge of the United
g ^^^ g^,^^^
•
States Health and ManneHospitnl Service,
^^^^
s;,ie,y ^^d the Saluda
announces that Dr. W. Herbert Harris has
^ ^^^^.^ ^^^^^^^ Association held a
been appointed to succeed Dr. Duke W ^ ^^,^^ ^^^.^^^ ^^ ^ ^ P^^,^^j^_
Goodman as representative of the service at
^^^ ^.^^^ ^^^.^^^^ presided. Dr. C. F. Wil-
Port Limon, La.
^.^^^^ ^^ Columbia, Secretary of the South'/
The magnificent new Watt's Hospital in Carolina Board of Health, presented a very
Durham, N. C, is nearing completion and interesting and valuable paper dealing with
it is expected that it will be formally opened the urgent necessity of giving instruction iu;
on November 1st. It is said that the cost the public schools concerning the prevention
of this institution will be about $400,000, of disease. Dr. G. A. Taylor, of Augusta,
truly a splendid philanthropy by one of (^a., discussed the prevention of malarial
North Carolina's most noble sons. and typhoid fevers. Tuberculosis and its
, . ^ r^ T iT-11- T- 11 c prevention also received its share of discus-
Acting Surgeon, Dr. J. \Villiam Folk, of K
the United States quarantine office for Win- ^'°"yah
Bay, and medical ofiicer in charge of An injunction restraining one J. W. Crawthe
Georgetown quarantine station, at South ford from practising medicine without li-
Island, S. C, has resigned this position, cense at Donald's, Abbeville county, S. C,
The resignation took effect on September has been made permanent after a hearing
the 16th. Dr. Field held this position for of the case before Judge J. C Klugh, at
twenty-five years, and will be greatly missed Abbeville. Counsel admitted that Crawin
this service. ford was practicing medicine and based
their defense upon the unconstitutionality
The annual session of the South Carolina
of the act and on the ground that the bill
Medical college, at Charleston, begun Oct.
was void of equity in that a violation of a
4, with record breaking egistration. Dur- -
^^.^.^^^^ ^^^^^ ^^^^^ ^^^^ ^^ ^,^.^.,,^d
ing the summer the college building has
^^ ^^^^ ^j^^ ^^^ constitutional
been thoroughly renovated and the facli-
.^/^ ^i^.^ed the order making the injunction
ties and equipments have been greatly in- .^ J^.^^^, ^he case will be carried to the
creased. A new physiological laboratory
.,^,
J"
,„^,t.
will prove a boon to the school.
^
„, ,, .» ,,, J. 1
r- 11 f 4.1 ,f A National Conference on Pellagra will
The Hospital Medical College, of Atlanta,
.^^ Columbia. S. C, on November
Ga., opened on Tuesday September he
,^^ ^,,^1 4^1,^ 1909, under the auspices of the
21st, wi h attendance vvhich surpassed the ^ '^^^ 3^^^^ ^f ^^^^^^^
expectations of the faculty. Addresses were
.^.^^^^ ^,,^ sanitarians are cordially
>
made by Rev. Dr. Young Dr. D. M. Mat- ^^ .^^ ^ ^^^^ ^^ ,^,,
thews, and the dean of tlie college and a
Although the malady is of com- ,
number of others 1 he management of this
.^,^^ ^.^^^,^j recognition in this country,
institution report^ great satisfaction with
fj ^^^ ^,,;,dv manifested itself in seventeen
the prospects for the ensuing term.
^^^^^^ ^^^^
j
.^-
^,,^,„i„g ^^^ proportions of a
Mayor Crabtree, of Chattanooga, Tenn., public health problem,
suspended Dr. W. A. Shafer, a member of The conference will include not only adthe
city board of public safety, on Sept. dresses, papers and discussions, but a luim-
9th. The mayor alleges Dr. Shafer is pro- ber of clinical cases will be presented; thus

J
I Board
i the
EDITORIAL. 253
affording an excellent opportunity for a elected, which is but an index to the high
study of the disease. esteem in which he is held by the doctors of
Information can be obtained by writing the county.
Dr. C. F. Williams, Secretary of the Board.
Mississippi Medical Examiners. ^ '
Secretary S. II. McLean, of the State „ „ ,....
•"•• *^"*' "^*"*'''
of Health
%P»?'«'e"t
of Mississippi, announced
young phy-
regular examination of applicants for °^ ^'"f"' P"'^^'^"!'"^'. ^ ^^
^nd M Ehz-
Washington, I. C., were
1 license to practice medicine to be held in ^^^^^? }''^^' ° ,
,.1 ^^ f' •. •
1 T 1 r^ ^ 1 -, J married recently, at the bride s home in
the New Capitol 111 Jackson on Oct. 12 and „t , , t\ ^ .. ,,-,i
I leakage
Washington. Dr. and
13. The examination is held under the
1°"^^^^ '" Purcelh-ille.
auspices of the State Board of Health. The
Mrs. Miller have
of the examination questions which
such a sensation and compelled the
Dr. Herbert PheianCole, of Mobile, Ala.,
and Miss Elizabeth Wells, of Canton, N.
caused ,
[board to call off the examinatior some Y., were married on September the l.Sth at
months ago, determined the board to safe- the bride's home. Dr. and Mrs. Cole will
guard this examination in a manner which live in Mobile, where Dr. Cole is engaged in
would make it impossible for a leak to the practice of medicine,
occur.
Dr. J. J. Powell and Miss Modane Car-
Pellagra Conference. ^^^- '^°^'^ °^ Gainesville, (ia., were married
in Gainesville, September the 1st, at the
.
,\ national conference on pellagra will be ho,^je of bride's parent's. Dr. Powell is a
held in Columbia, S. C, under the auspices prominent voung physician, andhas located
of tlie South Carolina State Board of
j„ Gainesville, for the practice of his pro-
Health, Nov. 3rd and 4th.
fession.
Gov. Ansel has appointed the following
scholarships for the South Carolina Medical
"*• •*• S- »ye. a very prominent physician
college at Charleston for the session of °^ Chattanooga, Tenn., and Miss Lucy
19()y.)().
Wade, of Waterbury, Conn., were married
First District—J osiah Smith, Charleston. Sept. 2';th. Dr. Dye is a graduate in medi-
Second District—Thomas W. Hutson, ^nic from Vanderbilt University, Nashville,
^j]jg„ Tenn., having completed the course there
Third District—J. Rayford Power, Abbe- " 1«97. Dr. and aud Mrs. Dye will reside
ville. ill Chattanooga, where Dr. Dye has gained
Fourth District—Alva Pack, Greenville, great prominence as a physician.
Fifth •
District— W. B. Marion, Chester.
,7
f.
Sixth District—S. R. Lucas, Florence. UC^ms .
Seventh District— H. Timrod Schifflev.
Orangeburg. "*"• ^- '" **a'''«'>. of Greenville, S. C,
died at his home on Sept. 16th. He had
Medical Society. been in ill-health for many months, and his
The Lexington County "°t
(South Carolina) ^^^l'' \?^
unexpected.
Medical society met in Lexington Oct. 4th,
^\'- ^fty-five years old. He
^'YV" '^""f
The feature
graduated from
of
the
the meeting was
College of Phj^sicians
an address
'^."'^ by Dr. T. II. Dreher
Surgeons, Baltimore,
of St. Matthews, who
Md. in 18/7, and
spoke on "The Business Side of Medicine." ^'"=^ ,t.'^ has practiced medicine m
^^l^*
Papers were
South Carolina.
also read bv Di-. A.
For the last five or six
H. Knowlton,
on
years he has been the special
"I'teriiie Deviations," and by
vaccmation
Dr.
F. A. Coward, on "The
quarantine agent of the State
Laboratory and
Board of
the f"'^
Countiy Doctor
" Health for the counties of the piedmont
A banquet was tendered the visiting doc- ^.°"^^
^^':V°"°^ ^^^'"f-, , ^.
tors on the h.wer floor of
^'the
Masonic build- ^}^'.^''' "'^^ °"! .
°/
ing, to which a number of friends were invited.
The dinner consisted of barbecued
the leading physi-
"'^''^ ""^ ^'« ^^^^'°'' "f ^^'^ country.
Dr. J. T. Williamson, an aged and prommeats.
Dr. R. li. Mathias acted as toast- iiient physician of Calhoun County, Ala,,
master. died at his home at Peek's Hill, August
At the afternoon meeting Dr. F. R. Geiger 30th. His death was due to a stroke of
of Brookland was chosen president; Dr. R. paralysis. Dr. Williamson had lived in
E. Mathias, vice-president. Dr. Jas. J.
Wiiigard of Lexington, who has been the
Calhoun county all his life, and was a regular
practitioner until about two years ago,
able secretary since the organization of the when an accident caused the amputation of
society five years ago, was unanimously re- his legs.

Dr. Robert E. L. Jolinston's funeral was
conducted September 17tli from the residence
of Mr. James E. Johnston, of Brooklyn.
He was a former resident of Alexanandria,
Va., and died recently in Brooklyn,
N. Y.
Dr. Cleveland B. Floyd, a prominent
physician of Fairburn, Ga., died at a hospital
in Atlanta, Ga., September the 3rd.
He contracted blood poison while performing
an operation.
Dr. Floyd graduated from the Atlanta
Medical College in 1895, and since that time
had been a regular practitioner in Fairburn.
Dr. Junius K. Battle, a graduateof Tulane
University, and a very prominent physician
and citizen of Eulaula, Ala., died September
28th. Paralysis was the cause of his
death. He was forty-eight years old when
he died, and a man who was very popular
in his state.
Dr William J. Bramlett died at his home
in Campobello, S. C. Sept. the Sth, after a
brief illness. He was a skilled physician
and had a Inrge practice. He was 54 years
old.
Dr. W- G. Austin, an eminent physician
of Utica, Miss., was found dying in his
office on Sept. 2.5th. He lived only about
half an hour after he was found in this condition.
Apoplexy is thought to have been
the cause of his death.
Dr. Austin graduated from the Memphis
Hospital Medical College, Memphis, Tenn.,
in 1894.
Review of Southern Medical Literature
THE CHARLOTTB MEDICAL JOURNA]
(iaillard's Southern Medicine, August, 1909.
Diagnostic Uses of Tuberculin.— Dr.
McGuire iCewton says that the application
of tuberculin by inunction is known as the
percutaneous reaction, and is described by
Moro, its originator, as follows: "A tuberculin
ointment is prepared by a combination
of equal parts of old tuberculin and
anhydrous lanoline. The lanoline base is
used because with it it is possible to prepare
a very concentrated ointment. The mixture
is made at a temperature of from 20 degrees
to 30 degrees C. Ten grammes of ointment
is sufficient for one hundred tests. The
point of application is over the skin of the
abdomen. In case the skin at this region
is not clear, that over the breast is treated.
The ointment is energetically rubbed on to
the skin for from one-half to one minute.
The area of the part to be treated is about
two inches. The positive effect is noted by
the eruption of a granular or papular
efflorescence at the point of application," ;
which appears in from six to twenty- four i
hours, to disappear in several days.
This reaction has a distinct advantage in j
that it can be applied without puncturing i
or abrading the skin or producing any dis- |
agreeable sensation at the time of its appli- i
cation, and, as with the cutaneous test, the \
patient can be assured of its harmlessness ;
and told that its most unpleasant effect conj
sists in a disagreeable itching in the event 'I
of a severe reaction. Its diagnostic value \
is not quite equal to the cutaneous, as it is I
not so sensitive, and it does not occur so
readily in the pulmonary and progressive
cases.
Wbooping-Cough.— Dr. S. A. \'isauska
believes that local treatment will give good \
results in many cases, a spray of peroxide i
of hydrogen, glycerine and water or a few I
drops internally to infants. Medicatedsteam J
often brings relief, especially where the ']
mucus is tight and ropey. A croup kettle .1
can be used to convey the steam or a coffee 1
pot will suffice. The medication should ;
consist of carbolic acid, oil eucalyptus and i
turpentine.
Local applications of mustard and cam- j
phorcted oil seems to make the child more I
comfortable. To cut down the number of i
the paroxysms the drugs most useful are j
sodium bromide, belladonna, antipyrine, (
quinine, bromoform, and recently he has '
•,
used passiflora incarnata ( May-pop >. Until
he began to use the passifiora his preference
was for a combination of antipyrine and
sodium bromide, but the results from the
use of the passiflora have been so satisfactory
that he has discarded everything else!
in favor of it. He has used this preparation
in thirty-two cases and the results were
astonishing; the severe cases being converted
into mild ones and complications of any
kind were averted. It is non-toxic, does
not constipate, is palatable and leaves the
little patient with no bad after-effect. Be-'
gin with average doses every two hours and
increase the dose until the paroxysms are!
under control.
Nfv Orleans Medical and Surgical Journal.
^V^ca ior tbe Systematic and Unl-i
versa Examination oi Scbool Cliildren's
Eyes, Ears. Noses and Tbroats.— Df:
F'rank AUport quotes the Vermont law
which he considers the best one that has yet
been passed:
Section 1 . The State Board of Health and
the superintendent of education shall pre-
'
pare or cause to be prepared suitable
cards, blanks, record books, and other need-
ful appliances to be used in testing the sigh:
and hearing of pupils in public schools, an(

REVIEW OF SOUTHERN MEDICAL LITERATURE. 255
,
necessary instructions for their use; and the treatment. Before this is used he would
superintendent of education shall furnish strongly urge a careful trial with ipecac.
the same free of expense to every school in Blue Swcat.-Dr. J. A. Storck gives the
the State. The superintendent, principal, following indications for the elimination of
or teacher in every school during the month the cause of indican production:
of September in each year shall test the n is the consensus of opinion that thorsight
and hearnig of all pupils under his ough intestinal antisepsis is impossible,
charge, and keep a record of such examin- However, much can be accomplished by
ation according to the instructions furnish- clearing out the intestinal tract and introed,
and shall notify m writing the parent ducing a new culture medium, one in which
or guardian of every pupil who shall be the bacteria present will not thrive so well,
found to have any defect of vision or hear- preparatory to this, calomel and urotropin
ing, or diseases of eyes or ears, with a brief mav be used, and then the feeding with
statement of such defect or disease, and sour milk may be begun. The rationale of
shall make a written report of all such ex- a sour milk diet is that lactic and succinic
aminations to the superintendent of educa- acids present nitrogenous putrefaction, but
tion as he may require. their action is of short duration. It is there-
Section 2. The Slate Auditor is hereby fore, necessary that, along with the sour
directed to draw his order on the State milk, such agents as thioform, ichthyol,
Treasurer for such sums and at such times tannalbin, etc., be employed,
as the Superintendent of Education, with If the stomach contents are deficient in
the approval of the State Board of Health, hydrochloric acids, its administration is inmay
require to carry out the provisions of dicated.
ithis act The total expense under this act Grape ferment and brewers' yeast are en-
< shall not exceed six hundred $(An).00) dol- ergetic as antiputrefactive agents and may
lars in any biennial term ending June 30. be employed in suitable cases.
Section.^. This act shall take effect July 1, The future diet of the patient should be
1905. carefully formulated. A lacto-farini.ceous
diet meets the requirements best. A grad-
,
Ameblc Dysentcry.-Dr. George Dock
^,^, ^^^^^^ t^ ^ ^^^^ ji,,^,^! ^j^t may be
points out that for treatment, not enough
hrought about by degrees, allowing only a
has been said or done regarduig prophysmall
amount of proteid.
laxis. 1 he amebic come from the water or
surgical Aspects of Cbronlc Diarrhea:
the soil, or from food off or out of the soil, or Appendicostomy and Caecostomy.—
Raw vegetables and greens are especially Dr. II. B. G.essuer says that there is no
likely to be carriers. If we cannot secure question in the minds of those who have
uncontaminated water at the outset, we written on this subject of the value of the
should do as much as possible to prevent method. The discussion revolves about the
ground and water infection by proper lat- selection of suitable cases for the operation,
riues, and with the increased activity of which is of course indicated in cases of disraciallycareless
market gardeners we should ease between the cecum and the rectum.
have inspection of the methods of fertiliza- i„ this connection let me quote again from
tion, and be certain that the use of human McCaw in Keene's Surgery: "There are
;manure is not in vogue. certain cases of chronic amebic dysentery
Curative treatment is most effective in the which proceed slowly but inevitably to a
beginning, and many cases of amebic dys- fatal termination without improvement. At
entery would never reach a positive diag- the autopsy table it is seen that the lesions
nosisif acute diarrheas were more promptly are of such extent that the entire gut is
aud radically treated. Purgation, colon practically disintegrated. The pathologic
flushing, intestinal antiseptics and diet form process has at no time been very acute, but
the basis of successful early treatment, has involved so large an area as to prevent
Later, rest in bed is an essential: free evac- any attempt on the part of nature to repair
uatiou just as much so. Beyond these are damages. It is discrediting a valuable
many methods that would he impossible to method of treatment to confine operation to
enmnerate now. Although while one of such hopeless cases. I'atients who show
these, enemata, including those of quinine, bv their response to treatment by rest, diet
is often of great palliative value, real cure or medication that their large intestines are
arely follows, nor can it if the lesions are not entirely crippled are the ones for whom
high up, without more pains than most irrigation from cecum to outlet is most suitpatients
can receive. 'I'he more rational able."
direct method, by an opening into the upper
!nd of the colon, is more promising, but V'/if Soi/th>:iii Piactitionfr, Aiigiisl, 1909.
here, too, success will depend mainly on Clinical Features of So-Called Acute
he thoroughness of the subsequent local Pellagra.— Dr. N. P. Walker says that the

256 THE CHARLOTTE MEDICAL JOURN.J
blood of one patient presented a typical pic- loathsome diseases that afflicts the human
ture of pernicious anemia: hemoglobin 35 race,
per cent., red cells 862,000, whites 9,400, Fourth. That it should be expected t«|
polynuclear cells 59.4, small mononuclear destroy the variolous virus in the vesicles
32.8, large mononuclear 4.8, eosinophiles thus rendering the scabs and scales h
0.4, myelocytes 2.8. In counting 500 white less, reducing thereby to a minimum tt
cells, there were noted 34 mormoblasts, 15
megaloblastsand 5 free nuclei. The autopsy
dangers of infection from a
smallpox,
given case
findings corroborated the clinical picture.
Exclusive of Ibis case the blood findings Epidemic Pneumonia with a Few Suj
are of some interest in thirteen other cases gestions on Management.— Dr. Stuai
in which partial or complete examinations Mann says that usually in the beginning
were made. Hemoglobin varied from 65 is well to act on the portal system with mil^
per cent, to 95 per cent., red cells from chloride of mercury and watch the elimina
2,.500,000 to 5,292,000. The white cells tion frequently, especially if there i
were decreased in 2 cases, slightly increas disposition to fermentation. In several
ed in 4, and within normal limits in 6. In my cases it was necessary to use salol an^
the differential counts no constant findings turpentine or the sulpho-carbolates.
of interest were noted. Excluding the When the first sound of the heart become
above-mentioned cases, nucleated reds were less distinct and the pulmonic second sound
found in three of ten cases in which com- loses its accentuated character or marked
plete counts were made. One of the chief nervousness order alcohol combined wit|
points of interest in this connection is the nourishment, and strychnia with carb
fact that nucleated red cells may be found of creosote, every four hours. If this dc
comparatively early in the disease and when not suffice give digitalin, with or withou
hemoglobin is normal or above. A more strychnia, and where the urinal secretion i
extended study of the blood may yield some scant combine spartein in grain doses,
information of value. the above is not satisfactory and there
Note on Pellagra In Maryland.— Dr. especial cardiac depression and pulmonai
W. S. Thayer says that the disease is met edema, give adrenalin-chloride, ten
with in two main forms; (l) as d.n acute twenty drops hypodermically to be repeate
tvphoidal condition; (2) as a milder chronic, as indicated. He especially mentions ths
and commonly recurrent malady. this is a most excellent remedy, as his
In the first form the disease is acute and suits with it have been uniform in equali|
fatal, running its course in a few weelcs ing the circulation and relievinc
with active delirium, fever and uncontroU- edema,
able diarrhoea.
In case of shock with pulmonary hemd
In the second form the disease may run rhage, in which the heart is "running aw^
a chronic course with relapses lasting, in witn itself" so to speak, acting like an
some cases, as long as 25 years. The gine without a governor, the author knoy
severer cases run, however, a much shorter of nothing that equals the adrenalin-chl|
course. With each relapse emaciation, ride,
anaemia and debility increase, and with the
progression of severe nervous and mental
symptoms the patient becomes profoundly
Abstracts of the Leading article
of the month.
cachectic, demented and bed-ridden, partly, Bees' Stings and Rheumatism.—Walj
as Neusser has said, because of weakness, er ( British Medical Journal > has iuves
partly because of changes in the cord. gated the statement that the sting of
The Texas Medical Journal, Aufrusl, 1909. will cure chronic rheumatism.
Bichloride ol Mercury Baths in the ed information from country
He colle
doctors.
Treatment of Variola.— Dr. R. II. L. Bibb farmers and from Dr. Fere in Austria, wl
concludes: treated 700 cases of chronic rheumati|
First. That the patient sponged over every with bee's stings during the last thi:
four hours, or as the cases indicate, with years. That the subject is worthy of ea^
1-500 warm solution of bichloride of mer- est consideration is evidenced from the 1
cury and his eyes, nose, mouth, ears and ports collected by Walker. Apeculiarf^
throat irrigated with a warm saturated so- brought out in these investigations
lution of boracic acid is the rational treat- knowledge that sufferers from rheumatii
ment of variola. are verj' little susceptible to the bee's stii
Second. That its use will prevent itching, The active principle in the bee's poison
foul odors, pustulation, abscesses and pit- probably formic acid, wliich is found it
ting. poison with an alkaloid. F'urlher study
Third. That it will greatly lessen the mor- the subject is advisable, and hypoderii
tality and suffering from one of the most injections of the poison could be tried.

A Case ol BaclIIary Infection of the ;„„ ,
Urinary Tract Treated by the • Corres u ic°^
ponding Serum and Vaccine.-Butler in ',
The London Medical Lancet, mentions the !,
ABSTRACTS. -,:.y
Iiematuria has been
^"'^'^ ^^^^ through the female side, and
" ^'^"^^'^ted on two occasions through
case of a woman ^"^
whose major
^^'^ side, m one
complaint
case the transmitting
was difBculty in holding urine and scalding "'!,"?', ^^"^f ^.^''^'^'^- I" t^'e family re-
.
pain on passing P""^^.,*^-^' Guthrie, it. .Medical
in
treatment was
which 12 members of
futile. Bacteriological examination of the tj I ° "^^'^ring two generations,
i"?,'
urine showed bacillus coli and streptococcus '"^^ hematuria was transmitted
ft, , ,
,the latter in much °".'ytbrough
larger
the
numbers.
female side.
Mixed In the six
ivaccine of
^'^"^ren
the two having
organisms was
hematuria
ordered
the condition is
^s the woman "'""'''^^ ^>' was ^"^"^^
acutely exacerbations.
ill a subcutane' There has
pus injection of 20 cubic centimeters of " ^^ ^"-^' *'^ '" "*">'
the ''T'^^
°^ '^^^ «^ases
polyvalent antistreptococcus ^' nor pain
serum
on micturition,
was
nor renal
f ,
given, without -^"'^^"'"^ss.
elTect. The
Xone of
followino- them
mornhave
suffered
ing 21) cubic centimeters more were'^mixed °"J ^''^''^' rheumatism, or gravel,
"°''
^t''^'"'
''' with normal ^">'
saline and ^^own
given as an enema
symptoms of scurvv,
and repeated in four hours, and again wUh^ ^"T"''^- °^ ^^"^'^d 's disease. There is
.ut result. In the evening 2.5 cul.ic centi- T ^'"'"""y ° .°'^'' hemorrhage in any of
beters of anticoH serum was "^?- *""t^'''«^ ^^^'s that
injected sub- ^
the condition
:utaneo„sly. and in twelve hours the tern- t%^ '^'"' '°, ^"^"g«'- ^'f^ ^^ even
perature had fallen to
^' a general rule.
nearlv •
normal The
One of the authftatient
felt better, pain over the kidney °'' ^ ""^^^^ ^''° ^"^'^^ nephritis with
I
vas lessened, and ^""^
micturition '^".^ was less fre- "?"!!:, 7*'"!'^ necessitate a very
luent and Prognosis
less painful.
for
Twelve hours later f/'^^^/^^.
the other members of
t5 cubic centimeters was given
uncertain
as an enema
whether
IK' ^l'^
these
Without result. The next dav 's cubic cen' "'^' "^- '^^''^'i'tary hematuria are of vasoimeters
was given subcntaneouslv. Again l""'"'' °"S'" or are due to structural changes
here was a drop in
'" '''^ ""^"^^ ^"''^^^
temperature and °' ''^'''^^
rdief
if pain and scalding. Twelve days after The Dillercntiatlon ol Aortic
ne Aneurysm
onset ot the acute illness the mixed vac- and Mediastinal Tumors -Tidy (
^ne was The
given and caused a slight rise of London Practitioner ) gives the followinofcmperature.
The next "
injection was given points:
JvoweeksMater. and thereafter at -a month's 1. .-Etiology. Age, sex, arteriosclerosis
Jter\ ai. J^ach injection caused a -real deal and history of syphilis and strain should be
t local pain and swelling. Kvidently the considered and valued, but it should be
;porler did not consider the ultimate fate borne in mind that this is mainly a /!>;w;7
this patient worth • recording. The fact reasoning. The history of primary growths
the prompt and pronounced improvement elsewhere is of importance.
>llowing at least two of his aiiticolic injec- 2. Cachexia is usually rapid with neoons
is suggestive. plasms. Patients with aneurysm are gen-
Congenital. .?ood general
Hereditary, condition.
and Family ^^^J'-^'"
I''''ej^"'.ar
^maluria.-.Mtken, pyrexia is
in The common with
I ondon
neo-
Medr^ i'''
M Lancet, reports seven case; of this rare '"""''"' P^'""*^ '^ ttS ^^
indition
rare
in one family which has been un- ] %, j' t
This observation for seven years The "in ''f/T'f ""^ ^ neoplasm is more
mily is ''''P"! ^l^^" '^t of
composed an aneurj^sm.
of 17 persons of' whom
have suffered from hematuria 'S ^^ Extrathorac.c glands and primary and
Uv is conflicting as to whetl e the gre!-, -
^^^°"dar>' '^'""rs elsewhere must be looked
Imother had hematuria or not she di^d ^^! ^,''''^^' s^P'-^'^Iayicular
r^'"'- ' f°^«^
. advanced age of "'se ^"^ the genital organs should be ex-
t'y vviU.
opsy. Iler only c'hild, a dauglUer, T.a!l 'Tl ""''
J' ,
maturia, married, and Pressure
had effecs
eight
are less
children
marked with
whom three are neoplasms
alive. There
than with
is no aneurysms,
eviwith
the
nee of any of those exception
wlio
of
died
those
having
connected
had
with the veninaturia.
Of thethree living °"^ '>'''^'^-
there is no
idence of the eldest son, .31 years of '• ^^''^h
age, neoplasms, involvement of the
ying ever had hematuria, '
but his six
recurrent laryngeal nerve is rare, and traildren
have all been hematuric; '^''^^^
the sec- tugging very rare. Paralysis of the
a son, aged 28, has suffered from hema- Phrenic nerve, leading to immobility of
ia, and also his only
"'^ diaphragm on
child
the affected side, is aged two not
irs. The daughter, ^^^P^^'^''^' i" neoplasms of the
a-ed a^ea ^3'vears .s years, and l'"^''"'^?'
lu,,^. This never
hnarried I„ .
occurs with
married,
aneurysms,
has J, hematuria. It ,s interest- 8. Tbe'sputum is scanty with neoplasms,

258
THE CHARLOTTE MEDICAL JOURNAL.
except with primary growths of the lung, not a common method of infection, but
when it often has the "red-currant-jelly" sundry cases are on record which prove its
possibility
appearance.
and indicate the undoubted dan-
9 Pleurisy is common with neoplasms, ger from that source. 5. Hospital infec- :,
10 The dullness of a neoplasm tends to tion. The statistics our author refers to do j
have an irregular outline and distribution, not testify to much danger of infection to i
11 A neoplasm mav appeal externally those who have the care of consumptives, i
and iiave transmitted pulsation. A distinct but show that with proper precautions such i
prominence is rare and the tumor need not service is quite safe. At the same time i
be in the line of the aorta. It is not ex- occurrence of tuberculosis among the porpansile
has no thrill and no diastolic shock, ters, especially among those who handle i
A svstolic murmur may be present, but is the sputum, demonstrates where the true |
rarelv conducted along the vessels. There dan gt^r lies, and inculcates the importance i
is no diastolic sound. of dealing effectually with this element o i
Gumma and aneurysm not infrequently d;niger. The writer says that ingestion of 1
coexist. In this and any case where gumma tuberculous material by the intestines is the i
is suspected iodide of potassium is a power- commonest, inhalation by the air passages ;
ful diagnostic instrument. In the general comparatively rare, except that which oc- •
diagnosis of whether or no an aneurysm be curs in the upper air passages, affecting the j
present Killian has recently been very sue- lungs through the lymphatics. Infection j
cessful with the aid of a bronchoscope. In througli wounds of the skin and mucous 1
all cases the X-rays should be employed, membrane is not common, but occurs :
but after rather than before physical ex- among those who handle sputum and other ,
amination. tuberculous material where proper precau- j
tions are omitted. Infection by coition, i
Tlie Infection ol Consumption.—Wil- though it occurs occasionally, is rare. «
Hams, in The British Medical Journal, dis- Finally, all infection from consumptive pa- ;
cusses the various sources of infection in tients can be avoided if the well recognized j
pulmonary tuberculosis. 1. Husband and precautionary measures are adopted and ij
wife infection. In one out of three cases carried out thoroughly.
where consumptives married three wives, . .
one wife survived, and out of nine cases Retroversion ol the Uterus.— Brewis, in ,
where consumptive husbands married twice. The Edinburgh Medical Journal, says that I
the last wife survived in three instances, after curetting the uterus, an incision should (
giving a total of thirteen husbands to thirty- be made immediately above the pubes, ex- j
one wives, of whom twentv-seven died and tending for a distance of about two and j
four lived in apparently good health. It one-half inches. The incision should be !{
would appear that the infecting husbands made through skin, superficial fascia, and
were often in an early stage of the disease fat. Retractors should then be placed at
when infection took place, and some sur- one end of the wound, one being placed
vived their wives bv many years. 2. Infec- parallel to Poupart's ligament, the other
tion throuo-h the air passages by inhalation, parallel to the inner aspect of the thigh.
Though it is improbable that inhalation is Strong traction is now made with those rethe
principal means of lung infection, there tractors, so that the edges of the wound are
is every likelihood of some infection taking widely separated, and the inguinal canal
place through the upper air passages, and area is exposed; but before reaching the inthat
the bacilli enter the lymphatics of the guinal ring, a well defined layer of deep
mouth and infect the lymphatic glands of fascia has to be reflected. This is bes'
this reo-ion and the tonsils, which are often done by dividing it parallel to the fibres o:
the seat of tubercle. The frequent occur- the external oblique until the external open
rence of strumous submaxillary and cervi- ing of the ring is exposed. The suprapubu
cal glands may be due to this cause. 3. In- transverse incision has two advantages ove
fection through the intestines. The most the one commonly used. Its position abov<
important item in this form of infection is the pubes renders it less liable to contami
that of milk and meat, and after the con- nation, and it also permits of free retractio*
elusive evidence of the British Royal Com- and good exposure of the inguinal area
missioners, confirmed by numerous other Before proceeding further divide the inter
authorities, there can be no longer any columnar fascia, pick up with a hook th
doubt as to the danger to the human body, mass, filling up the external ring, then sep
and especially to children, from bovine arate carefully the ligament from the fascia
tubercle bacilli contained in milk. The sheath. Having done this, you will be abl
danger of infection from the meat is not so to draw out the ligament. In doing sc
great. 4. Infection through the skin and make gentle, steady traction, and withdraw
mucous membranes by wounds. This is it until it presents a distinct shoulder. Tb
j
j
|

ABSTRACTS.
indicates that a point near the uterine horn ed onlv after thp t,v«„t;»tT • .-
suture
soitened.
through Poupart's ligament, the
round ligament, and the external oblique Carbon Dioxide Snow In Dcrmatoloav
hn'^fl;
',",''-","""".'•""" ""'or.cl. during ,l,a, tine, ha, employed ti, 08
them.ddle hne, and also at tlie other points toses, plantar and palmar war s obstinaL
where hey emerge through the aponeurosis, circumscribed patches of chronic ec "ma
ftlehgamenls are long enough, the ends and seborrhceic dermatitis, and supeS
may be farther earned down to each pubic epitheliomata. In eighteen cases Xr^vus
.^^.'"""^dn.rn catgut and, in the larger
lastlv cw/h/ pigmented growths and the
cul •
'" " ^"Perfi^i-1 ^-ascular ones. It
'sM ?H, f f 'Tf T-"' seems l"'''^"''- hardly
'^' P"''" ^"'''^'^ '^'^'
en
°"^ ^^°"1^ ^^^"""^ satisfactory
i . ed . Cni' iTT ^"V^
^>' •^^"It^ i" the deeply seated
bSo vascular
e dt n I I ^n . Tr" '''^r^,f varie-
'''''
'
Irated
""^ ^'^''^'^ '" ^^^" '""^- ^ies. In order to destroy them the vessels
at the base must be obliterated, and this
Treatment
^""l^. ^^difficult to
01 Severe
accomplish
Arthritis.
without
Schawow
(Deulsch. med. \Voch. ) ^'^tens.ve destruction of the overlying tis-
'peaks hiX sues
>f the beneficial effects of suplur J^or the removal of small moles, from
wafers
.. combination with m.,s.age gnnnaslS' ' '^
f ^^ ''^ ^P'^'ie^rf.down. he prefers the
flasis, and electricity, in t''e t'^le 'of Sg "«;;':: sli.lt'lv'd'" ff"^ "'"''•he
chronic
'^'^^•"'*' or ^''gl'llv
forms
elevated,
of pigmented,
this disease Acute
micular ^^^'^y
rheumatism
"-v. that carbon dioxide
is usually cured by --f\- !.irtv batlis, though the same number ^ 7"^" '"°'^. ^^'"^^le. In these he
of f I
)alhs and more
°""^ '^ ^"P^'';°'- '^
taken a home Zy lave ^^ ^"y "^her agent.
.o effect. In arthritis deforma" L d'chro^^c wU ^1'!? u^T ""'"'' '" '""^^.^
ressive '
hrit,. '^ T '" ^'^y^^
^J^' ^y ^ ^^°'^ P^^'^"'^ of fr^e^i"^ (from
P ^vlidlYstMnZetrfrvThTsriit" T'"' *? '^^^"'^ '^'^'''/' ^^'^'^ ^ '^^-^^^
.tes and which progr^siverv^ffectskl the f^S^-'e^ °/ ^''^^.^'-e ), and equally satisfac-
*'"'y '^'"^ '^''^'^''y
>inls
•"^^^''^
and is often
can
fntVl Tn be /
obtained in
'" t^'" P^^^'^
reseSesthe circumscribed y i '^f ^f patches of chronic eczema
''"\ "°
S",ernsl.f.v and seborrhceic dermatitis. [r'" J' In lupus ery-
Fibroh s i t !-^ '' ''""" ^'.'^'^«^'«':ed. thematosus the effects are quite good. The
^^'^'^^^
ore cSon ^"""-^ '^^
c o^/'v' ?"'"'r 'V^' snow to be a most excelffund
a L';. v",1 ..Tb r '/'' '"^^ '^^"^'i'^ f°^ the destruction f ^'T of senile
eatLm a^dh'eb Lt,,'"r" '" '
'" l^eratoses. One application, of thirty sec-
JleVesu Is whe,r«I T^ H °"'''''"''''^' °"^«" duralio,,, generally is sufficient In
iled ea. •^'^^'''^
is Tru L i iecliof' TTr"" " *"' -'Perficial epitheliomata it AS is
a rule, .,() injections of 2.,3 c.c. best to thoroughly freeze the lesion for forty
•CD were given, one daily, into the gluteal or forty-five seconds: then, after allowing
uscles. Improvement was generally notic- the tissues to thaw, reapply the refrigerant
259

,Q
THB CHARLOTTE MEDICAL JOURNAL
f . . h.lf minute or longer. In the cases There, however, it is not so universal and
areemployed a,d tte speed s^p y
p^^ ^^^ ^ ^^^^^^^_^^^ ^^ ^^^^^ ^^^^
i," ta'Tr.,u. an? illr wa'ts. which scarcely a bea„ of toil which ha, not a.^
£^XJ; ^^-.i^- "srdt !ir 'i^r^Ee'^f f ap]rf.t:f!^
;fa"?«e?rV.,, s,l.y sec„,.d app,.- .hi. ,o
J^^ ZS^l^^i^tS^^
cations. .
^^ g^^^jj charms, especially of blue beads,
Some Oriental Suggestions in Matters which are supposed to be an unfailing panoi
the Healing Art.-Sandler says, accord- acea against every possible ill.
ing to The London Medical Lancet, that
Bacteriologic and Serologic Invesllthe
Moslems are addicted to the queerest
gg.jons m scarlatina.-Schleissner( Fortpractices
for purposes of healmg or alleviatg^i,j.i(^e
tier Medizin) examined the blood.:
ing bodily pain. A Turk, for instance, in
.^^ ^ ^^^^^ number of cases, and came to the:
distress or suffering from some disease, how-
£oiio,^,i„g conclusions;
ever severe, knows of no better remedy than
^ ^^ appears that in those cases of scarto
fix a piece of his dress, torn off with true
j^^^j^^^ j,j which examination can be madel
Oriental equanimity, to an iron bar of some
^^^.^^ e„ough—before advent of anginasaint's
tomb, or to drink water from a tumj^j^jQgj
exclusively streptococci are found
bier into which he has previously put a
^^^^^ ^^^ tonsils, which on inoculation and,
sheet of paper with writings from the Koran,
^.^niy^tion upon beef serum develop in
Sometimes he will take a jar, the interior of
^^^^^^^, ^^^^ culture.
which has been written all over with strange -,^ -^^^ ^ ^^^^^ number of cases of scarlaformulee
and signs. He will then fill it with ^.^^"^ streptococci can be cultivated from the
water, wait till these formulae and signs
^^^^^^ without their presence in any way
have been thoroughly dissolved, and drink
jj^f^j-gagjug the seriousness of the prognosis,
the singular solution with an absolute faith
^ ^^^^ ^^^^ ^^ scarlatina patients in the
in its wonder working efficacy. Sheltered
^^^ ^^ ^^j^ ^^^gj. gj^.g ^yjtjj emulsions of
by the sombre cypresses of the great Ma-
J^^^^y streptococci cultivated from scarlahomedan
cemetery at Scutari (the ancient
^.^^^^ ^^^^^ fixation of complement: i. e.,
Chrysopolis, on the Asiatic coast of the
^^^^^ contain streptococci antibodies. These
Bosphorus) there stands in picturesque solibodies
do not appear to be present in the,
tude the tomb of a horse. Every Friday
gj-st week; in the sixth week they disappear
afternoon Turkish mothers carry to that
f^om the blood; the acme of their formation
tomb their crippled children to be submitted
^ppgars to be reached about the tenth day.
by a select "khodja" (priest) to^ an extra-
^
Differentiation of the various kinds of
ordinary course of treatment. These chilgfj-gp^cocci
can not with certainty be made
dren are dragged, with their diseased limbs , means of complement fixation,
dangling over the hillock, from one end ot
^ . .«
the tomb to the other and then back again Exophtlialmic Goitre, as a Sequel to
in the same fashion. The ocult influence Tubercular AMeetions.-Hufnagel (Munemanating
from this hillock is supposed to chener Med. Woch.) observed six patients,^
be an all efficient panacea. It is not diffi- all women, who presented tuberculous cacult
to trace in this case the crude, imper- tarrh of the pulmonary apices, besides t
feet association of ideas. The horse has fully developed exophthalmic p't/e, wit^
long been considered an emblem of vigor, uniformly distributed struma of soft, elastJ
tvnifving as Ruskiu says, "the flow and consistency, bilateral exophthalmus, n(
force of life" Hence the belief of the combined with retraction of pupils, sevei
Oriental, inherited, no doubt, from the persistent tachycardia, as well as nervoual
Greeks in the all conquering virtue and and neurasthenic disturbances, itie
influence of ocult and mysterious effluvia sociation of the two diseases is not so ve
which are supposed to emanate constantly uncommon, also in the case of childr"
from a horse's tomb. The wearing of a Among 1246 tuberculous children who ca
necklace of blue beads or of garlic as a under treatment during the past year the
potent means of keeping away disease or of were six affected with apex catarrh ar
warding off the evil eye is quite a universal exophthalmic goitre. One of these cliUdr
matter of sincere belief in the whole of presented the noteworthy findings that »
Turkey. This superstition is shared, as is former attack of measles had not alone ag-|
well known bv the lower classes of majiy gravated the tuberculous affection, but also^
a country 'in' civilized Western Europe, the exophthalmic goitre. To these cases

ABSTRACTS. 261
should be added those of 19 children who intention and the patient made a good resuffered
from exophthalmic goitre and scrof- covery. The uterus was closely moulded
ula, in some form, at the same time. All to the foetus: there was barely an ounce of
the signs of the disease were well marked somewhat turbid liquor amnii. The foetus
in 12 of these cases, whereas in seven the was the size of a full term child and, judgexophthalmus
was absent or only slightly ing by the general appearance, the length
marked. of the nails, and the amount of hair, it ap-
Eulenburg, who combines the thyreogenic peared to be fully developed. The skin
theory with the hematogenic theory pro- was of a dirty brown color; the cuticle,
pounded by Basedow, is inclined to assume wrinkled and easily detached, was covered
that the stimulus which strikes the thyroid in parts with a cheesy substance which was
gland,inducing the peculiarspecific changes deep yellow as if stained with bile. The
in the composition of the blood, is determ- bones of the skull were loose and moved
ined by a primary change in the constitu- easily as one pressed on the scalp. The
tion of the blood In view of the fact that wall of the uterus was about half an inch
according to the investigations of Lieber- in thickness; the muscle was pale and easily
meister, tubercle Ijacilli have been demon- split into layers. The placenta was situstrated
circulating in the blood in a very ated almost centrally over the internal os
high percentage of pulmonary tuberculosis, and lined the lower two-thirds of the uterus;
it is not unreasonable to assume that the it was of-very firm consistence. A thin
toxin formed by these bacilli represents the gray membrane separated the uterus from
actual etiological noxious factor, as far as the placenta and remained attached to the
tuberculosis is concerned. The nervous former when the latter was removed. The
disturbances, according to Eulenburg, are specimen was quite odorless. Microscopicprobably
due to the action of the tliyreo- ally, the placenta showed a finely scattered
toxin upon the nervous system. The ob- calcareous deposit, the villi had undergone
servations of Weonberg, to the effect that hyaline degeneration, and there was old
consumptives may suffer for years prior to thrombosisof the intervilloussinuses. There
the appearance of objectively demonstrable was a considerable amount of fibrous tissue
pulmonary changes, from nervous and neu- scattered among the muscle fibres of the
rasthenic disturbances, seem to be in favor uterus, but the muscle itself did not show
jf the possibility of a bacterial toxic action any marked change. The walls of the
upon the nervous system. arteries were thicker than usual, many of
the large blood spaces were filled with old
Case ot Missed Labor Treated by Ab- thrombi, and, in some, organization of the
lomlnal Section.— I'urslow ( Dublin Medi- thrombus was well marked.
:al I Journal mentions
hirty-three
a case in a woman,
years of age, married twelve Cancer of the Penis.—Don, in the Edinrears,
who had had four children and the burgh Medical Journal, says that syphilis
fear previously a missed abortion. She alone can be confounded with cancer of the
vas first seen in September, 1907. In Feb- penis, and a short, sharp course of iodides,
uary she had felt foetal movements; these with removal of a small part for microscopiontinued
up to June and then entirely cal examination, will clear up the diag-
•eased; since that time she had suffered nosis. The precancerous conditions are:
rom a rather severe constant pain in the 1. A surface shedding of the epithelium and
ibdomen from which she was very anxious a vascularity of the deeper layers, with
o be relieved. On examination she was much leucocytotic infiltration and induraound
to present the signs of. full term ges- tion. 2. At first only a marked thickening
ation, but there was very little liquor amnii, of the epidermis or leucoplakia, either uni-
.nd the uterus was hard and felt as though form or only over the papillae, producing
t were in a continual state of tetanic con- horny or filiform processes. 3. A condition
iraction; it was tender on palpation. The resembling "psoriasis preeputialis."' The
iervix was not typically softened and the mode of spread is: 1. Early involvement
s was closed. Two davs after admission by emboli of the nearest glands through
he was placed in the lithotomy position the lymphatic vessels. 2. Penetration lo-
,nder anaesthesia with the intention of dilat- cally into the neighborhood. This is a
(ig and evacuating the uterus: it was found comparatively slower process. 3. Permeapossible
to pass a Ilegar's dilator into the tion along the lymphatic vessels. Here the
erus and the same was the case with the infection must pass along the whole length
erine sound. As Purslow was at a loss of the penis till it reaches the trunk, and
explain this he susijected a fibroid in the consequently the spread by permeation is
wer segment. He therefore opened the
domen and removed the uterus by pan-
"ot of vital consequence. Infection of the
lymphatic glands is much earlier than perrectomy.
The wound healed by first meatiou of the lymphatic vessels would ac-

262 THE CHARLOTTE MBDICAL JOURNAL.
count for, and permeation into the scrotal Lysol Poisoning from Intra-uterine
tissues has not been observed till late in the Irrlgalion.-Piltz ( Munchen. Med. Wochdisease.
The parts likely to be infected all enschr. says that lysol has been since ) its
lie along the dorsum of the penis and in introduction extensively used on account
either inguinal region, but when the bulb largely of its alleged strong antiseptic propand
the membranous urethra are affected, erties combined with non-toxicity. Many
infection may already have reached the authors have, however, reported fatal cases
intrapelvic glands, and removal of the whole of lysol poisoning. Such poisoning is charpenis
is necessary. Even then the chance acterized by symptoms of acute nephritis,
of a cure is small.
acute cerebral and peritoneal irritation, and
by the presence of phenol and tribrompheuol
The Zittman Treatment of Syphilis.— jh the urine. It has supervened after the
Lawson (Journal of the Royal Army Medical
Corps) says that the Zittman treatment
of syphilis was first commenced at Netley
use of a 1 per cent, solution as an intra-
uterine douche. Craemer and Hammer
state that the drug enters the general circuin
October, 1904, following the recommendation
contained in the first report of the
lation through the intra-uterine veins by
way of the peri-uterine venous plexus. He
Committee on the Treatment of Venereal doubts if a 'i; to 2 per cent, solution of lysol
Diseases and Scabies in the Army. Since can injure healthy kidneys, but he advises
then 183 patients have been through the the exercise of great care in its use where
course. Forty-two of these were put through renal lesions are suspected. The prognosis
a second course, ten a third course, five a of poisoning is good, as the patients recover
fourth course, two a fifth course, and two completely, the kidney nephritis being
a sixth course, making in all 243 cases. transitory like that originating from the
Nearly all the patients improved gener- toxins of scarlet fever,
ally; a little more than half of them gained
weight. Twenty-four showed
Congenital Heart Disease and Polycy-
no improvethemla.-
Weber (Edinburgh
ment. Each course lasted fifteen davs.
^ ed. Jour.)
The evening before treatment is begun the
"l^ntions the case of an undeveloped man
patient is given pills containing 2 grains of
22 years old, weighing bo pounds, with
marked cyanosis, drumstick fingers, systolic
calomel, together with extract of colocvnth
murmur in the middle line orthostatic
and hyoscvamus. Kree diet is ordered; the
albuminuria, ,n whom
patient is kept in bed, except for an hour
was found the u^^^^
in the evening. The temperature of the ,"^"^11^ high polycythemia of 10,oOlJ,)00;
room is maintained at 80° leucocytes /OOO. The hemoglobin
F. at least. The
was 160.
first four days the patient drinks a half-pint ^^^^^^^ ^'^^ count has rare y been recorded,
I" other respects the red blood corpuscles
of a hot decoction at 9, 10, 11, and 12 noon.
appeared normal.
This decoction contains a small modicum of
mercury. At the same day at 3, 4, .5, and A Plea lor a Rational Puerperium.
6 he drinks a half-pint of a cold decoction Haultaiu says that for many years he has
made up of sarsaparilla flavored with lemon, thought that the conduct of the puerperium
cardamom, and glycerin. The day the pa- simulated more that of the convalescence
tient gets up he is given two purgative pills, from a severe illness than the management
The treatment is continued till the fifteenth of the sequel of a normal function. The*
day, when it is discontinued, and the pati- author found the same views expressed in
ent returns to a ward at the usual tempera- a paper by von Alvensleben, Das .^ufstehn
ture. The amount of mercury in the decoc- der Wochnerinnen in den ersten Tagen des
tion is extremely small, since the decoction Wochenbettcs, and publishes now his stais
strained before being administered. It is tistics. Thepuerpera, if willing, was enfound
that men put through the course couraged to sit up in bed to meals on the
without the addition of mercury experienc- second day. As early as she felt inclined
ed as much benefit as those who took the thereafter she was allowed to leave her bed
mercury. and walk to the fireside, where she sat for
The essence of the treatment appears to be an hour. On the following da}' this wa
prolonged diaphoresis and diuresis, brought repeated morning and evening. The neS
about by drinking large quantities of highly day two hours, morning and evening, wefC)
spiced liquids, and being in a room at a spent out of bed, the patient sitting and;
high temperature. walking a little if she so desired. The!
The patient suffering from severe rashes, fifth day after rising was practically spent
rupia, destructive lesions of the nose, and out of bed with the exception of a fe.^
syphilitic rheumatic pains in the limbs and hours' rest in the afternoon, and on th
joints appears to benefit much from the tenth day the patient left the hospital. Th
treatment. Affections of the mucous mem- number of patients who followed this line
branes are apparently not helped. of treatment was one hundred, all of whom

ABSTRACTS. 263
sat up ill bed on the second day; forty rose Malformations ol the Heart.-Keith in
on the third day; thirty-five rose on the the London Lancet, savs that our kiiowlfourth
day; twenty-five rose on the fifth ed^e of the heart has advanced since Peaday.
Of the one hundred cases, forty- cock's time, who in 1866 published his last
seven were pnmaparee and fifty-three mul- edition of Malformations of the Human
tiparae. Each was carefully examined be- Heart, still the standard English work on
fore leaving the hospital, and as many as this subject. One of the greatest discoverpossible
six weeks later. The morbidity in ies since that time is now only dawing, but
these cases— that is, a temperature over every year increases our assurances of its
100 F. or pulse o\'er 90 for twelve consec- truth— viz., that there is a fourth part or
utive hours—was represented by three chamber in the mammalian heart which
cases. In two infective temperatures de- hitherto we have taken no cognizance of.
veloped on the third day. One of these pa- The three parts of the mammalian heart at
tients left the hospital well on the sixteenth, present recognized are ( 1 ) the sinus venothe
other on the twenty-eighth day. Pel- sus, (2) the auricles, and (3 ) the ventricles.
vie examination on the day of leaving the The fourth part is thebulbus cordis, which
hospital (tenth or twelfth day) showed the is so well seen in the shark's heart. It is
pelvic organs to be normal, except in two usually supposed that the bulbus cordis
cases, where a slight retroversion of the has completely disappeared from the mamuterus
was present. In one there was con- malian heart, but now we have good reason
siderable varicosity of the veins of the legs, for believing that, in the same manner as
but the woman remarked that it was not the sinus venosus has become incorporated
nearly so bad as after previous confine- in the right auricle, the bulbus has become
ments— this being her seventh. All the pa- included in the right ventricle, forming
tients examined six weeks and more after that part loosely termed its infundibulum.
confinement showed involution to be thor- The credit for this discovery belongs to
ough, and the position of the uterus nor- Alfred Griel, prosector in the University
mal, with the exception of two, being of Innsbruck. He traced the fate of the
those previously noted as having retrover- bulbys by a prolonged study of the hearts
sion. It was most interesting to hear the of developing vertebrates. Independently
uniformly eulogistic terms in which, with- of him Keith has reached the same concluout
exception, the women described their sion from an investigation of malformed
so-called convalescence while the favorable human hearts and of the hearts of vertecomparisons
made by multipara; with their brate animals. Professor Peter Thompson
former confinements was most convincing, has recently identified and described the
Many voluntarily expressed the opinion development of the bulbus in an early huthat
they had never felt so well previously, man embryo. A large number of the very
and from the others when asked there was commonest malformations of the human
no dissentient voice. He says that it is heart are due to an arrest of the process
difficult to understand why woman has which ends in the incorporation of bulbus
been condemned for thousands of years to cordis in the right vetricle. The great maso
much enforced idleness. In consulting jority of cases of congenital stenosis of the
ancient literature there is no evidence that pulmonary artery are of this nature. Our
the prescription was founded on a physio- author makes 270 specimens of malformed
logical or even a physical basis. In primi- hearts the subject of his lecture in reference
tJve races immediate exercise was the usual to the bulbus cordis, and says that applycustom,
the woman, to cleanse herself, at ing our presence knowledge of the developonce
after the birth of the child plunged ment and comparative anatomy of the
into the lake or stream near which the con- htart to the explanation of these abnorfinements
were usually conducted. In malities, we find ourselves hampered at the
what might be termed "the religious very outset by a complete ignorance of the
epoch," when priests assigned to them- functional nature of the bulbus cordis. It
selves the position of obstetrical specialists, is especially large in the shark tribe, and
this practice seems to have been discontin- is often lined with valves and thickened
ued, and woman sujl)ected to the ordeal of endocardium throughout. Its musculature
purification, which varied in detail amongst is striated but the fibres are more fusiform
different authorities, but mainly consisted and less branched than in the other chamin
enforced solitude for from fen days to bers. The nerve supply is abundant. Systhree
weeks, which was chiefly spent in the tole occurs in it subsequent to contraction
recumbent posture, ; doubtless from want of in the ventricles. Somehow its function is
anything better to do. I-'rom this probably connected with the gill of respiratory sys-
arises the term "confinement," so generally tem; it is with the respiratory system that
used for the act of child bearing, it is correlated. When the gills become

264
THE CHARLOTTE MEDICAL JOURNAL.
replaced with lungs and the aortic stem as the eye is sufficiently clean the lids
divided into systematic and pulmonary should be gently separated and the cornea
trunks as in the amphibia, the part of the examined. Should there be any doubt as
bulbus at the origin of the aorta atrophies to the presence of any ulceration, a drop of
more than the par connected with the pul- fluorescine solution is instilled. If the
monary artery. In reptiles a part of the cornea is as yet unaffected, the lids are
bulbus musculature persists and can be gently inverted without allowing anything
distinguished from the proper ventricular to come in contact with the cornea—the
muscle; our author has also seen it well
marked in an abnormal human heart. In
the hearts of birds and mammals the bulbus
musculature completely disappears,
slightest abrasion being sure to become in-
fected, with disastrous consequences to the
eye—and painted with a two per cent, solu-
tion of silver nitrate by means of a wisp of
but its cavity persists, undergoes a great absorbent cotton wrapped around a glass
expansion, and forms the infundibulum of rod. If the conjunctiva is very brawny
the right ventricle. How far the infundi- and edematous, this painting had better be
bulum is formed by a downward expansion omitted. There is no necessity to neutralof
the bulbus cavity into the right ventricle ize the excess of silver solution; it is sufand
how far it is formed by an upgrowth ficient to mop the conjunctiva with a pledover
the vetricular muscle is difficult at get of wool.
present to decide, but the evidence of mal- The patient is kept in bed and provided
formed hearts points to the former process with some absorbent cotton and a basin of
being the true one. What the exact func- warm boric acid lotion, and instructed to
tion of the infundibulum of the mammalian wipe away the discharge as fast as it is seright
ventricle may be is difficult at present creted. Every hour or two during the day
to say, but its origin, its comparative anat- and at least every four hours during the
omy, and the arrangement of its muscula- night the conjunctival sac is thoroughly
ture make it certain that it has something irrigated with the same lotion from an unto
do with the regulation of the blood sup- dine by the attendant. A little boric acid
ply to the lungs. There are many clinical ointment should be smeared on the lids to
phenomena connected with this part of the prevent them from sticking together,
heart which need further observation and The silver application should also be reexplanation,
peated daily, the strength and frequency of
the application being gradually diminished
Acute Purulent Ophthalmia.— Render- as the case improves.
son in the British Medical Journal reminds
\
i
if the cornea becomes affected, one per i
us that the most frequent cause of purulent
^g,,^ atropine should be histilled everv four .
ophthalmia is the gonococcus, and if early
^^^^^^^ ^„j jf ^i^g discharge is still copious (
treatment is not successfully adopted the
^„^ ^^^ ^^^^^1 ^^1^^^ 1^^, made its appear- ,
loss of the affected eye is an event only too
^,j^g_ ^^^^ p^^ cent, silver nitrate solution .
probable.
should be stippled into the base of the ulcer, 1
If. as IS frequently the case only one eye .
^ut if the discharge has nearlv ceased, (
IS affected, the surgeon should first examine
cauterization with pure carbolic or the gal- I
the apparently sound eye, and should this
vano-cautery will be advisable. If the ulcer i
show no sign of inflammation, take imme- -^ obviously about to perforate, as shown (
diate steps to protect it from contamination.
^^^ ^^^ bulging of De.scemet's membrane, a t
This is best done by the use of a BuUer's
small perforation should be made so as to '^
shield, but until this can be procured or im-
^^^^^ ^^^ aqueous to escape slowlv, and ij
provised the sound eye can be efficiently
^^^^ prewe^n a large perforation with pro- J
protected by means of cyanide gamgee tisj
^f j^is. The later treatment of eyes S
sue secured fixed with a bandage. •„ ^^^^-^^^ perforation of the cornea has taken «
When a Buller s shield is employed, con- '
pj^^^ ^„^ j^f^ ^ prolapsed iris adherent to
,
i
.
|
stant attention must be directed to the strap-
^^^ ^^^^^^^ f^l,g ^^^^-^^ jj^^ scope of this ii.
ping over the side of the nose, and a vent- -^ -^ sufficient to state that unless >^
hole should be made near the outer part of
operative steps to free the iris or make an i
the eyebrow by inserting a small piece of
iridectomy are taken the eye will be lost A
drainage tube ihe shield must not be re- '
^^^^^^ secondary glaucoma.
moved until all discharge from the affected
eye has ceased. The next step is the care- Remarks on Common Types of Sore i'l
ful removal of all discharge from the af- Throat.—Green, in the British Medical ;
fected eye by gentle irrigation with warm Journal, mentions the difficulties that sore li
one per cent, boric acid lotion. The surgeon throats present both as to diagnosis and ll
or attendant should always wear protecting treatment, especially in small children. In ,'
;
|
>
goggles while engaged in the treatment of
any of these severe ophthalmias. As soon
considering the sore throat of scarlet fever
he enumerates four different conditions of j«

ABSTRACT. 7^5
sore throat that are met with. (1) The In adults, at anv rate, this method is attons.ls,
fauc.al pillars palate, uvula, and tended with less risk than opening through
oropharynx are swollen and of a deep red the pharyngeal wall. The only condition
color, bometnncs there is inflammatory that could be mistaken for a retropharynedema
Fhe appearance ( ) presented may geal abscess in an adult is a large gumma.
be that o follicular tonsillitis. ( M
A defi- Chronic retropharyngeal abscess in children
nite membranous inflammation may occur: is not at all uncommon, and the author althe
membrane is soft and leaves superficial ways performs the external operation and
ulceration as It d.sintegreates. (4) Marked up to the present, has not lost a ca.e In
and deep ulceration occurs in the septic tonsillitis a careful examination of the heart
variety; the ulceration may spread upward should be made, and if cardiac trouble is
to the nasopharynx and downward to the discovered small blisters should be applied
epiglotis and larynx; the soft palate may over the cardiac area. Gargles are worse
be perforated or the uvula may slough off. than useless in these cases; it is better to
The treatment of sore throat in these dis- give the patient guiacum lozenges to suck
eases deserves more attention than is usu- freely and to apply a warm alkaline lotion
ally paid to them. The application of what- to the throat with a brush several times a
ever fluid IS chosen with a brush is prefer- day. He prescribes sodium salicylate
able to the attempt to use a gargle, espec- sodium bicarbonate, and ammonium brolally
in children. The physician should mide; if there is a high temperature tincluake
the application at least once a day ture of aconite is added. There could be
himself. In these cases it is advisable to no doubt about the expediency of removing
douche the nasal cavities, and for this pur- tonsils which are the seat of chronic tonsilpose
the glass douche is preferable to the litis or which have been subject to recurspray.
As regards diphtheria, the diagnosis rent attacks of acute inflammation He
IS often attended with difficulty, especially has made a pair of forceps with the blades
when the membrane is confined to one or cutting up and down so that they mi

266 THE CHARLOTTE MEDICAL JOURNAL
and by tightening it up the amount deemed a true neuralgic pain. At times there is
necessary may be removed. The writer paresthesia. There are often associated
mentions laryngitis and the importance of symptoms in various parts of the body, as
an early diagnosis in laryngeal tuberculosis depression of spirits, mental torpor, uunatand
malignant disease of the larynx. In ural drowsiness, marked susceptibility to
intrinsic cancer of the larynx early diag- cold, torpidity of the liver, iudigestion,
nosis and prompt operation give belter re- painful spasms of tue calf muscles, general
suits than follow the removal of cancer in myasthenia, pyorrhea alveolaris, and hj'perany
other part of the body. Very excellent sensitiveness of the teeth. There is only
results have been obtained since the method one lesion likely to be mistaken for an inof
attacking the disease by the external duration, and that is a gumma. The misoperation
of thyrotomy has superseded the takes to which these rheumatic deposits give
older methods of intralaryngeal removal, rise are numerous. Many cases of cepha-
In extrinsic cancer of the larynx ulceration lalagia are of this variety; involvement of
occurs early and the glands are involved the intercostal muscles has been taken for
much earlier. Even in these cases an effort intercostal neuralgia and pleurisy; in the
should be made to extirpate the disease if abdominal wall they have been mistaken
the condition of the patient warrants it. It for acute and chronic appendicitis, gastric
should be laid down as an absolute rule ulcer, abdominal and pelvic adhesions, calthat
when an adult complains of hoarseness cuius of the kidney, and floating kidney;
or alteration of the voice of several weeks' involvemer.t of the gluteal region for sciatica
duration, the larynx should be carefully and hip joint disease: in the neck they have
examined, and if there is diminished mo- been mistaken for sw^ollen glands: the frebility
of a vocal cord, with or without defi- quently complained of growing pains of
nite tumor, the help of a skilled laryngolo- children he believes are due to this condi-
gist is necessary and should be promptly tion. A number of cases are cited illustraobtained.
ting these mistakes in diagnosis.
Chronic 'Rheumatic" Myositis.—Yaw- The Operative Treatment of Trigeminal
ger in The London Medical Lancet says Neuralgia.— HuUes (Wiener Med. Wochthat
the most frequent cause of the so-called ensch. ) presents an exhaustive review of
gouty pain is a form of chronic myositis, the results obtained in von Eiselsberg's
In a search of literature he had been amazed clinic, comprising 23 cases of neurexaiesis,
to learn of the frequency of the develop- with 22 severe recurrences and no cures;
ment of chronic myositis in muscles other 13 resections at the base of the skull, with
than those of the head and neck, and his 3 cures and 10 recurrences; 10 extirpations
attention has also been attracted to the of the Gasserian ganglion, with 8 cures,
errors in diagnosis to which this condition
had given rise. Among the causes affecting
this condition are heredity, climate, and
From this experience he draws the foUow-
ing conclusions: The medicinal treatment
may alleviate the pain for a time, and even
weather. Temporarily infiltrated muscles cause its disappearance, but permanent rehave
been observed in a child two years old. suits are unobtainable. 2. Peripheral neu-
They may appear at almost any time of life, rexaiesis generally leads to a recurrence,
and are common in old age. It is probable 3. After resections at the base of the skull
that no voluntary muscle enjoys an immu- recurrences are less frequent than after neunity,
but there are sites of predilection, the rexaiesis. 4. Extirpation of the ganglion
most common of which is in the muscles of offers the most reliable chance of a cure,
the head and neck. The gluteal, lumbar, provided it be completely removed. He
and deltoid regions, and calf muscles are suggests that in mild cases medicinal treatoften
involved. The muscles may be in- ment be pursued, since it gives about the
vaded at their points of insertion, or the
infiltrations may appear in the bodies of the
same results as neurexaiesis and does not
subject the patient to the risks of operation,
muscles: at times the infiltration extends to narcosis and infection. The administration
the periosteum to which the muscles are at- of aconitin and intraneural injections of
tached, and also to the fascia. The path- alcohol, repeated when necessary, can be
ology of these diseased muscles is largely recommended. If the disease, however, is
hypothetical. These deposits may develop of severer character and has involved two
in muscles that are overworked, in those of the branches of the trigemiuus, resection
not sufficiently exercised, in those that are
^^ ^j^^ ^ase of the skull is advisable. In
much exposed, and where an injury has .
,
i , it
"^'^'^ ^^^"^'^ ^^^^^- lio^^ver, ni which aU
been sustained. The symptoms are those
of pain, which may be shao-p and cramplike, tl^^ee branches are diseased, resort should
or aching sensation. If the swollen muscle at once be had to extirpation of the gang' iig-
impinges upon a nerve trunk there may be lion.

ACTS
267
The Etiology ot So-Called Congenital
erable
Dislocation
factor in
oi the
favor
Hip.—Thompson,
of the condition being
static
The London
rather than
-Medical Lancet,
congenital.
savs The
that f\"-- '.'^;"-' ^"-"'/-""Senuai. female
this condition is of - much greater at
frequency
freauencv a greater
mechani
in girls Ihan in boy; It is generally directmale.
The
"^ ^ '7.'^^^'
J°"^^ ^'^ acts
l^
disadvantage than does the
ly due to pressure ' "^,'^°"gen,tal
exerted on
theory
the
entirely
hip fails
joint T"" i
during the adoption of the erect atti ude ^ the greater preponderance
duuuae of the
of
J
_'^^. ....^u .. ,' or
_ _ ,
iggjo,, ,„
such a nature
females,
as
but the
to produce displacement
preponderance is
explained
of the head
by
of
a
the
reference
normal to
femur
the
from compara-
z
tive
nearly normal
anatomy of the joint in acetabulum. The the
usual
two sexe:,
his
Moreover,
tory of
the
such a case
suggestion
is this:
that The the
patient
condition
is
well-developed girlin whom the condition '1^'""'' '^', ^"^^"^"^
IVnSfLZZ^^^f^^ '^""'''^'^"^ becomes ;comes more ^^'^^i
marked as she
'^^y be
as she assumes
met wuh.
the
erect attitude. The child is rarelv seen A Case ol
until the third or Tubereulous
fourth year, when Nephritis
the phy-
as a
Sequel
sician
to
has Angina. to decide between -Theodor
the congenital
(Archiv f.
or
Kinderheilkunde)
acquired formation
says that
of the
the
malady. He
frequency
with
generally
which
chooses
nephritis
the
follows
former, basing
upon a mild
his
case of
opinion on
angina,
the results of a few dissecUons, , °,„ """'^ more P^rticuh
particularly in chil-
rf,' '^'^'- "/T'
on cases seen at a very
"^^^
voung ^^ ascertained
age, and
by arrying
on
out
certain pelvic conditions.
°f ^''^ He -i^ne
after
believes
every
that iTl' attack ^r"^'"^^-"?
the
of
condition
angina.
arises
Just as it
after birth from
has
certain
become a
Professional
ar.atomical'pecuTi;;iHes"of";iVe>em"lTepelvis;
measure to examine
l^^"^'"^"
When the mar.ably erect
after
attitude an attack
is assumed of scar-
the Jf"""^
female hip joint is not
°^
so well
buiiien,
calculated
this
to f ' ,?. , ''^°''^^ ''"'""""" l'' K "T"''''^
resist the upward thrust of the femur
^^ ^«" n cases of angina,
as is
in order to
the male
guard
joint. It depends
against
much grave
more sequela.
for He observed a
its security on
case of
the rim
nephritis
of the acetabulum,
taking an
which
unusual course after
is cartilaginous
a
during
mild attack
the
of an-
first two gina.
years The presence
of
of
life, than
tubercle
does bacilli
the male could
joint. In
be demonstrated. The child succumbed
other words, the head of the male femur is „,r,.« ,.»,.o 1 , , . -,•
much more securely fixed in the hip
-^?'' ^^^^' '° ^^'"^^ '"'^'^''y *"'^^'''^"
bone ,,',7^^
than A previous
is the head
observation
of the female. The
concerned
ace
girl
tabulum
13 years of age
lies in tlie male
who had suffered
hip bone,
from
while in
a mild attack
the
of
female
sore throat
it rather
eight
rests upon days be-
it. Morefore
going to
over, the
the seaside
joint
for
in the female
her
works summer
at a
vacation.
greater The trouble
mechanical
"--— meclianical
lasted
disadvantage
disadvantage.
^ only -."j- two iv^ days uay:
Hence „„a T
the so-called congenital dislocatioi
dislocatfon is reallv f"^,:"'
in many
"'IftrhTr
cases a static dislocation.
'":'' "-"'"' " ' ^"^^ perature. After her arrival
He — at the — ^-ro^'-uc '''V
."u^ ^
seaside
;.Y,-,j
illustrates his meaning by .some well-defined !. "/,^''f 1?" ,;"..^?I^'"^ T' V^° «^^^f ,«"«
iid then fell ill,
diagrams.
with
With
sudden fever
regard and las
to treatment, two
situde. The
classes
only
of cases may
symptom of
be
disease
made.
that
In the first
could be
anatomical
demonstrated was a slight
reduction can be
cedema-
easily and
tous swelling of the eyelids.
permanently accomplished, The examina-
while in the
tion of the urine,
second
however,
this showed is impossible,
the pres-
even under the
ence of
most
albumen contents
skillful manipulation.
above 1 2 per cent.
Illustrative
^s soon as the
cases
third
are given.
day ursemic
If the author's
convul-
views are
true, many other change: vZ^h '^^-"^
h^^.^^n ^^^ -^'^^" ''
^i^L"^!!!',^'^'
regarded as primary and as possible causes
of the dislocation are really secondary.
These are enumerated as follows: Small
and triangular acetabulum, small os in-
nominatum, head of femur
hours from uraemia.
Heart Disease.— Barr (Hrit. Med. Jour.)
says that drugs should only be used when
ijecessary, and always under strict medical
attened and supervision. People, unfortunately for
smaller than usual, shortening and ante themselves, have taken drugs indiscrimi-
version of the femoral neck, coxa valga, nately, without advice of the profession—
hour-glass constriction of joint capsule, grave mistake, especially in heart diseases.
stretched or absent ligamentum teres, and Cardiac tonics are thus taken; and the^
shortening of leg below knee. These con suiting continued high arterial tension,
ditions are discussed seriatim by the author maintained over a long period,
He
may work
summarizes h
, .
, , „, views as follows: I he disaster for the aorta. It is better to lighten
history of a we 1-developed girl with dislo- the load of a jaded horse than to apply the
cation of the hip rarely goes back before „,hip; remedies which lessen the work of
the adoption of the erect attitude. The fact the heart are often more effective than earthat
the child is well developed is a cousid- diac tonics. When the balance between
a

268 THE CHARLOTTE MEDICAL JOORNAL.
the two.sides of the heart is effectively main- a foreigrn body, why are not the placenta •
tained drugs are, as a rule, unnecessary, itself and the clots which form in the ulerus
except to regulate the blood pressure; when just as good for this puipose? A very large
this is high decalcifying agents and mod- amount of gauze may be inserted, and this ^
erate cathartics answer best. For cardiac soon becomes entirely soaked with blood, i
failure such tonics as digitalis, squills, stro- Thus the compression of the blood vessels j
phanthus, caffeine, strychnine and the lime is impossible, since they can be compressed !
salts answer best; their use should be dis- only against a hard substance, and the '
'
[
continued immediately compensation is re- tampon becomes very soft as soon as it is
stored. For tendency to thrombosis or soaked with blood. If the uterus would ;
embolism such decalcifying agencies as contract the vessels might be compressed, j
phosphoric and citric acids and their solu- but in these cases there is no muscular con- i
ble salts are to be used. In cases of throm- traction. When the tampon is used the ]
bosis and pulmonic embolism with urgent danger of infection is much increased. The
symptoms strong ammoi'ia should be freely sterized hand is a much more effective in- j
used. (Ammonia and spirits of chloroform, strument, and much less likely to produce J
aa five minims, in a wineglassful of barley sepsis, besides giving the operator a chance j
water every hour or half hour. ) In mitral
stenosis we may have free hemoptysis.
to massage the uterus freely with the hands. ;
The narrower the space in which thrombo- .
which should not be checked; it is an ex- sis has to occur the quicker will coagulation
cellent form of blood-letting. In all spas- take place. The tampon distends the uterus,
modic affections, such as angina pectoris, which is the opposite of the effect desired.
the best remedies are nitroglycerine, morphine,
atropine, amyl nitrite, ethyl iodide
and other preparations of iodine. With
This is truly a last refuge in postpartum
^
hemorrhage. In the Woman's Hospital at
j
Basel, out of 10,000 women confined, seven (
very high blood pressure, among a host of
remedies Barr mentions especially decalcifyhave
died of hemorrhage after labor, six 1
with the tampon. He has tried injections'^
ing agents, the benzoates, the hippurates, of adrenalin in two cases, without result. J
iodine and thyroid. He believes from his microscopic examina- |
tions that there is a pathological condition
j
Treatment oi Postpartum Hemorrhage, of the uterine muscles in these cases. The J
— Herff ( Munch. Med. Woch.) deals with only effective method left seems to be the i
the treatment of postpartum hemorrhage removal of the uterus by vaginal total ex-
|
;'
when the ordinary means of producing con- tirpation, or supravaginal amputation. The
traction, such as ergot and hot applications adominal operation takes but two minutes,
fail. The number of deaths from complete and then the bleeding stops at once, and
uterine atony is considerable. The causes the patient may be cared for at leisure. The
are of several kinds; changes in the blood question of sterilizing a woman is a serious j
which lessen its coagulability; changes in one in a young primipara, but itmustbei
the musculature of the uterus which pre- solved quick! or it will be too late,
vent effective contractions; changes in the
walls of the blood-vessels which hinder ^Interpretation oi the Poro Uterus
their contraction; changes in the tissues
-^
Relation to tbe Tliird Stage ot Labor.
around the uterus, such as peritonitis; an- Hart ( Fdin Med Jour. ) deals wUh the
j
omalies of position of the placenta render- ^^^^"^^ I
^^^ mechanism of the third stage
"f,,
oHabor. I he arguments against the theory
ing a portion of the walls less contractile;
functional changes which weaken the mus- "^^^P^'-^^'o^of ^^^ placenta bydirec
culature. Henkel's method of compression shrinkage of the placenta si e are that it .
of the abdomen mav be of use in a few ^^^ " acknowledged by its chief advo-
^°f
cases. A valuable method of exciting con- ^ates that the p acenta does not separate at ^
shrinkage to
traction is rubbing and kneading
4x4 inches and ,t has never i
the uterus
f
with one hand
b^^" demonstrated hat a greater shrinkage
within and the other without
than his occurs^
the uterus on the abdomen, and
He ho ds that when a
compress-
ion of the uterus against the pupic bene. Pani has died off the elastic. ty of the mus- ,
The aorta can be compressed against the ce, and especially of the interpenetrating 1
spine, leaving the lower portion of the bodv elastic tissue, asserts itself, and we g^t the ,.
bloodless. The tampon advocated by ^°^^'''' '^^'^^'' ^^^7^' ,^"'^'
.^"' ''^"
^^°''f
Duhrssen is of doubtful value. According '"crease of area of the opposed internal ;(
to its originator, it acts as a foreign body, ^^erine surfaces, the two surfaces shding ,
compressing the lumina of the vessels and
on one another without separation This ;:
'"crease m area is not participated ni by j
aiding coagulation. He has made use of
this method in six cases, without any sue- ^^'^ nonvascular, non-elastic placenta, and I
thus we get the disproportion between pla- t
cess, all the women dying. He criticises
the action of the tampon. If the gauze is cental cite and placental area, and the tear- ^
|
j
'

nig of the spongy layer. This occurs after
each pain, until at last, when both membranes
and placenta are thus separated, the
uterus, gathering itself up, as it were, expels
the placenta according to Schultze's
or Duncan's mechanism, which are really
mechanisms of expulsion but not of separation.
As regards the bearing of this
theory upon management of the third stage,
hesaysthat the latter may be conducted in
two waj-s. Ill the first method the attendant
graps the uterus firmly, brings on pain
by friction if he thinks the uterus sluggish,
and reinforce each pain by pressure. This
is the active method introduced by Crede.
In this way the third stage may be shortened,
but the practitioner will find that he
has hemorrhage, and occasional retention
of membranes with all their unpleasant
sec|uel?e. If the upper edge of the placenta
is at the Fallopian tube angle, he may perhaps
expel the placenta and membranes,
w//;//^.f a piece of the placenta the size of
the tip of the finger, and this piece may
become septic. The second method is to
keep the hand permanently on tlie uterus,
wait for pains, and not to compress the
uterus unless there are indications for it,
the UKiin one being hemorrhage. The size
of the uterus should be noted, and only
when its bulk markedly diminishes, indicating
separation, should gentle exi>ression
of the uterus or pressure in the suprapubic
region, according as the ])laceiita is
in the lower uterine segment or in the vagina,
be employed. This method goes on
the theory tliat the placenta is separated
after the pain, that hand pressure will not
separate it safely at the time, and that the
safe lime to use hand grapiiig is after the
placenta has separated.
/V\isccllcincous-
Oatmeal In Diabetes Mellitus
Pari (Cazz. degli Osped. ) says that, in
spite of its relative richness in hydro-carbons,
oatmeal is often not only well borne
by diabetics, but exercises a curative effect.
V. Noorden first drew attention to this fact
in 19(12. It is not possible to continue for
long on a diet of oatmeal alone, as nausea,
diarrhea and edema may occur, so that it is
well to alternate with other diabetic diets
for example, one or two days of strict dieting
(flesh, ham, greens, butter," cheese), then
three or four days of oatmeal, followed by
one or two days of greens, and so on in a
cycle. At first, after the oatmeal diet,
there is a slight increase in the glycosuria,
but this soon disappears and conies down
to the level, or even below, that obtained
by the strictest dieting. Seeing that we
—
ABSTRACTS. 269
know so little about the actual chemical
composition of the various starches, the
author thinks it not impossible that the
starch of oatmeal may have a specific action
on diabetes. He records a case of diabetes
in a young man aged 22, where the oatmeal
had a decidedly good effec*, and in a very
short time (a few days) brought about the
disappearance of the sugar, the oxybutyric
acid, and very much reduced the acetone,
whilst the body weight increased.— British
Medical Journal.
Regulin In Constipation.
In most cases of chronic constipation there
is an excessive absorption of water, so that
the intestinal bacteria cannot form certain
products necessary for a normal defecation.
II. F. Hoffmann, therefore, expresses the
opinion that perhaps the most valuable preparation
recommended for chronic constipation
is regulin, a pure agar-agar, containing
about 20 per cent, of an aqueous extract of
cascara. It is marketed as scales or tablets;
the dose of the former is one to two tablespoonfuls
in apple sauce or mashed potatoes,
and of the latter, three tablets twice daily,
after the chief meals Most other cathartics
lose their strength in time, the defecation
is often painful, and hemorrhoids are
likely to appear. Oil injections are usually
effectual, but are troublesome and disagreeable
to take, while diet alone only rarely
helps for any length of time. Only few patients
have the lime and means to resort to
massage and systematic exercise. With
regulin, the author claims that the intestines
will soon fuctionate properly, and it is even
possible to diminish the dose gradualh'.
In the beginning of treatment, it may be
necessary to resort to mild laxatives or to
glycerin per rectum. Hoffmann has tried
regulin in a large number of cases, including
intestinal vertigo and gynecological
cases, and reports the best results.—Therap'
Monatshefte.
Treatment of Diabetes With Leucofermanlin.
By means of a special method, Marcus
could demonstrate that in diabetes there is
quite regularly a diminution of th e antitrypsin
in the blood, provided no other
severe lesions, such as nephritis, psoriasis,
or advanced cachexia, are present. This
low amount of antitrypsin was not due to
the polyuria, since the urine never possessed
antitryptie properties. It was thought also
possible that a certain amount of trypsin
might be carried away with the urine, but
all tests in this direction were negative.
Several cases could be observed for as long
a period as six to eight weeks, and in every

270 THE CHARLOTTE MEDICAL JOURNAL.
instance the amount of antitrypsin in the
blood was in inverse proportion to the degree
of gl3'cosuria.
An attempt was then made to increase
the amount of anti ferment in the blood by
giving the patients pancreatin in large doses,
with the result that the sugar increased and
the antiferment diminished still more.
Much better results were seen when the antiferment
itself was given. The best preparation
to use is the leucofermanin (Merck),
since it contains more than twice as much
antiferment as the blood of a normal individual.
On succeeding days 1, 2, and3Cc.
were injected, so that 6 Cc. in all were
given. The antitrypsin in the blood increased
rapidly, the subjective symptoms
disappeared, and the amount of sugar excreted
was reduced, \n one case from 2 .5 to
0.3 per cent., though the diet remained the
same and no other drugs were given. The
leucofermantin also contains other ferments
besides the antitrypsin. After two to four
days a more or less pronounced erythema
will usually develop at the site of injection.
—Zeitsch f. experiment. Path. u. Therap.
The Incompatibility oi Iodide with Pagenstecher's
Ointment and Calomel.
It is well known, but constantly forgot-
ten, that if yellow oxide of mercury ointment
or calomel be placed in the eye of a
patient who is taking iodine in any form,
violent irritation is produced, and the morbid
process instead of being arrested is
accentuated. It is very easy to make this
error when treating a "strumous" child suffering
from phlyctenulee with yellow oxide
ointment locally, and with cod-liver oil and
syrup of iodide of iron internally. Ne.Kt
day the child returns, with all the symptoms
aggravated. Yvert ( Rec. d'Ophtal., August,
1908,) in a lecture at Dijon treated of this
subject. He tokl his hearers that the iodide
acted upon the mercury compound, and
Ijroduced a mercurous iodide which in the
presence of an excess of iodine rapidly decomposed
into free mercury and the extremely
caustic mercuricriodide. The same unl)leasant
experiences occurred when oxycyanide
of mercury was used locally to wash
out the bladder of a patient taking iodide.
Hollander ( Berlin Society of Medicine, May
16, 1906) pointed out that this double decomposition
with the formation of nascent
mercuric iodide could be utilized therapeutically
in cases of tubercle of mucous membranes,
buccal, laryngeal, and cystic. He
found that, especially in tubercle of the
bladder, excellent results were obtained.
The patient is given a teaspoon ful of a fiveper-cent
solution of iodide of potassium a
quarter of an hour before the local treat-
ment, which consists of the insufflation of
calomel or its injection in oily emulsion.
Yvert concluded by warning his hearers
never to put calomel or yellow ointment into
an eye until they had ascertained that the
patient had not taken iodine, either from a
medical man's prescription or in one of the
patent medicines which often contain it.
British Medical Journal.
Diagnosis oi Lead Poisoning.
The presence of basophile granules in the
red cells is an early and extremely valuable
sign of lead poisoning. A. Trautmann
finds that these granules occur in anemia as
well as in perfect health, but more than one
hundred granular cells to the million is certainly
rare. Twelve cases of undoubted
lead poisoning were examined, and each
showed over one hundred granular cells to
the million. The actual percentage is subject
to slight changes, hence it is often advisable
to make two or more examinations of
the same case. It would be most desirable
to make regular examinations of all individuals
coming into contact with lead, as
intoxication could thus be prevented.
Muench. Med. Woch.
—
Evolution and Treatment oS Tuberculosis
Among Syptailitics.
Emile Sergent tells us that syphilis and
tuberculosis are frequently associated in the
same subject. Syphilis constitutes a prime
factor in causing tuberculosis both directly
and indirectly. Directly a tuberculosis may
be engrafted on a syphilitic laryngitis or
tracheitis; indirectly, syphilis causes a condition
of the system which predisposes the
subject to the reception of the tubercle
bacillus. This occurrence of tuberculosis
in the syphilitic may take place in the early
primary or in the secondary stage. There
may be association of the two lesions in the
same location, as when we have a hybrid
lupus. Generally the soil is such that both
conditions are engrafted on it at the same
time. We may have local tuberculosis in
syphilitics, or pulmonary tuberculosis in
syphilitics, and either condition may be the
primary one. The author believes that the
contraction of syphilis by a tuberculous subject
is not as serious as has been thought.
Provided that the tuberculous subject is in
a fair general condition, he may not be very
severely affected by the syphilis. In all
probability syphilis is a cause of many cases
of fibrous or sclerotic pulmonary tuberculosis.
Tuberculosis also occurs in heredosyphilis
in young subjects. In all cases
except very late ones or very acute ones of
tuberculosis, anti-syphilitic treatment benefits
both the syphilis and the tuberculosis.

ABSTRACTS 271
1
It should be so administered as not to interfere
with the digestion and not to cause sore
mouth.— La Presse Medicale.
were-born alive", and of 28 cases collected
by Dicke during the year 1875 to 1903, 28
children were delivered alive, of whom 19
„ . ., - ^ ^ . Post-Mortem Caesarcan Section.
survived. It must be remembered, how-
^ver, that these figures are probably unduly
This operation is undoubtedly one of favorable, since only successful cases are
great antiquity, although it is diffiult to likely to be published. The chance of the
state at what period of time in the world's
history it was first performed. The iex regia
of Numa Pompilius, by which it was enacted
that in the case of a pregnant woman
child surviving will necessarily depend a
good deal on the cause of the mother's
death.
The researches of Breslau aud Runge
near full term dying undelivered the body have demonstrated that the fetus is most
should be opened immediately after death likely to survive for some length of time
and the child extracted, shows that it was
known to, and practised by, the Romans,
after the death of the mother when this has
taken place suddenly. In cases of high
That post-mortem delivery was recognized fever or of acute septic poisoning the fetus
in ancient mythology is suggested by the
legends surrounding the birth of Bacchus
uot infrequently dies before the mother,
The accounts of cases in which children
and of .Esculapius, and renders it probable are said to have been extracted alive from
that its first origins are to be sought at a the uterus even after the burial of the mothvery
early date. Rosenbauui is, indeed, of er, belong to the realms fiction. Of this
opinion tliat the operation was practised
probably by the professional embalmers
among the ancient ICgyptians.
description is the story of Francois de Civile,
who on great occasions signed himself
trois fois enterre et trois fois par is grace
Subsequent to the date of Xh^ les regia, Dieu resuscite," and who is said to have
numerous ordinances were passed for the
sanie purpose, but it would seem that the
procedure fell into disrepute possibly on
been delivered by a Caesarean section per-
formed on the exhumed body of his mather.
The most recent observations point to the
account of the bad results obtained as re- likelihood of obtaining a living child after
gards the life of children. With the spread a longer interval of time than twenty to
of Christianity and of the rite of baptism, twenty-five minutes after the death of the
which gave to the life of the unborn child mother being extremely small. In two rean
increased worth, the operation again cent cases racorded by trustworthy authoricaine
into favor, and in tiie first Iialf pf the ties, living children were extracted nineteen
eighteenth century Pope Benedict issued a
precept in which the indications for, and the
and seventeen minutes after the sudden
death of the mothers. The suggestion that
the precautions to be observed in, its per- in order to minimize the risk to the child
formance were duly set forth. the operation should be performed on dying
As Hubert remarks, the Roman Catholic patients before a fatal issue actually results
Church reproduced the injuuclion of the has found favor recently amongst various
lex n-gia in the following decree of its rit- obstetric writers. This suggestion is one,
ual: "Si mater jiraegnans mortua sit, fruc- however, of considerable antiquity, and was
tus

272
THF CHARLOTTE MEDIOAL JOURNAL
delivery by the natural passages should be other run-down conditions.—Gaz. Med.
out of the question.
Lomb.
An interesting case in this connection recentlv
has been the subject of a coroner's Treatment of Basedow's Disease with
Antithyroldin.
inquest in the town of St. Laurent in Canada.
A woman suffering from an abscess The patient observed by Galli-\'alerio
in the brain died during labor, and at the and Rochaz first noticed a slight swelling
order of the priest in attendance a midwife of the isthmus of the thyroid gland, but
performed post-mortem Csesarean section, typical Basedow symptoms appeared after
itissaid with a razor, and extracted a living an angina. A subsequent diphtheria conchild
who survives. The matter naturally siderably aggravated the condition, and
occasioned a good deal of comment in a palpitation of the heart, dyspnea, diarrhea,
small town, and in view of the rumor which and extreme prostration were marked sympprevailed
that the woman was not dead at toms. The milk of thyroidectomiz-id goats
the time the operation was performed the
midwife was held by many to have committed
murder. A post-mortem examinacould
not be taken, and rodagen, though it
slightly improved the condition, causedsuch
gastrointestinal disturbance that its use was
tion, however, cleared up the cause of death discontinued. In the meantime the cirand
all the parties concerned were exoner- cumference of the neck had increased to 36
ted. The performance of such an opera- Cm.
tion by anyone but a properly qualified Antithyroidin was then tried, in doses of^,
medisal man, especially in a case in which /2 to 2}i Cc, three times a day before-;
the patient was not dead at the time of its meals, with light wine. After 50 Cc, given
performance, might well expose the persons during eighteen days, the nodules softened i
concerned to a charge being preferred and there was marked improvement in the ,
against them of manslaughter, if not of subjective symptoms. This continued after I
murder —The London Medical Lancet. a second and a third similar course. Sleep
returned, weight increased, the appetite was '
Indications ior Euquinine. good, and the tremor and profuse perspira- :
tions disappeared. The pulse remained the ;
Previous eyperiments have shown that a same, but both exophthalmos and thyroid ;
large percentage of ths dose ingested of tumor were less noticeable. An attack of i
euquinine—the quinine carbonic acid ester influenza was followed by a return of the
quinine, which contains as much as 78. 2 symptoms, again relieved by the antithy-
|
percent, quinine— is rendered soluble by roidin. No after-effects were noticed, ex- |
the gastric juice, and also by the bile, which cept that some hair was lost after the second 1
forms soluble taurocholates and glycocho- course of treatment, and the finger nails be- I
lates. It is rapidly and completely absorb- came brittle. The liquid preparation seems j
ed, just like the quinine dihydrochloride, to be superior to the tablets. It will prob- ,
and hence is equally as active. This is also ably be necessary to take the remedy from i
proved by the fact that very large doses will time to time, until a permanent cure has \
give rise to toxic symptoms in man as well been established.—Therap. Montashefte.
as animals. Euquinine possesses the ad- „ .. „^ .^,— „ « ^ i, i
c , ^11 .^.1 1^ Brooklyn Physicians to Honor Dr. Cook. I
"^ '
vantage of being practically tasteless, but
care must be taken that it is not prescribed A public reception in honor of Dr. Cook .]
with acid substances. is being planned by the medical profession j
From a large number of cases collected of Brooklyn. A meeting was held a few ^l
from the literature by C. Zucchi, it is evi- days ago to make arrangements to welcome i
dent that euquinine is a tasteless drug which Dr. Cook back to Brooklyn, and among i
is readily taken by children in milk, broth, those present were reprejentatives from the I
or cocoa. It causesno gastric disturbances, following medical societies of Brooklyn: I
except in a very few instances vvliere an Medical Society of the County of Kings, the I
idiosyncrasy is present. The disagreeable Homoeopathic Society of the County of i>
symptoms of quinine intoxication do not Kings, the Eclectic Society, the Brooklyn i
occur. Euquinine is indicated as a pro- GynEecological Society, the Brooklyn Sur- I
phylactic and curative drug for malaria, gical Society, the Brooklyn Pathological :
even in cases where quinine itself is without Society, the Associated Physicians of Long I
effect. It is also a good febrifuge in typhoid. Island, and the Brooklyn Medical Society. „;
pyemia, influenza, articular and muscular A committee of arrangements was appoint- ';)
rheumatism, puerperal fever, bronchitis, and ed consisting of Dr. Elias II. Bartley. Dr. :^
tuberculosis. As antispasmodic, it is serv- Walter B. Chase, and Dr. Alfred Bell who J
iceable in pertusis. It has a decidedly bene- will communicate with Dr. Cook regarding 'i
ficial action in many neuralgias and is ^n the date of the reception.—N. Y. Medical 3
excellent tonic in anemia, chlorosis, and Journal. i
'<
'
I

AUBVKTISEMENTS.
A considerable proportion of all
gastric disorders take their inception
in insufficiency of muscular
action. Their correction calls for
measures restoring tonicity of the
stomach muscles ; for this purpose
GRAY'S GLYCERINE TONIC COMP.
is of exceptional value. Its use not
only increases muscular power, but
through improving the blood supply,
materially promotes glandular
and therefore secretory activity.
As a consequence, indigestion,
flatulency and distress are promptly
overcome.
77ie Dose. A {ablespoonful in ivaUr
before meals.
Samples and Clinical Data on request.
THE PURDUE FREDERICK CO.
29 8 BROADWAY. NEW YORK CITY
Officers of the North Ca rolina Med ical Society.
I Notes
Presiilenl, Ja». A. Hi.rn.ni:li«. .\»li«-\ illi-. 'f=^'°? ,' ^'"^ """"l"""- ''"' ''
<
' '
'
181 Vice-Prrxidcnl. E .1. W.Mi.l. Wllliiliit'li.ii. '
'
f.' -:
i
'
8od Vlce-PreHlilent. .In.). (}. M.veis. fluii)..!!,.. ,,,'', " ,'! ,'
i , i
(i.miiu ' '
3rd Vice-President. I,. D. Wli:ut.iii, Siinllitlel.l.
! i"T
Secretarj. D. A. St.inlou. Hiirli Point.
Treasurer. II. n W.ilki-r Eli/:tl>cth Cllj.
r;itN< III (,K9 (3 YKAKSTKKll).
Ut Dl«tru-t. Os.iii- .M.Muil.iii, Ellznbeth City.
Kin
UiKsell. WllmlUKtou
, Di<
J. F. Hii:hsm th.
Hubert A. Ro,>si
Italeittli.
!
(ac-ojic \. KOJB igh
u: R.H. Lewis,
iitii-io): Geo. G.
Raleigh.
>ii. Hiffh Point
Committee on ScienliBc Work : D. A. Stanton, Higb Point,
[tx-offlcio\: T. S. McMullan, Hertford; R.H.Bellamy,
Wilmlnjrtou.
Committee on Finance: G. T. Slkes, (Jnssom ; I. Fearing,
Elizabeth Cit.v : Wm. .Tones, High Point.
Committee on Obituaries: C. A. Juli.Tn. ThomasTllle; R.
P. SIcFa.vden. Ranilleman; J. W. McGhee, Raleigh.
C. M. StroiiK. Charl,.tie.
.1. fl. Smitb, Pilot Mouuta
I. M. Taylor. Morgunton.
James A. Burroughs. Asheville.
nsK or Dblfhatks, A. M. A. : Dr. J. Howell Way. Wayiiesville ; Alteinate. Dr. P. J. Th
rowell. Charlotte: .Alternate. Dr. D. S. George, Bayboro; Dr. T. E. W. Brown, Ashevi
iigan. Kayeltevllle.
Medical Society of the State of North Carolina meets in Wrightsville, June 21, 1910.
The Tri-State Medical Association of the Carolinas and Virginia (only members of
iState Societies eligible). Next Annual Meeting: Richmond, Va. Date of meeting
'I'ebruary S, 1910. President, Dr. I.eGrand Guerry, Columbia, S. C; Secretary-
Treasurer, Dr. J. llowell Way, Waynesville, N. C.
NEVA/ ORLEAINS F»OLYCLHNIC
Post Graduate .Medical Depanmenl Tulaiie University of Louisiana. Twenty-third
Annnual Session opens November 1, 1909, and closes May 2S. 1910.
Physicians will find the Polyclinic an excellent means for posting themselves
upon modern progress iu all branchesof medicine ami snr

,_^
THB CHARLOTTE MEDICAL JOURNAL.
Adenoids and Nocturnal Enuresis.- precipitancy, subnormal temperature, i
Aaenuius
Dl.:) states Gothic palate, carious teeth, urticaria, men- ,
one another and that when they PP
^^ thyroid inadequacy, as shown by persist-
^"
'''°'LmeW aninsuSencvofthein- eut nocturnal enuresis and abundant adecause,
namely, a"/"f^'^.^"^^^"-, n^y.. ,,„:^. Re

iig, immediate ligature is preferable to
:lamps, in order to avoid contusions of inaltrated
tissue. The vagina should be dii'ided
as far as possible below the cancer
ind the uterus then removed after the en-
:re pelvis and the intestines have been proected
with sterile compresses. 4. To obain
primary union it ;s important to shut
iS the unclean portion of tlie operative
ield. This can only be accomplished if
before lieginning the operation care is tacen
to ascertain whether sufEcient cancer
ree peritoneum is present in front of and
)ehind the uterus, as otherwise hysterectony
should be avoided and replaced by ligition
of the arteries. Drainage of the ablominal
cavity is not indicated, as the varina
serves sufficiently for that purpose.

The symptoms of all
THE CHARLOTTE MEDICAL JOURNAL.
Catarrhal Conditions
are favorably influenced by the combined
mild, soothing, sedative, antiseptic and astrin
gent action of
-

TABLE OF CONTENTS FOR OCTOBER. 277
Table of Contents for October, 1909.
Original Commanicationa. The Hypodermic Treat- Carbon Dioxide Snow in
A Plea for the Early and 7.' °' Malaria, by Geo. Dermatology, 259
J!--
Thorough Removal Kornegay,
of
M.D.Cieve- Some Oriental Suggestions
Tonsils and Adenoids in - '*°°' '^' '^*-; - 2.37 in Matters of the Healing
Chil.ln.-,.>.v Dunbar Roy,
Treatment of Consumption, Art 2fiO
M. D., .Atlanta,
'^
(xeorgia, 213 ^.
'-onman, M.D.,
T' Bacteriologio and Serologic
Accurac-v
Kichmond. \ a., 2.i9
in the Diagnosis
Investigations in Scarlaof
Diseases ef the Chest. '''°^' '
Editorial.
2t>0
• • •
by Lewis M.Oaines.M.D., „ Exophthalmic Goitre,
,, ^ as a
t, ,, ,
''"'^ Atlanta, Ga., .... 218 P®'l^^''*P'i°- Sequel to Tubercular Af-
^t'.'*^'"*
Tbe Inflnence of Modern _.°"',' '
' V r i,' -'V '^^'^ fections, 260
Educaiion on the Physi-
^°® l/e'!ord of the Fourth Caseof Missed Labor Treat-
_
cal Development of Wo- „ ° '
'
","-'
' u ' u ^'v V V,' i; ' ^'** ^^ '
^^ Abdominal Section 261
man. bv D.L.
Carbohydrate
Wilkinson,
Metabolism Cancer of the Penis, 261
\ JI. D., Montevallo, Ala., 221 >
The Zittmar Treatment of
n,"", ''r*'/.^^',
V.°.
iCarbuncles. bv .1 (i. John- ^"°'°'-'>: V"'!^!""?* ''"'*'
'
'
"' v Syphilis, 262
'^.'''"'?''
ston, .\I.D..Chest.«»
of
^H7
It-. Early Correction, Heart Disease,
267
The "^ Diflerenliaiion of Aorby
Dr. Hugh M. Lokey,
Treatment of Postpartum
tfc Aneury^urand Medi-
Atlanta, Ga., 232 astinal Tumors, 257 Hemorrhage, 2h8
(Acidosis P^oUowing Chloro- The Infection of Consump- Interpretation of the Poro
form Narcosis: Report of tion 258 Uterus in Relation to the
a Fatal Case, by .1. F. Retroversion of the Uterus, 258 Third Stage of Labor,... . 268
Patterson. M. D., New Treatment of Severe Ar- Bees' Stings and Kheuma-
Bern, N. C 2.15 tbritis 259 tism, 256
F'or Sale
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"d Street, New York City, N. Y.

HYDROLEINE
cod-liver oH after a
of the formula and proceti
deviaed by H. C. Bartlett, Ph. D.,
F. C. S., and G. Overend Drewry,
M. D., M. R. C. S.,- London. England.
Distinctively Palatable
Exceptionally Digestible
Ethical Stable
Sydroleine is gimply pure, fresh, codliver
oil thoroughly emulsified, and
rendered exceptionally digestible and
palatable. Its freedom from medicinal
admixtures admits of its use in
all cases in which cod-liver oil ia
indicated. The average adult dose
J3 two teaspoonfuls. Sold by drug-gists.
Sample \vith literature will
be sent gratis on request.
THE CHARLOTTE MEDICAL JOURNAL.
"As a result of an experience of many
years, I consider Tongaline the most efficient
combination of those drugs, which,
with our present knowledge of rheumatism,
give the best results in the treatment of that
and similar diseases."
Intestinal Dyspepsia.
A "lazy" or inactive liver is more often
responsible for abdominal discomfort and
the varied symptoms of indigestion, and
intestinal Auto-Toxemia, than is generally
supposed.
Why should this be so ?
about as follows : first, Hepatic Insufiiciency,
and a consequent sluggish bile flow deprives
the intestines of its natural stimulus
to peristalsis: both bile and bowel drainage
are thus interfered with and Constipation
results.
Second, when nature's antiseptic, antitoxic
and laxative secretion (the bile) is
insufficient in quantity and thick and tenacious
in consistency, stasis and putrefaction
of the intestinal contents ensue.
Third, the toxic produets of such putre'
faction are absorbed and Auto-Toxemia re-
sults.
In such cases, Indican, in varying proportion,
is usually found in the urine.
This" pathologic chain is more or less familiar
to every physician.
As to the remedy, calomel, podophyilin i
and quiek "liver-stirrers" are first thought i
of. In many cases they help, temporarily, .;
but are they the true physiologic cholagogue ? \
Does not their action depend upon their i
irritant properties ? Does not hepatic inac- (
tivity usually re-ensue after active liver
stimulation and catharsis?
Chologestin is a true pliysiologic cholagogue,
by virtue of its natural bile acid salt
(sodium glycocholate) and normal sodium J
salicylate from oil of wintergreen. Its action |
is not that of an hepatic irritant. It over- %
comes the physiologic deficiency (insuffi- J
cient percentage of bile acid,) which is '
usually responsible for hepatic torpidity. ;
The contained Paucreatin (U. S. P. Stand- \
aid) assists intestinal digestion generally:
The natural sodium salicylate acts as an
intestinal antisecptic and the sodium bicarbonate
contributes the necessary alkalinity.
Chologestin is in liquid form and the dose,
One Tahlespoonful, after each meal, should i
always be given well diluted with cold (
water. Formula, samples and literature (.
will be forwarded to physicians, upon re- i
quest, together with a handsome "Indican li
Color Scale" with approved test and inter- jj
pretation, by F. H. Strong Company, 56 \
Warren St., New York. )
The "Storm" Binder and Abdominal i
Supporter.
The profession is a unit in believing in J
the usefulness and actual necessity of some ti
form of abdominal binder after operations -
upon that region. The variety of binders i
that have been put upon the market is al- .
most without number. The very fact that \
so many different kinds have been in use ^
indicates that most of them have been un- :
satisfactory.
Dr. Katherine L. Storm, of Philadelphia, :
has placed upon the market a form of ab- j
dominal binder and supporter which bids
The pathologic sequence seems to be fair to become the most popular of any yet
introduced to the profession. This binder
took the prize offered by the Managers of
the Woman's Hospital, of Philadelphia. Iti
is a light, flexible, washable and durable!
appliance, without rubber or steel in its
construction. It is used for any purpose for
which an abdominal supporter may be needed
for mau, woman or child. It is applicable
for general support, with pad, it may be
used for local support as well, for instance,
for hernia. It is especially valuable for
movable kidney, enteroptosis or Glenard's'
disease. It is an ideal post-operative binder.
It is a great comfort to women during
the pregnant and puerperal states. It isj
readily adjusted and produces no discom-'
fort when worn. Measurements may be
taken, and supporters ordered from the mail'
,

ufactui^i, Katherine L. Storms, M. P
1612 Diamond Street, Philadelphia, Pa.
Those who have used the "Storm" biiu
have been particularly well pleased with
and for this reason we are anxious that o
readers should become acquainted with ^
many virtues. The company keeps a recoiu
of all nie.isurements sent in, so that order.s
may be duplicated without difficulty or less
of time. All mail orders filled within twent\four
hours on receipt of price.
Infantile Paralysis of tbe Muscles of
the Fool; its Treatment by Partial Ar-
throdesis.— Ducroquet and Launay ( Presse
Med., ) state one of the principal difficutties
met with by the surgeon after tendon grafting
to supply the place of the paralyzed
muscles, is the inability to tell just how
much force will be exerted by the accessory
muscle grafted on, and the constant failure
of the sole oi the foot to touch the ground
evenly, the foot being generally tilted to one
side giving varus of valgus. Toob\iate
this bad result, which prevents the child
from walking in the normal manner, the
authors propose an operation which thev
call arthrodesis, in which the calcaneo
astragaloid articulation and the medio tar
articulations are oi)ened, the articular carti
ABSTRACTS.
1 ages removed, and ankylosis of the joint
cansed, to prevent rotatory movements < t
the articulations, and to permit onh the
movements of flexion and extension. The
sole of the foot is then planted firmly on the Ruber's two cases the patients were aged .52
ground, and only a slightly stiff motion at and 20 years respectively; the important
the ankle is left. The operation for this points were ( 1 ) the establishment of an
purpose is carefully and described and ex- exaet diagnosis during life by means of
amples of the operation are given, showing skiagraphy: and (2) the relief afforded to
what excellent results have been obtained the patients by artificial feeding through an
in actual cases.
esophageal tube.—The London Medical
Lancet.
Idlopatlilc Enlargement of the Esophagus.
Dr, Armin Huberof Zurich has published
a very detailed account of two cases of idiopathic
enlargenieiit of the esophagus, an
affection which is rarely diagnosed during
the patient's life. Dr. F. Krauss wrote an
elal)orate monograph on this condition some
years ago, and Dr. Neumann in IdOO reported
70 cases, iiiort of which, however,
were discovered by the pathologist only.
The improvement of skiagraphy during recent
years has made this condition easier io
diagnose. As regards etiology Dr, Krauss
attributes the origin of the disease to a primary
nervous lesion—namely, partial paresis
of the vagus nerve and consequent atony
of the longitudinal muscles of the esophagus
combined often with local contraction of
the transverse muscles. In several cases
some infectious diseas such as diphtheria
was responsible for the malady. In Dr.
Temporosphenotdal Abscess Rupturing
Into the Lateral Ventricle.
A. A. Ckay recently reported to the Glasgow
Medico-Chirurgical Society a case of
this nature. On the opening of the abscess,
very fetid pus mixed with cerebrospinal
fluid escaped. After operation great improvement
took place. Consciousness and
intelligence were quite restored, and the
various paralyses, previously present, disappeared
to a great extent. A few days
afterward, however, meningitis set in, and
the patient died fourteen days after operation.
Post-mortem examination revealed a
long and tortuous sinus passing almost horizontally
backward from the abscess and
opening into the lateral ventricle at the
point where the posterior joins the middle
cornu. The infection thus had reached the
right lateral ventricle, and had then extended
to the third ventricle, from there to

280 THF CHARLOTTE MEDIOAL JOURNAL i
the left lateral ventricle uiid downward to Hemorrhoids preseni t«o forms, •iiigoma i
the fourth ventricle, through the aqueduct and simple varix. Diagnosis presents no j
ofSylvanus. From the fourth ventricle pus difEculty, Treatment is the same as in
had escaped into the arachnoid space, and adults, the Miculicz operation giving the
caused a basal meningitis, and involved all best results.—Archives Generalesde Chirur- ;
the cranial nerves. The chief interest of gie.
the case lay in the comparatively long time
^ Drcssina*"lorBurns.
the patient lived after the rupture, ot the
abscess into the lateral ventricle. This was Campho-Phenique makes an ideal dress- :
probably due to the operation being per- ing for burns. It is soothing, and while i
formed very soon after the rupture, and stimulating, does not irritate. Itsantiseptic ,
from the rupture being more a gradual properties makes it of inestimable value in •
leakage into the ventricle rather than a a wide field of both minor and major surgi- |
sudden burst.— British Medical Journal. cal work. i,
Campho"Phenique is not a recent produc- i
Cystalgia In Movable Kidney. tion. It has stood the test of time and en- 1
Ferdinando Gangitano gives the svmp- Jovs t^ie confidence of many of our promi- j
tomatologv of movable kinev as including
"ent surgeons and general practitioners. J
all sorts of neuralgic pains in the lumbar, Campho-Phenique is presented in both pow- I
crural, and intercostal regions, gastralgia,
^er and liquid form and a liberal sample I
hysterical attacks, nervous phenomena, with litetature will be forwarded upon re- ^
abolition of reflexes, diminution of the l^^st. ,
visual field, and disturbances of the genital
organs. The author records a case in which
the disturbances of the bladder were very
Hyperemia in the Treatment of Cliilbls>ins.
«•=••.=. -r
severe and of a neuralgic nature. The ^r: B. Ritter states that not one case of ,;
pvelo-uretero-vesical reflex was excited
chilblains failed to improve under the appli-
in
this caae. The nervous filaments become c^^ion of which hyperemia is produced,
congested or affected bv toxic elements and The same thing can be brought about by*,
react excessively. The same plexus which the application of hot air to the part, in the
supplies the bladder enervates the lower porabsence
of the constricting bandage. The
tion of the uterer. The pain resulting causes
application should extend from six to twelve
^^o^rs,
in the author's case a course of treatment
with
for
a pause of at least two houre
cystisis by means of lavage of the bladder
daily.—Pritish Medical
to Jou rnal.
be undertaken. The reflex genital pains Feeding by Rectum.
caused a curretting and other uterine treat-
^^ ^^^^^^ ^e remembered that injection of
mentto be undertaken, all of which produced
nutrient material into the lowerbowel excites
no benefit because the cause of all the trouble
^^^^^-^ secretion, andmav thus account for
was a movable kidney The pain was due
^^^ ;„ j,^ ^^^ stomach frequently cornto
contractions of the detrusor and sphmc- pj^j^.^^^ ^f j,^ ^^^^^-^ ^^^^^ ^^^^^ rectal feed-
ter of the bladder, and with them was combmed
disturbance of micturition.-La Ritorma
Medica.
-^^^ ^j^^-^ -^ important, because rectal feed-
j^^ jg ^ften advocated in gastric ulcer in
^^^j^^ ^^ ^.j^.g complete rest to the stomach,
Hemorrhoids in the Child.
not only from food but from the secretion of
gastric juice-— British ^ledical Journal.
Denis G. Zesas stf^tes that, although hemor
holds are rare in children, they do occur, Danger Due to Substitution.
forming bluish tumors about the anus. The Hardly another of all the preparations in exist-
4i _ 1 v ii .L r ,.1 r 1 ence offers a wider scope to imposition under the
author beieves that one of the factors is
piea of 'jnst as good" than the scientificallv standheredity,
there being an abnormal congeni- ardized Eucalyptol.
,
I
tal thinness of the mucous membrane of the The most recent fraud practiced in regard to this I
anorectal region . The vessels of this region product is an attempt to profit by the renown of the
j
participate in this thinness and they are
^j^rr^'a^cr'udV^oitThat h^^r^^ed
unable S^ to support the column of blood press- applicatioi:, ttie firm name of Sander & Sons is
i"8 against the walls of the hemorrhoidal illicitly appropriated, the make-up of their goods
veins. Constipation is an important factor
i
imitated and finally the medical reports commend- I
i
,
, • „ u-i ii 1. ng on the merits of their excellent preparation are,
in many cases, while in o hers a chronic „g^,^ „^^ „f j„ -^^ tj,^ ^^3i,^j l^,^ ,^ j,,^ i„;
diarrhea causes weakness of the walls. Tu- ended deceit.
|
mors in the abdomen and enlarged liver are This fraud, which was exposed at an action tried •.
occasional causes of pressure on the veins, before the Supreme Court of Victoria at 1 elbourne, !
•
T lifer.*;,.,, ,„-,„ ^lo^ k= 1 *• Infection may also be a cause, inoculation
talcing place trom simple subsphmctenc
ulcers and excoriations of the anal region,
and Others reported before in the medica literatiirei
show that every plivsician should see that his patent
gets exactly what he prescribed. No "just as
good" allowed.
I
j

ABSTRACTS.
Electricity in Ibe Diagnosis and Treatment
ot Infantile Paralysis.
II. Marques divides the treatment of infantile
paralysis and its S3^mptoms into three
stages. The first is the acute stage, when
measures to lessen irritation and infection
^re in order. Next comes a stage of regression
and paralysis. Beginning from
the early days of the disease, paralysis is
marked, and the muscles degenerate and
atrophy. The electrical applications are
now of great value in two ways: in diagnosis
of the possibility of recovery in the
paralyzed muscles, and for treatment of
these muscles to keep up their tone until
the greatest possible amount of repair has
occurred in the spinal cord. The Faradic
reaction is entirely absent from early in the
disease in the paralyzed muscles and the
reaction of degeneration is shown by applications
of galvanism to these muscles.
Upon the character of the degeneration reaction
depends the prognosis for recovery
of the various muscles. The use of galvanism
is invaluable; in fact, is the only
means of treatment of any value in exercising
the muscles and preventing atrophy.
It is given at first in continuous application,
followed by an interrupted current,
the pole being used over the muscles that
give the best contraction. The sittings
should be short and only the amount of
Sulpho-
Lythin
hexamethVlenakiine
u. s. p.
'Tablet No.6"
Cholagogue, Biliary and
Urinary Antiseptic.
Effective in all conditions produced by
Hepatic Insufficiency.
Effective in arresting, preventing and counteracting
bacterial invasion of the gallbladder.
Hence it is indicated in
Cbolangitis, Cbolecystitis and
Cholelithiasis.
Effective in Typhoid I'ever, as a preventive
and curative agent, being an Intestinal
Antiseptic.
Effective also in Toxemia of Pregnancy.
Sample, literature and clinical reports upon request
LAINE CHEMICAL CO.
Manufacturing Chemists.
NEW YORK.
m HENALGN
An Ideal Antipyretic, Analgesic and Expectorant
Of the greatest value for the relief of:
Hemicrania, Cephalalgia, Neuralgia,
Dysmenorrhea, Rheumatism, Gout,
La Grippe, Cold and for the Reduc-
tion of Temperature.
Samples F'ree to F>liy8lolans«
Etna Chemical Co,
NEW YORK CITY. U. S. A.

THE CHARLOTTE MEDICAL JOURNAL
Waterbury 's Metabolized
COD LIVER OIL COMPOUND
(Plain, also with Creosote and Guaiacol,)
MEETS EVERY DEMAND FOR A RECONSTRUCTIVE TONIC
,. It does contain Cod Liver Oil. Metabolized or predigested.)
(^
2. It is therefore free from all nauseating properties.
3. It builds tissue rapidly, because,
4 All tjie oil is readily and completely assimilated.
5 It is exceptionally palatable and children take it readily.
6. Climatic conditions do not affect it: equally good in summer and vvniter.
7. It is in every sense ethical.
Dispensed in full 16 oz. unlettered bottles
Samples and Literatara Fnrnished upon Repuest
WATERBURY CHEMICAL COMPANY.
No. 37 Pearl St.,
New York City.
Home Offce,
Des Moines, la.
Toronto
Canada

ADVERTISEMENTS.
THE CHARLOTTE SANATORIUM
Corner West 7th & Church Sts. Charlotte, N, C.
D. A. Tompkins. President
E. C. Register. M. D.. Vice-President.
W. D, Witherbee. M. D.. Secretary.
A
private hos-
pitaliiicorp o r a I e d
Au

-7g4 THP; CHARLOTTE MEDICAL JOURNAL J
matic dyspnea, and eruptions on the skin is placed in the cradle with an electrode :
that simulate true ezema, urticaria, milk fastened to each shaved area. Theelectrode i
crusts etc The vesical, palpebral, and placed at the end over the lower part of the
intestinal mocosa may be affected, and the spine is the anode, the other two are cath-
I
liver is enlarged. After a number of such odes, that at the root of the neck at first beattacks
a permanent hvperirophy of tissues ing disconnected. When everything has
j
may result. Geographic tongue without been prepared, a lethal current is passeu |
loss of appetite or had bad general health through the body until apparent death sets i
are manifestations of this state. The cause in. The cranial electrode is then disconj
of these attacks of congestion is a too large nected, that at the root of the spine being
|
amount of the fatty constituents in the diet, joined up in its place, and the operator by i
and the trSatment consists in reducing the means of a suitable break carries on rhythdiet
to the smallest possible amount con- mical excitations with a sufficient potential
sistent with the preservation of life, leav- to cause maximum respiratory expansions,
ino- oui the materials that will produce fats. These are practiced for one second with an
j
No medicinal treatment, Ventura savs. is interval of from two to three seconds. From
j
of curative value, and it should be resorted 10 to .'^0 of these are generally necessary to
j
to only a palliative to the local manifesta- restore spontaneous respiration, and a sue-
j
tio„g — Rivista di Clinica Pediatrica. cessful result may occur after a much longer
period. Carrying her work still further, Dr.
j
j
„ .. ..
Electric Narcosis and Resuscitation.
Robinovitch has succeeded in resuscitaling
^^^j^^j^ ^^^^^ ^^^diac or respiratory syncope <
Some time since we had occasion to refer Jias been induced by chloroform or ether,
to the condition known as "electric nar- tijg method of applying the current as well
;
i
cosis, " first discovered by Professor I.educ, as the current itself being essentially the i
of Nantes. It is brought about by passing game as that which we have described. The ;
through the nerve centers a current, prefer- possible practical importance of these ex- |
ably from a battery, which by means of a periments in surgery is obvious, for there
special commutator was interrupted 100 vvould seem to be no valid reason why, in ;
times a second, the current actually flowing cases where the administration of a general I
for one-tenth of the period between each anesthetic was attended with some anxiety, ;
interruption. This is now known as the arrangements should not be made to apply ,
I.educ current; and if there are no signs of rhythmical electrical excitations. -The Lon-
its displacing ether and chloroform for pro- ^on Medical Lancet.
,
ducing anesthesia in human beings, it cer- .
tainly has done so to a large extent in the
conduct of laboratory experiments upon
jjjg ^^11 Effects of Sunshine.
,,^ ., , .
,
animals. We have received copies of a If it be true that devils love darkness
Series of papers bv Dr. Louise G. Robino- then, according to L. L. Woodruff (Oph- I
vhch, of New York, in which she makes thalmology, April, 1908), they are in ad- ,
'
several important communications regard- vance of the medical men who advise their
ing the uses and properties of such currents, patients to get '"to God s sunshine as i
Speaking of electric anesthesia in labora- much as possible. ' Woodruff would have
;
tory work, she points out the following ad- us believe that light has a most pernicious <
vantages among others: 1 . The blood pres- action, not only upon the lower forms of
^
sure, respiration, and temperature remain protoplasm, but also upon maiikiud. the
about normal, even after eight hours or ultra-violet rays have essentially the same ;
longer anesthesia. 2. It can be induced lethal effect as Roentgen rays and those
not only centrally but locally, r.. No ani- emitted by radmm. All animals are pro- I
mals have been lost from this anesthesia, tected against the sun: they hide in the day ;
4 A voltage of from .S to 10 is all that is time, or are covered by hair, feathers, or
^
required to produce electric anesthesia, and pigment. Even plant cells must work n. ,
this potential is quite free from danger to the dark under the bark, or protected bv
,
•
life Finally Dr. Robinovitch has been green pigment. Man also needs protection, ,
able to perform important operations, such and by the ordinary laws of selection a race
as exposure of the brain, carotid artery, becomes pigmented in direc proportion to,,
vagus nerve, and abdominal organs, under the intensity of the light. The author seeb
]
its influence. Carrving her investigations the process going on m America, a laiid;l
further, she has made the somewhat para- where the blonde type is rapidly giving place:
doxical discovery that if properly applied to the brunette, and asserts that it is we .
this current can resuscitate electrocuted known that the tuberculous rapidly pensti,
animals. The animal having had the hair in the tropics. Knopp has stated that m the .
shaved off at three places—head, upper part Southeastern States of America ph hisical I
of dorsal region, and lower part of spine— patients only improve in the long, cold wiu-
,
j
|
j
;
j'

ADVERTISEMRNTS.
B-^^'^»^BS
fa For Upwards of Forty m
i Years the Use of I]
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I l>ypopbo$pbiK$ I
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I * i
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286
THE CHARLOTTE MEDICAL JOURNAL.
ter; they make no progress in summer. If marked in comminution, but it is obvious i
subjected to the "sunshine treatment," the in T-, L-, or V-shape fractures. In some
brunettes show better results than the cases there is no alteration of tone at all,
blondes, who invariably perish if they migrate
too far .south. Not only is tuberculosis
more prevalent among blondes, but neubut
there is likely to be persistent tenderness.
The cases reported are not particularly cou-
elusive.
'
rasthenia also claims Ihem as its victims. 7 ^
This disease is wofully prevalent in white Rheumatism.
_^
men both in the tropics and in the snow "The speculative and somewhat nebu- |
glare of the artic regions. It is made worse lous character of our knowledge of rheuma- I
in the land of pert-etual sunshise, butim- tism is indicated by the fact that salicylic
proved in dark, cold climates. Woodruff acid, the one agent which has given the '
appears to be in ignorance of the fact that best and most uniform results, and the one i
there is at least one resort of consumptives most generally employed, is used empiri- |
which seems almost able to recall the dead cally. !
to life, the South African Karoo— a land of The introduction of salicylic acid marked j
perpetual sunshine! The author stales that a great advance in the treatment of rheuma-
most migrains are due to eye-strain, the re- tism, and while its powers have been most ]
suit of astigmatism. The astigmatism is strikingly exemplified in its control over |
due to lid pressure, and the lid pressure is articular rheumatism, still its achievements !
accentuated by sunshine. In America a in connection with other forms of the dis- i
trivial error of refractioj' can, it seems, lead ease are scarcely less brilliant. i
to "terrible sequelje" and to "much truancy In fact in the treatment of all those dis-
and crime." We are unable to accept these eases and diseased conditions resulting from
views. In our experience, true migraine is the existence of the so-called rheumatic or \
rarely caused by errors of refraction, nor- uric acid diathesis, the action of salicylic i
can we believe that astigmatism, which may acid from natural oi.l of wintergreen ap- I
be due to a flattening of either the vertical proaches so nearly to that of a specific as
or the horizontal medians of the eye, is due to be excelled only by that of cinchona on
to lid pressure. The idea that a pair of malarial toxaemia.
spectacles can make a criminal a moral man But the administration of the synthetic
j
j
;
1
need not be discussed outside the yellow salicylic acid in full doses is almost always '
press. That exposure to direct sunshine productive of unpleasant and often danger- I
can have, under certain circumstances, a ous effects, such as irritation of the stom- J
pernicious effect must be admitted, but the ach, ringing of the ears and even delirium,
|
extreme views expressed in the paper are thus necessitating a diminution of the dose j
little short of ridiculous.— British Medical or a temporary suspension of treatment. )
Journal. This is also the case with many extempor- i
aneous prescriptions having salicylic acid (
On Percussion as an Aid to the Diag- as a base and combined with other indi- I
nosis of Fractures of the Skull.— Hogarth cated agents.
(Edinburgh Medical Jourjial) thinks that On that account during the past twelve
it is the best to carry out percussion with years I have jarescribed Tongaline many i
the fingers without any intermediary ple::i times because it is a compound of well rec- ;
meter. The head of the patient should be ognized agents and all the salicylic acid it
supported with the examiner's left hand contains is made from the natural oil of i
placed beneath the occiput, while the right wintergreen.
hand is left free to percuss. The two sides In properly selected cases Tongaline has i
should be compared, and the mouth should never failed to do all the work required of
^
,
,
be either oyjened or closed during this com- it. It is easy of administration, and as a
parison. The writer says that in case of rule it is not repugnant to the most fastidfracture
one of two changes in the note ious stomach."— Medical Sentinel, Sept.
elicited may be found to be present—either
the note is lowered in pitch over the frac- "l am slow to take up any new preparature
zone, or in addition to the lowering of tion or to spend much time upon the circuthe
pitch a definite crack -pot quality is in- lar matter that comes to my office, but in
•
i
i
j
troduced. Tongaline I found a remedy from which I
For either change to be brought about it obtained such excellent results that I shall
is necessary that a fracture (fissure) must always use it when indicated.
j
extend a certain distance over the surface Owing to the very changeable weather
of the skull. A very short fissure may not during the past winter I have prescribed
cause any appreciable change in the note, Tongaline for many cases of rheumatism,
and the same may happen possibly in a very neuralgia and grippe, in which it acted
j
,
j
j
!
close fissure. The cracked-pot sound is most splendidly." i
j
|
j
'
j
j

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THE CHARLOTTE MEDICAL JOURNAL.
DR. MORSE'S SANATORIUM
REAR VIEW OF SAr^ATORlUM FROM PARK.'
A reBiied country Sanatorium, with all the convenifii.
of a city; hot and cold water, bath, toilet, electric bells, t
The location, in the heart of the Blue Ridge, is one of unr.M, ,
beauty. Miles of graduated walks, for the control of ex i
cise, forming spacious "park." Climate unsurpassed, em
sine excellent. All rooms permit of veranda sleeping. Cot-
tages adjacent. Close personal contact with physician in
charge. Two mails daily. Telephc
U. Telegraph service.
connection with \V
Chimney Rock, N. C.
A private Sanatorium for the treatment
L'jCIUC PO^r^DMAN 'ORSE
CHIMNEY ROCK.
DR. STEEDLY'S PRIVATE HOSPITAL
Abdominal Surgery and Diseases of Women
SPARTANBURG, S. C.
SCOPE OF WORK limited exclusively to surgical affections, in either sex,
the abdominal walls (hernias, tumors, etc.) or of the abdominal organs—stoma
intestines (including rectum), liver, gall bladder, spleen, kidneys, pancreas, i
urinary bladder— and to all affections of the female pelvic organs.
OPERATING AND STERILIZING ROOM EQUIPMENT is the best obtainable
FURNISHINGS elegant, comfortable, and homelike.
ONLY GRADUATE NURSES in attendance upon patients.
f
TERMS; For room, board and general nursing—private rooms from %25M^
$50.00 per week; double rooms from $15.00 to $20.00 per week.
Anesthesia and surgical dressings in operative cases, flO.OU. Charges for profe
sional services according to the nature of the case and the circumstances of the patien)
For further information address
MRS. FRANCES M. MONTGOAIERY, Superintendent, or,
J. H. HUNTER, Resident Physician. j
«

ADVERTISEMENTS.
St Luke's Hospital
1000 WEST GRACE STREET,
== RICHMOND, VA. =
[JSAAt: AI. TA.'V'r^OR, ivi. r».
Both
Owned and personallvconducted
by Dr. Stuart McGiiire 'for the exclusive
use of his private patients.
Building erected for the purpose
to which it isdevoted, and combines
the comforts of a home with the
conveniences of a modern sanatori-
Location in residential section
convenient to all parts of the city
by means of the street car service.
Capacity for sixty patients, single
and double bed rooms, No wards.
Designed especially for surgical
and gynecological cases. No contagious
diseases, insane or colored
patients received.
Cost of bed, board and general
nursing from $14 to |i8 per week
For further information', address
the Secretary.
^^>^^^^^»^^^^^^>^m^^m9m»»9m^m^^^^»^^,
BROADOAKS
SANATORIUM |
Morganton, f
North Carolina. %
A Private Hospital for the #
Treatment o( Nervous and Men- ^
tal Diseases, Inebriety and Drug *
Habits X
A home for the Permanent Care #
of SELECTED CASES OF |
CHRONIC NERVOUS AND ®
MENTAL DISEASE. m
JVX. D.
Medical Officers reside in the SANATORIUM and devote their
whole time to its service. New addition just completed admits
of thorough classification of patients, and gives better faci-
lities for the care of all. Billiards, Tennis and other diverting
amusements.
Complete equipment for Hydrotherapy now being installed.
Correspondence with physicians solicited.

Treatment ol Severe Cases ol Chronic
Colitis.
P. L. Mummary says that cases Qf chronic
colitis naturally divide themselves into two
classes: First, those which, if carefully
treated by a suitable dietary, proper regulation
of the bowels, and perhaps one or
more visits to some suitable spa where
proper lavage of the bowels can be carried
out, get well and stay so; and, second,
those in which, in spite of prolonged care-
ful medical and spa treatment, but little if
any improvement follows, and in which relapses
quickly occur. The latter forms one
of the worst classes of chronic invalids and
chase after all forms of quackery. The first
task of the physician should be to find out
the real cause of the symptoms. The term
"chronic colitis" should be reserved for
those cases in which there is a chronic inflammatory
condition of the colon mucosa.
They should be made out easily with the
sigmoidoscope, as the sigmoid flexure is
practically always involved. Such cases
do well on lavage and the Plombieres
douche. In some of the cases with this
class of symptoms there is, instead of lesion
of the mucosa, some chronic obstructive
lesion, such as adhesions from a previous
peritonitis or perimetritis. Cancer of the
colon may cause symptoms of chronic
colitis. In another group of cases we find
a chronically inflamed appendix. In still
another group there is no inflammation of
the mucosa, but the whole colon is lax and
atonic and there is a marked tendency for
the upper portions to prolapse into the lat-
'
ter, and there is generally well-marked
ptosis of the stomach and the transverse
colon. Here lavage would be harmful.
Those cases which medical measures fail to
relieve may call for appendicostomy. The
most difficult cases to treat are those in
which there is a general atony of the bowel
combined with ptosis of the colon. Stitching
up the colon is quite useless, as it is unreasonable
to expect stitches to hold up the
stomach and transverse colon permanently
when the natural supports have not been
able to do so. In such instances very satisfactory
results follow appendicostomy and
the fitting of a belt to support the abdomen.
The object of operation in such cases is to
prevent the stagnation of the fecal contents
of the colon and at the same time by the
introduction of peristaltic stimulants to improve
and restore the muscular tone of the
bowel wall.—British Medical Journal.
THE CHARLOTTE MEDICAL JOURNAL.
quired during systole to keep up the circulation
is as low as possible. A mixture
containing bromides and iodides may be ;
given to these cases. Iodide of sodium has j
no practicable superiority over iodide of j
potassium; either will do, but the addition j
of bromide of potassium is advantageous, I
possibly partly because it quiets the nerv- 1
ous system, and we know that the blood
pressure is largely influenced by the emo-
tions. The various vasodilators, such as I
amyl nitrite, trinitrin, erythrol tetranitrate, I
are also useful, but should not be given as •',
a matter of routine Belladonna combined 1
with bromide and iodide is often beneficial, i
Wiere there is sleeplessness, as is not in- '
frequently the case, a hypodermic injection ;
of morphine is often of the greatest service, i
Digitalis should not be given in this class
of cases. Strophanthus causes less peripheral
constriction than digitalis, and so is :
safer, but even this drug is better avoided :
'
if the mitral valve is competent. The heart
muscle may be sustained and stimulated, if
'
desirable, by strichnine, but strychnine is
incompatible with iodide of potassium, as it
forms an insoluble iodide.
There is, however, another class of cases I
where aortic regurgitation has gone on for i
some time, producing the conditions in the
ventricle already described, without any i
sudden rise of pressure, causing sudden )
death, but where, as the result of the grad- i
ual dilatation of the left ventricle, the mitral
|
valve becomes incompetent. When this i
occurs the danger of sudden and dramatic I
death is to a certain extent lessened, but a ;
new series of symptoms arises. Before, the '
diflaculty which the left auricle had to face
was that of pouring, during its systole, the i
blood it contained into a possibly partly I
filled ventricle, but now, added to this, it
has a stream of blood underpressure forced '
into it during its diastole by the contraction >
of the ventricle; consequently the auricular 1
dilatation increases and the pulmonary',
blood pressure rises, so greatly increased :
work is thrown upon the right ventricle and
changes occur in the right side of the heart. I
For a time the increased pulmonary press-;!
ure may be compensated by hypertrophy of
the right ventricle, but in a heart already, i
seriously altered from aortic regurgitation'
this compensation is not, as a rule, long I
maintained; the right ventricle dilates, tri- :
cuspid regurgitation takes place, and we I
get engorgement of the systemic venous
system, with the usual symptoms of enlarg- i
ed liver, oedema of the legs, and possibly i
ascites; in fact, the case which was pri- ;
marily aortic regurgitation now puts on the,
The Treatment of Aortic Valve Disease.
In cases of pure aortic regurgitation, our symptoms of mitral disease and terminates'
efforts should be directed to lowering this as mitral cases do. |
resistance, so that the amount of force re-
This is the class of aortic cases in which i
j
;
|
'

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XXIV
THE CHARI,OTTE MEDICAL JOURNAL.
digitalis and its congeners are useful. The perfect than in the adolescent. The joints
peripheral vasoconstrictor action of the drug generally recover perfectly, and there are
is of less importance, because the regurgi- no sequestra, since there is little tendency
tation through the mitral orifice acts to a to necrosis of the bone. Treatment should
certain extent as a safety valve. Conse- consist of supportive measures and early
quently when the left ventricle contracts drainage of the aiiected foci. The author
there is not the same fear of it being unable recounts a case observed by him in an into
complete its contraction, so there is less fant of eleven days, in whom there were
risk of a sudden strain bringing it to a stand- eight distinct foci of infection in the long
:
<
i
still, while the beneficial effect of the drug
on the cardiac muscle is more marked, because
the right ventricle is now becoming
bones. The infant recovered with little de-
fonnity.—Bulletin de la Societe d'Obstetri-
que de Paris.
embarrassed and needs its assistance.
Speaking generally, we may say, when in Early Diagnosis oi Measles.
a case of aortic regurgitation the mitral E. Apert describes two signs that he convalve
has given and the right ventricle is siders pathognomonic of measles, and that
becoming
phanthus
embarrassed, digitalis or strois
beneficial.—The Hospital,
appear so early in the disease, or so late in
the incubation period, that isolation begun
London. at this time will prevent its spread to others
— in the family. It is not earlv enough to
Relapsing Scarlatiniiorm Desquamative make the diagnosis when the catarrhal
trytnema.
svmptoms have appeared. The disease is
G. Petges describes a form of erythema then infectious and all precautions fail to
that is easily mistaken for scarlatina. Its prevent its spread. The signs that are of
distinguishing points are the absence of value are Koplik's spots and conjunctivitis
marked fever, and severe symptoms, the of the pterygeal area, that is of the conmarked
pruritus that precedes it, the very junctiva between the lids. This appears
large plaques in which desquamation occurs ^hen Koplik's spots are seen, that is three
with an erythematous condition continuing, or four days before the skin eruption, and
and the recurrence of the attacks, one pati- both signs have disappeared when Koplik's
ent described by the author having had spots are seen—that is, three or four on the
twenty attacks. It begins with pruritus, inner surface of the cheeks, rarely on the
malaise, feeling of fatigue, chilly feelings, inner side of the lips, never on the gums or
headache, and inability to sleep on account palate. At first they are like tiny, grayish
of the itching. It appears over the entire granulations on the rosy mucous membrane,
body. Desquamation begins in a few days later becoming bluish. —Le Bullstin Mediand
lasts for some weeks. There is no his- cal.
tory of contagion. The plaques of desquamated
skin are large and very tenacious. Protargol in the Treatment oi Ophthal-
The cause of the disease is unknown, but "»*» Neonatorum.
the symptoms are in favor of an infection. Motais (Bull, de I'Acad. de Med,, May
It is probably this disease that is mistaken 4, 19U9), discussing the treatment of oph-
for second attacks of scarlatina.—Gazette thalmia neonatorum, pays tribute to the
Hebdomadaire des Sciences Medicales, de service rendered by nitrate of silver, which
Bordeaux. has been so long used; he, however, considers
it dangerous when ulceration of the
Osteomyelitis in tlie New-Born. cornea is present. He considers that great;
H. L. Devraigne says that osteomyelitis credit is due to Darier for his researches
when it occurs in young infants begins the organic compounds of silver—namely,
acutely with high temperature, extreme argyrol, collargol and protargol, the latti
pain on motion of the affected limb, moan- of which he considers by far the most valtl
ing, and refusal of food. An enlargement able. The method he adopts is as follov
of one or other boue is found accidentally. The lids are washed frequently with a lui
The source of infection ma}' be intrauterine, warm solution of weak permanganate
After birth there are several modes of entry potash 25 centigrams to 1,000. If thesec
for microorganisms, the principal of which tion causes the lids to adhere they shoU
are the staphylococcus, streptococcus, and be smeared with iodoform ointment. Eve
pneumobacillus. The last form of infec- six hours he uses two drops of a 20 per ce
tion is short, but exceedingly severe. A solution of protargol, no matter whether!
bronctiopneumonia from infective emboli corneal ulcer be present or not; this
may be a complication. The prognosis is does the cornea any damage. In s
affected by the age of the infant and the cases with abundant secretion, and ei
number of foci that are affected. When aily if the cornea is affected, he uses 1
recovery does occur it is quicker and more protargol drops every three hours.
'

—
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onsiders that accidental injury of the corea
is far less liable to occur than if the lids
e painted. If this treatment is regularly
arried out the secretion is diminished from
le first day, and in three, or at most four,
ays there is l)ut little discharge. The proirgol
is used at half its strength for seval
days after tlie case is apparently cured,
hould recurrence take place, which he has
ver seen if the treatment is fully carried
It, he reverts to that first recommended.
a corneal ulcer is present it ([uickly heals.
tropin is also rect)mmended in order to
/oid the occurrence of j)osterior synechitt.
e claims for this treatment that it is simwithout
danger, and it gives the best
suits. He describes ten typical cases.
ritish Medical Journal.
Treatment of Pneumonia ol Children.
The most prominent symptoms of pneumonia
demanding treatment are the fever,
consolidation, dyspnea, and pains. According
to A. Haginsky, it is a mistake to fight
the fever too energetically, as under its influence
antitoxins are formed which bind
the poison. A temperature of 40° to 41° C.
for a few days does not call for the use of
antipyretics, and can be tolerated without
harm. An ice-bag over the affected lung
or on the head will usually be very comfort-
able. Where the temperature continues
high, cold packs or baths are in place, once
or twice a day.
The diet should consist of milk, eggs, and

XXVI
THE CHARLOTTE MEDICAL JOURNAL.
broth, and some wine should always be al- tory affection. The cause of this affection J,
lowed, as stimulant. appears to be a congenital lack of develop-
Occasionally a digitalis preparation, cam- ment of the muscles, or of the medullocerephor,
or a saline infusion will be necessary, bellar nervous strands. The muscles of the
Very anemic children will require iron, infant are soft and flaccid; there is so |
while in the progressive type of the disease, marked a paresis that the child is unable
potassium iodide, three to four times daily to stand alone or walk. There is no affeca
tablespoonful of a 3 per cent, solution, tion sensibility. The spine is abnormally
may be prescribed. movable. The tendon reflexes are abol-'
Common complications are pleurisy, em- ished, and electrical contractility is almost
pyema, otitis media, and albuminuria. They if not quite abolished. Treatment consists
all require active interference. There is faradism of the muscles, baths, and mas-
less danger of paralysis of the right heart sage, combined with arsenic and strychnine, j
than with adults, but a venesection may —Gazette des Hopitaux. 1
sometimes be demanded. \
The treatment of pneumonia with specific Treatment of Sclerema Neonatorum. ;
sera has in general been unsatisfactory, as
Dio^jgi Tibone describes sclerema as a i
equally as goou if not better, results can be ^^ndition of the new-born, especially of
obtamed with the usual management.
premature infants, iu which there is a hy- !
Ihe prognosis of broncho-pneumonia IS
pothermia combined with slow and feeble 1
not so good as of lobar pneumonia, as the
p^j^^^ and a solidification of the subcuta- .
former IS generally secondary to some other
^^^^^^ ^^^ ^^„g_ with hardening of the skin. :\
disease or constitutional trouble. Since the .j.^^ -^^^^^^^ becomes excitable by no stimu- l|
fever is usually of longer duration, antij^jj^^^^^
^^^^^ ^-^^ ^ ^^^p^^^ ^^^ j^ -^ ,
j
pyretics will be required, while ice is usually ij
^j^ ^f ^^rsing. The indications for treatnot
well tolerated. It will often be neces-
^^^^^ ^^^ stimulation, artificial feeding, and ,
sary to prescribe expectorants, cardiac stimkeeping
up the temperature of the infant, t
ulaiits, mustard packs, etc. ^^-^ ^^^^ indication is carried out in various t
The treatment of the convalescent stage ^^ys-by applications of external heat, t
of pneumonia is no less important than that ^y hot baths, bv keeping the child in an
of the active stage. A change of climate i^^ubator, and by enveloping its limbs in |
will often be most beneficial.—Therap. d.
Lregenw.
i^jpermeable materials which keep the heat i
^^^ lessen the surface for radiation, cause ti
.„„ Ulcerative _..„„ Stomatitis. c.„..„„n.i„ fluidification of the subcutaneous fat cells, |
, , ^^ , j , ^
and make the slowed circulation mo 'e i
M. H. Grenet says that stomatitis is not rapid. The author gives histories of
'
19
truly membranous, since the supposed mem- cases in which these measures were used <
brane is composed only of debris of the with some success. The use of imperme- i
mucous membrane. It occurs especially able wrappers for the limbs is very simple ;
when the teeth are erupting, under defect- and effective, as well as cheap, and does ;
ive hygienic conditions. It is emphatically not interfere with the application of other .;
contagious, directly and indirectly. It may means of calorification.—Rivista di Clinica I
develop spontaneously in an infant who Pediatrica. j
has not been exposed to infection. The
cause is generally spirilli and fusiform iron as a Substitute lor Bismuth In X-Ray
bacilli associated with other microorgan- Diagnosis.
isms. The characteristic is necrosis of the
^^j^j^g ^^^ p^gt f^^ ^ears the practice of
mucous membrane. The breath is exceed- ^,- bismuth subnitrate to patients in'
mgly fetid. Ulcerations may occur at any
^^g^^ ^f ^ ^-^^ previously unheard of has'
point of the hnnig of the mouth The subbecome
quite common. This diagnosis,
maxillary glands are engorged there is
^„j ^^e other, an outcome of the first, the;
salivation, and buccal pam. It may be
treatment of tuberculous sinuses by mixvery
chronic m course. Complications are
^^^^^ ^f bismuth and vaseline, as recomrare.
The use of chlorate of potash is alj^ended
by Beck, of Chicago. Both of
most a specific for the disease.—Gazette des
^^ese uses of bismuth have been distinct
Hopitaux.
advances in medical science and have led
Congenital Muscular Atony.
not only to more acute diagnoses, but
^^ ^^^^ remarkable cures. At the
also
Levi-Sirurgue describes congenital mus- time, however, this use of the massive doses
cular atony as occurring in new-born chil- of bismuth subnitrate has recalled to us a
dren, and being distinctly regressive, end- fact previously well known, but apparently
ing generally in recovery, unless the infant forgotten by the new generation of medicaj
is carried off by some intercurrent respira- practitioners, namely, that this drug is
>
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XXVIII THE CHARLOTTE MEDICAL JOURNAL.
from innc-cuous, and if used too freely is diminish the first pain of the wound, and
liable to cause serious or even fatal results, the intestines are usually active soon after
Its action appears to be twofold, both the the operation. On the other hand, many
bismuth and the nitrate radical causing patients complain much of thirst, and condefinite
symptoms of poisoning. These in- siderable mental confusion is often evident,
toxications are serious, for even when nor For spinal analgesia, the author uses novofatal
they are chronic in nature, and may caine with the addition of a small amount
cause decided discomfort over periods of of suprarenin. Anesthesia usually sets in
many months. In this connection it is of in fifteen minutes and lasts from one to two
interest to find in the Miincheiter mcdisin- hours.
isck: Wochenschrift for June 8, 1909, a brief The only cocaine substitutes which are at
note by Karl Taege of Freiburg describing present employed are tropacocaine, novoa
method by which iron can be substituted caine, and stovaine. The first and second
for bismuth in x-ray diagnosis. The ob- are only slightly toxic, while the last is supjection
to a watery suspension of iron is posed to stimulate the heart. The disadthat
the metal sinks rapidly, and is not vantages are stated to be: of tropacocaine,
evenly distributed, while an oil emulsion is the short duration of anesthesia; of stovaine,
disagreeable to physician and patient alike, the occasional symptoms of intoxication;
Taege, therefore, suggests as a substitute and of novocaine, the lowering of bloodau
emulsiiou in tragacanth. He grinds pressure. The anesthesia is indicated in
iron oxide in a mortar with tragacanth
powder and then shakes the mixture thoroperations
in which chloroform is not safe
—on the lower part of the body, or in old
oughly with water in a flask. Enough patients when it is desirable to have them
tragacanth must be used to make the final get up soon. Spinal analgesia is contrainwatery
solution contain about one per cent, dicated in nervousness, anemia, cachexia,
of the substance. This gives a syrupy fluid and tendency to headaches, as well as in
in which the iron oxide remains in suspen- marked obesity. The chief after-effects folsion
for hours. If this iron preparation lowing the use of novocaine are vomiting
acts as well in obstructing the x rays and
is less toxic than bismuth subnitrate, it
and occasionally secondary hemorrhage,
while later there may be meningismus or
should prove a valuable substitute for the
latter more dangerous drug.— Berliner klinpareses
of cerebral or
Therap. d. Gegenwart.
spinal nerves.
ische Wochenschrift.
The Final Results ol Tracheotomy.
Recent Methods of Inducing Anesthesia. W. Wolf instituted an inquiry as to the
fate of those children who had been trach-
Special masks for anesthetizing have eotomised for laryngeal diphtheria between
been recommended by Geppert. Roth-Drae- 1395 and 1906 in Trendelenburg's Clinique
ger, and others, but the ordmary mask is at Leipzig. During this period 404 patients
still the most popular, both for ether and ^vere tracheotomised, of whom 264 were
chloroform. W. Busse states that it is not discharged cured. The high mortality was
generally known that many small opera- due to the fuct that many of the patients
tions can be performed in the first stage of ^ere moribund on admission. Wolf was
ether narcosis: It IS only necessary to in- able to trace 173 of these patients: 145, or
struct the patient to breathe deeply seven to 85.5 per cent, were free from any sympeight
times, and then to press a mask satur- toms; 18, or 10.7 per cent, were singers or
ated with 10 Cc. of ether firmly upon the athletes; 24, or 14.2 per cent., since the
face. The anesthesia lasts from five to ten operation had sufi^ered from hoarseness,
minutes, and is not usually followed by nau- shortness of breath, and colds; 7 cases, or
sea or ottiei aiter-etiects. ^ \ percent., presented more serious sequlse;
Scopolamine and morphine have been em- 4 showed signs of tuberculosis, but in 3
ployed subcutaneously, but generally a there was a family predisposition. One
small amount of chloroform is required also, had a permanent fistula, and the other two
This method of anesthesia is used by prefer- had had repeated attacks of pneumonia,
ence in cystoscopy and in obstetrics, yet No case of cicatricial stenosis was observmay
diminish the intensity of the labor ed. This was probably due to the fact that
pains and injure the child. Morphine- the lower operation had been perfomed in
scopolamine may also be used in conjunc- every case. Wolf concludes that serious
tion with spinal analgesia, especially in sequelte after tracheotomy are not frequent,
gynecological work (3 injections, each of 5 that the mortality from tracheotomy and
decimilligrams scopolamine and 0.5 centi- intubation are exactly the same, and that
gram of morphine are used, 2>2, 1>2, and Landouzy's statement that tracheotomy
]2 hours before the operation). The anes- predisposes to tuberculosis is not justified.
"thesia is usually of suflacieut duration to —British Journal of Children's Diseases.
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XXX
THH CHARLOTTE MEDICAL JOURNAL.
Ovarian Gralts With and Without Anas- haemorrhage. The conclusions from this
tomosls of Vessels. series of cases are that the results of treat-
Mauclsire believes that in order that ment of placenta praevia are so disappoint-
ovarian grafts may be successful it is best i"g by the present methods that ;t is incumto
provide a blood supply bv anastomosing bent on us to seek for improved methods of
the ovarian vessels with some others, pref- treatment. He has been looking over the
erablv the epigastric. He has had two records of 34 cases of placenta praevia re
positive cases in women. There is no doubt ceived at the clinic since 1904, in which the
that both beterografts and autografts have date of the first haemorrhage is mentioned,
been successful, both in animals and in '" every instance a warning hemorrhage
women, although not nearly all the grafts ^^^ occurred during the last few days or
have taken, and many have nndergone weeks before the child-birth. The physician
atrophy. The author gives a teview of the summoned merely ordered the patients to
successful cases recorded. Heterografts bed and the haemorrhage stopped with the
and autografts are made for the purpose of bed rest. These warning haemorrhages reavoiding
the nervous svmpl,oms that result curred three or more times before labor
came on, and the physician would have had
from double ovarian ablation, especially
obesity. Heterografts are also made to ample time to send the patient to the clinic
render pregnancy possible. Another indi- i^ the warning of these premonitory haemorcation
is amenorrhea from congenital ova- rhages had been heeded. The obstetrician
rian atrophy. If we are to succeed gener- is able to save the mother with contracted
ally the author believes that we must supplv Pelvis by perforation during delivery in the
nutrition to the graft bv furnishing it with liome, but with placenta praevia both mother
a circulatory supplv. This appears to be and child succumb in 15 to 20 per cent, of
much more important than a continuous tbe deliveries in private houses. Even in
nerve supply.—Archives Generales de Chi- the clmics the mortality is still from 5 to 8
rurgie. P'-''' cent, at the best.—Zentralblatt fur
Gynakologie.
Pathogenesis ol Unilateral Pleuritic Eifusion
In Cardiac Disease.
'
Crypto-Diphthcrias.
Feliziani says the pathogenic factors in Abrand says that cases come into every
this condition are pericarditis, perihepatitis hospital without visible membrane in the
from hepatic congestion, and pulmonary throat, which later prove to have been true
infarctions. Pulmonary hemorrhagic in- diphtheria, the membrane being located in
farctions are the cause in the great majority the larynx, nasopharynx, trachea, or e.soof
cases. These arise from cardiac diseases, phagus. They are discovered late in the
especially of the atrioventricular orifices, disease, when they have been severely pois-
Small coagula being detached and carried oned, perhaps diagnosed only by the sympinto
the lungsto form pulmonary embolisms, toms of diphtheritic paralysis of the palate,
Aortic affections and arteriosclerosis also and have already spread the disease toother
cause embolisms. The upper level of the patients. The symptoms that indicate this
fluid is not above the angle of the scapula, state of things are extreme fatigue, loss of
— II Policlinico. weight, rapid pulse, marked swelling of the
glands of the neck, with or without high
Treatment of Placenta Praevia. fever.—Annales de Medecine et de Chirur-
^ „ ^, .
Dr. B. Kronig summarizes the details of
twenty cases of placenta praevia at the Freiburg
clinic in which the women were under
Genital Tuberculosis in Woman.
the most favorable conditions in regard to C. Lenormant says that genital tubercuthe
medical supervision in a clinic, asepsis, losis is rare and is almost always secondary
etc., from the start. In every instance during
delivery haemorrhage was arrested by
version. He states that control of haemorto
tuberculosis in some other part of the
body, often the lungs. It may result as a
primary condition from coition with a male
rhage by the metreurynter cannot be relied who has genital tuberculosis, but this is exupon
owing to the fact that haemorrhage is ceedingly rare. In three per cent, of lapafrom
the isthmus as a rule and the metre- rotomies for gynecological troubles there is
urynter stretches the isthmus still farther, a tuberculous lesion found. This is usually
Four of the twenty patients bled to death a descending affection conveyed by the
and another succumbed to sepsis, and yet blood-vessels. The vagina is only infected
the conditions were exceptionally favorable when there are lesions of the mucous mem-
, 1 ., r gie Infantiles.
for all. Those who survived suffered long brane. Tuberculosis is rare where there is
from severe anemia. The more advanced pavement epithelium. It is more frequent
the pregnancy the greater the tendency to in the fundus uteri, tubes, and ovary. There

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other artificial method of
infant feeding.
Molliu's Food with fresh milk is
au anti-scorbutic diet ; as there is
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orisriiial life-giving clement of the
fresh milk remains unimpaired.
A baby grows on fresh
milk, modified by
MELLIN'5 FOOD
may be ulcerations or itifiltratioiis of the
surface. On the cervix it forms cauliflower
growths; in the fundus there is a chronic
localized endometritis. When the tubes are
involved the peritoneum is also attacked.
Surgical interference is generally necessary
to bring about a cure.— I'rogres Medical.
Mercury and Sulpbur.
I). Respighi finds that sulphur acts as an
antidote to mercury in the intestinal canal
and when suljihur waters are being drunk
it is found that the patient will tolerate a
larger amount of mercury than when they
are not in use, without the occurrence of
mercurialism. Sulphur is not only an antidote
to mercury in the intestinal canal, but
also to the mercury circulating in the blood.
Whenever we have symptoms of mercurial
poisoning in syphilis we should make use
of the sulphur water? as au antidote and
eliminant.—I.a Riforma Medica.
with his hands. The downward pressure
thus exerted overcomes the action of the
antagonist muscles and stretches the capsule
and ligaments until reduction is easily
done. Dr. Schichhold has applied this
method in many cases during the last forty
years with satisfactory results. The chief
advantage of this technique is that he can
regulate, himself, the force of the traction
exerted to the exact amount required for
reduction, as he grasps the neck of the
humerus with one hand and with the other
presses the head into place, both hends being
free for the manipulation of the joint.
The only assistance required is some one to
hold the patient firm in the chair, one arm
around the neck and the other in the axilla.
The technic allows rapid reduction of even
old dislocations without anaesthesia, assistance
or apparatus.—Medizinische klinik.
Hemiplegia from Cerebral Arteritis In
Heredosypbllitics.
'
Reducing a Dislocation of the Shoulder. Paul Savy says that the early symptoms
I)r, G. Schichhold relates the following of syphilis in hereditary cases occur within
simple method of reducing dislocation of three months of birth, and the dystrophies
the shoulder: The forearm is held between come from the fifth to the twentieth year.
the iihysician's thighs as he stands in front
>f the .seated patient. The arm is held firm
The manifestations of cerebral arteritis in
the form of hemiplegia occur in the interim,
>y tlie adductor muscles and strong pressure the earliest recorded having been seen at
an thus be brought to bear as the physic- five months of age. They occur from the
an imlls back while holding the shoulder secoud to the fifth year in general. They

XXXII THE CHARLOTTE MEDICAL JOURNAL
may be associated with other nervous trou- congenital or tertiary acquired syphilis, has
bles in cases that show evidences of syphilis, sometimes seemed of value Repealed lumor
they may occur suddenly in children bar puncture has been used with some,
that have given no evidences of syphilis, though probably only with temporary, bene-
They may be preceded by symptoms of ma- fit. Patients should be advised to eschew
laise or convulsions for a few days. Such alcohol, tea, coffee, and tobacco, to avoid
hemiplegias may disappear entirely under as far as possible mental excitement and
specific treatment in a few weeks or months, loud noises, and to keep the bowels acting
or there may be left a variable amount of well. During a severe attack the recumimpotence
and atrophy, corresponding to bent posture should be enjoined, with ice to
an area of brain softening due to obstruc- the side of the head. When all other meastion
of some one artery. These conditions ures fail, and when life is made practically
are entirely similar to the specific hemi- intolerable, the advisability of destroying
plegias of adults, which are often of a pass- the labyrinth—at any rate the static portion
ing nature, and are caused by cerebral of it—should be entertained,
arteritis with ischemia. Whenever we have
^^ Treatment ol Acute Rheumatism.
a sudden hemiplegia in a child we may look ,...,,„,
forsvphilis, even if there are no other signs —Plehn (Deutsche medicinische Wochenof
its presence.— Revue de Medecine. schrift) emphasizes the wrong principle
appears to be gaining ground, to
^ which
Aural Vertlgc-Simon, in The British ^^^^^^^ ^f their supposed toxic effects on
Medical Journal, says that as regards treat- ^j^^ kidneys. Leuthje was the first to detnment,
this naturally has reference to the Q^^rale the changes in the urine which are
underlying aural affection, and iii giving a
. ^, . . ^ , throw overboard the older salicylates, on
^^t .^jje,, salicylates are given even in
prognosis one has to take into consideration
^^^derate doses. Klemperer considered that *
the possibility of the amelioration of this -^ -^ „ecessarv to use the smallest doses poscond.tion,
and also the period of associa-
^^^^^ -^^ ^^^^^ ^,^^ ^^ ^^p^^^ ^^^ kidneys to I
'
tion of the deafness and vertigo In non-
^^^^ ^^^.^ influence. Hauffe, representing
suppurative affections of the middle ear in
^^^ Schweninger school, which refuses all ;
which the vertigo has shown itself much
^jgdicamental treatment, claims to have |
later than the deafness or timitus, it has
obtained excellent results without salicylic
seemed to the author that the treatment of
^^-^ 1
However, closer investigation has
the aural condition was more likely to lead
^^^^^^^ ^^^^ ^^^ ^^^^^ irritation of salicylic
to its improvement or disappearance In ^^.^ -^ ^^^^ imagined than real, and ! that
treating the symptom itself the drug of most
^^fgctly normal, healthy persons frequent- i
efficacy is quinine. Charcot instituted tins ,
^ jj^.,,^^^^ j^^^^^ of 'albumin, and even
treatment on the principle that It gradually '
^ vvithout taking any of this drug.
destroyed the hearing, when, as it has been
^j^^^^ ^_^^^^ ^f albuminuria not infrequen - :
seen the vertigo disappears. On the other
j^ ^^^^^ ^^j^il^ ^^^ ^^^-^^^^ -^ ^^^-^^^ g^,j. j
hand. Urban Pritchard reports a case of se- ^j^^^^
^^ considers that even if slight |
vere vertigo from a poisonous dose of qui-
:
i^.^-^^.^^^^^, ^f the renal apparatus were pronine.
It is, however, not necessary to give
^^^^^ ^^ ^^^-^ ^^^^^ ^-^^^^ -^ acts specifically ,
It m such large doses. Given a gram at a .^^ rheumatic fever, just as mercury acts in ,!
time. It seems to reduce the irritation of the
^jJHs and quinine in malaria, it would be i
vestibular nerve, probably by overcoming ^-^^ ^^ ^-^^ -^ f^^^^^ ^.j^^ ^^^i^^^ g^y^ ^^^^ j
congestive changes.
j^ -g „ecessary to give it in large quantities j
On the ground that vertigo is due to ane- j^ order to obtain the full specific effects,
mia of the labyrinth—which, however, is pjrst, however, it must be certain that the
probably not as a rule well founded— Ler- rheumatic affection is really acute. He
moyez suggested the use of amyl nitrite, prefers pure salicylic acid to the sodium or
We are all aware, of course, that in condi- other salts. Plehn g\ves it in doses of 1
tions of severe anemia vertigo is common, gramme (that is, about 16 grains) every
but whether this is an aural phenomenon hours, or 0.5 gramme every hour during
or not, even when associated, as it often is, the first day, but none during the first night,
with tinnitus, is a doubtful point. At the Qn the following days he gives 6 grains in
same time it is quite probable that the actual i.,. or 1-gramme doses. This is continued
cause of vertigo is not so much either con- until the temperature has been normal for
gestion or anemia as the alteration in the three days and all pains and complaints of
pressure of the endolymph which may be all sorts have disappeared. Then he gives
brought about by either of these states. The 4 grammes a day for a week, and after three
bromides and iodides are sometimes useful, further days, during which the patient reand
pilocarpine, especially in patients in mains in bed but receives no salicylic acid,
whom the aural condition is dependent on i^g allows him to get up, provided that no

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experience that the proper dosage of this
drug can be calculated at O.OS gramme per
kilo body weight per day Uhis corresponds
to about Tj grains per stone). When salicylic
acid produced disturbance of the stomach,
or other indications caused him to
modify the doses, he preferred to substitute
aspirin in doses of ,'j gramme, gi\en six to
eight times a day. With these doses bo'.h
of the acid and of aspirin the body weig.it
often increased during the medication, the
kidneys were not attacked, and even during
a nephritis the condition of the kidneys
improved.
He says that salicylic acid acts prophylactically
as far as the heart is concerned.
Complications such as endocarditis and
pleurisy occurred less frequently when salicylic
acid could be given freely from the
first than in those cases in which it was
withheld. He brings forward evidence to
show that this drug is not a ctirdiac poison
when given as he has described.
The writer deals with the actual fre-
Iquency of heart affections in rheumatic
fever, and shows that among 319 cases
treated by him with salicylic acid, only two
left the hospital with chronic heart disease
3ue to the attack of fever for which the pa-
tient had been treated. Those cases which
are treated outside without sufficient salicylic
acid, and which when admitted prove
refractory toward the influence of the drug,
usually do well when treated by injections
of {[uiniiie and anripyrin, or by intravenous
injections of collargol. He compares
his results with those of Hauffe, who deals
with his patients by means of so-called
physical therapy, and shows conclusively
that his results are considerably better.
Role of the Placenta In Puerperal
Eclampsia. — Meurice (Ann. de la Soc. de
Med de C'.and) expresses the opinion that
none of them satisfy the conditions except
the one which holds that the placenta is the
elaborator of the poisons which cause the
convulsive symptoms. Eclampsia is divided
into three periods; originally it is the
placenta which elaborates poison; under the
influence of this poison anatomopathological
alterations occur in the liver, kidneys,
spleen and other organs; last of all comes a
period in which excitomotor symptoms aie
manifested, which depend at first on the
influence of the toxic product on the brain,
and then on the labor which plays the part
of a determining cause. In some theories
sight seems to be lost of the fact that
eclampsia is a trouble coexistent always

XXXIV
THE CHARLOTTE MEDICAL JOURNAL
.. ^1^ TViooffof-t i"q orrhoids that a solution made of Protonuclein Powwith
pregnancy or Its sequelae. Theettectis
^^^ ^^ protonuclein Special Powder with Olive Oil
taken for the cause. All is clear if we ac ^^^ ^ ^^^^^ amount of this solution injected npthe
cept the placental origin of the poisons, rectum gives great relief and hns marked healing
From this organ the poison reaches all the powers. About three grains of the powdered Proto-
I luiu iia = s 1
^;v^„lotr,r,r nucle n in a tablespoonful of Olive Oil IS the usual
Other organs ny way of the circulatory
^^^„„j ^^^^
apparatus. The whole organism ot tbe ^
mother is introduced into a vicious circle;
Precautionary Measures.
first, the placental intoxication; second, the
functional troubles that arise from it. This ^s every physician has constantly under his care
theory accounts better than any other for cases of either typhoid, malarial or bilious fever, it
the factsobserved. Restingon exactscien- ^^^::!^:::t\i'^J-Z::^^':iZ
tific data and reliable experimental results,
^^^^{^^^ ^jth these cases is avoided. If it be true
it furnishes a simple, logical explanation of that the materies morbi of these diseases belong to
the series of lesions and symptoms found, the bacillus group, the remedies manifestly are an
Which contradi cts all other h ypotheses. antiseptic ^and ^an -^ipy^-'^^^^^As^an ^m^^^^^^^^^^
,,.„,, „. , , „, consensus of opinion is in this direction. When we
An Important Little Work on Biological ^^^^ ^^^ antipyretic and anodyne effect of anti-
Therapeutics, kamnia, we have a happy blending of two valuable
In view of the near approach of the season when remedies, and these cannot be given in a better or
biological therapeutics will claim a considerable more convenient form than is offered in Antikamshare
of the attention of practitioners, reference nia and Salol Tablets; each tablet containing 2 1-2
may pertinentlv be made at this time to a unique grains salol. The average adult dose is two tablets,
and valuable contribution to the subject which has Always crush tablets before administering, as it asrecently
issued from the press of Messrs. Parke, sures more rapid assimilation. As the necessity of
Davis & Co. The publication coneists of 52 pages, intestinal antisepsis in the treatment of this classof
exclusive of the cover, and appears in brochure diseases is fully recognized, would not the scientific
form It is handsomelv printed on white enamel treatment of the conditions preceding them be the
paper of first quality and'bears in colors a profusion administeration of the same remedies? Fortifying '
of halftone illustrations. The title is "Serums and the system against attacks is the best preventive of
Vaccines." A brief chapter on the origin and de- them.
velopment of biological therapeutics, with an inter- — •
jected hint as to what the opsonins may have in
store for us, constitutes the introduction. Then Uterovaginal Catarrh, Leucorrhea,
follow chapters on serums—antidiphtheric, anti-
dometritis. Etc.
tetanic, antistreptococcic, antigom-coccic, anti-
During the past two years I have experimented
tubercle and antivenomous; on tuber ulms; on vac-
^^^^ Glyco-Thynioline in the treatment of some of
cines. including the new bacterial vaccines which ^^^ catarrhal conditions which affect the female I
are exacting so much attention from the medical „g„itaiia xhe splendid results which I obtained
j
world; on organo-therapy, its development, and °„ the naso-pharyngeal surfaces led me to try it on 1
some of the Important products that are associated
^^j^^^. „^^^^.^^g surfaces where the conditions were
with it -"a tabulation." in the language of the
substantially the same. Actual clinical experience !
brochure itself, "of such creations of biologic pbar-
^^^ proven to my satisfaction that in Glyco-Thymo- )
macy as are really utilizable in medicine There
^^^^ ^j^^ practitioner has at his disposal a remedial i
are striking pictures of the Company's lionie lab- ^ ^ which in my opinion is unquestionably supe-
j
oratories at Detroit, with numerous interior views; ^? ^ ^^ ^j^^ topical applications which I formerly ;
the research laboratory; the operating house and
g^jpioye^ without fear of contradiction I can say 1
biological stables at Parkedale Farm (where the
j^ ^^. ^^^ the best deodorant ever put in a puru- 1
animals are cared for), with accompanying land-
^^^^ vagina. Under its influence the character of ;
scapes in nature's colors.
This little book, ".Serums and Vaccines," is distinctlv
"worth while." If you haven't seen a ;opy,
juupj,' importance to the female patient, is secured,
drop Parke, Davis & Co. a postal card at their
the discharge is rapidly altered, and that comfort, I
^^jipf^ a^^j freedom from malodor, which is of SO ;i
'
Givco-Thymoline, by reason of its peculiar comhome
offices in Detroit, mentioning this journal,
p^gitjo,, produces the rapid depletion so desirable, '|
and get one. It is a safe guess that any physician
^|ga„s^., t^e surfaces and maintains an aseptic con- ,i
who receive, the brochure will read it admiringly ^.^-^^ ^f j,^^ ^^^^^s.
and with interest, filing it away thereatter tor lu- ^^ ,^^ irrigation for the uterus and vagina, solu- 1
ture reference.
tions of 10 per cent, to 25 per cent, used ( 105 deg.) /
. , are most desirable; when the uterus is highly coni !
Treatment ol Fistula.
gested an intrauterine irrigation of pure Glyco- ;
J D Albright M I) i(22.S Broad St., Philadel- Thvmoline will produce wonderfully good results. ,j
phia, in his recent work entitled, "Rectal Diseases, When I exhibit Glyco-Thymohne on tampons I I
Their Diagnosis and Treatment bv Ambulant find that pure Glyco-Thymohne produces the best I
Methods," says, while discussing the treatment of results. Lewis P. Reim.\nn, M. 1).
Anal and Rectal Fistulae by Local Application:
"ARer the induration has softened and the pyo- There exist a number of cutaneous disorders !
genie membrane cast off, so that the interior seems which, in the mam, are due to a general bad state ,1
clean and free from inflammation, healing may be of the tissues. It is in these that a general up- '
stimulated by the application of a silver nitrate building process must be inaugurated in order to
solution, 5 per cent., or Special Protonuclein Pow- heal and improve the local cutaneous disturbance.
der mav be dusted along the tract by means of a It was formerly the cu.stom to order cod liver oil, ;i
powder blower. If the internal opening is small, with good results. Today, it is equally advantage- •]
it should be enlarged sufficiently to permit free irri- ous to give the cord. ext. ol. morrhufe comp. j
gation through it " (Hagee), which acts not only as well but better, j,
Others have found that in treating internal hem- and is devoid of grease.—Am. Jour. Dermatology. ,^
|

ADVERTISEMENTS
The Success of Listerine is based upon Merit
The manufacturers of Usterine are proud of Usterine-because
pharma^cy''''
°"^ '"°'' successful formulee of modem
.'"ensure of
.k ?.'^ success has been largely due to the
bought happy
of secunng a two-fold antiseptic effect in the one prepara^
«ff«^^°f
S't^" "rtlt ^"'^ffP'"^
the ozoniferous oils and ethers,
and that of the m.ld. non-irntat>ng boric acid radical of Listerine
^'fSance, strict uniformity in
^»fk ^^""f
constituents
methods and
of manufacture, together with a certain superiority in
production
the
of he most important volatile components, enable
tl^at
kZ.?C '"^I'^^y^'^''^^ ^} legion of preparations said to
somethmg be
like Listenne.
^^''^°^" °f>""="•'«; a 208.pag« book,
"^'ant.WnH'^ descriptive of the
antiseptic, and indicating it, utility in medical, surgical and dental
practice may be had upon application to the manufacturers.
Lainbert Pharmaca Company. Saint Louis. Missouri.
but the best advertisement of Listerine i,—
USTERINt
The Curette.
of advances and changes that our
A nil many physicians
pharmacopeia is
the first thoiiirlit uterine revised every ten years, but the
-l.pl.ng question is
is the curette^ The often
hemorrhage frequeml-; asked, would it'b^ up--to:;ia"trif *;:.^s7r;very year"
. .in,, to lack of tonicity of the blood vessels and One of the newest scientific producUin thenhar
m,., ular tissues of the utenne ^valls an.l to curette maceutical laboratory is Metabolized Cod Lher oil"
".r f xf " -^ ^"'' f^^q"«"tly 'Ian- Ths metabolized, or
,"""T''f changed oil is
terous The obtained
value of viburnum
byihe
as presented bv action of animal ferments under normal
^av.len•s Viburnum conditions
Compound in these cases has "f temperature, and is therefore ready reaay to
'ncUHively be
proven by
taken aken
years of clinical tx- up by the Ivmphatics. ^
.JL'"'^V^^ Jf"^
''
'? "'^ '^'^''^'' ""'""^ ?' ^ Ja°" "'".ecessarv. ' much more valuable this oil must be when put nto
\M«^t^~T~^' . ^°""
^
'^"'^y fo'' assimilation.
Gy»f«»«oay. Waterburys Metabolized Cod Liver
Th^ r.n- .'^''f'"V Oil Com-
1"' rapid rush tor the knife and its indiscrimi- pound is advertised in this Journal, and samples
f ill many gynecological cases where local "'ay be had from the manufacturer
-nal treatment should •
have been first conis
causing the pendulum to swing in the Going Some.
of 1 conservative gynecologv. fterine The attention of our readers is called to the ad
.'

XXXVI THE CHARtOTTE MEDICAL JOURNAL.
THE PINES, Black Mountain, NortK Carolina.
A private Sanatorium specially equipped for the treatment of early,
Tuberuclosis.
Besides the main building also have tents and cottages specially construct-
ed to insure thorough and constant ventilation. Altitude 2,800 feet. Situ-
ated in pine grove of twenty acres.
Rates on arplication.
CLYDE E. COTTON, M. D.
The Hygeia Private Hospital and Sanatorium [
lOi West Grace Street, Richmond, Va.
DEVOTED EXCLUSIVELY TO MEDICAL AND NERVOUS DISEASES
"P^XTENSIVE improvements and additions have just been completed, which make
'--' The Hygeia now the largest strictly private Medical institution in this country. All
approved Hospital facilities for Afz//^ cases, and full Sanatorium facilities ior chronic
cases. Equipment: Baruch Therapeutic Baths, Electricity, Vibration, Electric Light,
X-Rav, Nauheim Baths, Massage, etc., together with laboratory methods of diagnosis.
Usual Rates. Descriptive booklet.
J. ALLISON HODGES, M. D.
A
The Telfair Sanitarium,
GREENSBORO, N. C.
Nervous Diseases, Alcobolism
and Drug Habits.
Location picturesque and retired. Fresh air, sunshine
and quiet. The new sanitarium has 30
rooms. Most modern appliances, electrical, vibratory,
and hydro-therapeutic
Our'treatment meets individual requirements,
with avoidances of suffering or inconvenience.
The Telfair Sanitarium furnishes an ideal home
for nervous patients who may be in need of a
change of environment and the advantages of the
most improved electrical and hydro-therapeutic
appliances.
For detailed information write for circular and
reprints in Journals.
Clinical Results Prove Therapeutics
_._,_•__ VALVULAR HEART TROUBLE
naSarCin ascites and anasarca
ical results, reported by thousands of successful practitioners, demonstrate that
(OxyJuHtrom Arboreum Samb,icns CanacUnsis EXOPHTHALMIC GOITRE
and Unguictt ^ciUa..)
Gives R.elief in
Use Auasarcin :
Trial quantity and literatu
request, to physicians only.
BRIGHT'S DISEASE
CIRRHOSIS OF THE LIVER
any obstinate case and note result
Messrs. Thos. Christy & Co., London Agents.
1

SOUTHERN MEDICAL SOCIETIES,
MISSISSIPPI VALLEY MED. ASSOCIATION.
Pres., J. A. Witherspoon, M.D., Nashville,
Tenn. Vice Pres. Louis Frank, M. D.,
Louisville, Ky. Second Vice Pres.,
A. E. Sterne, M. D., Indianapolis, Ind.
Secy., Henry Enos Tulley, M. D.,
Louisville, Ky.
Treas. S. C. Stanton, M. D. Chicago, 111.
Next Meeting St. Louis, Mo,. Oct. 12, 13,
and 14th 1909.
SOUTHERN SURGICAL and GYNECOLOGICAL
ASSOCIATION.
Annual meeting at Hot Springs, Va., Oct.
5-6, 1909.
W. D. Haggard, M. D., Sec.
Nashville, Tenn.
Stuart McGuire, M. D., Pres.,
Richmond, Va.
SOUTHERN MEDICAL ASSOCIATION.
Annual meeting at New Orleans, La. Nov.
9-10-11-12, '09.
Oscar Dowling, M. D., Sec. Shreveport, La.
Giles C. Savage, M. D., Pres.
Nashville, Tenn.
MBDICAL ASSOCIATION OF THE SOUTHWEST.
Annual meeting at San Antonio, Texas,
October, 1909.
F. H. Clark, NL D., Sec, El Reno, Okla.
Jabez N. Jackson, M. D. Pres.,
Kansas City, Mo.
Tai-STATE MEDICAL ASSOCIATION OP THE
CAROLINAS AND VIRGINIA.
Annual meeting at Richmond, Va., Feb. 8,
1910.
J Howell Way, M. D., Sec,
Waynesville, N.C.
LeGrand Guerry, M. D., Pres.,
Columbia, S. C.
MEDICAL ASSOCIATION OF THE STATE OF
ALABAMA.
Annual meeting at Birmingham, Ala., 1909.
J. N. liaker, M. D., Sec,
Montgomery, Ala.
B. L. Wyman, M. D., Pres.
Birmingham, Ala.
FLORIDA MEDIC.\L ASSOCIATION.
Ainnual meeting at Pensacola, Fla., April
7-9, 1909.
J. D. Fernandez, D. D., Sec,
Jacksonville, Fla."
J. F. McKinstry, Jr., M. D., Pres.,
Gainesville, Fla.
MEDICAL ASSOCIATION OF GEORGIA.
meeting at Macon, Ga., April 21,
1909.
;iaude A. Smith, M. D., Sec. Atlanta, Ga.
Thos. D. Coleman. M. D., Pres.,
IAugusta, Ga.
KENTUCKY STATE MEDICAL ASSOCIATION.
Annual meeting at Winchester, Ky., Oct.
1909.
A. T. McCormack, M. D., Sec,
Bowling Green, Ky.
Jonn G. Cecil, M. D., Pres.,
Louisville, Ky.
LOUISANA STATE MEDICAL SOCIETY.
Annual meeting at New Orleans, La., May,
4-6, 1909.
E. M. Hummel, M. D., Sec,
141 Elk Place, New Orleans, La.
E. Denegre Martin, M. D., Pres.,
New Orleans, La.
MISSISSIPPI STATE MEDICAL ASSOCIATION.
Annual meeting at Jackson, Miss., April
13, 1909.
E. F. Howard, M. D., Sec,
Vicksburg, Miss.
J. W. Gray, M. D., Pres.,
Clarksdale, Miss.
MEDICAL SOCIETY OF THE STATE OF NORTH
CAROLINA.
Annual meeting at Wrightsville, N. C,
June 21, 1910.
D. A. Stanton, M. D., Sec,
High Point, N. C.
Jas. A. Burroughs, M. D., Pres.,
Asheville, N. C.
NEW MEXICO MEDICAL SOCIETY.
Dr. G. K. Angle, Silver City, N. H. Pres.
Dr. G. S. McLaudress, Albuquerque, N. M.
Secretary.
Dr. C. G. Duncan, Socorro, N. M. Treas.
Next meeting at Roswell, N. M., in the
fall of 1909, the date to be announce later.
SOUTH CAROLINA MEDICAL ASSOCIATION.
Annual meeting at Summerville, S. C,
April 21, 1909.
Walter Cheyne, M. D., Sec,
Sumter, S. C.
S. C. Baker, M. D., Pres.
Sumter, S. C.
TENNESSEE STATE MEDICAL ASSOCIATION.
Annual meeting at Nashville, Tenn..
April, 13-15 1909.
Geo. H. Price, M. D., Sec,
146 8th. Ave., N., Nashville, Tenn.
B. D. Bosworth, M. D., Pres.,
Knoxville, Tenn.
MEDICAL SOCIETY OF VIRGINIA.
Annual meeting at Roanoke, Va., fall of
1909.
Landon B. Edwards, M. D., Sec,
Richmond, Va.
Stuart McGuire, M D., Pres.,
Richmond. Va.

WE SUPPLY BOTH
Serum andGlobulins
Thousands of physicians use no other diphtheria
antitoxin than the old " stand-by " — PARKE, DAVIS
& CO.'S ANTIDIPHTHERIC SERUM.
Other thousands are using the newer product—
PARKE, DAVIS & CO.'S ANTIDIPHTHERIC
GLOBULINS (the globulins of antidiphtheric serum;
more concentrated than the regular serum; smaller pack-
age per given number of units).
Both SERUM and GLOBULINS are prepared with
scrupulous care. Both are rigidly tested, bacteriologi-
cally and physiologically. Both are of assured purity,
potency and uniformity.
SUPPLIED IN PISTON-SYRINGE CONTAINERS.
500, 1000, 2000. 3000, 4000 and 5000 units.
Note We also supply Antidiphtheric Globulins, Dry—the glob-
ulins of antidiphtheric serum precipitated, purified and dried—a highly
concentrated antitoxin that remains permanent indefinitely. Bulbs of
3000 units.
Write lor lUnstnted Brocbme en " Serams and Vaccines.'
PARKE, DAVIS 4 COMPANY
L^aboratories: Detroit. Mich., U.S.A.; Walkerville. Ont.; Hounslow, Eng.
Branches: New York, Chicago. St. Louis. Boston. Baltimore, New Orleans, Kansas City, Minneapolis;
London, Eng.; Montreal, QuS/i Sydney, N.S.W.; St. Petersburg, Russia;
Bombay. India; Tokio, Japan; Buenos Aires, Argentina,

'^"^^*^'^3«»v
Iharlotte Medical Journal.
A SOUTHERN JOURNAL OF MEDICINE AND SURGERY.
'^If: Charlotte, N. C, November, 1909. ph.*^.^^um
Table of Conte7its, Page 353.
EUCAPREN
Astringent and Anesthetic
One per cent Beta Eucain Lactate
in 1:5000 Suprarenalin Solution.
A stable article that will prove very
convenient to the eye, ear, nose and
throat men, and in all minor opera-
tions.
Eucapren Solution, 1 ounce bot-
tles, and £ucapren Triturates, 20 in a
It vial. One triturate makes 15 minims
I
of solution.
ARMOURaQdCOMPANY
[fntercd at the Posl-Office at Charlotte, as second-clas* tnotter.]

Late Researches in
Diphtheria Therapy
Investigations by Fritz Meyer (Berliner Klinische Wochenschrift, Jtme
28, 1909; editorial comment, Medical Record, July 31, 1909) on the
effect of diphtheria toxin and antitoxin upon the heart, demonstratAt
1. "Antitoxin, if administered early in sufficient doses,
absolutely prevents the fall of blood-pressure."
2. "If given later, but before the fall has occurred, it
delays the onset ; but
?. " If given after the pressure has once fallen, it is quite
without effect."
4. " Antitoxin given early in sufficient dose prevents myocarditis
after the injection of toxin in any amount."
Meyer states that large doses of Antitoxin given early will eliminate
cardiac complications and postdiphtheritic cachexia. He recommends
5000 units as first iniection, and when this is not promptly
effective, 20,000 to 50,000 units at a dose.
These doses conform with those of McOollum and other competent
observers, who, recognizing the danger in giving too small doses to
neutralize the toxins, advocate 5000 to 40,000 units.
A CONSERVATIVE RULE IS:
Administer 1000 units for immunizing.
No therapeutic dose should be less than 3000 to 5000 units.
In laryngeal, postnasal, severe or neglected cases, 10,000
units.
If marked improvement is not noted within eight hours,
double the initial dose or give at least 10,000 units.
Mulford's Antitoxin is a thoroughly reliable product. Its
record is unsurpassed. You do not experiment in specifying
ovu: brand. Valuable literature mailed upon request.
H. K. MULFORD COMPANY
PHILADELPHIA

ADVERTISEMENTS.
Id MEET YhreateningAnemia
IN NURSING WOMEN
ciCORDEXtOCMORRHUAE CGMP
IS THE BEST RED CORPUSCLE FEEDER
IN THIS CLASS OF CASES.
Each fluid ounce of ^ Cordial of ihG Extract of Cod Litter Oil Compmmd represents the extract
obtainable from cme-third fluid ounce of Cod Livr Oil (the fatty portion being eliminated) 6 grains
Calcium Hypophoaphite. S i;rai}^ Hodium Hypophosphite, with Glycerin and Ar
SUPPUEDIN fctft(tTO0tl ti^MCti C(k DISPENSED BY
^16 oz Bottles
SAINT LOVIS. NO.
THE time has come when it is
necessary to specify ANGIER'S
distinctly on your prescriptions
if you would be sure to avoid
substitutes.
ANGIER'S PETROLEUM EMUL-
SION has achieved a world-wide
reputation in the treatment of
Bronchitis, Coughs and other
Respiratory Inflammations.

THE CHARLOTTE MEDICAL JOURNAL.
SANMETTO
GEMTO-URINIARY DISEASES. ,«
A Scientific Blending of True Santa! and Saw Palnietto with Sootliing Demuicents A
in a Pleasant Aromatic Veliicle
A Vitalizing Tonic to the Reproductive System.
SPECIALLYVALUAL E IN ^
PROSTATIC TROUBLES OF OLD MEN-IRRITABLE BLADDER- >^
CYSTITIS-URETHRITIS-
f DOSE:—One Teaspoonful Four Times a Dar. OD C- =
LIQUID
Acknowledged
Premier
in the Field
of
Antiseptics
for Cases
of
Major
and
Minor
Surgery
-SENILITY.
£M. CO., NEW YORK. ^
campho-phenique:
POWDER
Liquid
in
25c andSlOO
containers
tend for Sample* and L>lteratura to
CAMPHO-PHENIQUE CO., ST. LOUIS, MO.
1 oz. and I lb.
containers
A
^'
A
The
Superior
Dry
Dressing
for
Cuts
Burns
Ulcers
and all
Superficial
Wounds
St. ]M:ar»:^':» Ho«»i>ital
DRS. FUIXILOVE AND PROCTOR'S
JS A.1VA.TOI«IUIWI.
ATHENS, QA.
For the treatment of Medical, Surgical, ynecological and Obstetrical Cases. No contagious diseasfil
or insane patients admitted. Capacity :-Twenty-one beds. Thoroughly equipped with all modellK
appliances.
Training School for nurses, affording skilled attendants for all patients. Nnurses furnished for thei
treatment of patients in private homes.
Ambuance ser\-ice day or night for those who are too ill to be moved otherwise.
Tenns:-For Bed, Board and eneral nursing. Double rooms, J12.50 to Jao.oo per week. Privatesi
Rooms J25.00 per week. Special Nurses for an additional charge of $10.00 per week. In Surgical Casesi
fee of I5. 00 is charged for the preparation of the operating room. Charges for professional servicesi
are Dased on the nature of the case.
For iurtber Information address. 1
ST. MARY'S HOSPITAL, ATHENS, QA. i
J

ADVERTISEMENTS.
i=[>iui;ii;ij
wm
Reconstructive Food
and Tonic
BOVININE represents the most valuable combination of
Food and Tonic elements known to the medical pro- "^
fession.
BOVIMNE has proven'clinically to be most valuable in
all forms of Tuberculosis.
BOVININE enables the ners-e cell to assimilate its'specific
elements, which it fully supplies.
BOVININE promotes :,the metabolism of fat and albumin
ni muscle aud blood, thereby restoring the bodily
health, strength and normal powers of resistance.
BOVININE supplies full and complete nutrition through
its Food and Tonic properties.
( THE BOVININE COMPANY
V 75 Wesi Houston St.. New York City 3
The Standard of Therapeutic Efficiency,
NOT OXLY FOR THE LAST YEAR BUT I'OR THE LAST QUARTER
OF A CENTURY HAS HAYDEX'S VIBURNUM COMPOUND GIVEN
DEPENDABLE RESULTS IN THE TREATMENT OF
Dysmenorrhea, Amenorrhea, Menorrhagia, Metrorrhagia
and other diseases ol the Uterus and its appendages.
There has been no necessity for any change in the formula of H. V. C. because
Its therapeutic efficiency has made it "Standard" and so recognized by the most
painstaking therapeutists and gynecologists from the time of Sims. - C><
Unscrupulous manufacturers and druggists trade upon the reputation of Hayden's
\'iburnum Compound, and to assure of therapeutic results insist that the genuine
H. V. C. 07i/j' is dispensed to your iiatients.
SAMPLES AND LITERATURE UPON REQUEST
NEW YORK PHARMACEUTICAL CO. ll^lZll^fff
HAYDENS URIC SOLVENT ol ineMimable valus in Rheumalism, Goul and other condlUons indicalins an excess of Uric Acid.

^^^^^0B '-
' POND'S
THE CHARLOTTE MEDICAL JODRNAL.
mmmm-^mmm <
WHAT A DOCTOR PRESCRIBES
Hatcliechubbee, Ala.,
April 30, 1908.
The Rock Hill Buggy Co,
Rock Hill, S. C,
Gentlemen :
—
The wheels to my bugg>readied
here about the same time as your
letter, and I waited long enough to take
several rides before replying to your letter.
Am delighted with the job in every respect,
and shall be glad to advise anyone who
is looking for style, comfort, and perfection
in workmanship, to invest in a "Rock Hill"
buggy. Yours truly,
R. A. White, M. D.
.
s Buggy
Further comment on the above letter is hardly necessary for
Dr. White has evidently used enough bnggies in his practice to
make his opinion worth something.
We are willing to guarantee that you will be just as well pleased
as Dr. White, if you will use a No. 17 Doctor's Buggy.
Rock Hill Buggy Co., Rock Hill, S. C.
*'A Little HigKer in Price, But—"
BURNS
The pain and discomfort of superficial burns are
promptly allayed by the application of compresses
saturated with Pond's Extract. The danger of infection
is also reduced to a minimum.
fihxUs may t
EXTRACT ^^^'^^q^-'^-—^-'^^^^--^^-'--'-
POND'S EXTRACT CO., Ne York and London

ADVERTISEMENTS.
Successfully Prescribed
forTwenty FiveYears
Rh eum a t/sm
ATeura/g/a
Sciatica
LumJbago
Malaria
Grippe
ffea-s/^y Coids
Gout
Excess of Uric Acicf
Relieves Pain
Allays Fever
Eliminates Poisons
Stimulates Recuperatio
Samples by Express prepaid- Mellier Drug CompanyTTSt.Louis
1910 fiNTI^SMNIfl TABLET CSLCNOSR
EVERY
Physician in the
world will receive a
copy of this beautiful
Calendar on January 1, 1910
and in the meantime we
hope he will remember that
"Antikamnia Tablets" and
"Antikamnia & Codeine
Tablets" are giving just the
same excellent results that
they have given for the past
twenty years.
[HE AMTIKAMNIA CHEMICAL C0MPANY-5T.L0UI5.U.5.A,

THE CHARLOTTE MEDICAL JOURNAL.
KEEP IT IN MIND
WHEN PRESCRIBING SALINE CATHARTICS THAT
ABBOTT'S SALINE LAXATIVE
—just purified magnesium sulphate (epsom salt) 60 per cent in
effervescent combination—stands without a peer, lo this;
prove it for yourself, and there you are—one of many thousands
of pleased users.
Fermentation of the alimentary canal (auto-intoxication) is
the cause of over 90 per cent, of all non-coutagious sickness.
"THE CLEAN-OUT, CLEAN-UP AND KEEP-CLEAN"
idea giTcs immedial
They never 1
purifying; are
ble and unifoi
-paves the way 1 ipplication oft
SALITHIA [the
veaken; are blood-cooling and bloodpromptly
effervescent, perfectly soluthe
business and never gripe."
You are urged to give these preparations a trial— to specify them on your prescriptions. They
are in the trade ALMOST everywhere. If your druggist cannot supply you, send direct. Per
dozen, either kind or assorted: small J2. 00, medium, #4.00, large *8.oo. In less than halfdozen
lots 20, 35 and 75 cents respectively. Cash with order, delivery prepaid.
_ Samples to interested physiciai.i\s on request, mentioninif this journal.
THE MBBOTT ALJtMLOIDML COWIF'AIN^'
Manufacturing Chemists
Main|Offlce and Laboratories Rrt\/EINS\A/OOE>, Chicago
NEW YORK, 251 Fifth Avenue SAN FRANCISCO, 371 Phelan BIdg. SEATTLE. 225 Central BId

ADVERTISEMENTS
^-Xc^xjui'sJiJ^tenoii^
Unlike milk or other ordinary food-stuffs which require
digestion, vary in composition and often irritate or produce
fermentation and flatulence, Liquid Peptonoids is predi-
gested, uniform and aseptic.
Its nutrient content comprises the essential Protein and
Carbohydrate elements of Beef, Milk and Wheat in
physiological ratio, extractive-free, and palatable form.
It is peptogenic, restorative and mildly stimulating.
It is, therefore, eminently suitable as an Emergency Nutrient
or Auxiliary Food Tonic.
THE ARLINGTON CHEMICAL COMPANY,
YONKERS, N. Y.
Sampiei
H^'u^xviO >4^teivoiisLy
"RELENE"
(PURE CHLORIDE OF ETHYL)
DOCTOR:
What it says is intended to
This Advertisement is to
CATCH YOUR EYE
SECURE YOUR INTEREST
A LOCAL ANAESTHETIC
ALSO AN ADJUVANT TO ETHER
IN GENERAL ANAESTHESIA
Put up in glass tubes only,, ready for instant use. Harmless, no matter how frequently
repeated. AUTOMATIC SPRAYING TUBES. No. 14, sOc No. 34, |t.io. No. 70, Graduated,
I1.60. Sample tubes mailed on receipt of price, postpaid in U. S. Safe delivery guaranteed.
For Literature and Clinical Reports, address
FRIES BROS., '^^t^i'r^ 92 Reade St., NEW YORK

Vm
THE CHARLOTTE MEDICAL JOURNAL.
J^ortli Oarolina iJMLedioal Oollege
OLDEST MEDICAL COLLEGE IN THE STATE
SESSION OF 1908-1909 BEGINS SEPTEMBER 15, 1908.
W. O. NISBET, M. D.
Professor of Diseases of
the Digestive System and
Dean of the Faculty.
JOHN P. MUNROE, M. D.
Professor of Neurology and
Practice of Medicine.
I. W. FAISON, M. D.
Professor of Pediatrics and
Clinical Medicine.
E. C. REGISTER, M. D.
Professor of the Principles
and Practice of Medicine.
B. C. NALLE, M. D.
Professor of Physical Diagnosis
and Clinical Medicine.
R. L. GIBBON, M. D.
Professor of Practice of
Surgery.
G. W. PRESSLY, M. D.
Professor of Principles of
Surgery.
A. J. CROWELL, M. D.
Professor of Rectal Diseases
and Genito-Urinary Surgery
and Secretary and Treasurer
of Faculty
For Catalogue address
FACULTY
E. R. RUSSELL, M. D.
Professor of Diseases of the
Eye, Ear, Nose, and Throat
W.D.WITHERBEE, M.D.
Professor of Dermatology,
and Materia Medica.
C. M. STRONG, M. D.
Professor of Gynsecology.
C. H. C. MILLS, M.D.
Professor of Obstetrics and
Clinical Gynaecology.
C. N. PEELER, M. D.
Professor of Anatomy and
Superintendent of Dispensary.
R H. LAFFERTY, M. D.
Registrar and Professor of
Chemistry and Physiology.
L. B. NEWELL, M. D.
Professor of Pathology.
WM. ALLEN, M. D,
Professor of Bacteriology
and Assistant in Pediatrics.
C A. MISENHEIMER.M.D.
Clinical Professor of Surgery
J. P. MATHESON, M. D.
Clinical Professor of Diseases
of the Eye, Ear, Nose and
Throat and Professor of
Yygiene.
.
DR. PARKS KING
Assistant in Surgery.
DR. WM STRONG
Assistant in Gynaecology.
DR. C. S. McLAUCHLIN
Assistant in Anatomy.
DR. MYERS HUNTER
Assistant in Obstetrics and
Clinical Gyangecology.
HAMILTON McKAY, A.B.
Assistant in Anatomy.
BENJAMIN TEAM, A. B.
Assistant in Chemistry.
S. A. HARDING
Assistant in Bacteriology.
C. M. LENTZ.
Assistant in Gemto-Urinary
Dii
CALDWELL WOODRUFF.
Assistant in Histology.
H. B. MALONE
Assistant in Clinical Microscopy
and Pathology.
A. J. CROWELL, M. D., Charlotte, N. Cl
In. y. rost graduate
# JW&diicsil School and Hospital
# Second f\w&niie. and T\A/e:ntieth Street, INe\A/ -VorU City.
$ Six Imndieil physiciaLis matriculated during Iho past year. 225 beds in the School Hospital. 105.000
c._

THE
I "I I)
ADVERTISEMENTS,
s Essence of Pepsine
The Gastric Juice Extract,
to Promote Toleration of Potassium Iodide
results of laboratory investigation concerning the pli3'siological
and chemical relation of gastric juice and potassium iodide have
been entirely confirmed by clinical experience in the use of
Fairchild's Essence of Pepsin, the gastric juice extract, as a vehicle for this
important drug.
Any ordinary dose of the iodide combined with this Essence shows
perfect compatibility. For instance, in a mixture representing five grains
(in saturated solution) to a teaspoonful of the Essence; there is no precipitate,
the enzymes are not thrown out of solution, are not injured. Such a
mixture will exhibit (i) the characteristic action of Fairchild's Essence
upon milk, and (2) under the U. S. P. test, the standardised proteolytic
action of the original Essence.
As a vehicle, it is found that the Essence agreeably masks the taste,
and certainly promotes the tolerance and physiological effects, of the
iodide.
Circular suggesting the various methods of using Fairchild's Essence in
administering potassium iodide will be sent to physicians upon request.
Fairchild Bros, & Foster
New York
STAFFORD WATER
Noted (or Its Remarkable Remedial Properties In
PARENCHYMATOUS NEPHRITIS,
ACUTE NEPHRITIS, ALBUMINURIA,
and its Therapeutic Value and Efficiency in
Diabetis. Chronic Interstitial
Nephritis and Cystitis.
For Sale: THEO. F. KLUTZ & Co., Salisbury, N. C.
"
S. M. PURCELL, Salisbury, N. C.
liURWELL & DUNN CO., Charlotte, N. C.
D. P. FRIERSON, Charleston, S. C.
P.\TRICK McINTYRE, Asheville, N. C.
MURRAY DRUG CO., Columbia, S. C.
For Literaluro write
COLBURN, MORCAN 6l CO.. lessees.
OSSKLRG, MISS.

THE CHARLOTTB MBDICAI< JOURNAL.
COCOEMULSION,LILLY
^ Chocolate and Cod Liver Oil A New Departure in Cod
Liver Oil Emulsions.
^ Strength —Same as the official emulsion—contains 50
—
per cent, finest Norwegian Cod Liver Oil.
^ Palatability—Coco-Emulsion is free from the unpleas-
ant fishy odor and taste which characterize ordinary emul-
sions. Repeatedly it has been shown that patients who could
not take other emulsions would thrive on Coco-Emulsion,
LiUy.

TASTELESS
ADVERTISEMENTS.
WHY
Waterbury 's Metabolized
COD LIVER OIL COMPOUND
(Plain, also with Creosote and Cuaiaco!,)
MEETS EVERY DEMAND FOR A RECONSTRUCTIVE TONIC
'• 't do*'" contain Cod Litfer CM. (Metabolized or predigested.)
2. It is therefore free from all nauseating properties.
3. It builds tissue rapidly, because,
4. All the oil is readily aud completely assimilated.
5. It is exceptionally palatable and children take it readily.
6. Climatic conditions do not affect it; equally good in summer and winter.
7. It is in every sense ethical.
Dispensed in full 16 oz. unlettered bottles
Samples and Literature Fnrnished upon Repuest
WATERBURY CHEMICAL COMPANY.
^o. 37 Pearl St.,
^ew York City.
Home Offce,
Des Moines, la.
Toronto,
Canada.

THE CHARLOTTE MEDICAL JOURNAL.
NEURILLA FOR NERVE DISORDERS NEURILLA
If Patienr suffers fromTHE BLUES (Nerve Exhaustion),
Nervous Insomnia, Nervous Headache, Irritabitify or
General Nervousness, pive four Hmes a day one
feaspoonrul NEURILLA ;r-*i
Prepared from ScutoUarlo Lateriflora.
Fasst Oora Irtcarnata and AromatlcS.
DAD CHEMICAL COMPANY, NEW YORK and PARIS
MALIGNANT GROWTHS.
At the Atlantic City Meeting a Prominent Surgeon remarked:
"/ zai/1 7iot quarrel with the Alexander Treatment as to whether it is my
knife and my skill, or Oleian Creosyn Comp. {Alexander), but I do
know that when I use Oleum Creosyn Comp. for six weeks before and after
an operation, I ?iever have a recurrence.
l-s of treatment of one thousand cases of mali^uaney.with Qleun
following results; —
P»lliarii6r 4rf, of .1906, No. 12,912, No morphine or other deleteriou
THE ALEXANDER COMPANY, 118 West 49th Street, New York City
On May 24th and 25th, 1907, there was submitted to physicians of New York City and vicinity U postmalignant
cases, together with their histories, (10 showing microscopical verification], treated AND apparently
CURED by the Alexander Method during the past 8 years. Many of these former patients were accompanied
by their medical advisers. All are well to-day Information concerning these cases will be
gladly furnished, also a chart. record of 100 CASES TREATED SERIATIM,
Since 1900 thousands of physicians have employed this method, and the results on the whole have been
such as to warrant the statenient that no other remedy approaches Oleum Creosyn Comp. [Alexander!
in the therapeutics of mallignancy.
TENT COTTAGES WITH OPEN FIRE PLACES
FOR TUBERCULAR PATIENTS i
In the midst of the forests of the beautiful Blue Ridge Mountains of North Carolina— i
seventy-five miles south of Asheville, at an altitude of 3, 850 feet. Climate unsurpassed.!
The fall season being long and sunny and the winters ag:reeably mild and equable. 1
Tents supplied with electric bells; our own water works system with baths, toilets,!
etc, Completely equipped Laboratory, X-Ray machine, etc. Graduate Nurse in charge -(
Terms, $60.00 a month for board, milk, eggs and medical services. Best of references. .'
Address
Highlands, . = .---
I O \m ^k l« El ;
DR. MARY E. LAPHAM,
=
North Carolina i
yeai's' course unexcelled laboratoi-y and clinical facilities. Dormi- 1
'^*"*^ tory formedical students in first two years. Over seventy teachers.
UNIVERSITY DEPT. OF PHARMACY ^^^^^^Zr^.^^
for degree of Ph. C. Food and drug analysis for students prepared.
t)? Women admitted on same terms as men. Begins Oct. 1, 1909. '
irklTlCIAMA ^"^ Catalogue* Address DR. ISADORE OVER, Dean, i
LUUIOIAISA p. o. Drawer 261 NEW ORLEANS, LA.

ADVERTISEMENTS. XIII
LITHIA
SPRINGS
WATER
III
111
ALBUMINURIA OF BRIGHTS DISEASE
PREGNANCY AND SCARLET FEVER
BUFFALO
DR. JOS. HOLT, of Xezc Orleans Ex-Prcside7it of the State Board of Health of Louisza«a,says;
"I have preprescribed BUFFALO LITHIA WATER in affections of the
kidneys and urinary passages, particularly in Gouty subjects, in Albuminuria, and in
irritable condition of the Bladder and Urethra in females. The results satisfy me of its
extraordinary value in a large class of cases most difficult to treat."
DR. GEORGE BEN JOHNSTON, Richmond, Va. Ex-President Soulher?i Surgical and
Gynecological Association, Ex-President Medical Society of Virginia, aiid Professor of
Gynecology and Abdominal Surgery, Medical College of Virginia: "it is an agent of great
value in the treatment of the Albuminuria of Pregnancy."
DR. J. T. DAVIDSON, M. D.. Ne-w Orleans, La, Ex-President, Ne-v Orleans Surgical
and Medical Association, says:"I have for several years prescribed BUFFALO LITHIA
Wa ter in all cases of Scarlet Fever, directing it to be drunk ad libitum, \^\\.h. the effect of
relievingall traces of Albumin in the urine, and have found it equally efficacious in
enial diseases requiring the use of alkaline water."
HUGH M. TAYLOR, M. D., Projessor of Practice or Surgery and Clinical Surgery,
Universitv College of Medicine, Richmond, fa.- "I have used, with good results BUF-
FALO LITI I L\ W.-KTIvR in Uric Acid Diathesis, Gout, Rheumatism, Albuminuria of
Pregnancy, Scarlet I'ever, diseases of Women, Renal and Vesical Calculi, and Cystitis,
ad in many instances with signal h^\\t^\.y
Medical Testimony on request. For Sale by Druggist generally.
BUFFALO LITHIA SPRINGS WATER CO., BUFFALO LITHIA SPRINGS. VIRGINIA.
Diagnostic Methods
Chemical, Bacteriological \
Microscopical
By Ralph W. Webster, M. D., Ph.D.,
Assistant Professor of Pharmacological Therapeutics and
Instructor in Medicine in Rush Medical College,
University of Chicago; Pathological Chemist
at Cook County Hospital, Chicago.
Octavo, xxxlv 641 Pages WItb 37 Colored Plates and 164 Other Illustrations.
Clotb, $6.00. Net; Hall Morocco. $7.50, Net. Postpaid.
Publishers,
P. BLAKISTON'S SON & CO.,
Philadelphia

NEAREST TO NATURE
THE
ENSIGN
REMEDIES
THE CHARLOTTE MEDICAL JOURNAL.
DEAR DOCTOR:
—
Have you some chronic cases which are giving you trouble and not
yielding to your present prescriptions? Have you cases which you
consider incurable, like Diabetes, Bright's Disease, Paralysis, Locomotor
Ataxia, Chorea, Epilepsy, Arthritis Deformans and other diseases
which are down in the text-books as incurable? Let us advise you to
give these cases Biochemic Treatment. Not the abortive twelve-salt
system of Schuessler and his followers, but the full, complete system
as represented solely in the Ensign Remedies. We add to the twelve
salts found in the ashes of the dead body those other elements which are necessary in the process
of life and the healthful operation of the various organs ofthe animal body We get results—that
is the point. We do not suppress disease, but eliminate it. We change the disease state; most
systems are content with removing disease products and getting rid of distressing symptoms. We
obtain the latter through a curative action. We supply deficiencies and restore functions. We
follow the natural law and thereby get exact results. Biochemistry is a science.
We have reports from doctors which would sound extravagant to any one unacquainted with
our system. One doctor from North Dakota says: "I have cured hopeless, given up cases; I have
cured cases pronounced incurable except through the use of the surgeon's knife, and I have
cured cases which the surgeon would not dare to touch," A doctor from Indiana reports the cure
of arthritis deformans, impotency, sexual weakness, varicocele and hydrocele in his first report.
And so it goes all over the world, for we send remedies to all countries. A doctor in Bahia Brazil,
reports astonishing results in a large number of cases; another from Godavari, India, is getting
started in good shape and is very enthusiastic over results in a district where malaria is v ery destructive.
And so we could multiply cases enough to fill volumes.
But what we want is to have you test the remedies for yourself. You can do this readil y and
at little expense. Send for some'of our literature and read what we have to say. It will pa y you
in cash by giving you professional success far beyond your expectations. Success in practice
means financial success. The Ensign Remedies will 'get you the business. We do not expect you
to sell them as Ensign Remedies, but to prescribe them upon indications which we furnish.
WRITE US TO-DAY
Ensign Remedies Co., Department o. Battle Creek, Mich.
CANADIAN OEFICE: WINDSOR, ONT.
WILLIAMS' PRIVATE SANITARIUM
A PRIVATE HOME EXCLUSIVELY FOR
Alcoholic, iyiorphine and Drug Habitues and
All Forms of Neurasthenia
GREENSBORO, N. C
JACKSON SPRINGS SANITORIUM.
A new and modenily arranged building including modern diagnostic
apparatuses and various electrical appliances for the treatment of noncontagious
diseases. Special attention given to renal, hepatic, digestive
and nervous diseases.
Patients have free access to the celebrated Jackson Springs mineral
water which took second prize at the St. Louis World's Fair. This
water is especially indicated in above named diseases.
Centrally located in Moore County, N. C, amid the sand hills and
long leaf pines. Elevation 700 feet above sea level. Rates reasonable.
For further information, address
/\. A. yncDONALD, 7V\. D.
0\A/nei- and TWariagei-
JacUson Spr!ng;s, IN, C

ADVERTISEMNTS.
? :$:?: - >:?:$: - >? :$:^:$:$9S;$SSS:i':?:? J?S:»g:?:?:?:g8i:$S:$ -$^S;$i$:$:-$:?-g3
PROFESSIONAL CARDS
DR. GEORGE W. PRESSLY
Charlotte, N. C.
Practice Limited to Surgery.
DR. W. O. NISBET
Diseases ol Digestion
Offices: 9 North Tryon Street
Phones; Office, 21. Residence, 1196.
Qffice Hours: 8:00 to 10:00 a. m., ii;oo a. r
to 1:00 p. m.; 3:00 to 5:00.
Special Hours by .\ppointnient.
DR. JOHN R. IRWIN.
Ch,\rlotte, X. C.
E. R. RUSSELL. IVf D.
J. P. MATHESON. M. D.
221 S. Tryon Street, C ..aki.otte. .N. C.
Hours: 9 a. m. to 1 p. in., and 4 to 5 p. m.
Sundays 9 to 10 a. m.
Special hours by appointment. Practice limited
to the Eye, Ear, Nose and Throat.
Phone 418—687.
JOHN P. MUNROE, M. D.
SPECIALIST IN NERVOUS DISEASES.
Offices Charlotte Sanatorium, Charlotte, N. C.
CONSULTATION PRACTICE.
Will meet physicians in adjacent towns and
country for consultation in general medical
cases.
W. D. WITHERBEE, M D.,
CHARLOTTE, N. C.
Practice limited to treatment of Cancer and
Skin Diseases.
Office, Charlotte Sanatorium.
CHARLES M. STRONG, M. D.
Diseases ol .Women and Surgery.
Special attention given to Abdominal Office Charlotte Sanatorium, Phone .521
Residence 609 S. Tryon Street.
Surg:er>' and Diseases of Women.
Phone 144.
ANDREW J. CROWELL. !^. D
Ch.vrlottk, X. C.
Practice Limited To Genito-Urinarj- and
DR, CHARLES H. G. MILLS
Realty Bulldinq, Charlotte. N C.
3>
v|
Rectal Diseases.
Hours: 8. .30 A.M, to 12. M.
Practice limited to Gynecology and
^>
3j
4 to 6 PM. Sunday by appointment
DR. A. M. WHISNANT.
Obstetrics.
DR. GEO. \AJ. F»R LY
\(>
*
18 S. Tryon St., Charlotte N,C.
Office Hours:
Now has his office at the Charlotte
8:30 a.m. to 1 p. m., and 3 to 6 p.m.
Sundays by appointment. Practice
Sanatorium and does all his work there.
limited to Eye, F.ar, Xoseand Throat. I'RACTICK LIMITED TO SURGICAL CASES.
DR. ED\A/IIN GLADrt^OIV,
An Advertisement In
TME STATE"
COLUMBIA, S. C.
Will sell it. The reason is evident. The .STati
covers its State. Write for rates.
SPECIALIST
TUBERCULOSIS
Southern F»lne-s, IN. C
THE JOUkXAL keeps, for the bene- *
fit of its subscril)ers, the names and ad- \|/
dresses of all unemployed nurses who |j
reside in Charlotte. Direct telegrams ^
and phone messeges to the Charlotte *
Medical Journal for information. $)>
TKe Baltimore Medical College
PRELIMINARY FALL COURSE BEGINS SEPTEMBER 1.
REGULAR WINTER COURSE BEGINS SEPTEMBER 20,
Liberal Teaching Facilities; Modern College Buildings; Comfortable Lecture Hall and
Amphitheaters; Large and Completely Equipped Laboratories; Capacious Hospitals and
Dispensary; Lyingin Department for Teaching Clinical Obstetrics; Large Clinics,
Send for Catalogue, and address DAVIU STREETT, M. D., Dean,
712 Park Ave., Baltimore. Md.

THE CHARLOTTE MEDICAL JOURNAL
Eleeant Pharmaceutical Specialties
Attention is Called to the Excellence and Valuable Therapeutic
Properties ol these Preparations.
FLEXNER'S SOLUTION
OF ALBUMINATE OF IRON.
(LIQUOR FERR.I ALBUMINATIS. FLEXNER.)
Albuminate of Iron is a definite chemical
compound of albumen and iron. In the man-
ufacture of the preparations of this iron salt,
we use fresh egg albumen onh'. Albuminate
of iron is the organic compound present in
the red corpuscle of the blood. It does not
disturb digestion, neither does it constipate.
Contains in each teaspoonful one grain of the
iron salt and it is perfectly stable and bland.
Clinical experience has demonstrated its superiority
as a chalybeate.
PINT BOTTLES, $1.00.
Please Prescribe ORIGINAL Bottles,
OUR Label.
ROBINSON'S ELIXIR PARALDEHYDE
10 PER CENT
HVI'XdTIf, SKDATIVE, ASOIIWF, MIRKTIC.
InHlVnf innc • SleeplesBnese, irritability. Ner- ,'
inUILdllUnS . vou«nM., Headache, lollc, Etc ;
t insomnia, and produces unbrok leep of fro:
four to seven hours' di
It is proposed as possess
digestive disorders.
le good without the
lilies of Chloral,
lixir contains 45 grains of the Paraldehyd
fluidounce, dissolved in an aromatic menwhereby
the objectionable taste of the
.1 is to a great extent disguised, and the >'
tion rendered palatable
DOSE— 10 per cent. 2 to 8 fluidrachn
Pint Bottles, $1 50
N. B.—We also make 25 percent.
Price, per pint, $2.oo.
WE ALSO MAKE FLEXNER'S .
Svrup Albuminate of Iron Comp. - - I Pi.ts I Solution .Mbuminate Iron and Strychnine. S.vrup I H Piflt
^ "
) $1.00 .Albuminate Iron with Quinine and Str.vchnine f St.Ofcl!
I
If your dispensing Druggist has not yet received a supply, we will send you either form by ExpreSBi]
I
PREP'MD, upon receipt of price named.
ROBIINSOIN-F»EXXEX COA\F*/\INY, |

t^-^-'''
ADVERTISKiMENTS.
>r,T-ini — -^ot-.-^ ii:^^ r^ors p. _10C30
Qmogestin
(See "New and Non-Official RemtdU,--)
_
D
Does NOT dissolve GaJl-Stones.
It DOES
OVERCOME HEPATIC INSUFFICIENCY,
INCREASE THE FLOW OF BILE,
RELIEVE CATARRH OF THE BILE TRACT,
^
D
2 PREVENT FORMATION of GALL STONES, g
J CHECK INTESTINAL PUTREFACTION,
RELIEVE INTESTINAL AUTO-TOXEML\.
One Tablespoonful well diluted, after each meal.
DOSE .
F. H. STRONG CO.
S8 Warren Street, New York
Q
1 i i i ni-ift
e botttts ontu.
THE CONTROL OF PAIN
is almost invariably
the first indication for treatment in every acutely painful affection.
But, in obtaining effective analgesia, care must always be taken never to
alter or obscure the pathologic picture. The great therapeutic utility of
PAPINE
depends not alone upon its remarkable pain-relieving properties but
also on its complete freedom from the narcotic and toxic action common
to other opiates. Papine does not nauseate, constipate nor create a
habit It has, therefore, no contraindications of age or physical condition
BATTLE & COMPANY
PARIS ===^=^^= ST. LOUIS :
SL JL
LONDON

THE CHARLOTTE MEDICAL JOURNAL.
"We Progress Through Change"
"THE ALLISON LINE"
of j^-Ii^.sicians' tables, chairs, cabinets
and specialties show the "Progress"
we have made through years of constant
improvenicut and "Change." If your
equipment is old fashioned and out-of-
date you have failed to progress with
the times and a "Change" is due.
Three things are essential to the successful
practitioner of medicine—knowledge, self-confi-
dence and the proper appliances. If you
have the first two, we can supply the third.
We are confident that we can
supplement j-our difficulties to
a minimum. An examination
of our catalogue will show to
casual odserver wh)- the word
"ALLISON" has become as.
synonj'm for the BEST. II
W. D. ALLISON CO.
INDIANAPOLIS, IND.

lDVERTISEMENTS
THE ILLS Oh
THE AGED
require gentle, yet efficient treatment
"pepii'/ienv^jnv ((jude)
IS peculiarly adapted to the hematinic
and reconstructive needs of the elderly
invalid, as it is active in its bloodbuilding
properties, while free from
harshness, irritant action or constipating
effect. 60
t'Slon ^- J- BREITENBACH CO.
'lUatiln!'" NEW YORK. U. S. A.
Out Bacteriological Wall Chart or oar Differential Diagnostic
Chart will be tent to any Physician upon Application.
PEACOCK'S
BROMIDES
In Epilepsy and all cases demanding continued bromide treatment,
its purity, uniformity and definite therapeutic action
insures the maximum bromide results with the minimum
danger of bromism or nausea.
CHIONIA
Is a gentle but certain stimulant to the hepatic functions and
overcomi;s suppressed biliary secretions. It is particularly
indicated in the treatment of Biliousness, Jaundice, Constipation
and all conditions caused by hepatic torpor.
LITCRAI
Rcaucs
PEACOCK CHEMICAL CO., St. Louis, Mo.
PHARMACEUTICAL CHEMISTS

.^^'^^^ •^•>-^-^ j^'j'a^ J-
jy^yg'-'gyyyg jy-^-jg-g- •^•-
J
THE CHARLOTTE MKOICAL JOURxVAL.
~ CONCENTRATED PROMPT POWERFUL
IzrO^W^XX^^A.
Rheumatism and Kidney Remedy
Formula— Colchicum, Hyoscyamus, Rims Tox., Chirette, Gaultheria, "j
*
Potass. Iodide, Magendie's Sol. (i iiiin. in lo),
Cactus Grand., Cannabis {i niin. Tr.in lo) Potass, Acet., Phytolacca.
Dose— lo to 30 drops, in water.
Indications— Rheumatism, Neuralgia, LumbaKo, Gout, Gravel, Stone and Kidney Troubles,
and for Organic Disease of the Heart, especially Valvular disease. J
We ask a trial of the I-Own-A Remedy at our expense, as we guarantee it to|
give marked relief within 2 to 6 hours from first dose, and particularly recommend
it for chronic cases, as the more you use it, the better you become acquainted
with it, the more highly you will think of it, the larger you will find toj
be the percentage of cases, all the requirements of which it will fully meet.
Left entirely in the hands of the profession, for prescription.
Put up in only one style, vtrithout menstruum, at retail J
price of $1.00. Eacb bottle will make a 16 ounce bot- ',
^
tie, with eacb teaspoonful containing 10 drops (not
minims) of the I-Oivn-A Remedy proper.
Professional testimonials, and samples sufficient to test it for two or three
weeks, sent by mail to any PHYSICIAN upon direct request to
I. O. WOODRUFF & CO.
Manufacturing Chemists
257-9 William Street
New York
^'$t^J$^^^^Sr^^^^^S«:^$:^^J^^*^^'^^€^^€$i$t^^$t^'C:

; !;>
The Charlotte Medical Journal
Vol.. LX CHARLOTTE, N. C, NOVEMBER, 1909. No. 5
Constructive and Imperative Operative
Surgery, Extraordinorily Unique
Cases, with Successful Results.
I Wilmington,
RrssEti, Bellamy,
N. C,
Ex-Captain and Senior Surgeon of Squadron A., N.
Y. Cavalry, Late Instructor, etc., in New
York and Cornell Universities— lo
years. Alun. mis iiellevue Hospital,
N'ew York City and at University
of Vienna, Austria.
Since my return to my native State, North
Tarolina. (1908) after an absence of eigheeu
years, principally spent in New York,
Colorado, and Europe, it has been my good
brtune tonandlefive cases which were and
ilways will be especially interesting, intructive,
and novel to me. It seems that
he time is now ripe for the surgical world
o know about them.
Dr. William T. Hull said to me three
ears ago, when I told him of the enormous
mount of work I was doing and the seven
ears' experience in one of the hospitals in
Cew \'ork in Lesser Surgery, "Vou are doiig
just the thing. So few surgeons know
nything about minor surgery; they only
;uow about major work, ['"ewer lives would
e lost, if more attention were paid to cases
[Ot in the category of major surgery."
' Will
the operative surgeon enlarge his
phere of action and become as well the
onstructive surgeon, doing the combined
'ork of architect and builder? Are these
le fantastic images of a prophetic vision?
he history of the development and growth
f surgery in the past gives reality to our
icpectations and hopes of what the future
ay unfold, and is this, in truth, not the
eat work of surgery in the future?"
Swing Mears).
To save every part of the organism should
: the aim of the surgeon, and to remove
ily those parts which by leaving will prove
detriment to the body. Often it becomes
icessary to substitute, and as a covering
id filler I have found the egg membrane
be most satisfactory. It is easier to apy
than skin and seems to have a special
tion in filling of concavities, as the fol-
—
vania a considerable time attempting to
learn some things relative to egg membrane.
Sad to relate, I have found almost nothing.
Egg membrane is added to the egg while
it is in the thick-walled terminal part of the
hen's oviduct, just before the egg is laid.
It is the hardening of the oviduct secretions;
likewise is the shell. The egg membrane
is a non-cellular, interwoven, and
keratin substance like formation containing
C, 49.78; H., 6.54. N., 16.43; S., 4.25;
and O., 22.90. (Lindvall)."
Technique.—The egg is secured the day
it is laid and thoroughly washed and scrubbed
with green soap, a stiff brush, and
warm water, followed by a solution of bichloride
of mercury 1-1000. It is then
cracked with a sterilized hammer and the
shell removed by pieces, or it is cracked
and divided, the yolk and white emptied,
and with fine forceps and scissors the membrane
is removed in strips ]-2 inch wide to
two inches long. The inner or albuminous
surface is laid on the surface of the wound,
a sterile salt solution dripped on and rubber
tissue placed over it, which is held in position
by sterile gauze.
One of the interesting things about the
membrane is that it in every case has grown,
no pus ever having shown itself. The great
annoyance, liability of infection, and subsequent
suffering of the patient is avoided.
Dr. J. ^L T. I'inney in a recent
article on skin grafting, cites cases
which he classifies as unsuccessful. One
feels like suggesting that an area, even as
large as the cases he mentioned, could be
covered with membrane, a number of eggs,
it is true, being required.
In all the cases, from time to time, new
membrane was added to facilitate the healing
of the granulating surfaces, and increase
new tissue cells. In some inexplainable
way, the membrane seemed to act as
a filler as well as a surface covering.
CASE I., E. W., CRUSHED AND TORN LAST
PALMA PHALANX MIDDLE FINGER
This patient had a box weighing over 100
pounds fall for a distance of some inches
cases will lend to show. After on his finger literally crushing out, at least,
iwing hausting the libraries here and finding one-third of the end of the finger. After
isolutely nothing as to its histology, the using every known method for some days,
Hewing information was iqailed me by a deep gaping wound, going almost to the
y friend, Dr. S. H. Schotz, Jr., Medical phalanx, still remained. At the eame time
ispector for the F.quitable, to whom I am the nail was removed.
pecially grateful. He writes in a letter, In order to get the opening to heal, I,
ijed July 9, 1909.
from time to time, placed pieces of mem-
"My Dear Doctor: I have spent at brane over the end of phalanx, as described
'e libraries of the University of Pennsyl- by me under head of technique. The finger

290 THE CHARLOTTE MEDICAL JOURNAL.
not only completely healed over, but has
been so built up as to virtually make it stand
out as the others.
The patient, a mulatto, has only a modified
color of the joint, it being rather white,
while to the feel it is very velvety.
CASE II., E. N., FIRST, SECOND, THIRD FIN-
GERS, FIRST AND SECOND JOINTS OF
LITTLE FINGER TORN AWAY BY
RICE THRESHING MACHINE.
After trimming out and endeavoring to
save as much of his hand as possible for
two or three weeks, freeing it from all infection
( the patient having been seen six
hours after he had met with the injury on
a rice plantation some miles down the river )
I found that in several places, especially
the joint of the little finger, there was virtually
no covering, and in these placef- egg
membrane was rather freely used, as well
as over the end of the index stump.
Patient is now well, and by having saved
one phalanx of the little finger, as well as
replacing parts of the first, second, and
third metacarpo phalangeal joints covering,
this man is able to perform a fair amount
of work and especially carry on part of his
labor, using n hoe in the fields.
CASE III., C.H., SLOUGHING UNGUAL FIRST
AND SECOND INDEX FINGER JOINTS;
PHALANGES EXPOSED AND NE-
CROSED bones; ABSENCE OF NAIL
AND skin; METACARPOPHALAN-
GEAL JOINTS DOUBLE SIZE.
(CHEMICALLY PURE CAR-
BOLIC ACID burn).
This case was referred to me by a physician
with request that amputation be made.
After I had seen her once, she went to
the hospital, without my knowledge, and
there she tells me a consultation of surgeons
was held and they decided to amputate her
hand. She again reported to me and I
found a virtuallj' indescribable condition.
Considerable cellulitis of the hand existed.
The finger had only last phalangeal joints;
necrosed bones, foul smelling, were showing
protruding through a sloughing mass
of tissue unenveloped with skin. The metacarpo
phalangeal joint was as large as her
thumb, and the finger was so foul smelling
as to have tempted me to ask my assistant,
a young woman to whose care and patience
much of the construction of the new finger
is undoubtedly due, to open wide the windows.
The history of the case was that at some
time she had shown evidence of syphilis,
and had a mild attack of hemophlegia, but
had been successfully treated by her physician.
She implored me many times, in the name
of the Almighty, not to amputate her finger,
.
and at times her prayers were almost pa- j
thetic. Large doses of anti-syphilitic prep-
arations were administered and her finger j
and hand carefully treated by all known '
anti-septic methods. Great patience was ,
shown by each of us in the separate sittings.
At different times, necrosed bones of twO;'
last phalangeal joints was removed by in-
cisions bejng made on the side of the finger i
avoiding the tendon, or at least, what was]
left of it. By the application of splints, we,'
succeeded in keeping the member in excel-
lent position. 1
WHITE FINGER GROWN ON BLACK HAND.
It was most interesting to see the white
tissue growing on the jet black hand,
and, to our surprise, to find new nail cells
sprouting. As the weeks passed, and ever
months, the finger began to assume origiiia
proportions, as a part of a nail had growr
and the two joints were partially restored
with a distinct line of pinkish white anc
black in evidence.
While the patient has no control overthfmovements
of the two joints, partial iiexioi
and extension of finger exists, she has to al
appearances a slightly shrunken wliitt
finger grafted on a black hand. This pati.
ent, a woman about sixty years of age, was
seen and hand dressed seventy-two times ii
the space of three months.
This case seems incredible, but it is thi
greatest proof of my twenty years of stud} i
1;
: 1

ORIGINAL COMMUNICATIONS. 291
that apparently useless parts of the body
can be restored or saved, by reconstruction,
with patience and application of unique,
It was cleansed with difficulty, and the external
ear rapidly assumed a bluish, turgid,
swollen condition. Drains of gut were in-
novel methods.
serted, and
No. 4., X. Y. Z.— I.aceration with com- placed.
plete obliteration of hymen, partial perineal
a series of interrupted sutures
tear. Picket fence injur>'. Six year old
child. .Medico legal interest.
As is the childish custom in villages and
cities in this pari of the world, children
straddle the fences and often banter each
other in the rapidity in which they can walk.
This Utile girl slipping was impaled and had
to be bodily lifted from the fence. She par-
tialh- fainted, and when seen by me less
ihiin an hour afterwards, she was in a very
iier\ous state and was suffering considerable
jiain. After she was chloroformed and
a fairly large aniotint of clotted blood renin\ed,
it was found that, for a distance of
line half inch, the hymen and perineum was
destroyed, and the roof of the wall of tlit-
.vagina badly lacerated. After trimminup
the edges the parts were easily apposed
•and sutured. The most careful anti-septic
methods were used and the limbs tied together.
In a week the parts were healed, and in
t'.Mi weeks the little girl was returned to
>cllc,(.l.
Medico Legal Interest.
'! his case is not only exceedingly rare, as
unable to find anything in literature
I am
simulating it, but is recorded especially to
,be a beacon light in studying all cases of
ruptured hymen as yiroof of chastity.
Xo. .S., M. J.— Bevelled pi tia'l ellipse
II I -^ed wound virtually se er! n principal
iltarlnnents of external eai
While trying a pair of mules, this man
ivas thrown over the side of the wagon and
me of the wheels ran over the side of his
liead, making an absolutely indescribable
•ondition. Dr. W. J. II. Bellamy, my
father, found the patient, a few minutes
.^fter the accident, lying in a state of col-
•apse, semi-conscious, and bleeding pro-
fusely, as not only the temporal but many
''
' :> smaller branches of the arteries were
inna well forward and place it over the
emporal regions, and the glistening skull
was easily noticed. Some of the occipito
,rontalis and fashion was detached as far
is the parietal eminence, and the wound

292
THE CHARLOTTE MEDICAL JOURNAI .
facial, and a posterior branch with the The Doctor's Obligation.—Withtheknowl-.l
occipital.
edge and equipment for the highest service']
As the days passed, the pinna gradually it becomes, in my judgment, a sacred obli-:l
regained its color, and the senation was gation upon the physician to use to the full;
partially restored. On account of the per- his capacities and his qualifications not':
feet growth of the external ear the hearing alone for his fellowman writhing in pain:,
does not seem to have been affected. The before him, but his fellowmen in the throes
j
patient has now returned to work. of social and civic agony. And who need |
10 North 3rd street. " oftentimes the well balanced conservatism j
of a level-headed thinker more than they
j
ThcoDuty ol The Doctor lo His
^eed their material wants supplied or their
|j
Municipality.
physical ills relieved. That verv conserva- (
By Roy K. Flamiapn, M D Health Officer, ^ however, which makes ihe doctor's!
Cnarlottesvine, Va. ,. • ,11 j i- 1 .advice
worth having, renders him slow to •
Duty Sense of the Doctor.—Of all the callingsto
which men give themselves it would
take the initiative in public matters, and so |
if he would make a start toward assuming;/
be easy to demonstrate, if it were not in this his fair proportion of the civic burden j
presence totally unnecessary and inappro- (which share I repeat is larger than that of;,
priate, that the duly sense of the average the average man) he needs to discipline >
doctor of medicine reaches the highest point,
and every failure in the fulfilling of a duty
on the part of the physician is, in my judgment,
because of a failure in the apprehenhimself
by closer attention to the minoi 1
matters of public concern, which daily ,1
come under his observation or lie directly \
within the province of his professional:!
sion of that duty and not on account of wanton
neglect. Asone who for fifteen years has
trod the path of this profession, and whose
duties. •\
The Doctor's Characteristics and Qualifi-'\
'•
cations.— I hold, and I believe it can be
knowledgeofthecommonfailingsofhisclass demonstrated, that the qualities which are,<
is gained by a rather deeper acquaintance demanded of and are developed in the aver- j
with the failure side than with success, I am age doctor by force of the circumstances of
the less hesitant in laying before you now his daily life and in consequence of the 1
somewhat in detail an aspect of the doctor's attitude of mind which comes from his \
duty which has in many localities been peculiar relationship with mankind that he ;
totally misapprehended. is best qualified to lead and instruct the J
Service Withheld.—Though the doctor people of his town or community, along all ;:
gives himself freely in service and sacrifice lines which make for social and civic as
to the welfare of the individual sufferer or well as pliysical betterment. He knows ii
to those individuals who constitute his the needs of the people as a whole, he sees i
practice or who ask for his aid, I wish to the seamy side in the houses of the poor, i
emphasize that he does not render to his he gets the viewpoint of the merchant and |
city, town, village or community that full the clerk, the professor and the rich man i
and efficient service which it has a right to pour their woes and their wants into his ij
expect and which service is all the more open ear, their difficulties and trials become i
binding upon the profession, because only his. Who, therefore, is so fitted to adjust ..^
the members of that profession know to them and to apply the cure?
;
what extent it is withheld.
The Doctor as a Litisen.—\.t\. me quote
as a kind of text to what I have to say Section
one of Chapter three of Principles of
Medical Ethics adopted unanimously by
Responsibilities'for Health Department.— \
To begin with, manv municipalities and I i
any number of smaller communities have j
I
no adequate facilities for meeting the public i
health needs of tlie locality. No record of I
the House of Delegates of the American deaths, no record of births, no idea of the
Medical Association at New Orleans, May number of cases of preventive sickness in , (
7tu, 1903. As good citizens it is the duty the neighborhood, no well defined plan fori i
of physicians to be very vigilant for the lessening the mortalitv or ameliorating the
welfare of the community and to bear their conditions which tend to increase the death 1
part in sustaining its laws, institutions and rate. This stale of affairs imposes a duty, I
burdens. Especially should they be ready , that none but the medical profession can 1
to co-operate with the proper authorities in meet. Whether he realizes it or not the] i
the administration and i
observance of sani- doctor must stand sponsor for the character \
tary laws and regulations. And they should of the Board of Health of his town. It is,
j j
be ever ready to give counsel to the public therefore, distinctlv "up to him" to make; i
in relation to subjects '
especially appertain- jt what it should be. The individual doc- ;;
mg to their profession." tor is the pivot on which the health office \
*Read before the Virginia Medical Society, Oc- swings, for without his co-operation there'
tober, 1909. is no hope for efficiency. The general: 1
: ! i
'•
j

ORIGINAL CO.MMCNICATIONS. 203
pubiic is not alive to the possibilities for will say this is not preferable to being left
jjood that lie in a properly conducted health behind, or trampled down or ignored. The
department, consequently the financial sup- doctor must not miss the significance of the
port of the department is invariably inade- trend of events. For unless he broadens
quate to its needs. The only hope, there- the range of his activities to include a
fore, for rapid progress lies in the high deeper knowledge and a wider practice in
sense of duty to the public welfare in the the preventive side of his profession the
doctor which the ethical principles of the future holds no rainbow of promise athwart
medical profession inculcates and which his pathway.
needs to be more deeply impressed upon Civic Duty.—Another duty touched upon
medical men everywhere lest the old ideals in the text quoted is that of bearing full
lose their force. part in sustaining the laws, institutions,
Duly of Prompt and Accurate Reports.— and burdens of the community. I have
Then again a concert of action is necessary already dwelt upon the doctor's special
among the doctors in the matter of report- qualifications for service. I wish to specificing
infectious diseases. The health depart- ally lay before him the duty of getting into
ment is absolutely dependent upon them for the thick of his municipal or community
this information, and upon the promptness life, instead of wrapping his dignity about
and accuracy of these reports the whole him like a cloak and letting the places of
public health structure rests. 'I'he doctor's honor and preferment in the community
first duty, therefore, to his municijiality fall into the hands of those whose use of
after aiding in the formation of an efficient them have done so much to discredit our
health department is to report the prevent- whole system of government. The doctor
able diseases he is called upon to treat, should get into politics; the council chamespecially
typhoid fever and tuberculosis, ber needs him, the school boards need him
Even,- doctor reports scarlet fever and diph- sadly, the boardsofsupervisorsneed him, the
theria and smallpox, but from the. stand- whole governmental scheme needs his qualpoint
of the community welfare it were bet- ilies of heart and head and hand. It means
ter to neglect to report smallpox than to sacrifice and disagreeable duties and "more
fail to regularly record and report every kicks than ha'pence," but did the-se ever
suspectfd case of consumption, for small deter the real physician when he heard the
pox kills its tens, but consumption kills its duty call. The trouble with the doctor has
ten thousands. The doctor's heart and been that he has pulled at cross purposes
hopefulness have out-run his head and his with his brethren so long that his sight and
helpfulness in his dealing with the early
stajie of tuberculosis, and the tendency has
hearing have been somewhat dulled. It
may be that he is so wrapped in the task of
" lo let these cases rock along in the trying to keep life in the sick individual or
;! until past the point beyond which so busy trying to keejj up the fences of his
a well nigh impossible
_'.e-is of no avail. Xow that the jjro- precarious clientele (
n's and the world's eyes are opening task) that he has not had any eyes or ears
i:!v diagnostic measures and positive for the special fitness of the rival praciMi'ds
of cure of this dread disease the titioner for service of a wider kind. Who
I'll becomes a malpractilioner of a ter- knows but that observation along this line
•ype who does not arm himself com- may not prove to be the best kind of enfor
this battle, and who does not lightened selfishness.
;s strength and his equipment to that Duty of Public E.xpression.—Another duty
' \- agency in his town or community the doctor owes his people is the expression
•lids to lift the terror of this scourge of his thought either in public speech or
lie hearts of men. Prompt, accurate written word. The most useful knowledge
..uiplete reports to the health depart- in the world is his, and practically his
ilien form the essence of the highest alone, we see every day in the newspapers

294 THE CHARLOTTE MEDICAL JOURNAL.
the ej-e of the public, but the body of the to the purity and healthfulness of that fu- (
profession has but small part in this iliumi- ture he is pledged.
j
nation. Each doctor, it is true, bears his The Duly of Organization.—To be able to ;J
own torch, but it is as though the world is find fault with and to discover new duties j
dotted with lightning bugs. When they for an already over-worked and certainly .
should be, as it were, great dynamos or under-paid profession is an easy task, the .]
electric search lights, or even the biograph question as to how the purposeful doctor j
conveying the energy or the light or the may be able to do these things brings me to |
many-sided truths of the incomparable my last point, the greatest duty he owes his j
science of health. With knowledge even municipality, i.e., to get nearer to his pro- j
from the Garden of Eden came grave re- fessional brethren in more active, effective ,(
sponsibilities and the doctor, more than organization than has been his habit hith- \
others, accepted the charge as the keeper erlo. The local medical society which )
of his brother. Then his educated mind heretofore has been more or less of a purand
tongue and pen should be used in the poseless farce, must come to be the forum
broadest way for the benefit of his fellow- where the discussion will not simply be
j
j
i
men. stuff, cribbed from some ancient authority
Duly of Protest Against Social Crime.— and worked over, l)ut pointed, definite
•
j
In addition to matters of a purely medical essays designed for publication, with pur- \
nature, upon the medical profession there pose in every line.
*
rests in a peculiar way the solution, if solu- Results the Touchstone.—Our day is a day ,^
tion there be, of the great social evil, and of deeds rather than of words, and "results" '
the checking of the tide of young men and form the touchstone of every activity, so i
boys who yearly by the thousand dash the perfunctory and ill-atlended local medi- '
themselves to pieces on the breakers that cal society meeting must give way to defi- .:
girdle the cave of the scarlet woman. Who nite business-like sessions, in which com- i
IS to sound the note of warning if the doc- mittee work before hand shall have reduced i
tor does not? Who knows like he the needs matters for discussion to workable shape, i
of the hour? What higher service can one Details.—There should be a Hoard of i
perform to his municipality than to stand Health committee to keep the society in i
as a bulwark against the overwhelming touch with that body, backing it up with I
ignorance and heedlessness that wrecks so active aid or with the not less important i
many men and leaves our girls and women constructive criticism. And then, too, if .
at the mercy of ills, the origin and end of the local society really means to measure ,
which take hold on hell itself. up fully to its duty to the municipality it
Duty to Discriminate in Regard to Profes- must have a wise and very alert publicity :
sional Secrecy.—And here let me deplore the committee to edit and place before the pub- ]
misapplication of that principle of ethics in lie in the daily press, matters under dis- i
the code which seals the lips of a doctor to cussion which the public should know. «
the undoing of the innocent marital victim The doctor has blamed and laughed at the
of a conscienceless libertine. This rule of people for their ignorance of things mediabsolute
secrecy under any and all circuui- cal, and yet no steps have been taken by
stances, however virtuously conceived, has the profession at large to enlighten them,
served in innumerable instances to foster Let it be done authoritatively and systemunchastity
in men and women, who know- atically through a publicity committee,
ing that the knowledge of the consequences Duty of Study.—This business-like comof
their impure practices would remain for- mittee plan should likewise be applied sevever
locked in the breast of the physician, eral meetings in advance in connection with
went out from his office to spread the miasm topics for special study, and let it be study,
of their presence into homes of innocence not a farce. The life of the people lies :
and purit3^ If it is right at the demand of the hand of the doctor; surely he should
the law for the doctor to unbosom himself give his best thought and study to the most
of the secrets of men, are there not times approved methods of treatment; he is not
when the highest law, the inner light from doing his duty to his people if he does not
God, authorizes, naj', demands a loosening use the opportunity afforded by his society
of his lips? The medical profession meeting for keeping in touch with the rapid
must purge itself from these time-worn advance in the healing art which the world'
and suspicious alliances with condi- of thought and investigation lays at his
tions that tend only to the destruction of door. The "Regular" says "all methods
civilization's most cherished institutions, for the cure of disease are mine to be used
namely, the family and the home, the doc- for the healing of mankind," and yet be
tor is no farther confessor, but a man whose frequently passes by many remedial agents
responsibilities reach into the future of the without a look. What does the average
race while that race Walks this earth, and doctor know about psycotherapeutics? The

ORIGINAL CO^niUNICATIONS. 295
quacks take possession under the name of 5lh. To labor for the correction of any
a new cult and the doctor has a black eye, tendencies and practices in the profession,
what does he know about the principles of however time-honored, which in any degree
massage and the value of manipulation of cloud the purity of his sacred art.
joints and muscles ii' restoring strength to 6th. And, finally, as a means to these
wasted tissue, must the osteopaths "r/ /ut to get into touch with the vanguard of
forced in Portugal and also in the cilN- of
ioday. How much more important, there-
Xaples. The physicians were required bv
ore, IS It that mutual study cement the
law to report all cases of consumption and
ellowship which should exist between mem- ^..^^e liable te heavy penalties for their fail-
5ers ot a i)rotessioii whose altruistic deeds uretodoso
re the wonder and admiration of the world. ^^ consumptives, as previouslv mention-
May I for a moment go over the points I
^d, were isolated, and their clothing, the
|iave made as to the doctor's duty furniture of their rooms, and all the ordi-
1st lo build and back his board of
^^ry articles used, were
lealth. Reporting diseases with careful
^]^^;, jeath. The rooms
destroyed after
were also thoro
'T'V° ''^"'''f •. „ oughly cleansed and purified. These laws
,
2nd. lothrovvhimself into the political
were rigorously enforced for more than fifty
nd cuic life of his town, by standing for
yggj-s
>ffice and working for the highest good of Notwithstanding these facts, this great
IS people.
. plague continued unabated and undaunted
3rd. To give freely by tongue and pen ;„ ti^^ devastating career, spreading the
us houghts and observations Ss to the best
death-laden germs throughout all Europe
aeihods of control and cure of disease. The These same restrictions with many more
rticles for publication always being care- ^^ded on have, for the past quarter of
uUy censored by a committee of his concentury
been enforced in our own lubercu-
''^-ffi^' '!< •
. ,
4th lomstruct and warn men and boys,
S well as women and girls, against the
l^r stricken country, and yet the great
piajjue is still roaming, claiming his vic-
vils that lie in the train of vicious and im- »Delivered before the State Medical Society of
horal conduct. Virginia, at its meeting in Roanoke, Oct. 5 to 8.
—

296 THE CHARLOTTE- MEDICAL JOURNAL
iivas to \.he sadXuue oi over iv/fo/'t-jery sfven lencc of pulmonary tuberculosis consiituUs a i;
of the deaths that occur in the entire worlds national, a racial, and a social problem, \
from all causes including- war, famine, pes- comparable to which none other is wortyef |i
tilence and alcohol. consideration. It has been carefully esti- ||
The every day experience of patholo- mated that over 1,500,000 people are an- i
gists, connected with our leading scientific nually incapacitated for work in the United ;(
schools and institutes, in the recognition of States on account of this one affliction. ;|
healed and unsuspected lesions in the lungs One hundred and fifty thousand is a low j
and othdr parts of the body, is sufficient estimate of the number of lives directly ter- j
evidence to demonstrate the wide preva- minated in the United States each year by J
lence of non-active infections as v^'ell as tuberculosis. ';,
the inherent powers of individual resist- The average age at the time of death is j
ance. computed at thirty-five years, enforcing an :i
Statistical observations concerning the nnual preventable loss to the nation of ;
frequency of tuberculous lesions, found du- many years of future industrial activity, ,
ring port-mortem inquiry have varied con- approximating one half of man's average ;
siderably, according to the thoroughness existence. If the value, to the State, of;;
with which all parts of the body have been each healthy inhabitant during the entire :i
explored, During recent yea's these re- period of usefullness is estimated at $1,000, 1
searches have been conducted in a more the economic loss in one year from deaths !
systematic manner than formerly, and re- so premature will approach at least $500 for ,i
ported cases of latent infection a-^e formore each individual thus removed, making an i
numerous. annual drain of §75,000,000 upon the Uni- i
Naegeli's statistics upon this subjet ob- ted Stales from this source alone. This is
tained from the critical stady of five hun- entirely exclusive of the additional expense i
dred autopsies at Prof. Ribbert's institute necessitated for the maintenance of charity 1
;
in Zurich, are particularly startling. After organizations and the demands imposed by i
carefully inspecting every organ of the body the disease upon private benevolence.
j
including the lymphatic glands as well as The above figures form a very conserva- \
examining a large number of microscopic tive estimate of the potential loss each year i
sections, he reports the finding of tubercu- in the United States from a cause admitted 1
lous lesions in 97% of all the cases up to the to be within the limits of prevention. The |
fifteenth year, 96% up to the eighteenth year computation of many students of political .\
and neail}' 100% up to the fortieth year, econom)' and observers of medical coudi- 5
The^e results apparently corroborate tho tions estimate the financial loss to this i
popular German belief that every person country as a result of tuberculosis to vary
possesses a slight focus of tubercular infection.
from
year.
$200,000,000 to $400,000,000 each \
In New York City 15,000 people die '
•
The obscure localized lesions, affecting annually from this disease and abovt an (
the vast number of human beings compared
with those actually succumbing to
equal number die annually in the States of
Illinois and Ohio. In New York City, in
the disease of pulmonary tuberculosis, af- 1905, 32,000 cases of tuberculofis were refords
a striking commentary upon the ef- ported to the board of health. In Austria
fectiveness of self-immunization. In this the tuberculin test has recently been em- i
connection it is not only necessary to consider
the many individuals who perish anployed
upon healthy soldiers, with a /w/-
tive result in 60% of those who were prenually
from the disease, but also the myr- sumably well, thus demonstrating the fact
iads of those whose capacity as wage earners
is restricted. Th. number thus afflictthat
a latent focus of tubercular infection \
existed in each one of these apparently,
ed is truly appalling, and in nearly all healthy soldiers,
countries, exceeds in economic loss and If this test were used in this country
human suffering all other combined agen- among the apparently healthy no doubt
cies which contribute to the pathos of fate, like result would be obtained. We can
When we consider the working power of readily see how appalling this condition of
labor which constitutes the chief commodi- things would apjiear, and how important it
t^ of State, it is not difficult to comprehend is for the medical profession to begin tike
the tremendous depreciation of economic great fight oj educating the public along
resources entailed by the ravages of such a lines of hygiene and sanitation as a predisease.
Even without regard to the magnitude
and depth of human suffering, the
deprivations and blighted prospects incident
to prolonged illness, the dismem'^erventive
measure against the spread of tijf
bercular infection.
|
When we consider the astounding facte;
that over one million human beings have
ment of families, and the agony of heart and this year surrendered their lives to this arch
Tsi\\\&., the glaring fact remains that the preva- enemy, including over one hundred thotl-
;
j

ORIGINAL COMMUNICATIONS. 297
sand of ourown people in the United Stales, firming the theory of the specific infectious
twelve thousand in the City of New York nature of the 'Hsease.
alone, agrgregating an average of about It remained, however, for the distinguishthree
thousand persous each day in the year, ed Dr. Koch to demonstrate the absence of
with a possibility of indefinite continuance tubercle bacilli in other than tuberculous
of these conditions, is it not high time for ev- conditions. He even accomplished the
ery father, mother, and child to buckle on the successful inocculation of animals from
armor of warfare to save our nation from pure artificial cultures of tubercle bacilli,
parasitic decay and destruction? after the elimination of all extraneous ele-
I have endeavored to portray, in a con- ments, and the removal of all accessory
servative manner, the great havoc that sources of error. Dr. Koch thus estabthis
greatest of all scourges is playing with lished the real cause of tuberculosis
the human family, and will now jiroceed to among man and animals by the discovery
give yon a few additional ideas of the na of the bacillus and confirmed it by the results
ture and chief characteristics^f this malady of inocculation experiments,
before otTering some plain but scientific The apparent etiologic identity of all
facts for its prevention and extermination, forms of tuberculosis in different species
Before going to war with so formidable a was determined also upon the basis of the
foe it might be well to ascertain, if possi- characteristic histologic structure of the
ble, the strength and chief traits of our primary tubercle. Recently a mass of evieneuiy,
giving due consideration to the va- dence has been presented liy numerous obrious
lines of procedure, the modes of inva- servers.bothfor and againsttheacceptanceof
si^n, the habits ajid even the topography essential ditference of essential difference in
and climate of the country. I'ntil this is the cultural characteristics, virulence and
done we cannot expect as good results from powers of transmission. While we are of
our efforts toward the overthrow of this tlie opinion that human and bovine tuberking
of all diseases, culosis have the same origin and can be
We are all familiar wi'h Dr. Koch's dis- transmitted from one to the other, yet there
covery of the bacillus tuberculosis in the is great room for speculation: but snfiice it
year 1S,S2, which revealed to the world not to say we are more interested in eradicating
only the hiding places, bul the habits, act- it from our fellow creatures, whose lives are
ual work-shops and full paraphernalia of more precious than gold or silver, than we
this secret foe. Hy an original method of are in eradicating it from the lower anidifferential
staining. Dr. Koch succeeded in mals.
isolating the tubercle bacillus and demon- In this connection, if you will permit the
strated its presence in infected areas in all digression, I am of the opinion that every
parts of the body. Previous to this, char- up-to-date physician should be able to use
acteristic tubercle formation had been re- and own a first-class microscope with an
cognized in the scrofulous affection of oil-immersion lens that he may diagnose
glands, bones and joints, although the pre- his cases at his office instead of sending
cise infective agent had not been discover- specimens off to the specialist. There isno
ed. The recognition of nodules or tubercles good reason why every general practitioner
in the lungs was obtained about the middle who has any aspiration to keep abreast of
of the seventeenth century. Ai the begin- the times, should not do his own bacterioning
of anatomic investigation with the dis- logic work- The diversion from the routcovery
of ca'Mty formations and pus collect- ine part of his work and fascination of
ons, numerous conjectures were offered as spending at least one afternoon of each
to the pathogenesis of the disease. week in laboratory work, saying nothing
The first efforts towards the inoculation of the consolation of being able to diagexperiments
were made in tlie beginning nose his own cases without outside assistof
the nineteenth century, but were not at- ance, is sufficient to amply reward him for
tended with clearly definable results. Vir- the outlay in the purchase of a microscope
chow cleared the atnK)sphere to some extent with all the necessary equipment. Of course
by exi)oundingthe jjathologic andhistolog- if heexpects to do good and satisfactory work
jic structure of tubercle. Villemin, in l,S6.=i, he should take a special course in microonducted
a series of inoculation e.xperi- scopy and bacteriology provided he did not
aents of the greatest value. In addition get this knowledge in his regular college
;o introducing into animals an infective courge.
Material obtained from tuberculous tissues In the study of the tubercle bacillus in
md the sputum of consumptives, he inject- iis various aspects, we find some very iui-
;d into a second group some non-tubercu- portant features to consider, not only in
ous pus, and in a third, a caseous matter reaching a clear diagnosis, but also in ma-
'rom tuberculous cows. A tul)ercular de- king a prognosis. In studying the anatomy
Josit was found after these injections con- of the tubercle bacillus we find the length

2')S THE CHARLOTTE MEDICAL JOURNAL.
varj'ing from oiie-fourth to one-half the di- while the father is breathing; quick-lime ,j
ameter of a red blood corpuscle. This dif- dust in the cement factory, his child is 1
erence in length and shape v^aries with the breathing pulverized glass in the glass fac- '\
virulence and stage of the disease. Short tory. The one eats the tissues of the lungs, |!
and thick bacilli indicate great virulence, the other irritates them, until they are in a
and when clumped toogether in schools the receptive condition for any germ disease. \
virulence is even greater, while if the bac- In the coal mines, while the fathers are be- ]
illi are long, flexed and scarce, it indicates ing crushed, crippled and killed, his chil- I
a chronic condition of long standing. There dren are working in the coal-breakers above. !
is also a marked difference in the anatomy For ten or elven hours a day these ehildren >.
of bacilli from sputum and those from cul- of ten or eleven years of age, stoop over the i
lure growth. chute and pick out the slate and other im- £
These little pointers I have learned part- purities from the coal as it moves past them, j
,
:
:
i
ly from actual experience in my labratory The air around them is so black with coal i
work since taking a sjjecial course in re- dust that they are compelled to wear lamps
search work at the Pathologic Institute in on their caps at noonday in order to seethe i
Berlin, and consider them worth remem- coal which is moving under their feet. i
bering. Many of these children contract miner's
j
Having in a crude way searched out the asthma, and finally develop pulmonary tu- (
real cause and working force that destroy berculosis. There are now in this country i
the living tissues of
organism (the tubercle
the vital
bacillus)
parts of our forty-two thousand
we will mines and quarries.
children
Eighty-two
employed in
thousand
\
\
proceed to show some of the chief modes of children are to day breathing the lint of cot- :
contagion, the main routes and thorough- ton mills in the United States. Five thoufares
travelled by this marching army of sand three hundred and sixty five are
destructive parasites whose camps and tern- breathing pulverized glass from glass facporary
abiding places are found in every tories. Eleven thousand four hundred and i
nook and hamlet throughout the world, sixty-two are steeping their systems in the '
!
Only recall some of the myriads of sources nicotine of tobacco factories,
from which this infection is carried and In the laundries of our countries little
spread over the country. Go with me, if girls and young maidens are standing all (
yon please, to the work-shops, and the par- day sorting filthy linen, or folding flat- i
asite-producing industries of our cities pieces into a hot mangle where the heat is
First among these are the dust-producing so intense that they are compelled to work
trades which cause many of the various almo,t without clothing. Many times they
throat and lung diseases. Take the cement are worked far into the night and must
factories that are now springing up all over turn to their homes through the dark and
our country and whose business it is to deserted streets of our cities, and in all
manufacture dust. The workers are .?ur- kinds of weather, uncared for and unprorounded
by and work in an atmosphere tected. We can readily anticipate the risk
made foggy with small particles of quick- these younggirls run in leaving these steamlime,
which makes up the major part of the heated apartments and rushing out intothei
commercial product called cement. .Add crisp, wintry night air, trudging their way
to this the fact that the workers, in order to through the suow or rain to their respective
adjust the machinery, and keep the equip- homes in some distant and perhaps unsaniment
going, must be constantly exposed to tary part of the city.
the sheets of flame that keep the massive Are these not favorable sources for the
cylinders red hot, and you will have only propagation and spread of tuberculosis?
a faint idea of the cement worker's life. Those induitries which employ little chil-
The clouds of curling dust arising from dren just long enough to sweat out their
these sactories can be seen for miles away, vitality, leaving them diminutive little
This dust, when inhaled, produces an irri- wrecks to drift aimlessly through a long,
tation of the mucous membranes of the dependent life of poverty and disease,
mouth, nose and throat, and is also carried should be classed as social parasites and
to the bronchial tubes and lungs, setting up should not exist in any civilized country,
irritation of these organs, and producing a We might cite hundreds of such sourc
raw surface for the direct invasion of the where the constitutions of the youth of o
tubercle bacilli. land are ground up io these mills of coJj
The cement factories of America might merce. After going through these varic
well be called the homes of tuberculosis, processes of grinding there is barely enot
This applies with equal emphasis to the fer- constitutional vitality left to survive th
tilizer plants, glass factories, cotton mills, age when tuberculosis and other contagion
coal mines, etc., etc. In glass factories, infections are most apt to attack and swal-J
children do a large part of the work, and low them up. It is usually wheu the cog^

ORIGINAL COMMUNICATIONS. 299
stitutionisruiidownandatalowebbthat its deadly mission, to be inhaled by any
tuberculosis ,s most liable to be contracted, passer-by, and if lodged in suitable soil of
One of the chief characteristics of the tuber- the mouth, nose, throat or lungs in the
cle l,acillus is to start to grow and multiply course of a few weeks or months these viewhen
the soil is suitable. Weak constitu- tims go out on the same mission spreading
tions furnish this kind of soil. We find the same infection, as well as addin-re
these weakhngsni all lines of trade the cruits to that great armv of millions who
great majority of whom if put to the tuber- have gone before to that bourne, whence
culin test, will be found to have tubercu- no traveller returns
losis These weaklings can be found in Having merelv touched upon the chief
candy factories where rhe fly is a constant points of this mammoth subject giving some
visitor and on-looker and is ever ready to of the leading characteristics that should
deposit his share of infection on the candv claim the attention of the medical profession
that we purchase from the confectioners. in the fight that is now being made I «hall
Over half a million bacilli have been conclude my paper bv offering a few sufound
in one fly speck, and his flyship is gestions along the lines of prevention and
capable of carrying over 6,600,000 bacilli extermination of this world-wide scourge
on his legs and wings. One person who that is now challenging the skill of the
has tuberculosis in the worst stage is capa- whole medical profession. One of the
ble ^.f eKpectorating in a single day over strongest *and most important preventive
one billion of the bacilli. We have similar measures against pulmonary tuberculosis,
coiuluions to the above in our bakeries, is the careful management of the children
wliere possibly the head baker is a victim of tuberculous parents and grand-parents,
of tuberculosis, and with his usual domestic There is beyond all question, apredisposicoinpanions,
the flies, contribute a large tion to this disease in such children; also
share of this infection, in the way of depos- in adults who are the offspring of tubercnits.
to the bread we eat on our tables. The lous parents of grand-parents. The consame
rule applies to our tailor shops, where stitutions and general welfare of this class
tubercular cutters or seamstresses are con- should excite the interest of not only the
Btantly, but unwittingly, infecting the cloth- immediate relatives and friends, but of the
ing we purchase from them, tlie bargain family physician as well. While I do not
counters 111 some of our large department believe that the disease itself is hereditary,
stores, the "cheap John" clothing stores, yet I am fully convinced that there is'a
the unsanitary confectionery and grocery strong hereditary tendency.
Stores, ice cream saloons, common restau- When this tendency exists with marked
rants, fruit stands and stores, moving pic- anemic conditions, low vitality and slight
ture and vaudeville play-houses, waiting- cough or constant clearing of the throat,
rooms and toilets in railroad stations and dyspeptic symtoms, loss of appetite, tired
other public places, state-rooms in steam- feeling, slight evening fevers, etc., etc.,
ships, and berths in Pullman sleepers, there is good ground for suspicion of begin-
There are set free in the United States every ning tuberculosis. Where there is much
year one hundred thousand prisoners from doubt and anxiety on the part of friends
our jails and penitentiaries. Over 2.5^ of and relatives, it might be well to use the
these have some form of tuberculosis, and tuberculin test. If a positive result is
are allowed to roam the country, spreading found, this class of patients should take
the infection as they go. When we consid- a course of building-up treatment until all
er a company of 2.S,(HI() advance agents the worst symptoms are cleared up, then
from this one source spreading this deadly advise a climate of pure, dry atmosphere in
infection over our country should we not a high altitude, where such persons can
appeal to our national government for help? spend the rest of their lives in ease and
Tliese and thousands of other sources that comfort, following their ordinary avocacould
be mentioned in the same category, tions. This is the proper climate for all
are the homes and common dwelling places persons who have an inherited piedisposiof
the tubercle bacilli. They are carried to tion to pulmonary tuberculosis. One other
these places l)y the victims of tuberculosis important preventive measure should be inand
the common house fly. The infection, augurated in every country throughout the
when once lioused in a locality where the world. I refer to the prevention of marsoil
is favorable, is very hard to exterini- riage of all those who have pulmonary tunate.
The way by which this infection is berculosis. While such a law, if inauguspread
and taken into the .system, is by the rated, might at first seem radical, yet it
sputum of persons who have tuberculosis, would prove a step in the right direction
This sputum, after drying on the floor, toward eradicating the disease and saving
sidewalk or street, is taken upas dust by a future generations from the blight of this
Fraught of air, or gust of wind and sent on curse. It is a well known fact that the

300 THE CHARLOTTE MEDICAL JOURNAL. I
married state hastens the progress as well have yet been discovered. When properly |j
as the spread of the disease. If we wish to compounded they can be administer- i
be sure of success in our fight, we must use ed iiite?-7ially, externally, as well as by ||
some strategy and diplomacy in searching forced inhalation. With these two ger- ji
out and capturing the victims who are the micidal weapons and a bounteous supadvance
agents in the spread of this deadly ply of pure, fresh air and ivholcsome -i
infection. These should be caught if possi- food, any ordinary case in the incipient]
ble while in the incipient stage and placed stage should be arrested within twelve |
in sanatoriums where they can be treated weeks. Teach him the use of the thermom- j
;
,
scientificall until cured. Eighty per cent eter, that he may keep a record of his most i
of all cases in this stage, who have fairly important symptoms, reporting same at I
good constitutions, can be cured. In the regular intervals, and to avoid taking ac- >
other more advanced stages of the disease,
the victims should not only be captured,
live exercise when his
above 100°.
temperature is at or
j
but quarantined under the same restrictions In short, give hiui a full set of specific I
that govern other contagious diseases, such rules and regulations in type-written fonni;
as scarlet fever, diphtheria, etc none , of to follow, and instruct him to itupart these
which is comparable in death-spreading lo his friends and acquaintances who may
qualities to pulmonary tuberculosis. The be victims of the same disease. We should
question naturally arises, can these plans
be carried into effect? Have we a right to
also educate the immediate relatives and
j
friends of the patient, as well as the general 1.5
curtail the privileges and rights of our fellow-man
along these lines? And is it hupublic,
along the lines of hygiene and sail-. |]
itation. The starting place toward educa-J
mane to thus cut off from the social world, ting the masses is in the public schools.!
those unfortunate people of our own woof
and blood? These are the greatest as well as
One week in every three months should be \
devoted exclusively to the study of hygiene i
most far-reaching questions to answer in
lining up our forces for the battle that is
now approaching.
and sanitation, in adPitiou to these studies i
in the regular curriculum, requiring each \
teacher to prepare a special course to be h
As previously mentioned, without a full taught to all the pupils, both small and :;
supply of strategy and diplomacy, these
plans cannot become effective, notwithstanding
all the combined forces of the
large, during these special weeks. The 1
teachers should also require the pupils to <
recite to their parents the same lessons on -,
medical profession, backed by the govern- hygiene and sanitation that they recite to
|
ments of the respective nations of the entire them, and in this way educate parents as :
world. The three most important essen- well as children on these important sub- j
;
\
tials in this
diplomacy.
fight are education, means and jects, preparing
Education is necessary for the years war."
them as if for a "thirty
The playgrounds should be
victims of the disease, for the general pub- carefully selected and the
'•
importance of
lie, and for those who are expected to do open air exercise impressed upon each pupil {
the fighting. Educate the consumptive by of the school. These principles should, j
telling him first of his real condition, and also be taught from the rostrum and the j
then teach him to co-operate in arresting pulpit by men fitted for this purpose. Ed- j
his disease and preventing the spread of ucatiou as previously mentioned is only one'
his infection to his fellow man. Teach him of the main essentials toward the preventhe
laws of self preservation, habits of tion and extermination of this dread dis-J
cleanliness, personal hygiene, and how to ease. The next important essential is the
avoid taking cold, and to live an out-of door means hy vihich to establish sanatoria for
in suitable weather, both day and night, the three classes of patients who are victims
wearing suitable apparel for body warmth, of this disease in its three respective stages,
to take tepid and friction baths, to regulate There should be in each county or city ol
a diet that will sustain and nourish all the 50,000 inhabitants, three sanatoria: one foT
organs of the body, and to keep the secre- those who have tuberculosis in the incipient
tions and excretions in as normal a condi- stage, and are curable; one for those whc
tion as possible, avoiding all things and in- have the dise.ise in the second stage with a
fluences of a deleterious or depressing char- possible chance of arresting it, and one foi
acter, and seeking those influences the third or incurable stage,
that are elevating and of a cheerful Where it is feasible, several counties 01
nature, administering only such medi- cities might combine funds and establish
cines
toms
as are indicated by
'of each individual
the symp- these sanatoria under a joint corporation
case. We These sanatoria should be established bj
have in Guaiocol and Iodine, with their the stale governments, assisted by the na
respective derivatives, two of the best lued- tional governments, hence the importance'^
c iiies for the treatment of this disease, that legislation ! Let the medical profession |j
1j

a unit work to this end and it will be only
a matter of time when the laity will fall in
line and thus assist in taking the matter np
with our law-makers.
To accomplish all this it will be necessary
lo use a large amount of diplomacy, The
best talent, tact, and influence should be
brought to bear upon the laity, the lawmakers,
the public benefactors and the
wealthy consumptives oi this country. This
la'ter class may not be disposed to give up
\fi'\x individual rights and privileges for
;ne mere sake of humanity by condescendng
to live in a public sanatorium, yet if the
oroper influences are brought to bear upon
his class, and with some diplomacy, we
|nay not only conquer them along the line
)f submission to certain rules and regulaionsofthe
openaii sanatorium, but we
nay, by conciliation, induce them to give
)art of their means toward the equipment
ud endowment of these humane iustitupons.
In this connection I would suggest that
special committee of two well known
lembers of this Society be appointd
from each county in the State,
1 act in conjunction with our legislave
committee, in bringing the mat-
;r of establishing county sanatoria before
ach of our county Legislato.s, State Sena-
)rs, tiovernor Swanson and some of our
eathy public benefactors, reporting the
ults of their eflforts at the next meeting
this Society.
Sexual Hygiene.
H. C. Buck, M. I)., Friars Point, Mississippi.
I am not sure I have chosen the proper
:le for this paper, but Webster tells us,
ygiene means 'a system of principles or
les designated for the preservation of
;alth." We might add moral, mental
id physical, accepting this as the strict
fiiiition of the word. I feel that I am not
r wrong in my selection of a title. Man
s ever Ijeen slow to accept or adopt new
)Ctrines or theories; in the dim past men
fused to accept the truth that the earth or
e world as it is called was a globe and reived
on its axis, but finally some sage
d philosopher boldly asserted "the world
move," and from then on mankind acpted
the truth. The world moves and
nkind moves with it; we live in an age
progress; "onward and upward" is a
>gan of the present era. Until within tiie
St few years the question of sex and the
cussion of the sexual natures of men and
men was looked upon as being if not im-
)ral, at least indelicate and immodest;
nee never discussed, but to one that notes
; trend of human affairs and the spirit of
orm and advancement that is gaining
ORIGINAL COMMUXICATIONS. 301
ground each day, it is very gratifying to
note that the education of the boy and girl,
not only morally and mentally, but sexualh'^
is occupying the attention of very many
prominent inembers of the medical profession,
as well as that of moral and christian
men and women in other walks of life.
The question that confronts us today, the
scope and gravity of which can not be estimated,
one that should and must appeal to
us as physicians, is. Shall the boys be
taught the nature and functions of their
sexual organs and the moral restraints necessary
to a pure life by parents or guardians,
or shall they be left as heretofore, to
grow up in ignorance of these matters, or,
if knowledge is obtained, get it from vicious
sources and surroundings that are but too
often the first step in a life of shame and
misery.
A writer of ancient history says, "In
ancient Germany boys and girls bathed together,
naked, even when fifteen years of
age, and were not ashamed." Such a state
of affairs shows a woeful lack of modesty,
and certainly is not desirable, nor indeed
at all advisable for "Young America" as
is evidenced to all who read.
A writer says "innocence and ignorance
in regard to vice is no safeguard to a young
man or woman in this age, when it is so
evident on every hand, and no fond parent
need flatter himself that his pure girl or boy
will not sooner or later become subject to
improper conversation and influences."
In an article by Dr. Win. Lee Howard,
of Baltimore, he says: "As puberty silently
and insidiously arouses the girl to introspection,
as vague and sometimes uncontrollable
sexual desires force her along a
trail of automatic queries, she seeks in vain
for truths which she scarce dares own to
herself that she was conscious of or understood,
innocent of any wrong feeling, her
soft, sweet and womanly emotions are ignored
by her mother, her teacher and her
married sisters, and either through harmful
floundering in her development, or more
often through the harmful tales of a sexual
neurotic, she learns that e\'ery living man
and beast is the product of sexual gratification.
This knowledge coming to her through
muddy and contaminated channels cannot
but defile her thoughts, and she goes out
into the world without realizing the great
truth that sexual gratification is not sensual
gratification."
The question has been asked: "Does not
knowledge of the nature and functions of
the sexual organs tend toward making a
girl less modest, or is not such knowledge
a shock to her modesty?" I contend this
depends wholly upon the source of such
knowledge and the manner in which it is

302 THE CHARLOTTE MEDICAL JOURNAL ':\
Obtained. A writer on this subject said a should commence when they are very young
j
mother told him that when her daughter by teachmg them the beautiful laws and
Tsked her questions she answered them in arrangements of nature ,n the reproduction
\
the spirit that such instruction should be of plants and flowers emphasizing the sex t
given He savs: "This girl after receiv- differentiation Gradually as shementally
fng a straight-forward answer from her develops, she should be led along nature s
j
mother kissed her and said 'Mother, I am paths up to the reproduction of birds then
rrtofvou " Who can sav that this girl animals, explaining their mating habits
was injured by this knowledge obtained and the season therefor. \X hen nature was j
roL uch a source? Did not this mother, giving the girl the first earb' signs of her i
Hhis instructing her daughter, erect own reproductive powers she should have ;
around her a "stone wall" of protection: the whole truth plainly told her. Now he ,
for what lessons or impressions are more girl will see the beauty, the wonderful, the
beneficial or more lasting to man or woman ethical side of norma sexual feeling and
than are those received from mother? The sensual sensations will be suppressed. She |
very word "mother" seems to carry a halo will seek for no mysteries to dream about,:,
of love and protection. Again Dr. Howard have no morbid curiosity to lead her to ex-,
says "The^e are thousands of girls in the periuient, but be m the normal condition o^
upper and middle classes who, while not a heallhy woman who knows and will bej
hinocent, are ignorant of the primal laws master of natural passions until the time ot ,
of nature, many have tried to get the in- mating comes."
^
formation their\dolescent longings crave. So far I have devoted my attention o the^
many have tried to seek out the mystery girls and nearly all writers on the subject
after having been snubbed or denied by that I have read do the same thing. This
their mothers. If the opportune moment is right to some extent for upon the woman i
arrives, and it generallv does, the girl falls rests the sacredness of the home, of mora s
into the selacious seductiveness of some of Christianity. A woman-a womanly ,
vicious minded woman, the seeds ot false woman-I admire and respect above all i
sexual education are sown and their spumy things on earth. It seems to me that when ,
growth forever crowds out the tender tie the great Creator was creating the earch and ,
between mother and daughter, and as the the fullness thereof He saved the best of all:
mother dissembled, so will the daughter His materials and of this He made .^
j.g
,, In an ariicle I read recently is this thought, I
'
That the maternal instinct or feeling of which I most cordially endorse. The writer;
motherhood is a natural attribute of a girl says, "The agitation m favor of woman s
and is born in them is evidenced by the care "rights" is, m reality, a movement to deand
maternal love the little mother bestows throne a queen, ^/^Y ^^ ."°"'^"'^'
^f
on her doll. Why should not this feeling woman is the one adorable thing in all the I
be explained to the gid when of proper worid. As a woman, she is a living textage
and she be taught the beautv and grave book of moral education for man as a wife,
;
:
responsibility of motherhood while she is at she dignifies and makes human and lioh
the same time impressed with the beauty what man shares with the bru e; as a,
and grave importance of virtue and chastity, mother, she reigns supreme, for the hand;,
as well as instructed and warned regarding that rocks the cradle wields the destinies ol
the misery and shame of those who lose generations and ages.
these beautiful characteristics? The ques- But what about our boys? W e must retion
verv naturallv presents itself: How member the cradle just as often contains .,
shall we teach these things? I think this little man as a little woman, and he is ju -
should be left, in a great measure, to the as deserving of our care, is just f "iP°r
,
judgment and tact of each individual; but ant in his sphere as is the giriin he.s. io 1
this I will say: Don't snub or evade your often we hear a mother say: Oh, JoUnii).
son or daughter when they come to you for is alright; he is a boy; but I ^m aiixiouM
information. Gain and hold their coiifi- about Mary." Look after Mary, of course
dence, and remember life is new to them, but don't neglect Johnny. It is a sad com ,
and their young minds are busy with the mentary on the humanity as well as tm,
problems that are daily presented, to use Christianity of our State ^Mississippi tha,,
)
slang, "thev are from Missouri, and must she has no reformatory school and heh
be shown,'"' and it is far better for you to "convicts" range in age from htteen year:,
teach them than for them to go elsewhere to ripe old age. In an article in oneof ou,,
for information, which they will surely do newspapers commenting on tliis^ state o,i
if refused bv you. affairs I found this thought: \ ou h an |
\oain I quote from Dr. Howard, who criminality are as far apart as the pole^, n
says" "The truth as we know it should be the formative period of juvenihty there mav.
instilled into the mind of every giri. I be the elements of either crimmality or o.
. , ; , ;
|

ORIGINAL COMMUNICATIONS.
nobility. The environment, the develon- anri V.r^„ 0^.1 tu^ i-,-
,, iiiciaiuci. ludKe a Liium vvasno mvstery to this vouiip- -XmprioQ,, "
him to come to you with all troubles, real •
trite savine- that first ;r„,.r
.,
pr:^^ ;;^::r:i:" r;s^r,^- r I^IH: ESEf
S
your boy can becouje a manly man without sician as well as lavman for
being a moral wreck. u^are wholfv
Right here I want dependent upon the negro for our Lrvants
How".rr' " e^pre..ed by Dr. and for
''"rT"'
nursL for our children
HowYd.n an We know
article condemning mixed that very nearlv, or quite, all
schools and
of
sending
these
boys
ne
to female school groes are absolutelvvoid of vir ue o mor-
^^If^'^lly '^fter the boy als. yet very
Sfn^fsit,""''' many parents trust
reaches
the^r
he age of HtUe
fourteen. Dr. Howard „nes to the care of these neoroes o en
'^?'^.''^^f^'-"^'« ^'>e boy, allowing them to anTfVm AT go to
and
thek homes .^ere
I am of the opinion that such a course they are exposed to all kinds of d sease
"s si'e^^'th^n Urro'ne'n ''" ' "^^ ^""^^' "^^^^ P^>'^'"^ f -"^ moral,
siss es than and
the
too
one I have mentioned, often their pure souls are contaminated and
,7 he wanK.r 7 ' ^'^''' receive stains that hardly a life
"'n''\ "\'r!"
time ofW
.","'^
alittirtt vin'dolifr"
'"f" ^"^ "^^ ""'' >-°"^ P^^^' can
a
overcome and
little It will do him no great harm, but that you can never entirely efface
Sr^ndTcl'r r ^1"%"°'"",;^ ^ -^ ^"'^^^ ^^>'«' '"^'° T '-- '^^'^^
^ ^o end
^onldhon r 1 I n "° '''^^'' ^^ °"' I'is or her sexual nature unaided is
should hon.,r and
the
respec all women. gravest and most cruel mistake."
1 nave no patience with the idea a great
many physicians and laymen entertain that Examination and Diagnosis ol Diseases
a boy or man must indulge in se.xual rela- ol the Anus and Rectum^
tions to prove or assert his manhood. We „ ^, „ ^
can just as reasonably • say a girl or woman ' ''!',• -^'-D.. Richmond, Va., Instructor
o-
should do '"
the same t^ pr^ve'or' Z^^TZ '7^!-^:^;:Zr\^;]:fi^^^^
womanhood. In a paper on this subject geon, Memorial Hospital.
by Dr. C. 11. Cook, of Natick. Mass., ,, , , -^ • ,
't ''as been said
.u
that it is the careful doc-
among many other things found in the
paper, he says,
tor
•'Whenever
who examines his
a man patient's
consults
rectum, for
^ him and makes '^ that claim
probably
he tells him
no part of the
that human
if the sexual ^"^tomy relation
that has
is necessary
been more
to health
neglected by the
or physiologically necessary ^^'^''^S;^ practitioner.
it cannot
There is
be
apparently
morally wrong; "o
neither
Sood reason for this,
can it be wrong
unless it be that
f.,r
the woman who ministers to the need " ""'' '"^*^"^^' schools have not given suffic-
tie
said further,
'^''^ly
"that
careful
grantin

,i(M THE CHARLOTTE MKDICAI, JOURNAL.
diseases often has a tendency to assume mistaken for vesical, urethral, prostatic,
serious proportions and result in destruction vaginal or uterine affections,
of tissue and loss of function of the parts, To begin with, when a patient presents
or may in some instances become malig- himself for treatment, the history of the case
nant. There is no portion of the body to should be carefully taken, allowing the
which this applies more forcibly than to the patient to tell his story in his own words,
rectum. While this may be a little tiresome to the
Medicine and surgery have undergone a physician, still, if he has been an attentive
very complete revolution during the last listener, it will have the effect of putting
decade or so; old slip-shod methods and the patient somewhat at his case and will
guess work will do no longer, for the pa- engender in him more confidence in the
tients expect and demand more than a physician. While this appears in itself of
casual glance and the asking of a few ques- little consequence, it often means a great
tions. It is not uncommon even now for a deal, for if the patient is unduly excited,
patient suffering from some rectal trouble embarrassed, or lacks confidence in the phyto
call to see the doctor and inform him that sician, the examination to follow will hardly
he wishes treatment for his piles; for the be successful.
patient often has no conception of other Age, vocation, habits, mode of living,
diseases of these parts, and the physician, previous diseases, present symptoms and
after asking a few unimportant questions, how long present should all be gotten and
will write a prescription for some ointment recorded, and if deemed necessary, his anto
be applied as directed. The patient may cestry should be inquired into, though
or may not have piles—the ointment may heredity is of very little importance in rectal
possibly do good, but most probably will diseases. It is very important in prescribnot;
but, at any rate, you will admit that ing a diet and the amount and kind of exthe
patient has not received a square deal, ercise a patient should take (which is nee-
He is most assuredl}' entitled to a careful essary in rectal diseases), that we should
and painstaking examination to elicit, if have a clear idea of his present habits in
possible, the true nature of his malady. these respects, for it would hardly be to our
A correct diagnosis having been made credit to advise more exercise for a profesand
the proper treatment given, good re- sional acrobat or foot-ball player, or to insults
will be gotten in the great majority of form him tliat he was eating too much meat
cases. Without the proper examination, when he might be a vegetarian. Just very
it is fallacy to hope for betterment except recently, a lady told me that she had changby
mere chance. ed doctors because when she asked the
Diseases of the anus and rectum often former physician the cause of her child's
progress very rapidly, and the delay of a sickness, he stated that it was due to drinkfew
days in receiving the proper treatment ing too much milk, when the fact was that
may convert the simplest trouble into one the child had a great dislike for milk and
of very great magnitude, thereby causing had not drunk a glass of it for a year,
the patient a great deal of suffering, loss of Such little mistakes have caused many a
time, expense and probably endangering doctor the loss of a patient: but they would
his life. As an example, take a case of not happen if we enquired a little more
thrombotic hemorrhoids, which is one of the closely into their regimen,
simplest of conditions to treat and can be The Sims' or left lateral is the best all
cured in three or four days, but which, not around position for the physical examinainfrequently,
if left alone, results in fistula tion; still others, as the knee-chest or lithotor
perirectal abscess, often taking weeks or omy positions may, at times, be preferable,
months of careful attention to effect a cure. We should first carefully inspect the anal
Again, as in other portions of the body, it region, noting the shape and size of the
is most important that an early diagnosis orifice, color of the skin, whether unduly
of malignant disease of the rectum and anus dry or moist, any ulceration, fissure orfistulshould
be made, for it is only in the early ous opening, external, protruding or interstages
that we can expect to eradicate can- nal hemorrhoids, polypi, etc. By having
cer. the patient strain, at the same time pulling
With a little experience, an examination the buttocks well apart, we can gain a fair
of the rectum and sigmoid is made quite as view of the lower part of the anal canal,
easily and as satisfactorily as an examina- By palpation, any tender points, fistulous
tion of the vagina, and should be made tracts or fluctuation indicating abscess may
quite as much of a routine. If we made be made out. Digital examination is one
more frequent rectal examinations, the of the most valuable means of diagnosis of
diagnosis of a great many of the obscure disease in the first three or four inches of
pelvic lesions would be cleared up; for it is the rectum and sliould always precede the
uot rare for diseases of the rectum to be instrumental examination. The finger,

ORIGINAL COMMUNICATIONS 30S
covered by a rubber cul, should be well
lubricated and first passed upward and forward
until the spinctures are passed, then
upward and backward. While the finger
There are various specula on the market,
but for m )bt purposes there is none better
or easier of introduction than an ordinary
small or medium sized Sims' vaginal specuis
passing through, note the condition of the lum.
sphicters. If there is a twitching, tender The speculum or proctoscope should first
muscle, it indicates an acute trouble near
the margin: if it is hard and firm, it indibe
thoroughly lubricated and introduced by
a firm but gentle pressure against the sphinccates
a chronic condition: if relaxed, you
would expect some malignant or exhaustter,givingsufl&cient
lime for relaxation of the
muscle. In passing through the anal canal,
ing disease.
Between the spicters we must look out for
the instrument is held at an angle of 45 degress
to the table or on a line with the
openings of fistulas, fluctuations, foreign
bodies, etc. I'urther on, we note whether
the membrane has its normal folds or
whether it is smoothed out— the latter indieating
stony—whether the mucous mempatient's
body while in the knee-chest posi-
tion. After passing the sphincter, the tube
is lowered until it is parallel with the line
of the table. If the proctoscope is being
used, the obturator is now removed, when
brane is soft and pliable or harsh and dry
showing insufilcient secretion. Polypi,
carcinoma, stricture and ulceration may be
air will rush in and inflate the canal so that
the tube may be further guided to the desir-
ed height; the parts inspected and applicafelt
if present, and their nature determined tions of the necessary remedies made by
by the sense or toucli if the finger tip be
sufficiently educated. One can scarcely
hope to be a successful proctologist until
means of dressing forceps or applicators,
By this means the whole of the rectum
may be very easily examined; and by the
he is able, to some extent, to recognize what use of the longer tube or sigmoidoscope,
he feels. the whole of the sigmoid or, as claimed by
While the finger is in the rectum, the
coccyx should be grasped to see if there is
some, the lowest extremity of the descend-
ing colon may l)e inspected. This high
tenderness or inflammation there. The examination should only be attempted by
prostate in man, ovaries, tubes and uterus one having had some experienee in the use
in the female .should be palpated to ascer- of these instruments, and is best done then
tain if these be enlarged, inflammed or ab with a specialty devised pneumatic scope
normally situated. Often, diseases of these with an electric light attachment with which
organs have their symptoms referred to the the bowel is dilated just ahead of the instruregion
of the rectum and vice versa. If ment. The small electric light at the distal
gynecologists would supplement their vaginal
by a rectal examination, much addiend
makes the passage of the instrument
much easier and decreases the danger of
tional information would ofien be gained, injury to the mucous membrane,
and probably occasionnll\' a'sist materially 304 East Grace Street.
in making a correct diagnosis. Upon withdrawa!
of the finger, the character of the Mercuric Cataphoresis versus Radiodischarge,
blood, pus or mucus should be tberapy and Excision In the
noted, and also, the odor.
An instrumental examination is necessary
When we wish to explore higher than three
or four inches of the rectum. The general
impression that this is extreme' V painful
and that a general anesthetic is necessary
is entirely fallacious, for with proper care
Treatment of Cancer.
py ^medee Granger, M. D., New Orleans. La.,
Lecturer on Radialogy and Electro-Physics,
N. O. Polyclinic; Radiologist to the Char-
ity Hosijltal; Member Societe Francsise
d'Electrotherapie, Paris, etc.
It has been my good fortune for the past
and gentleness there is usually very little four years to have charge of the X-Ray and
pain, but more the sensation of discomfort.
Before passing the speculum or proclo-
Electro-Therapeutic
Charity Hospital at
Department of the
New Orleans, and I
scoiie, the finger should always be gently have been afforded a splendid opportunity
passed into the rectum for the double pur- to study this unfortunate and only too compose
of lubricating the canal and stretch- moii affliction. There 1 have seen not only
ing, to some extent, the muscle. Another
and important purpose is to be sure of no
obstruction to the passage of the iiistruthe
failures of the X-Raysbut also of surg-
ery. A large percentage of the cases refer-
red to the Department for X-Ray treatment
ment. The knee chest position is probably
the best for instrumental examination, getare
patients suffering from recurrence fol-
lowing excision—which in most instances
ting the chest as close as possible to the
table, the thighs perpendicular to it and
was radical and thorough. These poor un-
fortunates now inoperable by any method
flexing the back to the fullest extent before are sent to the Department in the hope that
beginning. the X-Rays might help them. In a few

306 THE CHARLOTTE MEDICAL JODKNAI .
very rare cases of this kind cures have been tliis type no matter how small might and
reported from the use of the X-rays, but all often does mean the spreading of the dis"
we can hope for, all I have ever seen these ease into the lymph or blood vessels,
rays do, is to relieve pain, and for a time As already stated I have studied closely
improve the local and general condition of the results from the X-Ray treatment and I
these patients. This improvement is not have been greatly disappointed. I have seen
seen in every case, and when it does take no permanent cures except in skin growths
place it is usually of short duration. Even and these mostly of the rodent ulcer type,
when the exposures to the X-rays were be- In other growths I have not seldom noted
gun, recurrences took place in from three improvement but this was only temporary,
to twelve months. I know that several operators have reported
I do not mean to criticise the work cures in inoperable cases of cancer. I have
of the operators, quite the contrary for not been so fortunate and in all frankness I
I know them to be men of ability who must admit that I have often met with fail"
get good results in other operative fields, ures in cases when I thought the X- Rays
but in this instance it is my firm conviction specially indicated and confidently expectthat
they attempted to cure by excision a ed good results. My technique might be
disease which is not amenable to such treat- faulty, as I have always insisted on the
ment. This view is based on the fact that avoidance of X-Ray burns and liy so doing
I am for over four years a firm believer in failed to produce the degree of skin reacthe
parasitic or infectious nature of cancer, tion uhich so many operators deem necesand,
therefore, I can't hardly see how a can- sary to obtaiii satisfactory results. That
cerous growth can be excised without gener- numbers of cures—probably the majority of
alizingthedisease through the openedlympli cures—have followed a moderate or severe
spaces, and without implanting the disease X-Ray burn there is abundant proof. But
in the freshly cut wound edges, and cause an X-Ray burn is an evidence of the delocal
recurrences. Our observation bears structive effect of the X-Rays, and I believe
these statements. The improved technique that the latter should be used to produce
and extensive surgical operations performed retrogression of the growth and not to destroy
in the last few years, have not materially it. If this is the object desired than Merimproved
the results obtained in these cases, curie Cataphoresis will accomplish it more
That this is recognized by the surgeons quickly without any danger of serious conthemselves
is I believe fully proven by their sequences. The healing will be simpler,
readiness to try other methods of treatment the scar will not be so fragile, and recurin
these cases, viz: injections of mixed tox- rence much less frequent than after an Xins,
the X-rays, serum injections of boiling Ray burn.
water and lastly a method termed "fulgu- The changes which are brought about in
ration". carcinoma either in man or in animals, by
Of course, some cases have been cured exposing them to the activities of the X-Ray
by incision, and in these cases the favorable or of radium, have been shown by Exner,
results was undoubtedly due to the fact Perthes, and others in man, and by Apolaut
that the incision was made beyond the in- and Embden and Bash ford in mice, to prefected
area, the knife at no time cutting sent exactly the same histological picture as
into the latter, and no infected cells or blood that which is presented in tumors underfrom
it comhig in contact with the fresh going spontaneous retrogression. This fact
wound. has been under observation for over a year
In nearly every case of recurrence this in Buffalo. A section of tumor retrogradtakes
place on the site of the scar resulting ing under the activity of the X-Ray or of
from the excision. The more thoroughly radium is in no way distinguishable from
this has been done, the less favorable are one taken from a tumor undergoing spontathe
chances of success from a second incis- neous retrogression or retrogression induced
ion or any other method of treatment, by serum treatment. Examination of the
When the disease recurs after a radical blood of mice which have recovered from
operation with removal of all the glands tumors through the activity of the X-Rays
draining the a£f jc;ed part, it is usually asso- shows that this fluid does not contain any
ciated or quickly followed by a general me- acquired immune factor. If however ill
tastasis. the course of treatment a mouse is heavily'
Should we not heed this significant warn- bled, the tumor will frequently begin
ing from the pathologist never to cut into a grow—a phenomenon which leads to thfei
cancerous growth even to remove a section conclusion that the X Ray does not act!
for microscopical findings unless we are directly upon the tumor, but through such
prepared to operate in event that the micro- immune factors as the mouse still possesses,
scope shows the specimen to be malignant. For this reason it would appear that the
because the mere incision into a growth of X-Ray and the radium reduce the virulence!

ORIGINAL COMMUNICATION. 307
of the tumor or so injure the x factor that petent to throw aiiv light on this phase of
the natural immunity brings about the ret- the subjejt. (Gaylord)
rogression of the tumor. In this wav it is (8) The conclusive experiments of caupossible
to explain those tumors which are car of the uterus by CuUen demonstrate that
not affected by the X Ray, and also the the disease is auto-infectious,
fact— winch has been frequently observed (9) The existence in most large cities of
—that tumors which are being favorably cancer houses, i. e. houses in which sucaffected
suddenly begin to grow in spite of cessive occupants have developed the discoiitnued
treatment. ease. These observations are becoming too
Ini support of the parasitic or infectious frequent now for it to be possible to explain
nature of cancer, the following arguments all such instances bv the excuse of a mere
have been adduced from the modern re- coincidence.
search into cancer: The ideal treatment for cancer, therefore
( 1 ) An analogy exists between certain would be to destroy the infected and pathochange
in th epithelium in cancer and those logical cells and the germs or parasites not
occurring in the epithelium in certain of the only in the growth, but also those which
acute exanthemata notably variola and have migrated beyond into the apparently
sheep pox. known infectious diseases, healthy surrounding tissues, without open-
(Gaylord). ing up any lymph spaces or other avenues
1 2) lumors m mice are almost never of infection. Tliis I believe can be best
found ulone. In breeding establishments, accomplished by Mercuric Cataphoresis, a
where one case appears it is always accom- method which consists in driving into the
panied by others. Healthy mice, brought diseased tissues by electrical action the libin
contact with mice with primary tumors, erated ions of zinc and mercur.\—both pow-
acquire the same. ( Murre! ). erful antiseptics and j
germicides.
api^earance of sarcoma of a rat -^ careful study of this method and my
in a cage which had contained rats inocu- observations and the results tn the treatment
with sarcoma points to the possibility of 24 cases of cancer with it, formed the
A gradual transformation of normal
cells into cancer cells occurs at
subject of a communication which I presented
to the American Electro-Therapeutic
Association at its meeting in New York in
September 190d. The paper was summar-
I * .; ) The
j
i lated
I of cage infection in this form of cancer,
! (Gaylord)?
I (4)
I epithelial
i the margins of priinarv cancers. (Orth) '^^/^ '" ^'^^ following conclusions, viz:
.S The (
transformation '" ^^''?'''',
) of an adenosar- J^^' Z^^^.T
^P^^'!^'^'^' ^
^^f
I
Icoma '^'
into '' a sarcoma "^ '^''^"'
(I- hrlich is ) most Th h^r/h/ Proliferations '"If ?
easily explained By
mto the ap-
assuming the transfer- ^'°'^'S' Y S^
eiice of an infective factor fr^, n the epithe- S'e ai^d' imnr^'' '':'f"T''" n"""
limn into the connective .i.sue of the^tro- ^J:, ^tScaric^^i^^^'Tl^fL^
and most important action is due to the seu,i.
The epithelial cells of the deeper lective action of the current, which forces
I •,,.,„.
layers of warts, after successful treatment I
the diffused chemicals along the paths of
I with
the X-Ray, no longer proliferate to cancer proliferation, because these have
I torin a new wart, but reproduce normal greater couductivitv than the normal tisskill
(I'erthesJ. showing that [
the stimulus sues. Besides a true selective action also
.to iiroliferation has been removed, and that results from the fact that cancer cells sucthere
remains eiiithelial cells capable of ;
cumb more quickly to the diffused cheminnrnial
proliferating function. cals than normal cells.
I
/ ) The unknown factor in cancer is ap- (2) It is incapable of producing an auto-
,pareiitly added to normal epithelium from infection of the edges of the destroyed area,
Iwhi.hitcan be removed leaving normal because no infected cell or germ can exist
.epilhelium. Through the proliferations of within the effective radius of its energy
[the cells of the cancer, which increase enor- (3) The bloodless character of the appliilmously
this factor (i. e. infective agent) cations, even in situations where the vascuinust
of necessity gradually increase in larity is great, and the toxic and stimulalamount.
The increase in bulk, through ting effects of the current more than coun-
Itraiisplantation in mouse lumors, is associa- teract the depressing and untoward effects
(ted with increased virulence. The only in old patients, and in anv patients, when
(known agent which can fulfill these condi- the size of the growth requires prolonged
jtioiis IS a living organism. The unknown application. After the applications the
'tact(,r may be an ultra-microscopic organ- patients make rapid recoveries, because
.ism, or one that is simply undemonstrable. they have not been weakened by the loss
IFiltration experiments in infectious diseases of blood attending the use of the knife or
ijof unknown origin or etiology are not com- curette.

30S THE CHARLOTTE MEDICAL JOURNAL.
\
j
(4) Although we have used the method
on most unfavorable cases, and taken desous,
had gotten in the habit of taking about
a half pint of whisky every evening; several
perate chances, we had only one death dur- of his friends congregating at his house to ;
ing the application and we are convinced play cards, imbibing a generous quantity
that in this particular case the method was of whisky during the evening. In no other
j
•
not responsible for the fatal result. particular had the use of whisky appeared 1
(5) As a cure or palliative in growths to create disease or embarrassment.
within the mouth it has proven of inestima- Evidently something more than a simple
ble value, especially so on account of the prescription was here indicated. The cause
inadequacy of the other methods of treat- was explained to him with the advise that
ment. We were able to harmlessly and he should instantly stop all alcoholic beveri
i
'.
•
i
easily transmit the cataphoric products to
the site of the application by means of an
ages. This he asserted would cause very
little discomfort, since he had no desire for
|
(
electrode of small caliber and special design,
so insulated as to absolutely protect
the healthy parts of the cavity, and yet
the liquor, and only took it "because the
rest did", and to enhance the pleasure of
the evening. I directed him to take the
j
i
capable of definite and controllable diffusion pure alkaloid emetine, in a single dose to be i
from the uncovered point of electrode. taken just after he had gotten into bed, be- ;
In the cured cases, the cosmetic re- ginning with a milligram and increasing ',
(6
)
|
I
,
suits were excellent: the resulting scars are the dose until evidences of full action were
much smaller than would'at first have been manifested in slight nausea. When this
expected from the extent of the wounds oocurred he was to lessen the dose and keep
after the separation of the sloughs. They close to the point of nausea without touch-
I
i
j
are soft, pliable, smooth and with practi- ing it, and to continue the remedy nightly |
cally no degree of retraction.
(7) Lastly, we are convinced, as a result
until further direction.
He was also given a supply of cicutine «
of our experience in these cases, that although
we can expect some improvement
hydrobromide, a milligram in each granule.
This is one of those highly specialized wea-
|
I
and occasional cures from this method in
inoperable cases, that it should not be reserved
for such cases, but be used in operative
cases as early as possible, and before
pons which modern science has provided
us. Among the many the uses to which this
agent can be put. Dr. Waugh has especially
called attention to its value when a person
J
;
(
the local disease becomes general, if we
wish to obtain a large percentage of permanent
cures. And we further believe
that such a result can be confidently exfeels
the dread of approaching insanity,
Whatever may be the pathologic conditions
which underly this special sensation, cicutine
hydrobromide gives relief. One granj
I
|
i
pected. ule containing a milligram should be taken i
every two hours until this special sensation I
Chronic Alcoholism.
disappears.
By Geo. B. Simpson, M. D., Parkersburg, W. Va. A third attack occurred a few days after i
A gentleman recently applied to me for the patient applied to me, but four of the i
treatment, telling me that he feared he w^as granules succeeded in dissipating it com- ;
about to lose his reason. On several occa- pletely. After that, as the action of the i
sions, without anyknown cause, he suddenly emetine upon the liver and the various di- ':
felt profound depression with a bewilder- gestive secretions became manifest, no fur- i
ment and dread so profound and strong as ther difficulty has experienced,
to incapacitate him for any exertion or However, this was only the preliminary
amusement. After twenty-four to thirty-six treatment. A careful examination into the i
hours it would pass away. The only treat- circumstances convinced me that the true i
ment he received was vigorous cathartics, trouble was that the gentleman had not sufwhich
he took on his own prescriptions, ficiently hard or engrossing occupation for I
thinking that possibly sluggishness of the an exceedingly powerful and active intellect. |!
liver might be the cause. This man was a His work stopped at 3 p. m., beginning at |
tall, powerful individual, about forty-five 9 a. m., and while it would have been a
years of age, in excellent health; and while severe task for a man of ordinary intelli- J
his occupation is sedentery, he takes a great gence, it was not sufficient to fully occupy i
deal of exercise. He has no business wor- his powers. During the summer his after- ;l
ries, his family relations are ideal. His noons and evenings were spent at golf and i
financial affairs could not be in better shape, tennis, but during the long winter these ;!
A most careful examination failed to pastimes failed him, and cards and billards i
show fecal impaction. The liver is slightly were the only resort. After examining the I
enlarged. Further investigation showed matter thoroughly, I concluded it would be I
that for the past two years this gentleman, wise for him to undertake some business i
;
who had previously been perfectly abstemi- interest of sufficient magnitude to fully en- <
\

,
ORIGINAL COMMUNICATIONS. 309
u- iss all his pouers, and one which espe- the enforcement of the suggestion, bv law
c.,;llv involved the employment of a num- will [ think, so apppeal to you all, that in
1"M .A men, whose direction would be under the near future I will have your assistance
h.. immediate personal control individually and collectively, as t'he Medi-
Ilans are now being made for fulfilling cal Society of Virginia, when I endeavor
this need. 1 he case seems notable in the^e to secure the passage of a law by our next
days when so many people are complaining Legislature that will require the sterilizaof
overwork. Here was a man who was tion of certain classes of our criminals I
falling into alcoholism because he had not have the rough draft of such a law now
work enough but it is such a new subject, this steriliza-
Durmg the Civil War it was a common tion of a man, criminal or otherwise and
observation that .some of the most valuable is so hedged about with foolish sentiment
officers in the field only showed their true and ideas of cruel and unusual punishment
worth during the conflict. When the war that I admit it will be up hill work to eduwas
over these men quickly degenerated into catethe average legislator to the full kiiowlalcoholism,
finding civil life too tame to edge that no single measure for the prevensufficieatly
interest them after the excite- tion of crime would be more far-reaching
ment of war. in its deterrent effects, first, and preventive
In dealing with an alcohol user there effects second, than a law which provided
seems to be nothing which so completely for the sterilization of certain classes of
fills the .physical indications as emetine, criminals. Stop the breed is the whole pro-
The patient takes a full dose at bedtime, position.
goes promptly to sleep, remains sound One of our oldest proverbs is, "An ounce
asleep until morning and gets up fresh, of prevention is worth a pound of cure"
active, ready for his breakfast and his an 1 this may be taken as the text for my
work. The bowels more freely, with bil- paper. Prevention is the crv of the age—
lous stools, and the craving for liquor, if or to put it better, of the ages,
there is any, disappeared. This remedy Jenner, with vaccination, was one of our
seems to more completely fulfill the iudica- greatest and earliest preventors of a loathtjons
for eepatic elimination than any pre- some disease. We have to-dav anti-vacciviously
employed. Hy the use of this one nation societies, made up of the uneducated
remedy I hove repeatedly slopped an attack and hypersensitive cruel inidunusual-talkof
pending delirium tremens, which .seemed ers. And were we 1 1 wander into the realms
passed beyond the period when it could be of serum-therapy, with the antitoxine for
successfully averted. dyi^htheria, tetanus, meningitis, hydropho-
It IS necessary, however, toemploychemi- bia. we could more than take up the time
cally pure emetine, since preparations ordi- allotted for this paper. The medical mind
iiarially known under that title contain of this generation, as well as that of preenough
of the other acrid emetic alkaloid of vious generations, is centered on the great
ipecacuanha to render it impossible for a basic proposition of Prevention,
sufficient dose to be retained on the stomach Four States in the Union— Indiana, Utah,
to properly accomplish the object. This is Connecticut and California—have passed
the more important now, as the Rio ipeca- laws requiring that certain classes of crimcuanha
seems to have disapfieared from the inmals shall be sterilized. Indiana has
market, being replaced by tlie Carthagena had such a law for several years, and has
variety, which all but the last pharmacopeas sterilized several hundred. Utah has only
proscribed on account of irritating qnalities. very recently passed the sterilization law.
None of the American supply houses fur- Such a law is bound to come in Virginia.
nishes the pure alkaloid, but a good phar- Texas and several other Southern States
macist can prepare it from the root or the bave earnest and thoughtful men giving
xtract. Unless cephaliiie is excluded it is their time and efforts to the securing of the
difficult to secure full action of this drug on passage of a sterilization law for habitual
the liver, because the necessary dose will criminals, believing, as I do, that fifteen
ause vomiting. ^ or twenty years after the enactment and
Slerillzallon of
enforcement of
Habltn'al Criminals.^
such a law our criminal
iivfi,... \- class Will
r- . ,.• be , , ,.
immensely decreased,
liy ( lia.s. \ . Carrnigtcm, Ric iiiioiit Va \l„ . t j i
nf n
About a year ago I read a short paper on
f^r. Jresideiil and Ft/lows of the Medwal the subject of sterilization, before the N a-
i>ocuty of V irgiiiia: tional Prison Association, then meeting in
llie proposition of the sterilization of Richmond. That little paper provoked an
labitual criminals, as a prevention of crime, immense amount of discussion and cories-
8 so new to us, that the novelty of the sug pondence. One dear old ladv who has tapstion
will, I hope, engage your thought- ken a keen interest in prison work for years
uiatleulioii. Ihen the positive merit of and is a deep thinker and good worker

MO THE CHARLOTTE MEDICAL JOURNA].
came to me after the close of my paper and ly go to work the next day. I have only
said, "I don't suppose I ought to speak to sterilized four convicts during the time I've'
you on the subject of your paper, but I am been surgeon to the Virginia Penitentiary!
old enough to speak my mind, and if all The first one has given splendid and conof
'em (meaning habitual criminals ) were vincingly good results from the operation,
treated as you recommend, it would do an He was a negro sent to the Penitentiary for
immense amount of good, and save a lot of murder, with a long sentence. He had
i
j
j
crime and meanness;" and the old lady was only been at the prison a short time when i
dead right. he was adjudged to be insane, and was sent i
I have been surgeon to the Penilentary to the Asylum at Petersburg. While there ;
for over ten years, a long enough time to he is said to have killed a fellow inmate, f
see father and then sons come to the prison, and seriously injured a nurse; later he was i
and by looking back over the records I returned to the Penitentiary as cured; had i
learned that the grandfather had also been a relapse, and was bandied back and forth |
an inmate. Now this hideous reproduc- between the Asylum and the Prison several i^
tion of criminals, from father to son and times, as he became better or worse. Final- i
to grandson, should be stopped; it is right ly he escaped from the Asylum, and when ij
and proper that it should be, and it will be recaptured was returned to the Penitentiary, j
in time—in a very short time, too, if you Just at that time, the legislature having i
doctors of Virginia will awaken to the im- passed a bill requiring the insane criminals
portance of this proposition as a crime pre- to be kept at the prison, instead of sending I
venenter, and tell your representatives in them to the asylums. ;
the House and Senate that from a medical This poor creature was most dan- i
and surgical standpoint it is a good meas- gerously homicidal, and was the wildest, i
sure. fiercest, most consistent masturbator I have I
A good doctor has enormous weight in evtr seen. I steriized him. That was six i
disscussing such a subject with a thinking years ago. Improvement with him was ;
member of the legislature, and when you reastniably rapid, both physically and men- >
sift the whole matter out the talk of cruel tally, and now he is a sleek, fat, docile, in-
and unusual punishment does not amount telligent fellow—a trusty about the vard— '
to anything. I mention this, because this ^^,^^^ ^^^ sterilization. i
IS the single argument I have heard rged
against the measure, and such an argu-
-
,„, ,
' ^^^ ^^cond case was
, , ,
a debased
,.,,,
httle
i
I
ment can only have force from a sentiment- negro, a degenerate with a vicious record
'
al standpoint. in the reformatory, and a heinous record at
The criminal has by reason of his acts t^e penitentiary, as a masturbator and soforfeited
the rights of citizenship, and as a
^^^.^^ Sterilization about four years ago
further punishment he is sent to the peni- .. ,,. ,,.
tentiarv at hard labor, &c., and as a cured him of his vicious, debasing habits,
still
further punishment, if he is a rapist, mur- and he is now a strapping, healthy looking
i
derer, burglar, or guilty of arson or train- young buck, and when he completes his
wrecking, he should be prevented from resentence
and leaves, he can
producing his species; that especial breed . .
not reproduce
should be stopped.
J^^""] \ .. . u
I am not discussing here in this paper. The third and fourth cases are of too rewhat
criminals should or should not be cent cate since their operatior to report exsterilized.
Of course, a law that provided act results;*both of them were insane, de-
.
for sterilization should be most carefully
bilitated masturbators; they had been under
drawn, and only habitual criminals, third , j * . » f ^u„.
• , J M, r I
A observation and treatment for months
termers, and those guiltv of heinous and j , ^,
revolting crimes, degenerates, and such finally last month I sterilized them. They
like, should come within the pu-^vue of the are greatly improved already, both mentallaw,
ly and physically, and they will be cured
Sterilization is a very slight operation; j^ time.
you simplv resect the vas deferens, and it • ^m.- i ui .i ^ * *u:.
. ,,- J .,, . ' , . This IS probably the first paper on this
-^
is generally done with cocaine anaesthesia.
f i
-' ^^
A small nick is made ihrough the .skin of subject ever read before this Society. I
the scrotum, near the pubes, and after an have wished to make it short and forceful,
assistant has forced the vas, with the accompanying
vessels i» to the line of the
cut, pick up the vas with forceps, resect it,
, fc , .1. 1 J J
tying off each end, then close the wound,
and I hope the statement of facts will carry
conviction to your minds, and make you
, ^ - ^ -i- »• i u»
advocates of a proper sterilization law be-
'^"^"^'^^ one stitch generally suffices, and apply a
" h f
fore our next Legislature,
collodion dressing. Your patient can usual- 932 Park Avenue.
.
•

KDITORIAL.
Charlotte Medical Journal
''^^'" '^"'^ ^^^ 'p'"^^ ^o"^^ a"d therefore
less blood is carried to the failing vaso-
Publlshcd Monthly. motor centres. A vicious circle is estab-
EDWARD C. REGISTER. M. D., EDITOR I'^hed in this way, and eventually the blood
CHARLOTTE. N. C. pressure sinks to nil, unless in some way
suRoiG^b SHOOK
- tli's vicious circle can be broken and the
311
Vasomotor centres oiven a chance to recover
under an increased blood supplv. Strych-
1 he importance of surgical shock is so "iue and whiskey act principallv by direct
great that its consideration from any view- stimulation of these centres, and their adpoint
IS worth while. In all probability, ministration is followed by the desired reas
Muhlberg says, surgical shock is allied suits, provided the nerve cells are not beto
the physiological phenomena of inhibi- yond the capability of reaction. When
tion, but differs from the physiological con- however, the nerve cells are powerfully
dition in that It involves to a greater or less shocked, a direct stimulation apparently
degree the entire nervous system. Of the depresses rather than stimulates them
important nerve centres in the nervous sys- The injection of normal saline solution is
tem. the vasomotor centres take first rank, more often followed by favo able e u It
Hence, ,n surgical shock it i. the vase- because the liquid, bv mechanicallv fil in.
motor inhibiion which calls most urgently the blood-vessels, partiallv compensates or
for treatment. In vasomotor collapse it is the loss of tone produced" by t^.e relaxed
theartenolesthat are principally involved; arterioles. Atropine bv its stimulaUno ef
the heart, probably through its connection feet on the vasomotor centre and perin Teral
with the nervous system, is also implicated, arterioles, its depressing effect oi/die va4
butmuch ess seriously. The heart is an is /«. ..r..//.... the dependable drug hi ccn'
organ that wil stand a great many insults ditions of shock. According to Takamine
and much hard treatment, as those who adrenalin, injected into the circuSion'
'"""''' are aware: but the
Zn„,°," r 7 causes an enormous rise in blood pres ire;
I«H Zn'^V'-T f"' " ^^'^^^'''.S'-^' 'silive due not so f much to the stimulauon of th^
-'
Tm? r v,^ Tf,"" '"- •^""^- ^^««'"°'0'- ^^"tres
"'r'^" ^ as to the direct
mgstimula- a relaxation of the arterioles through- tion of the heart and arterioles. It produces
.Ut the bod;, In . consequence of this, the its effects almost as well on the hLrt and
ood-pressure falls the pulse weakens or blood-vessels isolated from the centra ne^
iisappears, and unless some heroic method ous system hen they are in physiologi
ion is adopted the patient dies cal connection with their
> resusci . ,.^ ^ ,,„wc..i uics uai connecuon wuu tueir nerve centres. It
f collapse. Ihe heart continues beating however, is verj- evanescent in its action
or some time after the arterioles relax, but
ts contractions are feeble and often irregu-
typhoid revBR.
ar. I ater on, the heart stops its contrac- As was pointed out by Schottmuller
ions: bu
as
here again the cause lies not so long ago as 1902, typhoid fever mu.st be renuch
,n the hear as in the falling blood- garded as a primary .septicaemia The
^.en'tlien "T '""'''',^'^r^r'^^ ^^"^'""^ ''^^ ^eeii found in the blood re
Vhen the blood-pressure sinks, blood can peatedly by the fourth day of the disease
.0 longer be forced into the coronary arte- Kayser cultivated the micro-organism from
les, and the heart stops in consec|uence of the blood with his bile medium in 100 per
I lack of oxygen. It ,s for this reason that cent, of the twentv-one cases he
he
examined
mammaluin heart does not beat rhyth- during the first week. Working with the
nically when excised from the body; its Strassburg typhoid commission, Brion
emoval
and
stops the coronary circulation, and Kayser had the opportunitv to make several
^^'''"" '^'^^- examinations during
?.?.*?ir\rT'"''''';"^-, the incubation sta.e,
inatecl Wood is transfused through the and in no instance recovered typhoid bacilli
OTonary ve.s.sels. the mammalian heart can from the stools. The tvphoid bacilli
)emade
quickly
to resuine its contractions outside pass from the blood into the bile
ne When
body. It is the vasomotor system, then, injected into the ear vein of a rabbit as
atner
has
than the heart, which requires treat- been done on numerous occasions notably
iienl 111 conditions of collapse. There is by Pratt, Peabody and Long in the Laboraiso
another factor in vasomotor collapse tory of Clinical Pathology at Harvard Uni-
/hich must not be overlooked. When in ver.sity, typhoid bacilli were recovered the
onsequence of over stimulation or of some following day from the gall bladder IJorr
oibon III the blood, the vasomotor centres in fact, obtained tvphoid bacilli from the
lye way and the arterioles relax, the circu- bile in less than eight hours after they had
itioii m the central iit-rvous system, where been introduced into the circulation Pratt
asomotor centres reside, is interfered with, in IWl, reported that the typhoid bacillus
ks a result less blood circulates through the was cultivated from the gall bladder in

312 THE CHARLOTTE MEDICAL JOURNAL. ]i
|
twenty-one out of thirty cases of typhoid in Krehl's clinic, found that inflltratiou of
fever that come to autopsy at the Boston the lymphatic tissue of the intestine occurred !
City Hospital. It is now almost universally not only in the second, but also in the third, 'i
admitted that the micro-organisms become fourth and even fifth week. Necrosis and ;|
widely iHsseminated throughout the body, sloughing of the swollen Peyer's patches j
They have been recovered in a single sub- were observed as early as the second and i
ject at autopsy from the heart's blood, the as late as the seventh week, lie concluded i
spleen, the liver, the kidney, a mesenteric that the characteristic typhoid symptoms :
lymph node, the gall 1)ladder, the urinary are not the result of the intestinal lesions, j
bladder, the right middle ear, and the bone but the two are co-ordinate. Typhoid fever i
marrow (Pratt). It has been isolated from is tlius a general infection in which intesj
the urine in a large percentage of all cases tinal alterations can occur. Not only are ,J
examined. Jacobi and Munch report that these cases of typhoid fever without intesj
they found it in 25 per cent, of their cases, tinal lesions, but \'elich has observed severe I
Petruschky calculated that in one of his typhoid ulceration of the intestine without j
cases each cubic centimetre of urine con- any disturbance of the health; in other
j
tained 172,000,000 typhoid bacilli, and words, without typhoid fever. In an article i.j
Gwynn estimated that 500,000,000 per c.c. published in the Jour. A. M. A. in 1907,
j
were present in a case reported by him. A from which we quote at length, Pratt, Peaj
number of recent investigators have found body and Long conclude that it is probable |
typhoid bacilli more often in the urine than
in the stools. Among ninety-eight convathat
the typhoid bacilli in the intestine I
come chiefly from the bile. There isnc:)
lescents studied by Herbert, only three evidence that they are thrown off in large -j
showed typhoid bacilli in their stools, while numbers from the ulcers as was formerly :fl
they were present in the urine of eighteen, taught. If so, one would expect to find an (
He found they occurred in the urine in large increased number in the lower part of the I
number, in the stools only in small number, ileum, but Foster and Kayser, as well as >
The presence of the typhoid bacilli in the v. Drigalski, showed they were more abund- il
rose spots is well known. Richardson, ant in the upper portion of the small intes- i
Drigalski, Jehle, and Rau have found it tine. Councilman says that he has not inrepeatedly
in the sputum when bronchitis frequently been unable to demonstrate t
was associated with the typhoid infection, bacilli in sections through the base of ty- I
and Dieudonne even recovered typhoid phoid ulcers. Jurgens reported that typhoid 4
bacilli from the sputum seven weeks after bacilli may be present in the intestinal con- i
fever had disappeared. Still more upset- tents in the usual number when the ulcers j
ting to our older ideas, however, is the fact have entirely healed.
that undoubted cases of typhoid fever with- i
out intestinal lesions have been reported by
structurb or opsopsins.
such investigators as Opie and Bassett. Numerous investigators, among them I
Jehle observed a case in which there were Savtchenko, Besredka, Loehlein and Dean, j
no characteristic changes in the intestine, have regarded opsonins as identical with ;
and yet the sputum contained typhoid amboceptors. Muir and Martin have shown i
bacilli. Rau \so\aied dar/7//is /jpkosas from that not every immune body produces an !
the sputum when cultures from the stools opsonizing effect. Hektoen has, from a'
were negative. Years ago Bumgarlen stated series of experiments, decided that opsonins
that the typhoid ulcers in the intestines are distinct substances or antibodies. New- I
should be regarded as metastases rather feld and Rimiiau, Newfeld and Toepfer, I
than as primary lesions, a theory which Keith, Bulloch and Atkin, agree with Hekwas
revived by Scholtmuller in 1902. Later toen and Wright and Douglas that opsonic |
knowledge has shown that in cases of ty- action is due to the presence of hitherto
phoid cholecystitis, in spite of the discharge unknown distinct bodies. Before this c^ i
of enormous numbers of typhoid bacilli into be accepted, says Schorer, it will be neces-' i
the intestine with the bile, there are no in- sary to repeat many of the experiments !
testinal manifestations. Not only are there that have been made, inasmuch as in Eng- j
no intestinal symptoms, but in a fatal case land and America especially, these inves- i
reported by Burlew there were no typhoid ligations were made at a time when no dis- i
ulcers in the intestine, although the bile tinction was made between normal and: j
containing typhoid bacilli entered the immune opsonins. The existence of nor- j
duodenum freely. In chronic typhoid mal and immune opsonins is now (luite, i
bacillus carriers, although the typhoid generally accepted. Newfeld in a consid- )
bacillus may be the predominating micro- eration of the causes of phagocytosis, states |
organism in the intestinal contents, no in- that he believes bacteria and foreign bodies f
testinal disturbances are produced and are only taken up by the leucocytes when! i
health is maintained. Wennagel, working the latter are stimulated. He bases this;
|
I
J

EDITORIAL. 313
assumption on the phagocytosis of red Recently Muir and Martin, Levaditi and
blood cells by leucocytes, which occurs luman, and Huhne.Xewfeld have ascribed
only when a special haemotropic serum is the action of normal opsonins to complejpresent.
hi the haemotropic serum, accord- ment. Cowie and Chapin have found that
[ing to Xewfeld, the physico chemical con- normal guinea pig serum restores the op-
Idition is so changed that a part of the body sonic power to normal serum which has
I
is modified so as to serve as a stimulus or been heated to 550° C. They believe from
jappetizer for the phagocytes. Virulent their experiments that opsonins (normal)
organisms dissolve with greater difficulty exert their action because of an amboceptorland
give off less appetizer, and because of complement group. Hektoen has recently
[this there is less phagocytosis of virulent published results of experiments from which
|organisms than of organisms with decreased he concludes that the activating element is
(virulence. Spontaneous phagocytosis, ac- free from the opsonin, and therefore he be-
Icording to Xewfeld, is due to changes in lieves that opsonins belong to the third order
|the cell, one of these changes accidentally of antibodies of Ehrlich.
istimulating the leucocytes to phagocytosis.
Iln immunization Xewfeld believes a specific
ueprosy.
limmune substance is produced, which sub- i^ver since Biblical times the leper has
stance modifies bacterial or other cells so been considered as "unclean," and in cerithat
they will serve to stimulate the leuco- tain localities, even up to the present time,
icytes to phagocytosis. Immune opsonin or the afflicted person cries out, or bv a bell or
jbacteriotropin, is a thermostable substance other means indicates his presence, that he
fwhicli does not require complement. Xor- may be shunned, from the supposed fear of
[mal opsonin, on the other hand, is believed infecting others. The great dread of the
jto produce its action because of normal disease leprosv has undoubtedly been furjambncepter
and complement, which gently thered bv many writers of fiction', and such
dissolves bacteria and in this way stimu- books as '"Ben Hur" have had great influllates
the leucocytes to phagocytosis. Im- ence; on the other hand, there has been very
jmune ojisonins resist temperatures up to little said or done to check or lessen the
;55 C. for one hour, 65° at times not being popular prejudice in this direction, which
sufficient to destroy their action. If the has been too often shared bv physicians,
opsonizing action of immune .serum is once who, not having devoted special attention
ost it cannot be regained by the addition to the matter, accept thoughtlessly the gen-
)f fresh complement. Muir and Martin eral verdict. It may safely be said that the
lave found that inactivated immune op- word "leprosy" strikes more terror into the
;onin absorbs little or no complement. He- heart of its victim, or suspected victim, and
ause of the properties of immune opsonins, also into the mind of the average lavman,
hey are generally regarded as belonging or even physician, than that of almost any
the antibodies of the second order of other disease known; and yet, to those who
ihrlich. They apparenlly iwssess two are really well informed, it bears no comnroups,
the opsont,))hore and the hapto- parison to either cancer or tuberculosis in
>hore. Of these the opsonophore group is the mental distress which it should cause in
lestroyed by heat, age, acids, etc. It is those afflicted, while syphilis and many
bus seen tliat immune opsonins resemble other diseases should inspire far more dread
he agglutinins and precipitins in structure of contagion. Few realize that, in this
nd by some investigators have been climate at least, leprosy is really a harmless
liought to be identical with agglutinins. affection to those who may come in contact
Normal opsonins, though not ackiiowl- with it. A good many years ago the Lepdged
by Wright to be different from im- rosy Committee of the Royal College of
lune opsonins, have characteristics by Physicians of London wrote as follows:
rhich they differ from the latter. Xormal "The all but unanimous conviction of the
psonins resemble compleineiit in tiiat they most experienced observers in different
re absorbed or fixed by sensitized and noil- parts of the world is quite opposed to the
snsitized bacteria, blood corpuscles, spe- belief that leprosy is contagious or comific
precipitates and indifferent bodies, municable by proximity or contact with the
nd exhibit thermolability aild suscepti- disease." And recently, in connection with
ility to deterioration by age. Noguchi the Karly case, Dr. Welch, of Johns Hopas
found that normal opsonins resemble kins, remarked: "Leprosy is practically
implement in that they are highly labile the least contagious of all the infectious
odies, lose tlieir action on standing sev- diseases." Dr. L. Duncan Bulkley, v\hom
"al days, are preserved for a long time we quote, after careful study of Leviticus,
hen i)reseiit in the blood in a dry state, chap, l^ and 14, and of all the other referiid
ill this condition can be heated to 135° ences to leprosy in the Bible, is convinced
without destruction of their functions, that what we know by that name was not

.!14 THE CHARLOTTE MEDIOAL JOURNAL
intended or included in the descriptions presents a white diseased surface, and these '\
given. It is, he believes, improper to ap- instances probablv related to psoriasis, as i
ply the term, "the leprosy of the Bible" to in the case of Moses' hand, Miriam, and l|
the disease under discussion, lepra, or Gehazi; also in many places the Bible '
elephantiasis Graecorum, as studied so thor- speaks of the skin tun ing while with white !
oughlyin Norway and observed abundantly hair on it, referring to leucoderma, etc. It :.'
in the East, and more or less over various is to be remembered that not long ago the i!
portions of the earth. word lepra, now exclusively applied to lep- j
It is to be remembered that the Levitical rosy, or elephantiasis Grsecorum, was a
law was given at Sinai, or soon after, when common designation for psoriasis, used thus j
there was an enormous, untrained horde of by Mr. Erasmus Wilson of London, and !(
Israelites, recently escaped from bondage,
who were being welded into a nation, during
forty years of a roving, nomad life. In
also as the title of quite a large book on ;
psoriasis, by George Gaskoin; while the i
word "lepra'' is used in the Greek New •
order rightly to shape this people the great Testament to indicate the leprosy of the li
law-giver Moses, by Divine direction, formu- Bible, and this word lepra means scales, •
i
i
lated many laws and rules, in regard to Finally, the word zara'ath, translated lep- ;
health as well as in regard to moral and rosy in the Old Testament, signifies a smitreligious
matters, which formed the basis ing or stroke, and in the German of the
for the national life of the Jews for many middle ages the same word was translated
centuries, and are operative in a measure aussasdig, indicating an outcast, or one uneven
to the present day. fit to live with others.
Now among the manv ordinances relat- , „
„
'
^ 1,1.1 ... iiig to health it became necessary to treat
DRIC ACID rtND GOUT.
of diseases appearing on the skin, some of His and Freudweiler have not long since
which are contagious and which, if neg- produced evidence to account for the
lected, would readily spread among those Sodium Urate deposits in cases of gout,
living together in tents, unless some sanitary
precautions were taken. We must re-
They showed that an inflammatory process,
similar to the one observed in gout, can be
member, however, that there were no books produced by a crystalline deposition of
and no medical science in those days, but sodium biurate; and Kionka has shown by
that the priests were about the only ones animal experiments that a long-continued
who possessed knowledge of any kind, increase of the alimentary uric acid content
Consequently we find in Leviticus just about of the blood leads—at least in certain places
what we would expect, a layman (in medi- —to a precipitation of uric acid crystals,
cine) Moses, writing for lay priests, and The concurring views of numerous authors,
consequently it is by no means a scientific that a primary overloading of the blood
discussion of the subject of leprosy. with uric acid plays an important role in
It is, therefore, no wonder that the de- bringing about a condition favorable for
scription of the various conditions found on the urate deposit, meet with no serious
the skin should be more or less confused, controversy. The questions, however, still
so that only by the most careful study can remaining to be studied are: \. Why in
one make out what is intended. Several cases of leukemia, pneumonia, and of
who have investigated the matter state that chronic nephritis, in which there is like-'
undoubtedly a number of different diseases wise a noticeable overloading of the blood
appearing on the skin are included in the serum with uric acid, there seldom or never'
Biblical accounts, and one can discover in- results a condition similar to the one obdistinct
references sufficient to identify some served in gout; and 2. Why the deposits!
of them; thus, writers have found allusion are always formed in certain predetermined;
to syphilis, favus, ringworm, pinta, scabies, places in the body H. Strauss, in his re-,
psoriasis, eczema, morphcEa, leucoderma, cent excellent monograph, says in regard to!
and perhaps other affections on the skin, the first point, that the combination of goutl
but, as intimated, before, no one well ac- and leukemia has been described by Duckquainted
with true leprosy, as recognized worth, Pibram, and Ebstein, but that such'
today, would Ije able to find any descrip- cases are very rare; however, he refers to
tion at all fitting to any of its symptoms in the fact that gout and nephritis occur COthe
Bible. The cry of "unclean, unclean," incidently by no means infrequently, ."^cand
the eeparation of those afflicted, with cording to Strauss in gout the overloading
out the camp, related therefore to various of the blood serum and the tissue fluid witi
eruptions on the skin and not at all to uric acid is not a necessary condition fe
present-day leprosy, and affords not the the precipitation of the crystalline deporfi
slightest reason for such action today. of acid sodium urate. And, also, the fa
It is, however, now known that neither that this crystalline precipitation does n
the tubercular nor the macular leprosy ever take place in all tissues, but only in certait

EDITORIAL. 315
definite locations, shows that the purely ism, in localities where there is already an
chemical process caused by a superabund- abundance of uric acid, which is conseance
of uric acid in the plasma cannot be quently precipitated,
the decisive factor. The consideration must
be added, to which attention has
stand/\rd
already
oil vs. hookwormbeen
called, that a similar increase is possi- The gift of one million dollars by Juo.
ble in the blood of those who are not gouty. D. Rockefeller, the Standard Oil magnate.
On this account it is important to investi- for the purpose of fighting hookworm disgate
tiie causes for the precipitation of ease offers considerable opportunity for
urates from a solution which contains large speculation and theorizing. Th^at the gift
amounts of uric acid, but is not saturated, 's so huge vastly impresses the popular
This shows the direction for an investiga- mind; but, balancing the money against
tion of the relation between alkalescence ^^^ task of applying it properly and suc-
^nd activity of the blood. Researches along cessfully toward the eradication of Uncinafhese
lines have been conducted by Klemp- riasis, it shrinks relatively to lather small
rer, who employed the method of determning
the COj content of the blood, by
dimensions. During the past decade, thanks
to the brilliant investigations of Dr. Clias.
5trauss, and by Magnus- Levy according to \\'. Stiles, of the United States Public Health
he titration procedure of Loewy. None of and Marine Hospital Service, we have come
hese, however, have brought to light any to know apparently about all there is to
eduction in the alkalinity of the blood, know about Hookworm disease. That it is
Strauss has shown that the human organ- exceedingly prevalent throughout large
sm holds with extraordinary tenacity to a sections of the South is thoroughly demon-
jlood alkalescence within a certain limited strated. That thousands of individuals, of
ange ( .500-.3.5() mg. XaOHto lOOcc. blood), the large working class of people, are affect-
le concludes therefrom that the influence ed and thereby rendered unfit for particif
the alkalis introduced into the body does patingin the great industrial upbuilding of
lot seem of the highest importance in the tli's section can easily be believed. The
olution and hence excretion of uric acid, disease seems to present few or no difiicullowever,
it may be said that Iv Pfeiffer ties so far as diagnosis is concerned, the
las succeeded, by the introduction of alkali symptoms being well defined and the parauring
a gouty attack, in diminishing the site being easily found in the stools. And
mount of uric acid deijosited from solu- the treatment is so cheap, so short, so easily
ion; and tiial, on the other hand, the addi- applied, and so magical in its results that
ion of an acid reacting compound to a solu- its very simplicity has aroused the risibili-
OH containing uric acid, or its salts, does ties of many a lay news editor. A few cents
ot under all circumsta'..ces cause the pre- worth of Thymol and a dose of Epsom Salts
ipitationof uric acid. However, uric acid turns the trick and, presto! the hitherto
an be retained in solution, as has been pale, stunted, anemic, lazy, shiftless,
lownby Min.sowski and extemporaneouslv doless, good for-nothing, dirt-eating Southy
Goto, by means of a chemically pure em white is transformed into a useful and
ucleic acid, namely, thymic acid. These desirable citizen. It is, however, not with
bnflicting reactions can b» explained bv a"y purpose of attempting to detract from
fact that uric acid has been wronglv the worth of endeavors to banish a disease
iified as an acid while the other mem- which has probably for many, many years
ers of the xanthin group are regarded as cast its blighting influence over this sunny
asers. The importance attributed to the land of ours, that we write in this vein.
roducls of local processes in the precipita- There can be no doubt, but that it is enon
of uric acid is not detracted from bv tirely possible to combat the disease so sucle
results of more recent animal experi- cessfully that it may be entirely eradicated.
ents made by van I.oghem, Silbergleit Vet the undertaking is a huge one and will
id others, wiio found that in animals the "ot be carried out without opposition. Mr.
troduction of alkali favors the formation Rockefeller's contribution and the method
urate deposits, while the introduction of he has adopted, by the appointment of a
:ids inhibits it. This can only be explained commission composed of the following emi-
' the assumption of local metabolic dis- »e'>t men:
irbances or changes. The peculiar tela- '^f- William H. Welch, professor of pa-
)n of the lymphatics in cartilages causes thology in Johns Hopkins University; presito
appear, as I>:bsteiii mentioned, that dent of the American Medical Association;
re a local retardation of the circulation I'r- Simon Flexner, director of Kockeuld
generate a condition of fluids over- feller Institute of Medical Research;
flen wilh uric acid. Strauss attributes Dr. Charles W. Stiles, chief of the divisestablishment
of a gouty attack to the ion of zoology. United States Public Plealth
aping up of certain products of metabol- and Marine Hospital Service, and discov-

316 THE CHARLOTTE MEDICAL JOURNAL. ;
:
'
ererof the American species of Hookworm, » « ^ R-^h-w^y sukoboins. |j
and the
America;
prevalence of the disease in The Association of Seaboard Air Line 'i
Railway Surgeons held its eighth annual i;
Dr. Edwin A. Alderman, president of the meeting in the hall of the House of Repre- :|
University of Virginia; sentatives in Raleigh, X. C, October 19lh 'I
Dr. David E- Houston, chancellor of and 20th. :'
Washington University, St. Louis, Mo.; The sessions were largely attended, there :i
Prof. P. P. Claxton, professor of educa- being present surgeons from all sections of
tion in the University of Tennessee; the country through which the Seaboard
Mr. J. y.. Joyner, State Superintendent Air Line passes. The meeting was called :
of Education in North Carolina, and presi- to order by Dr. James R. Rogers, of Raleigh, li
dent of the National Educational Associa- chairman of the committee on arrange- i
tion; ments, and following this there was a prayer j
Mr. Waller H. Page, editor of The by Rev. Milton A. Barber, rector of Christ i
World's Work; Church. There were a number of addresses ,i
Dr. H. B. Frissell, principal Hampton of welcome, the first of these being by Gov- 1/
Institute; ernor W. W. Kitchin.
Mr. Frederick T. Gates, one of Mr. City attorney, Walter Clark, Jr., welj
Rockefeller's business managers; corned the doctors on behalf of the city,
j
Picot, physician of the State I
Mr. Starr J. Murphy, Mr. Rockefeller's and Dr. L. J.
counsel in benevolent matters; Hospital for the Insane, on behalf of the!
Mr. John D. I^ockefeller, Jr , would seem Medical Society of Raleigh and Wake i
to guarantee that there will be results which
are worth while.
The work merits and receives the approcounty,
eloquently expressed thevvelcomeii
to the visitors. Mr. W. H. Pace, of the
j
Raleigh Bar, and legal representative of t
bation of the whole nation and of the medi- the Railroad, and Chief Surgeon, Jno. M. )
cal profession particularl)'. And since it Burke, of Petersburg, Va., responded. The I
affects our Southland especially, we should address of the President, Dr. William Wes- j
doubtless feel very grateful to Standard Oil. ton, of Columbia, S. C, followed. Dr. i;
It would have required many years to have Weston discussed various topics in refer-]
secured so large a sum of money by legis- ence to the work of the Seaboard Air Line f
lative enactment on the part of Stales or surgeons and the profession and their rela- 1
the nation to be applied for such a purpose, tion to public health, which he held the .
Perhaps it never could be done. When the thing of main importance. In his remarks •
taxpayer is asked if he may be called upon he said that the physician is the one de- i
to contribute his share for such an enter- pended upon in the problem of health,
prise, he usually puts his foot down upon He dealt especially with some of the more 1
.
i
'
'
:
|
it very promptly. But everybody must use recently discovered problems ot health and
Standard Oil. It is, therefore, only neces- hygiene, which the South has now to face,
sary to raise the price a little and whether Some of his utterances were sensational and |
he will or no the consumer must contribute, radical, Ijut none the less vital and true,
Such an admirable arrangement it would The association voted unanimoush' to
be if it were possible to obtain the assist- adopt the recommendations of Chief Sur- \
ance of Mr. Rockefeller in a campaign geon Jno. M. Burke that the management'!
against tuberculosis, typhoid fever and of the Seaboard Air Line be urged to eslab- i
other prevalent and widespread diseases, lish a relief department for the employes'
He need only squeeze the people a little and a chain of hospitals under the relief \
harder and the funds are forthcoming. And department auspices.
then while it is perhaps only human nature This action was taken on recommendathat
we should each and every one imagine tion of a special committee named to outthat
we could have done better if the doing line some scheme along the line of the rec- |
had been left to us, it does seem that there ommendations of Dr. Burke in his annual 1
are ruore powerful and weighty reasons ^-ddress. \
why such a sum of money could have been ^ committee including the officers of the
j
',.,,, . , ^ , . association, will lay the matter before the, ,
applied to better purpose in the fight against
^^^-^^^ g,,^ ^^ whatever thev can to bring I
tuberculosis. Of course it wouldn't have about the establishment of the department.; |
counted so greatly in that direction, because Discussion developed the fact that many of j
of the vastly greater need, the results would the Railway officials high in authority arej J
^1''^^^ heartily in favor of a relief depart-, t
contain less of the spectacular and, on a
,r , , . , ^, , , , , ment for the system. It looks as if it will i'
purely selfish basis, the South would have ^^rtainlv be inaugurated soon after the sys-j .:
received less of the benefits than it will tem passes out of the hands of the receivers. '
from this million dollar fund. A large number of interesting papers weKj j
i i

EDITORIAL. -,jy
'^ """''"'
S. C.i Dr Cameron B rm
°»" »' - dean ^f medical de:
D K II IWrlll '
,"^^:, panment Tulane University, New Orleans,
f T.
'
K"-^'»"ond. was La.; II. F,
wV:,i u
Harris,
u°^ M. D., secretary
lect^l a member State
of the executive com- Board of Health, Atlantk, Ga.; C W G
The- association adjourned to meet in Lt^d^'of'HeStL.TaUimore^tr-loh'lt
o be hxed later.
ders, M. D., State Hospital, Columbia; 1
co^rERENCE ON PEbbftGRrt. W. Mobley, M. D., State Sanatorium,
Ihe National Conference on Pellagra Milledgeville, Ga.; C. C. Bass, M D New
1^ u" ^'"'"'"l^'a. S- C, November 3rd and Orleans, La.; H. P. Cole, M. D., and G J
th, brought together, from all parts of the Winthrop, M. D., Mobile, Ala.; J. M. King
nited States and from many foreign coun- M. D., Nashville, Tenn.; J. H. Taylor m'
ries, about three hundred of those who D-, Columbia; J. F. Brown, M. D., Fairave
taken most active interest in observ- view, N. C; H. E. McConnell, M. D.,
igandinvestigatingthedisea.se. ToC. F. Chester; J. J. Watson, M. D., Columbia'
Williams IS due chief credit for projecting C. S. Pixley, M. D., Winnsboro; William
ie conference and arousing the enthusiasm Allan, M. D., Charlotte; W. O. Nisbet, M.
lanifested in so large an attendance. Aside D., Charlotte; T. W. L. Bailey, M. D.,
•om the discussions of the disease, its eti- Clinton; J. H. Randolph, M. D., and R. n!
log>' and prevention, the main object of Greene, M.D., Hospital for Insane, Chattale
convention was the formation of a hoochee, Fla.- Rea Parker, M. D., State
ational Association for the Study of Pel- Hospital, Williamsburg, Va.; J. M. Bucgra.
Dr. J. \V. Babcock, of Columbia, hanan, M. D., State Hospital, Meridian,
la Ur. C. H. Lavinder, of the I'nited Miss.; J. Roddey Miller, M. D., Rock Hill;
ates Public Health and Marine Hospital John Lunney, M. D., Darlington; Theo-
;ryice, have also taken active part in pro- dore Maddox, M. D., Union; H. H. Grifotnig
the conference. According to re- fi". M. D., State Hospital, Columbia; M.
)rtsread at the confeience the disease is a B. Young, M. D., Rock Hill; Crown Tor-
"'^ "nport not to the South peculi- rence, M. D., Union; D. S. Pope.
I K
M. D.,
riy, but really to the whole of America. State Hospital, Columbia; A. B. Clark, M
I "'''"'•/' expressed by j)., Plan.eisville, 'mSv"of°,
majority
and E. M. Whaley,
of those who
M.
addressed the ^^^ •
, ,
t^ r „/
vention, is that

3]§
THE CHARLOTTE MEDIOAL JOURNAL
Wavnesville N. C, was unanimously places the doctor entirely beyond the pale I
'
adopted-
°^ ^^^ ordinary free, independent profes- <
"Resolved, That this conference recog- sional man. it is placing in the hands of j
nizes the widespread existence of pellagra a layman—and he may be a very honest, \
in the United States and urges upon the upright man, too—the right to say when |
national o-overnment the necessity of bring- and how the professional man shall use !
ino- its powerful resources to bear upon the those means and tools which he alone i
vit^kl question of its cause, prevention and knows how to use. A law which says_ a
control
doctor must not prescribe a drug in tne i
"Resolved That while sound corn is in manner which to him seems best, abrogates
\
no way connected with pellagra, evidences those precious rights so long cherished and, i
of the relations between the use of spoiled indeed, at once destroys his place m mod- :
corn and the prevalence of pellagra seem so eni sc-ciety. It were quite as justifiable to (
apparent that we advise continued and sys- say that he must not employ aconite, opium, i
tematic study of the subject, and, in the chloroform and other dangerous drugs as to
meantime we commend to corn growers attempt to deny him the right to prescribe I
the great importance of fullv maturing corn alcohol. The Greensboro and Guilford;
'
upon the stalk before cutting the same. countv doctors resented the action of the |
"Resolved That the work of this confer- authorities, and in a meeting held behind ;
ence be brought to the attention of the vari- closed doors the Guilford County Medical |
ous State and Territorial Boards of Health Society adopted the following resolutions j
and thev severallv be urged to specially in- which we herewith print m part:
vestigate the disease, particularly as regards "Resolved, Bythe Medical Society of the
its prevalence, and that they also see that County of Guilford, in regular meeting, i
the proper inspection of corn 'products sold duly assembled, that, in protection and per- ,
in the various States be had." petuation of the dignity, honor and inde-
The climax of the conference, however, pendence of our profession, we solemnly .
was reached when The National Associa- protest against the inauguration of such ;
tion for the Study and Prevention of Pella- methods as unwarranted by law, grossly
era was formally organized. Dr. J. W. unjust to the individual victims, in deroga- :
Babcock, superintendent of the South Caro- tion of the rights of the citizen, discredit-
lina State-Hospital for the Insane, Colum- ing to the medical profession, and calcu- i
bia was elected president; Dr. William A. lated to bring the orderly administration of ;
White, superintendent of the United States justice into public disrepute and contempt. |
Hospital for the Insane, Washington, D. "Resolved second, i hat we hereby pledge 1
C vice-president, and Dr. George A. Zeller, our united effort towards disconntenai.cinK
superintendent of the State Hospital for the such a perversion of justice in the name of
Insane Peoria 111., secretary-treasurer, law, and towards repelling the assault upon
Later, 'a vice-president for each State inter- the efficiency of the medical profession and
ested in the movement, will be named its integrity, involved in such procedure:
An official pellagra congress, to be held ^^^^ to that end
under the auspices of the association, is
"Resolved third. That we hereby forbid
scheduled for June, 1910 in Peoria 111.,
prescriptiomwhich
city was chosen without a contest. ^ny arug^isi vyuo v
[ ^ ,
written bv members of this society from ex-
GUIUFORD GOUNTY PtIYSICIftlNS AND Wriuen uy ii.e ,
PUoniBiTioN. hibiting the same to the inspection of anj^
The medical profession of the whole State one without the written consent of the phy^
have probably awaited with considerable gjcjan writing it and the patient receiving
interest the outcome of the action taken by .^
the physicians of Greensboro, N. C, in re-
'^.n^ ,„ ,
f^,,,*!. That we hereby re
gard to the prosecution of certain doctors
Resolved fourth, That we ^erebyje
in the city courts because of alleged viola- affirm the resolutions of the North CaroliW
tion of the prohibition laws of the State. Medical Society, adopted at their anuvia
One physician was tried on the charge of
meeting in 1908, and pledge to them and*
having written a prescription for whiskey
^^^^.^ establishment and perpetuation Ott
for himself. The city ordinance requires
the chief of police each dav to inspect the ti^arty support.
,,.»..
prescriptions for whiskey filed in the drug These resolutions upon their publicatioi
stores and at the end of each month publish and presentation by representatives of ta
the number of prescriptions given by each medical society before the board of aldei
physician. The doctors consider, and
g^, aroused considerable factional feeling
we believe justly, that this espionage if
aldermen unti
not unconstitutional, is an invasion of their /^cuon was ueic.ic^ y
professional rights. Indeed, such a law their next meeting.
;
i

EDITORIAL.
AI

320 THE CHARLOTTE MEDICAL JODRNAl . ,
!
I
i
i
j
;
i
After these general papers the Laboratory the Domiciliary Visit in the Struggle
section took up in turn three general topics Against Yellow Fever,"
—Air, Diphtheria and Animal Tests and Dr. Francisco Valeiizuela, of Mexico
Inoculations. "Bacteriological Tests of City, presented a careful study of the cam- i
Air Analysis," by John Weinzirl, of the paign against yellow fever on the Isthmus,
University or Washington, Seattle; "Preliminary
Note on the Determination of Carbon-Dioxide
in Air by Electric Conductivity,
with a Record of Some Experiments," by
of Tehuantepec, in which he explained the |
methods of fumigation adopted to utterly i
exterminate the mosquito. He said his re-?
cent experience all over Mexico could now
Professor R. C. Howe, of the Massachusetts confirm the guarantee that yellow fever is
Institute of Technology. fully under control. A report of yellow
The discussion of Diphtheria was led by fever in the Mexican republic from August,
F. H. Slack, B. L. Arms and Marion Wade, 1908, to date, prepared by Dr. Edudo
all of the Laboratory of the Department of Liceaga, president of the Superior Board of ;
Health of Boston, who presented a joint Health of Mexico, was read. He showed i
paper on "Longevity of the Bacillus of that throughout the republic of Mexico;
Diphtheria on Swabs," and there was a re- during the past year there had been no epi- j
port of the committee on standard methods demic of yellow fever, but only a few isola- j
for bacteriological diagnosis of the bacillus ted cases. j
i
,
]
i
,
of diphtheria, presented by Dr. B. R. Rick- President Swarts expressed the grati- I
ards.
tude of the convention to the Mexican mem-
A discussion of rabies and glanders came bers for their remarkable reports. And i
up under the head of animal tests and in- Surgeon-General Wyman discussed the
oculations, a paper on the "Period of Incu- three papers, saying that they gave evidence
bation of Inoculation Rabies" being pre- of the care being taken by the Mexican
sented by B. L. Arms, Jr., of the Boston
Department of Health, while there were reauthorities
in the suppression of the scourge.
Typhoid fever received special atteution
portsof the committees on methods for diag- in the general session. The report by the I
nosis of rabies and on methods for the bac- committee on typhoid fever urged emphatteriological
diagnosis of glanders. ' ically that physicians be urged to make i
In the Section on Vital Statistics, the prompt report to health officers of 4II sus- 1
Chairman's address was read by Dr. Chas. pected cases. Physicians, the report said, J
A. Hodgetts, of Toronto. The following must not only be skilful in diagnosis, recog- «
(
are some of the more important presented:
"Morbidity Statistics in the Matter of Innizing
the enemy on its first appearance, but
|
must also be faithful in reporting, the part 1
sanity in Immigrants," Dr. Peter H. Bryce, most often neglected. |
of Ottawa, immigration officer of the Do- Dr. William Royal Stolkes, of the Balti-,
minion of Canada; "The Ages of 500 Cases more Health Department, spoke on the preof
Hook Worm Disease and Frequency of vention of typhoid in the citv and country
the Disease in Different Age Groups,,'" a districts, illustrating from his own experi^
carefully prepared scientific study, by Dr. gnce. Flies beheld to be the largest typhoid
C. W. Stiles, of Washington, and "Small- carriers, showing that where proper sewet;
pox in the United States," by Assistant and screens had been provided there coul(
Surgeon-General J. W. Trask, of the United be no disease. Nearly, if not all, of Typ«
States Public Health and Marine Hospital A of the typhoid bacillus, he contended, was
Service. carried by flies, while Type B, a milder di
In the Section of Municipal Health Offi- ease, he attributed either to drinking wati
cers a series of resolutions were adopted con- or milk.
demning the practice which is declared to
^^ ^ y Chapin, of Providence, R.
obtain in many cities of apponitmg the
spoke on "The Control of Milk-Borne
health officer for political considerations,
breaks of Typhoid Fever."
rather than merit, as contrary to the best ^ , . , ^, . „ , . . ,
interests of public health, and recommend-
./"dustnal Hygiene, Fresh Air and
tilation problems
ing that when
were discussed, with
proper officers are selected
series of J
they
papers
be continued in office and
by invited New dismissed \ ork soe4
for cause only, it being represented that in o agists, who in a great city are daily 1
the course of his duties the health plymg problems which the theorists m p-
officer
Nation
naturally has to take many stands which
have advanced.
may make him personally or politically un- A smoker at the Jefferson Hotel, a
popular, yet which are for the best interests
excursion on the James River, an auto
. , . bile tour of the citv and environs and al
of the community.
^^^^^-^^^^ ^^ ^j^^ ^^-^-^-^^^ ^^,^^^^^ provided <
A paper was read by Dr. Carlos Manuel tertainment in a city far famed for hos
Garcia, of Mexico City, on the ''Utility of tality.
I

EDITORIAL. 321
EDITORIAL NEWS ITEMS. Dr. Archie A. Barron, a young graduate
in medicine of Vanderbilt University, Nash-
Dr. F. J. Hunt, of Detroit, Mich., spent
a few days in Hickory, N. C, a few days
ago, in company with a party of his friends,
ville,Tenn., who has been practicing medi-
cine at Lake Toxaway, N. C, during the
summer months, has recently located in
looking for a location
Sanitarium.
for a Tuberculosis Charlotte, N. C.
It is supposed that a suitable
be found in a few days.
place will Dr. William D. Tewkesbury, of Washing-
ton, N. C, a graduate of the George Wash-
^, ~ , , , ";: ^ ington . University School of Medicine, has
The South Carolina State Trained Nurses' been appointed superintendent of the Vir-
Associalion met in the chapel at the Roper gi„ia State Tuberculosis Sanilorium, at
Hospital in Cliarleslon, S. C, on October Catawba Va.
the 27th and 2Sth, with Miss Leila V. Jones,
superintendent of nurses at the Roper Hos- The annual convention of the Southern
pital, presiding. Medical Association was held in New
The attendance was large, and the meet- Orleans, La., on November 9-11. The
ing a great success. There were several meeting was ver^' interesting and instructinstruclive
addresses made to the nurses on ive, there being more than a hundred papers
different medica l subjects. read by prominent members of the associatioii
representing every section of the coun-
A resolution was unanimously adopted at
try'.
:he annual meeting of the stockholders of , , , . , . ,
he Anderson County Hospital Among the subjects
Association,
which received espe
.
cial
in the hospital building
consideration
in Anderson,
was that of pellagra.
C, on October l.ith, to double the ca- At the monthly meeting of the Richmond
>acityof the hospiial building, making fifty Academy of Medicine and Surgery held
)eds instead of twenty-five. October 26th in Richmond, Va., Dr. J.
Another resolution provided for several Shelton Horslev read a paper "Report of a
ledsforindigent persons without cost. This caie of Transfusion of Blood," which was
astitution has just completed its first year, very instructive and interesting to the
nd its history has been a most remarkable academy. Dr. R. W. Martin, of Lynchburg,
was expected to be present and ad-
'^'^^^ Work on the hospital at the
^^^ members, but for some reasons he
federal prison
'^^^ Prevented /rom bemg . Atlanta. Ga.,
present
has been
and
begun. It is to
Papers were read
a two-story, stone structure, which
by Dr. Charles R. Robins
is
. cost in the neighborhood of $100,000 ^"'^ ^I^Ouire Newton in the place of
theaddress.
P''
hen completed.
^ , , „,^. ,
When completed the new hospital will ^.^t th>s meeting Dr. J A. White, of
R'^hmond,
one of the largest and
was elected chairman of the
most complete in
- - committee on entertainment of the In-State
le South. It is planned that the feder
Medical Association which will be held in
uilding, when finally completed, will ac
)mmodale
Richmond on February the 8th, 1910. Drs.
from 2,000 to 2,.S()0 patients
he hospital is behig t,uilt "on the prison )^'- ]:°"^- C^^rald A. Ezekiel and George
J"^"
r, Ilandley were nominated to membership,
servation.
—» and will be elected at the next meeting.
Governor Ansel, of South Carolina, on n-< r^ \ i ^VJ^- i^ ^ • .•
The Ochmnlgee Medical Association met
:tober 29th, . appointed Dr. H. A. Ilines,
Seneca, and Dr. William Kggleston. of '" ^\';'^^,!:/.'^,' °" ?', ^ fj ^i/ ^^°^
artsville, members of the executive c^m- "/ °" dehvered the address o
'
;;-*'lcome, ^^^'^f and the response on the part of
ittee of the State Boardof Health of South
irolina. vice Dr. J. A. Hayne, of U.reen- Hj^ association was made by J. I. Clark
* J ^ ^
,,
.
1
»
^^f Th of Eastman, Qcttnati ^,Q Ga. An All address orirlrficc Tvoc was rl

322 THE CHARLOTTE MEDICAL JO0RNAL. j!
Dr. O. O. Fanning, who lias for the past parents at their home in Charlotte. Dr.
year, soefficientlv superintended the Wesley Brem during the summer underwent sue- !
Memorial Hospital in Atlanta, Ga., has re- cessful operative treatment al Rochester, ;
signed his position in that institution. Dr. Minn. He is an energetic young doctor of i
Fanning is a promising young physician, the highest scientific attainments: his recent
and a man who will be greatly missed in &n\c\e: \n\.hQ Joiinial of the American Mcdi- I
that institution. He graduated with hon- cal Association, of September 11, in which I
ors from the Atlanta School of Medicine in he reported his investigation of the blood i
the spring of 1908. for the tubercle baccilli attracted very wide ,
Dr. Fanning is succeeded at the hospital attention and most favorable comment. He '
by Dr. George N. MacDonell, of Savannah, is a graduate of the Medical Department of {
Ga., who will no doubt fill the position very Johns Hopkins University ,
acceptably. Dr. MacDonell is a graduate ^^ ^ g Watkins, recently of Concord, !
of the Atlanta College of Physicians and ^ ^^ ^^^ ^^^^^ ^^^^^^^ assistant physician '
Surgeons. ^_^^__ ^^ ^^^ g^^^g Hospital for the Insane at Mor- i
The new Rex Hospital, Raleigh, N. C, ganton. Dr. Watkins is a native of Ruth- ;
was occupied October 1st. The furniture erfordton. ___^_^ I
and patients were moved from the tempo- ^^ ^^^^^ ^^^ ^^^ p^^^ ^f ^1^^ f^^^^jt^, ^f ^j^^
rary quarters to the new building without Chattanooga Medical College to exclude i
accident.
^ women from admission to the school failed i
The regular monthly meeting of the East recently because of the fact that the board;
Mississippi Four County Medical Society of trustees had already decided that the I
washeld at Armory, Miss., October 12. Dr. school shall be co-educational Some of
L. C. Flemster, of' Nettleton, presided and the doctors of the faculty have been urging i
" good attendance of physicians was re- the abandonment of the co-educational fea-
ported.
ture in the medical department for a long
time. At the meeting of the board of trus-
Dr. Addison G. Brenizer, a native of tees last spring, the matter was taken up
Charlotte, N. C, recently a student at the and again decided in favor of the women.
Medical School at Ileidelburg, Germany,
has been elected physician in charge of the The National Wholesale Druggists Assonew
American Hospital in Paris, France, ciation, at the recent meeting in Richmond,
This institution was opened November 1st. Va., urged the importance of laws to check
It is the only American hospital in Europe, the sale of cocaine. The association went
on record as recommending that efforts be
At the regular bi-monthly meeting of the
^^^jg to obtain national legislation against
Hamilton County, Tennessee, Medical So-
^jjg drug,
ciety held in Chattanooga, October 15, a
large and enthusiastic attendance was reported.
The society was addressed on
As a result of differences between the
Superintendent and corps of nurses of St.-
"Iritis" by Dr. George H. Price, of Nash- Peter's Hospital, Charlotte, N. C, nine
ville. nurses went on strike, and all efforts to ad-j
The North Carolina Association for the young ladies promptly found places at other
Prevention of Tuberculosis will meet in hospitals and the authorities of St. Peter's
Greensboro, N. C, January 25. 1910. An j^^ve procured other nurses.
attractive program is being arranged, a
number of men who are prominent in the The city authorities of Chattanooga^
fight against the disease, having consented Tenn., in conformation to their policy ol
to be present. The American Tuberculosis curtailing municipal expenses, have cut
Exhibition will be in the city to aid in the down the appropriation to Erlanger Hoswork.
Dr. W. L. Dunn, of Aslieville, is pital, so that this institution instead of be-
President, and Dr. Chas. Julian, of Thomas- ing run on a basis of $18,000 per year froi^
. just matters were ineffectual Most of the
ville, is secretary. city and cou»ty, must now be operated on
$10,000; $5,000 from the city of Chatta-
Dr. Arthur T. Reeves, a native of Bun- „oog-a and $5,000 from Hamilton county
combe county and for the \ ast three years .
connected with the government hospital
Nurses Graduate.
service in Panama, has returned to Ashe- ,
ville where he will locate permanently. Sixteen young women were gradua
from the Touro lafirraary Training Sen
Dr. Walter V. Brem, a native of Char- for Nurses New Orleans, on the evening
lotte, N. C, now located in'Christobal,Ca- Sept. 30.
nal Zone, Panama, has recently visited his The exercises were short, and

EDITORIAL. 323
solely of addresses by the president and vice Barr, Columbus, Miss.; Charles Henry Otpresideut
of the Board of Managers of the ken, Jr., McComb, Miss.; William Arthur
institution, and the Riving of the awards. Toomer, Tremont, Miss.; William A Car-
Those who completed the course and re- peuter. Meridian, Miss.; Lewis Winston
ceived diplomas and medals were: Misses Walker, Little Springs, Miss.; James Rob-
E. L. Xoble, Z. A. Schapper, L, A. Netter- art McCIain, Mathiston; General W. Mcville,
Mrs, L. Connell, Misses L. P. Cuyler, Gowan, Sturgis, Miss.; James Robert Chaa-
L. E, Xicholls, J.T.Gill, Mrs. O.G.Lytle, dler, Hattiesburg, Miss.; Marion Lexter
Misser A. G. Dupuy, P. Jacobs, C. Col- Montgomery, Louisville, Miss.; Samuel
longues, O. M. Ayraud, Mrs. L, M. Brad- James Tilden Darden, Mvrtle, Miss, ; John
ford, Misses F. M. Roettger, E. Weiss, E. Edgar Powell, Timberville, Miss.; Samuel
W- Racine Logan Stephenson, Marks, Miss.; Robert
The Judah Touro prize of $100, awarded Forrest Payne, Hudsonville, Miss ; John
to the pupil attaining the highest standard William Stringer, Soso, Miss.; Carsie Z.
of excellence in all branches, was won by Ballard, Monticello, Miss.; John Gordon
Miss F. M. Roettger. Prince, Claude, Miss.
New Collefle Hospital.
N„^^^^ Graduate.
NIrs. Joseph Brown Whitehead of Atlaii- The graduating exercises of the first class
L''.n?r H ^;';'""^'.'"^° tbV'^.'^i'"r^' °f "^^^^^ to have completed their course of
hospital at the Georgia School of Technol- training at the training school of the Charogy.
She therefore has the privilege o lotte Sanatorium were held at the Academy
naming the building which will be called of Music in Charlotte on the evening of
the Joseph Bro\yn Whitehead hospital, in October 12, 1909. Mr. D. A. Tompkins
memory of her husband, the late Joseph president of the Sanatorium Companv pre-
Brown Whitehead.
.
sided. Rev. . W. M. Kincaid, D. D., of the
^JlYA ^"^^ ^^ >nstitution from Mrs. pirst Presbyterian , church opened the exer-
Whitehead and her two pung sous, Joseph cises with prayer and Rev. Plato T. Dur-
Brown \\ hiteiead and Conkey Whitehead, ham, of Concord, N. C, delivered a most
and will make possible the beginning at eloquent address. Mr. Tompkins presented
once of that much-needed building-a hos- the diplomas and Miss E. E. Cherryman,
pital for the boys at the 1 ech. superintendent of the Sanatorium, awarded
Dr. Moore Locates at Chester. the prizes.
'^^^^
Dr. A. Wylie .Moore, has located
following
in diesare
the graduates: Miss
ter, S. C, for the practice of
Josephine R.
his profession
Hunnicutt, Lynchburg, Va.;
and is occupying a suite of
^'ss Lena offices M. Weller,
in the Repubhc, Ohio; Miss
Agurs building. ^^'^^^^
Dr. Moore is a graduate ^- Tittsworth, San Antonio, Texas;
of the "^^'^^ academic Lillian and medical departments
D. Davis, Orlando, Fla.; Miss
of the University of Virginia and has
Catharine
served
A. Olwill, New York, N. Y.;
as surgeon on the ^^'*^ ^^^''^
staff of Bellevue
L. Call, Freeport,
hospital,
La.: Miss
New York city. Dr. Moore is a Chester ^^^ry J. Crooker, Norfolk, Va.; Miss Florboy
and is a brother of Dr. B. S. Moore, of
^"^^ ^^- Haines, Xenia, Ohio; Miss Lillian
Charlotte, ^^'-ncastle, N. C. and is a nephew of Dr. W. Va.
^.^Y^'^'
Gill Wvlie, of New \'ork.
^"^^^ young ladies were delightfully entertained
after the exercises by Mr. Tomp-
Mlsslsslppl Medical Examinations. kins.
I
Out of the eightvone applicants at the
. recent meeting of the .Mississippi Medical
Physician Held lor Murder.
[Examiners (State Board of Health) only An investigation by the coroner's jury into
' twenty-one were licensed to practice inedi- the killing of E. K. Judson, patient of the
cine. The sixteen negro members all failed Jackson, La., insane asylum, whose horrif
to pass. bly burned body was found near St. Francis-
* This remarkably small percentage is due ville. La., October IS, resulted in the holdjin
part to the rigid policy instituted by the ing of Dr. E. C. McKowen for the murder.
board, and also to the close watch kept on The coroner's jury found that the body of
{the applicants to detect the possible use of Judson had been placed by the side of the
' jacks." There were a good many instances Yazoo & Mississippi Valley railroad tracks,
of this kind. Tiie successful applicants near Wakefield, by Dr. McKowen. No
^fe:
George Walton Wallace, Arbo, Miss.;
motive for the crime is given.
Dr. McKowen is in prison at St. Francis-
Louis Stinson, Canton, Miss.; William ville.
jjames Coleman, Aberdeen, Miss.; William
U- Lusk, Winona, .Miss.: -Marvin Montgoin-
All the evidence indicated that Judson
had been killed, apparently by strangulajCry
Hall, Belle Prairie, Miss.; Frank Ellis tion, some distance from where the body

324 THE CHARLOTTE MEDICAL JOURNAL
was found. It is considered probable that married in Galveston, Texas, on October
an effort to burn the body to conceal identi- the 25th.
fication was interrupted by the fear of the Dr. Rogers graduated from the University
slayer that some one was approaching. of Maryland School of Medicine, Baltimore,
— Md., in 1901. He received his license to
Marriages.
practice medicine in North Carolina in
1901, and also joined the North Carolina
State Medical Society in that year.
Dr. Thomas .Newby While, of Belvidere, Dr. J. R. Paddison, of Oak Ridge, N. C,
N. C. and Miss Jane Denson Pretlow, of and Miss Zora Sapp, of Kernersville, N. C,
Frankljn, Va., were married in the Episco- -were married at St. Leo's Hospital in
pal Church in Franklin on October the Greensboro, N. C. October 28, 1909. The
20th. ceremony was performed immediately pre-
Dr. White is a graduate of the College of ceeding an operation for appendicitis which
Physicians and Surgeons, Baltimore, Md., Dr. Paddison underwent successfully,
having graduated from that institution in
18S2. He is a prominent physician of Bel- »»•• V. B. Cox. a very popular physician of
videre, where he and Mrs. White will re- Chester, S. C, and Miss Leila L. Da Vega,
gi(jg of Chester, were married at the bride's
home on October the 13th.
Dr.ThomasDuhart Walker. Jr., of Coch- Dr. Cox graduated from the Southern
ran, Ga., a very popular physician of that Medical College in 1890, and since that
place, and Miss Margaret Love Thornton, time he has been a very successful practiof
Tallapoosa, Ga., were married at the tioner of his profession,
home of the bride on October the 20th.
Dr. Walker graduated from the Medical »r. J. J. Delambre. a physician of Lake-
Department of the University of Tennessee, land. La., and Miss Blanche Major, of New
Nashville, Tenn., in 1893, and since that Roads, La., were married September the
time he has made himself a very popular 29th, at the home of the bride,
practitioner throughout the state of Georgia. Dr. Delambre is a promising young physician,
having graduated in medicine from
Dr. E. Barbour Pendleton and Miss Vir- the Medical Department of Tulaiie Univerginia
Hunter Goodman, both of Richmond, sity in 1902.
Va., were married October the 23rd.
Dr. Pendleton graduated from the Medical
Department or the Lmiversity of Louis-
E. F. Fenner, a young physician of
Henderson, N. C and Miss Louise Samp-
•
•
r t^ i ^ tt
i
• • • „ V Ml T' ioon J son, of Manchester, Va., were married in
ville, Louisville, Ky., m 1889, and since ^, '-^ , ^ i i r ^i ^ •. »i
. ,1 . . 1, •
u t 1 *i the Presbvtenan church of that citv on the
that time has been very successful in the . r ,-^ . i .i. o,,.i
^.-„„t;„„ „c i,;„ ^^^f^. ;„., evening of October the 20th.
practice oi his proiessiou. •
*^
t-v ^ • j .. r .i t'
Dr. Fenner is a graduate oi the Lniver-
Dr. J. H. Thacker and Miss Mida Burton, sity of Maryland School of Medicine, Baltiboth
of Reidsville, N. C, were married on more, Md., having graduated from that in-
October 14th, which was quite an event in stitution in the spring of 1905. He is a
the social circle of that town. popular physician of Henderson, and has
Dr. Thacker is a very prominent physi- "any friends there, and throughout the
cian of that place. He is a graduate of the state, who wish for him and Uis bride untold
Medica-Chirurgical College of Philadelphia, happiness.
Pa. Class of 1889.
n^_ L_ 0_ Mauldin, one of the most prominent
young physicians of Greenville, S. C,
Dr. William Powell, of Petersburg, Vi
and Miss Carrie M. Floyd, of Woodruff, S.
and Miss Sara Breckenridge Early, of ^"^' '^"'='= ^""."=, ^:'-f '"'-""'"'" y""'V"' "1'
T ir • • -rr J ii 1 C, were married in the Presbyterian church
Lvnchburg, Va., were married m the parlor r ', .
" j ^ r^ . i ,i 4-.i
c .u TT t 1 r' 11 • T 1 t_ Va i m Woodruff on October the 2/th.
'
of the Hotel Carroll in Lynchburg on Octo-
I, , ,. , , , r », nr j- i
Mauldin graduated from the Medical
ber the 5th
College of South Carolina Charleston, S.
Dr. Powell is a prominent young physician
and member of the Chamber of Com- Cm the spring of 190.. He took a course
merce of Petersburg. He graduated from
'^^ A""y and Nav-y m Washmgton,
f'*^,
the
D. C., m 1904 and U.en took post graduate
University College of Medicine, Richmond,
Va., "in 1901, and since that time 7''^"^ " ""^'
^^°"^'1';„0
-'Austria, in
has _
.
been practicing t- 6
his profession t^ in Peters-
He is a member of the American Medical
^^^j.^ ''
Association, South Carolina State Medical
Dr. Frank O. Rogers, a popular and sue- Society, Greenville County Medical Society,
cessful physician of Concord, N. C, and and tlie Tri- State (Virginia and the Caro-
Miss Ella Tillar, of Little Rock, Ark., were linas) Medical A-ssociatiou, and an honor-

EDITORIAL. -,,r
Soci^r'"'' '' ''" ''"'^"" '^°"'^'' ''^'"^^ ^.^ "^^^ b^^" P^-t-i"^? "T, ^- profession
II, '\f ij-
'" Plaisance, 1 where he has met with orpat
prominence "
• V'\l'^" success
'^r Vc "^^uV^'^^'
as a physician
in his the stale of South Carolina. He and
his bride will live in Greenville. Dr. Hammond Hampton Garner, orio--
Dr. Peter McLean, a prominent voun£r !"^">: I^arlington, S. C, died in the ciry
f
physician of Laurinburg
^^^P'^^} ^^ Santos, Brazil, X a C a„d
few
m!s!
days ago.
Alice Lee Elliott were "'^' ''^
married at the '^^^- ^^'^"^
bride's hi^'^r.^'r 'T'^ °l
home on Little River. X. C, on October t^,e versW M^rvIaLTf'"r/^Ti'" ''"'-
\ers.ty ot
30th.
Maryland School of Medicine in
Dr. McLean graduated from the Medical !,;! "''"f^ °^ ^^'?*-' ^^ the practice of
^f^^""
Department of the University of Maryland IreTft rhll"he",trh '°"' ^°""- ^°°^
Baltimore, Md., ^^^"^ ^'^ health
in 1906, and
became so
since that , f impaired
time he has been a very successful practic- LiaLr 011?.^^""'^^ ^"^ ^''^ '° '""'' ^
ing physician. He received his
'""^"^ ^'^'""^•
license to ^^clZjJ" f
'L^
practice medicine '''^
in 1607 and
years
joined the f .1 . /t / he removed
North Carolina State Medical Society i' Ir "' :
1908.
*^ Hendersonville, N. C, where
— -
Ocaths.
— Dextero, sailing between Xew York City
the West India Islands and Hamburg,'
Germany. There he remained until the
society in fag remained until 1908. Then he was
.. elected physician and surgeon on the ship
Dr. J. Meador '.^^'' Goldsmith, of P^''' Atlanta °^
'f J^'^ °f ^^"s year, when on
Ga., and a very prominent physician of that
f"'s ^'ovaRe he became ill, and was placed
city, was found dead in a room '" uospital at
of a
Santos
local where he died.
hotel, where he had engaged lodging for «- r-.
Sunday "'^•. night October the 2ld it is be "««Pf «* •»• »"««»•«. a well-known
lieved that death was ^?."^,^°^t
due
the
to
State
a
of
hemorrhage luoiiua^e
Louis-
flZ'V^ of
,a„a,
the lungs.
died at his home at Cottonport Octo-
Dr. Goldsmith graduated from the At- "^V^i •
apoplectic stroke was the
"^i"
lan.a College of Physicians a dSugeo^s "jT n 't^^''''-
In 1S(. ^^"'^^te
, and since that time has takenl^ost "/' was very prominent in his
Graduate courses in several Xorthern ins - ^'the
tutions'
°' ^"^ sTal^ ^^ate BoarJnf Board of Health. rf Ttf ''"l" He ""''''^T' was also
president of the State Medical Society.
Dr. ^^''' W. A. Childress, cue of
^""^"^e
the
graduated
oldest
from the Medical
t^
and best-known physiciansof
department of
Atlanta, Ga
Tulane University in 187,5.
died a liis Jiome, after a protracted illness.
an October the 1st.
The Trained Nurse.
.''' '"^- ^^^^"'"^" "°^'^"d' of
:oUege^o?^'eor.!^?'^r'"M'°'".-''''''^^^^^
Philadel-
^ rearfs=;s ^ ^^""''' ^'•' ^ '" ^''^ I''>ia. recently delivered an address before a
mass meeting called at Philadelphia to re-
Dr. ^''^"' J. IM. Bearden. a physician of !• ^^'! '""^^ent system
Uijav
of training nurses;
ja,, shot and ^o ^^o'lsider
killed
the
himself
duties,
October the
obligations and limi-
'th. It seems iliat ""^ the
""""^^^
cause of which '" *^^ ^^'^'^ '0°'^is
l"""""^ '^^''•''e
inkiiown. t)r. Dorland's position is somewhat radical.
Dr. Hearden "^^ graduated ^e do not
from
agree
the
with
Southern everything that
f
kledical College, Atlanta ^^-*'
Ga ^^^ '""'^^^ '^
in 1881
°^ sufficient value to
the nursing profession, and to the medical
Dr. C. R. Barham. aged forty one years.
Profession and really to the general public
lied at his home in Boykins, Va., after an
^^^^ ^^^ '^eem it proper to reproduce it in
llness of several months.
full-
Dr. Barham l-*""' graduated ^
in 1890, from the
l^orland says:
Jniversity of Virginia, "'
Charlottsville, l>ave no \'a.,
u.se for a trained nurse and
nd was very prominent throughout would
the
not have one of her kind in mv
"
tate of \'irginia.
house." Thus emphatically did a promin-
ft _ "e"t lawyer in one of „„ „ our great cities,
ur. , presi-
,
-.. o. «. E. c. Kaullman. nauiiman. one oneot of the most prom- dent of the board of trustees of a large hos-
.itig voung physicians of Louisiana, died pital, express himself to me recently
I Ills borne in Plaisance ou October the Were it generally recognized, 'he
n. He but
was only twenty-.six years of age, voiced a very common sentiment which has
"f^^^^'jlerful intellect. He been growing at
ra.l,r/"w
an alarming rate, and is
rachiatwl from the Medical Departmenl of already largely prevalent among the better
uiane Lniversity m 190,5, and since that classes of our people. It is with extreme

326 THE CHARLOTTE MEDICAL JOURNAL.
reluctance that I am forced to tins adiuis- add, so far as an independent and self-resion.
Foolishly closing one's eyes to an specting medical staff is concerned. Xovv,
unpleasant fact, however, will not benefit what has been the outcome? The net rethe
matter in the least. The naked truth, suit of the system of training evolved by
sooner or later, must be met, the causes for these women after three decades or more of
its existence ascertained, and the remedy absolute control is appalling. The type of \
applied, if one be found. Admitting the nurse as depicted in the beautiful charac-
fact, as we must, therefore, what is the ters of Florence Nightingale and Dorothea :
cause of this remarkable reaction in popu- Dix no more exists, save in rare and iso- (
lar sentiment toward a calling which should lated instances, than does today the noble !
command only the profoundest respect and red man of Cooper's fascinating tales. In j
heartiest sympathy of everyone? her place we find ourselves confronted by a I
There is but one explanation, and it is to cold-blooded autocratic fraternity or close j
be found in the attitude of the trained nurse corporation, smothered in red-tapeism that I
herself. In making this statement I wish apparently would sacrifice a life rather than i'
it to be clearly understood that I refer to break some inflexible and arbitrary petty ;
the t ained nurse as a class, and not to her lavv, whose main object appears to be com- '.
indiv .dually, for I well know that there are mercialism, and from which it would seem i
many noble and excellent women engaged that almost every sentiment of humanity I
in th is humane vocation who are radically had been obliterated. This organization is t
and practically opposed to the autocratic dominated and completely overshadowed i
bearing of those fellow-women who are by a few forceful spirits, for the most part
bringing down upon themselves and their imported from other lands, women of un- !
calling the righteous indignation and re- doubted and unusual executive and organ- i
sentment of a long-suffering people. izing ability, who, it would seem, have i
The attitude to which I refer, and which thoroughly subdued and cowed the vast i
I shall presently elaborate, is intolerable in majority of the girls trained under the sys- '
its every respect. It can be traced largely, tem they have devised. In no other way J
if not altogether, to one chief source, namely, can be found an adequate explanation for i
the malevolent influence very commonly the remarkable submission displayed by .
exerted by the imported head-nurse upon these girls under injustices that stir to the I
the probationers and older girls in the train- very utmost the spirits of those who acquire I
ing schools. I recognize that this is a start- even a faint insight into the matter,
ling statement, but I am speaking with a If you will, inquire of any observant phy- ;
knowledge of things as they are, and I am sician who has been associated with these i
prompted to do so with but one object in training schools in whatever capacity, and i
view—the befriending of the nursing fra- he will, if sincere, assure you that the im- i
ternity. The welfare of this noble and very ported head nurse has usurped an authority j
necessary calling is being jeopardized by that is more absolute in proportion than j
defects in the course of training that can that assumed by the autocrat of all the
be, and must be, promptly righted if the Russias. She domineers over the girls in
growth of the popular antagonism to the training in a manner such as a similar
trained nurse would be arrested. There- nnmber of young men would not counteti-
fore, the mincing of matters will not do. I ance for a moment. (One illustration will
believe the time is ripe for a bold, plain answer. The daughter of a leading phystatement
of facts. sician of a city of central Pennsylvania |
T/ie Imported Head Nurse. when slightly indisposed one morning wj
It stands to reason that those who are, peremptorily ordered by her foreign chief
and have been, in control of the training to eat her "porridge" or leave the tableschools
for nurses throughout the country command which she was woman enough to
from the time of their establishment, must disregard until she had taken her coffee),
be responsible for the development of the She reserves to herself the right to allot to
system in vogue, its defects as w-ell as its the matriculates separate and distinct cacommendable
features. This is a logical reers according to her personal whims ;
and necessary conclusion. It is also a well fancies, and likes and dislikes, whereby
known fact that almost without exception some favored ones profit by an excess, and
in the larger institutions these dominant in- others under the ban of official disfavor
dividuals have been foreign-born and for- suffer from a deficiency, in the practical
eign-bred women, who have even, in cer- courses afforded by the schools. She arbitain
stances, so cleverly manipulated the trarily curtails or prolongs the course in
governing factors of the hospitals in ques- training to suit her personal plans or to
tion as to include under their supremacy regulate the excess or deficiency in the numthe
superintendentship of the entire institu- ber of matriculates without respect or contion—an
impossible state of affairs, let me sideration for the rights or convenience of
,

ABSTRACTS. 397
the iiKliyidual girls; and she caps her au- the number of matriculates from other
Ihonty by claiming the privilege of refus- countries.
ing a diploma after a long and tyrrannous An irregularity in the individual course
course of training, to any or every nurse of training which is stronglv suggestive of
who in any manner, trifling or otherwise, a medieval and irresponsible autocracy
may have incurred her displeasure. Her A commercialism among the -raduate
despotism is absolute: there is no court of nurses which is more suggestive of class
eal It matters not that three years or discrimination than is the most radical trademore
liave been consumed in arduous, unionism.
earnest toil. It matters not that the pres- A growing popular antagonism to a callsure
of poverty is threatening, or that the ing which should be held in the highest
?irl may be looking forward eagerly to the esteem bv the people of all classes
;ime when she may bring her hard-wrought As far as the imported head nurse periarnnigs
to the support of her family. One sonally is concerned, there are two main
ierehction of duty or one breach of an arbi- causes, as I see it, for the deplorable failure
rary hospital rule will annul all that has she has achieved, and probably the forerone
before, and the offending girl may be, most and that of prime importance is the
ind frequently is, summarily dismissed lack of affiliation between her and the sturom
the institution in disgrace. Is it to be dents. Without exception, in mv experi-
;vondered at that the number of native girls, ence, she has not won the confidence and
mbued with the spirit of American inde- alTectionate regard of the student classes
)endeiice and superlative womanhood, seek- On the contrary, she is heartily disliked by
ng admission to these training schools, has all and abjectly feared by many This in
limiiushed remarkably in recent years, or and of itself, is a fatal error. Why this
hat the average .standard of mentality and should be is bevond my province to' state
noral tone of those who do matriculate is positively, but' from my chance personal
lot all that the friends of scientific nursing observations I should attribute it largely to
irould desire? Is it any wonder that those the despotic adiministration which she has
vho weather the storm of tyrrannous abuse seen proper to institute and which I have
lid win the coveted piece of parchment or already referred to.
official document suffer the inevitable reac- Again, it is unfortunately true that these
ion that such injustice engenders? Who women, earnest though thev may be in their
an blame them altogether for fostering a love for their chosen calling, are verv often
iehng of retaliation wliicli they can inflict weak enough to permit national ties' to innly
upon an inoffensive and supine public? fluence and even to master them. They
[erein do we find the true explanation for seem to forget that thev are aliens, mere
le autocratic and offensive stand taken by sojourners in a strange land, wtth ostensicertain
element of the nursing fraternity, bly but one object in view, and that the
nd to this ultimate cause can all the dis- training of the native girls in their own
strousanddistressingtrainof evils be irre- adopted calling. Hence it comes to pass
itably traced.
that in most of these training schools ^
the
"Mnie Mene, Tekel, Upharsin." Canadian girls and those coming from
What is tlie conclusion to which we are across the sea are favored in everv possible
resistably driven? This only: The extant manner. I am told by one who is thor-
'Stem of [ training to our schools of nursing oughly acquainted with the intricacies of
IS been weighed i in the balances of time the problem, that in one of the schools in a
;:id results, and in many of its features has neighboring State, from 85 to 90 per cent.
;en found wanting. The final outcome of of the girls are of Canadian extraction. A
lie maladministration and mistraining of physician of my own city who is connected
ose who are in authority I is an evil which with one of the prominent hospitals recently
reatens not onlv the flimsy superstructure informed me that the foreign head nurse
ey I have erected but even the very fouii- and superintendent of the institution aslitioiis
of the nursing fraternity as well, tounded him by remarking: "YourAmeri-
'
'hat are the results that obtain? Subjected can girls are utterly incapable as trained
an ( ultimate analysis they appear as fol- nurses. When I want a really good nurse
''^^^- • I must send to Canada for her!" Such a
' I A lower standard of mentality and mor- statement, which, it is needless to say, is
pity among the matriculates and graduates, altogether without fouodation in fact, and
The almost total obliteration of the hu- as absurd as it is false, is an affront I
to
I Unitarian aspect of the vocation. American womanhood, and could be proinpt-
KA notable diminution in the number of ed only by a partisan feeling of nationality,
gplicatioiis for matriculation from the na- which at once stamped the speaker as en-
Ife American girls. tirely unfit to the position she held. Be
fjA remarkable and suggestive increase in this as it may, the woman but typified her
II

328 THE CHARLOTTE MEDICAL JOURNAL. !
class, which almost without exception is ning expenses of the institution which will;
strongly influenced by national prejudice, make a somewhat favorable showing at thej
Eirors in the System of Training:. expiration of the fiscal year. Can tliis inj
In addition to these personal traits of the any sense be construed to represent a square!
superintendents of nursing, which have
done much to bring to pass the present undeal?
Just as appropriate, it seems to me,
would it be to add to a course in medical]
fortunate state of affairs, it stands to reason
that mistakes should be made in the process
of constructing a new system of nurtraining
an extra year in which the stu-j
dents would be compelled to clean and pel-!
ish medical in surgical instruments and';
sing founded on modern scientific princi- other paraphernalia, and then claim that|
pies. Time alone can determine the value thereby the preparation of the students forj
or uselessness of anything, and of a system the practice of their profession is the better'or
theory as well. That which promises and more thorough. And just as consist-
well at the outset may result disastrously in ent would it be to condemn as inferior andl
the long run. Therefore, there are to be mediocre all other colleges which did not i
found in the system of training, as now ad- countenance this imjjosition upon their stu-
vocaled, certain glaring faults demanding dent bodies and proclaim these institutions
immediate correction or elimination in or- as affording courses of instruction of g
der that a degree of perfection may be at- lower standard than that set by them, li
tained. enter a hearty protest against this injustic i
In a recent address delivered before the to our student nurses, who have entered s li
graduating class of the Philadelphia School training school, as they believed, aud have
for Nurses I took occasion to call attention not matriculated in an employment agency, •;
to some of these evils. Again, it is not necessary that a nurse;
It is my desire at this time to enlarge up- should acquire an extensive medical educa
i
on these defects, and to point out, as far as tion equal to at least a two-years' course in i
this may be possible and practicable, the a medical college. She is not to become a \
remedy—which, let me emphasize, must be poor doctor, but the best of nurses, and res' j
radical in order to eliminate the canker assured there is a vast distinction betweer I
which is marring and even threatening to the two.
destroy one of the noblest aspects of Samar- This, I believe, may be regarded as axi j
itanism in the world. omatic—that good nursing is not facilitatec j
The Education of a Nurse. by too elaborate an education in profes \
In the first place, then, the education of sional matters; rather is it hampered oi
nurse does not mean a comprehensive in- even rendered useless thereby. A superfi
struction in the arts of scrubbing, washing cial knowledge of physiology and anatomy
and the other ordinary kitchen duties. Yet together with a thorough acquaintance witl
how often do we see from five to ten months hygiene, will answer every purpose It is
or more consumed in just such menial labor just as well that the nurse should know
as this? Frequently has my indignation that the femur has nothing to do with th(
burned when I have seen sweet and refined arm, but it is beyond her province to exyoung
girls who came from homes of cul- pect her to accurately set a broken limb
ture and dignity compelled to perform tasks Every nurse should know that there an
which they had never dreamt of when at certain disease-bearing or disease-producinj
home, which they would never be called germs, and that these may.be, and gener
upon to do after their graduation and which ally are, carried by means of unclean handi
would bear no more relationship to their or instruments; but, as I see it, itisnoti
education as trained nurses than would a sential for her to trace the life history oi._.
knowledge of horse-shoing or of cobbling, bacillus, nor to enumerate the pyogen|
And somehow I never could quite free my- germs, nor will it aid her nursing in tl
self from a lurking suspicion that there was slightest degree to know that the bacillll
an economic reason behind it all, and this bremensis febrisgastrica will produce S3'mii
suspicion was largely confirmed when I no- toms closely resembling typhoid fever, Iju
ticed the conspicuous lack of hired help in in which the Widal reaction cannot be ob
such institutions. tained. A fair knowledge of pharmac
Of course, this extra and altogether use- however, together with the ability to quie
less work, so far as concerns the actual ly and accurately make percentage soli^
training of a nurse, consumes time which tions, is an excellent adjuvant to the
can only be taken at the expense of the ma- ity to rocord a temperature, a pulse-i
triculates, and"ultimately and indirectly of and a pulse-respiration ratio. Ifi in ad
the patients. The course of training is tion, a course of instruction in nursing
thereby unnecessarily lengthened by at engrafted upon a fair general educati|
least one year. And to what purpose? None and this is backed up by a heap of comt
whatever, save a curtailment in the run- sense, then may we expect to find
| 1:

ABSTRACTS 329
ble nurse—provided she has the nursing there should be a general system adopted
instinct. I

330 THE CHARLOTTE MEDICAL JOURNAL
Now let me ask in all good faith, have I "she shall not have the tweuty-five-dollar ^
not proved the friendliness of mv attitude case." Honestly, I think they are right. ,
toward the trained nurse ? I am her friend, The growth of a nurse is naturally, and ;
in very truth. I sympathize with her from should be recognized as a process of evolu- j
the bottom of mv heart. Her life is a hard tion. If there is not this improvement, this ,
one beset with physical perils. Is it any evolution, with the lapse of time, then is |
wonder when we come to consider her pro- there something radically wrong. Therelonged
'immurement in the sick room, the fore I enter a protest—in the kindliest spirit,
constant inhalation of germs and that their I assure you— against the autocracy of those :
noxious, putrefactive products, the loss of trained nurses whose spirit is hard and mer- i
sleep aud the irregularities in her diet— is cenary and whose slogan is do the public j
it any wonder, I repeat, that she so frequent- —good."
ly succumbs to disease or finds it neccessary Lest there be some who think I am uiis |
to seek retirement for protracted periods to taken in this matter, permit me to quote the ;
recuperate her shattered nerves? schedule of prices advocated by these mis i
It is then because 1 am the friend of the taken enthusiasts, and printed m an orgai i
nurse 'that I feel actual regret when I see of the nursing fraternity ( American Jour ;
her yielding to temptations that imperil her nal of Nursing, Vol. Ill, No. 2, page ssh) i
high calling. It is because I am her friend "Acute diseases, $25 per week, matennt' :
that I feel prompted to remonstrate, in a cases, $30 for the first week, $2.-> for sul i
kindly way, with her, when I see her totter- ceeding weeks, unless there are two nurses (
ing over pitfalls that can work her only in- when $2.5 per week each, will be char^^ec
jury aud injustice. And so, when I come for the entire time; nervous cases, S^n pe
to speak to her of some of these faults on week; contagious cases, $30 per week: fo ,
her part, I do so not uncharitably, but with attendance at an operation, or one day' j
a real desire to render her some assistance engagement, $5; from two to six days, ^ i
over the hard places in her career. per day." Then, with a grim sense ol hu ,
T/ie Growth of a Nurse. mor worthy of a Carlyle or a Switt, as i
;
The growth of a nurse, therefore, is the special concession the very generous state :
very neccessary and logical subject to which ment is affixed: "No extra charge is I
|
1 would now direct your attention. A nurse be made for attending to the body atte
]
'
has acquired her diploma, and is entitled to death."
offer her services to afflicted humanity. I appeal to my hearers. What could h ,
What does she often do? Alas! If you look more cold-blooded and revolting than tin
opposite her name in the nurses' directory As some one has written, 'Arguments ma
in which she is registered, you will find the be brought forward to justify trades- union
startling legend, "For Iwentv or twenty- in the commercial world, but the most cas(
five doltar cases only!" With one stroke hardened and reckless agitatator and strike
she annihilates the vears of experience that would shrink from trading in the blood an
one would deem essential, and leaps at once sufferingsof humanity." If thesamepni
into the seats of the mighty in her profes- ciple should be adopted by the medic;
sion. It matters not that her wiser sister profession and invariably lived up to, th
has been devoting her energits to her call- poor and middle classes would be entirel
ing for five or ten vears, and now claims deprived of medical attendance, save tlii|
her right as a twenty five dollar nurse, afforded by hospitals and eleemosynary ii
Has she not a diploma? Therefore it is her stitutions. No greater instance of clas
privilege to demand the highest remunera- distinction— against which socialism an
tion her profession affords. So she argues, the unions are raising their earnest protes
How many yowws, doctors, think vou, can —could be imagined. Therefore, I beg i
claim five or ten dollars per visit the first my hearers, in the name and for the sal
few vears of their professional careers? of humanity, to concentrate their influem
How'manv surgeons can place the bold- against such commercialism as this.
tvped card upon their mantel-pieces, "$.500 Stale Registration oj Nurses. i
cases only?" I believe the nurse earns all There is one other matter on which I dj
she can get, and even then is not well paid, sire to speak a few words in closing. I ret
But hers is also a humane calling, and to the recent agitation in a number of t!
when see stamps it with a mercenary mark, states on the question of the registration
then she drags it from its high pedestal and nurses. Let me say at the out-start that
wrongs herself and it. I know many phy- do not ^^^"k /he time is ripe for snch
. . , , ,
^, movement on the part of the nursing traU
,
sicians who have expressed themselves as ^.^^^ However it may eventuate, today f
unwilling to recommend a nurse who regis- £„gg]. of public opinion points unequivoc:
ters herself in this manner, "if she will ly away from such a procedure as th
not take the fifteen-dollar case," they say, Souud the views of the level-headed int
j

ABSTRACTS.
^'°" '''" ^"^' ""^'^ °^ ^t^t^ examination and registration
' fTnT; I mistake l-V not, 'V°".'' a strong f'"r feeling permeating of nurses than for the examination andrL-
d^ T"r fT T''^""''''" '" ""•"'^""- "^^^^'°" °f ^ ^--^-P °fP— bhich savors
employed
of
fn
trade-umon.sm among the any one of the liberal arts." He Ui
learned professions
en pro-
niclud.ng the nursing ceeds to add, as a further protest against
the
b'wftnu:ra"a^^7'^""""°""'^^P'^'
whole m'atter
nyea win sucn I'-r'^^^--^ thTthe
a taint
unfortunate patient is compelled to pay
It will be of genera interest to note that the same rate for the poorest nurse ^h at is
he Idea of state registration ,s not .ndigen- demanded for the best, and that patients of
.ns here but ,s purely exotic, having taken moderate means must pay the hfoh
songui price
among the women so-ourning in for a nurse or do without;- A physfcian
his country from this British I ..es, where, of my own city recently asked one of hese
.y the way, I notice it has also stirred up a women who was heartily advocating this
'loleiit storm of protest. It is also well stand on the part of the nurses what tie
.orth noting that Its most ardent advocates people should do who were unab e to pay
-If.ntTrr' ';'"?°''^V''"V'r^^^ ^"^^' ^ P''*'^^ ^'"1 '-^'^^v^d the stern reply^
-a fact which, in and of itself, in the light "Let them do without '"
*'°"^ resulLs to which I have It will not be necessary for
Irf.llT f''f me to quote
ere called attention, should at least lead to further from the views of men of distinction
cautious inquiry into the matter and en- in their chosen professions. I have read
ul a slou-ness and deliberation of action, the criticisms of many of the medical men
nn,.M'' K^' f °7^^t "'^^P«" lliese of 'uy own state upon the proposed act.
romen can bring into play in order to per- They all sounded no uncertain note. Many
etuate heir hold upon the nursing frater- of them were most amusing, and some were
ity in this country. Personally, I do not more positive than polite. As I haveintiesitate
to declare myself as emphatically mated throughout this paper, I am heartily
pposed to the movement and I can safely in favor of fair play for every one, includdd
that the medical profession as a whole ing the nurse. I believe, therefore, that
opposed to state registration of nurses in such an act as that which has been conl'""'^^'^""-
'\ 's "«t templated in
f": .}
various
v^'",^'
states of the union
jnfaned o the medical men by any means, authorizing the state registration of nurses
lUe Iloiiorable William N. Ashman, is unfair to everyone, including the nurse-
•esident judge of the orphans' court of the that it is unwise at the present lime and in
ty of I hiladelphia, while .speaking on this view of the recognized trend of public opin-
ibject said: It has been urged by some ion; that it is contrary to the humane spirit
tnetnends of the proposed law" (the which is supposed to actuate those engaged
ate law for licensing and registered nurses) in alleviating the sufferings of mankind
:liat to meet the demand of people of mod- and that it is uncalled for from whatever
ate income for skilled nursing will lower jwiiit of view ii may be regarded. Thus do
e rate of coinpeii.s.ition, since the average I publicly place mvself on record, and I
tzen and the poor have not deep purses, appeal to the public to give the matter carets
seems to indicate that the real reason ful and judicious consideration before perr
appealing to the legislature is not a initting an endorsement of a movement that
iMtion of the welfare of humanity, but a readily work a lasting injury to the noble
itter of dollars and cents. The public vocation of the trained nurse.
od cannot be held in abeyance for the T/w Remedv.
ke of private gain. Civilization has ad- Such is the pernicious system of training
need too far to admit of capitalization of for nurses in vogue in this country, these
esuffeniigs of humanity. The interests of are its originators and supporters, and these
SSickinan were safeguarded whenthestate the results of three decades of trial. What
ensed and appointed the physician as the now is the remedy ? Far be it from me to
solute authority in the sick room. When do it otherwise than to offer a few suggeso
generals with equal authority attempt tions as follows:
manipulate the same army, the battle is h'irst and foremost. The abolition of the
nerally lost." Such is the opinion of an imported head nurse, and the substitution
'
ui^nent jurist of the land.
in her place of native women trained at
ine distinguished profes.sor of medicine home and from the undesirable traits of the
Cornell university. Dr. W. Oilman prevailing system.
ompson, for whom I entertain Uie pro- Secondly. A curtailment of the course
mdest respect and admiration, has re- of training so that it shall not in any initly
said (Xew York Medical Journal, stance exceed two years. Already, I unnl
2,Slh, 19(X>): "We are in the hands dersland, has such a step been taken in
lay in this slate (the state of Xew York) Chicago and elsewhere.
a nurses' trust. There is no more real Thirdly. The elimination from the course

.3.32
THE CHARLOTTE MEDICAL JOURNAL.
of all unnecessary medical, surgical and the medicinal treatment is considered quite :|
other instruction which does not pertain to fulh' with the reproduction of many tried :
the proper education of a nurse, and which formulae. These have not been printed as Ij
has apparently been incorporated with the a suggestion that the disease be treated by 1
obvious purpose in view of unduly prolong- rule, but that the combinations of the vari- I
ing the course in order to hold the services ous drugs indicated, as used by the recog- j
of the marticulates, or to enhance in their nized specialists of today, may be seen. ;
minds the importance of their chosen call- The chapters dealing with the diseases!
ing. Moreover, it stands to reason that the of the eye, ear, nose and throat, and the I
elected courses of instruction should be skin are quite instructive. |
given by teachers of large practical experi- Reproductions of temperature charts have i
ence and not by immature young medical been inserted in a number of places, with |
graduates. the hope that this valuable aid will be more
Fourthly. The just regulation of the pften employed in private practice than it course of iraining so that each and every
j
is at present. matriculate shall be assured of a systematic
!
This book contains many instructive 11-;
equalization of the hours of instruction in lustrations. It is beautifully bound in
the various branches.
Fifthly. The shortening of the daily pecloth,
well indexed and contains 653 pages,
j
printed on a good quality of paper.
riods of service for the individual nurses so
j
that these shall not exceed six hours at a Philadelphia General
stretch, and the insistence upon a regular Volume VII. 190S.
Hospital Reports. <
Edited by Herman i
rotation of service for the girls. This will
correct the obvious evil of a continuous
service of from twelve to eighteen hours, as
B. Allyn, ]\I. D. Philadelphia: Printed]
by Dunlap Printing Co. 1909.
j
Many important changes in the hospital]
i
i
:
i
J
,
is frequently insisted upon at present, and
often to the lasting injury of the nurse or
patient, or both.
•
and its management have been made since (
Vol. VI. was issued. The hospital is now i
called the Philadelphia Hospital for the I
Insane, and the Philadelphia Home for the
Indigent, which are now in course of construction.
A tract of ground has also beer j
secured at Byberry, where it is intended tc
remove tuberculous patients.
•
^ r ., ., , r rT Thc iucreaslng number of patients ha; I
-r-
The Diseases of Children. By Henry Enos
^gje jt „ecessarv to have more Residen
Tuley, M. D., Professor of Obstetrics,
physicians. There are now thirty Medica
University ot Louisville, Aledical Depart-
^,,^ ^^^^ Dentarintenies.
ment; Visiting Physician Masonic Wid- _,,.,, ^ . ^_„ , .
^his
ows' and Orphans' Home;
book contains 2/2 pages and i:
Secretarv of
the Mississippi Valley Medical Associa- "^^^^-X ^"^ . ^f b°""J '" ,
Book Notices.
"^h, It als<
.^
j
I
tion; Ex- Secretary and Ex-Chairman
contams several interesting illustrations.
of
the Section on Diseases of Children, _^ ,. . „ .i • r^ n ^ j .- „
American Medical Association, etc., ^tu^'^f '".
•
f ?.b'f /°'l^f^^ >
Nathaniel Garland keirle A.M., Tr Tn M. D
Louisville, Kv. Illustrated. Baltimore:
Southern Medical Publishing Company. ?• Sc. Professor of Medical Junspru
.OQ9
dence and Emeritus: Professor of Pathol
. ^, , , , , . . ogv College of Physicians and Surgeons
, ,
This book has been written with the
director of the Pasteur Institute, Balti,
needs of the general practitioner and stu- more, Md. Baltimore: The Lord PresS:
dent in view, and the diseases of children 1909. Testimonial Edition,
have been described as they are seen by the This book contains a well brought on
busy practitioner in his daily rounds. On introduction by William H. Welch and
account of the belief of the author that the biographical sketch of the author by Harr
question of infant feeding is one of the most Friedenwald, which are very interesting
important which confronts us, more space This volume is a collection of writings
has been devoted to that subject than is rabies published by a committee in behal
given other important ones. He wishes to of the author's friends. The engraving c
interest the general practitioner in milk, its the author in the first part of the book i
care and handling. very good indeed.
Each disease is considered in a methodi- This book is neatly and well bound i
cal manner. Special attention is given to cloth, carefully indexed, and contains 3!
the dietetic and hygienic management, and pages of very instructive reading matter.

BOOK NOTICES -,..
of Preventive Medicine from an American ^^^ chapter on "Naval Hvgiene" also was
Standpoint, by George H. Rolie,
^"'""^'y rewritten
M. D by Henry G. Beyer, Major
Late Professor of '^'"'ted
Therapeutics States
Hveiene Navy
f]^^°'^ and professor
Physicians and Surgeons, Baltimore, Etc.. C.
-i^'Xiin^ton, u.
and Albert Robin, M. D., Professor of ^he other chapters were revised aad sup-
Pathology, Bacteriologv and P'^"ented
Hygiene
by the editor. We feel confident
Medical *'^^' Department ^^'^ edition will
Temple be favored
Universitv' with the
riologist C.ty Water Department, Wilmington,
Delaware: Member American
throughout the countrv.
teacners
Public Health Association, Society \mer- "'^^^""^^ °^ the Diseases of the Eve for Stuican
Bacteriologists; Corresponding Mem-
^"^ General Practitioners.
-l"^^ By
ber International Society for
^''^''^^
the Preven- " ^ay,M. D., Chief of Clinicand
tionof Tuberculosis, etc.; Jj'sfuctor in
Formerlv Oplithalmologv,
Path-
College of
ologist and Bacteriologist ^U-Vsiciansand
Delaware Surgeons.
State
Medical Depart-
"— -^ of Health. '^'>""- Fourth iouiiu revised revisea ^'"'^'^'-sity.
and ?J,on ,£?i"'°,'''^ ^^w York,
, ,
mnn ion- T// j- ^ *"'^'^' A' ilarged l'^-*"'!
edition with ^O;^- many Attending
illustrations
Ophthalmic Surid
valuable tables. ^0*"^ Mt.
Philadelphia-
Sinai Hospital,
F New f,^°" York;
Davis . Company, Publishers ^°"S"'t'"gOplithalmologist ' 1908 to the French
1 ae advances made in hygiene and sani- th^Sl ^ *° ^}^
Governeur Hospital, to
tary science, more especially ,^^^ Hospital, and to the
in
Italian
the field of n ^^.f
causation and prevenUon of'infe ous •^-- re-
' dis Se'd WUr^ "o ^^'^I^,f
eases, made it necessary to subiect this we 1 r , r ^. ', causation and prevention of infectious dis' v sed wttrT 0"g'»al illustration
° •^°"- reeases,
made n ^^'^l^,f
it necessary to subiect this we 1 r 1 r ^. ', 0"g'»al illustrations
known and popular te^^t-bolta Sor^^gh ur'et' nL"/o fwTr^' '1^%'^ ^^
known and popular te^^t-bolta Sor^^gh ur'et' nL"/o fwTr^' '1^%'^ ^^-
"/'r.":_._^^.^-^-' .^^'l^? ^'l^P'-s treating p^. p':;bHshers ' '' '""" revision. Several of the chapters '' °°' "^ ^°"
' '^
treating
'^ ^°'""
p^ p^bHshers
3f subjects in which the discoveries were Th^fiffl. »H> f.u-
.ore ^u.c recent lecem .vere were entirely rewritten^Ui;: rewrtten, while in in aL'^sJ. \ntriwt 1S" 10117 iJi'^!""^^^^-'
7 — "» -Pi^caicu
>thers were brought up to date by including
mch
Augusf 1908
matter At
as thLZw /TT'^- 7
appears ,5"^^' ' ^^^essential
in th,. Ucri.l
^\ ^"'s early date, the sixth
^''^"''^' '" ">« ^'^hi edition appears.
)f recent
In this
advances
edition the author
jraUm„„„t co,„ril,„tors Bh-e,, i„ ,he Physiology for Beginner.. By Walter lloore
''''
SoolTlv.^n'/'''^'"?'' '""^'^r
°" This little book
School
contains
Hyg,ene
192 pages. It is
vxercise and_ Irain- neatly bound in cloth, and confains a grea
f •• I^fl»ng,
JImI/
• and Cloth- many instructive illustrations. This book
adinf'XsonaM "' ^''' °"' "''''''''' is taken up chiefly with inculcating practiby
Dr Fra,?o is VV- r'''f ' T' '''''''"'' ?'' '^^^ concerning t'le health, most of the
Ipshur, lecturer on difficulties
thnli
of the ini,,.mant I
science of ohvs
P"'^''^ ''^-1''' -d iology beuig deferred for etSntien'"'- etetics n
l^ters^udy'^^''"
the ITniversity College of Medi- The main object of this book is to hrino-
Vriiitan".'::K;'ca''"'f/"-- '"" ^"-'f''^'' -" ^"^ ^^"^>' °^ Pli-ology nearer to t.: H "f
wr ten ,1 r r " was entirely the community, and
l^'^^f",^
especially to the life o
wruten throughout by Walter D. McCaw, the child, for no other study has any better

334
THE CHARLOTTE MEDICAL JODKNAL.
opportunity to connect school and society, views as to aphasia have been inserted and 'I
The book also tells to some extent, the ele- amaurotic family idiocy and congenital 1
mentary actual history. This is in order hypotomia have been considered. A short ;j
that the work may in part supply a connect" sketch of zherpes zoster is included. Was- [•
iug link of the primary grades and the sermann's reaction is inserted under syphilis '|
biology of the high school. of the nervous system because received too ;j
Altogether, we think that the writing of late for insertion under syphilis. ;l
this book will be the cause of a great deal The price of the book is $5.50 net. It J
of good. contains 1438 pages, It is completely in- 1
dexed, beautifully bound, and contains ;
The Practice of Medicine—A text- book for mauv attractive illustrations. The work is ;
practitioners and students with special certainly up-to-date, and is complete in every ;
reference to diagnosis and treatment, By detail as any work of the size now on the i
James Tyson, M. D., Professor of Medi- market. i
cine in the Universitv of Pennsylvania
and Phvsician to the Hospital of the Uni- Atlas and Epitome of External Diseases of '
versify; Physician to the Pennsylvania the llye. By Professor Ur. O. Haab, of <
Hospital; President of the College of Phy- Zurich. Edited, with additions,by George •;
sicians of Philadelphia; Member of the E. deSchweinitz, M. D., Professor of i
Association of American Physicians, etc. Ophthalmology, University of Pennsyl- i
Fifth edition, revised and enlarged with vania. Third Revised Edition. With J
five plates and 245 illustrations. Phila- 101 colored lithographic illustrations on :>
delphia, P. Blakiston's Son & Co., 1012 46 plates and 244 pages of text. Philasi
Walnut Street. 1909. delphia and London: W. B. Saunder- j
The usual effort has been made to place Company, 1909. Cloth, $3.00 net.
this edition abreast of the requirements of a This book filled a well defined want when i
new edition. This has not been altogether it was first published a few years ago. It I,
easy. In the first place, it is most import- still meets this demand and its continued )
ant to keep a text-book within reasonable and well deserved popularity is attested by i;
limits, while the literature on the disease the publication of anew edition. The sub- f
considered has become so large that it is ject matter has been brought up to date and a
often difficult to decide what is truly new some nev chromo-lithographs have been t
knowledge and worth including. It takes added. This volume has proved of great •
quite a long while to see a book of the size value both to those who study and those •
of this through the press, and it not rarely who teach ophthalmology and no doubt this r;
happens that new facts arise too late to be new edition will continue to be equally val- :
availed for a given edition. uable. Not only is the book excellent as :
As to actual additions, the infectious dis- to illustrations and subject matter, but it is I
eases have been revised, diseases of the published at a very reasonable price so that :
blood have been worked over, and the treat- it readily comes within the reach of medical i
ment of tuberculosis has been modernized; students, while the majority of other atlases ,
that with tuberculin has been elaborated by are so expensive that the price is prohibit- I
the assistance of Ur. Trudeau and Dr. Bald- ive to most students and many physicians. .
"
,
- . win, of Saranac. The opsonic index has
- -
,-
received as much attention as it seemed to Abstracts of the Leading articlCS I
deserve. The importance ef blood cultures £
j^j^ rnonth
has been emphasized. '
i
The subject of diseases of the stomach i ,
has been enlarged and a section on testing The Treatment of Lupus Erytliematosus,
,
for occult blood bv the late lamented Dr. —Morns, m the London Medical Lancet, J
J.
Dutton Steele added. Cammidge's pancre- says that there is no specific for lupus ery- J
tic reaction has been inserted. Additions thematosus. The guiding principle is that,!
to diseases of the circulatory system are internal remedies should oe used when thfe,.
many and include an elaboration of the disease is associated with vasomotor dis-f
Adams-Stokes syndrome, and enlargement turbance in the extremities, and where
of the space devoted to pericarditis. there is evidence of autointoxication by
poisonous substances circulating in the
Tetany and Exophthalmic Goiter have been blood. External applications are to be i_
largely rewritten, with the assistance of lied upon only when no signs of systemic
Drs. John Rogers and Silas P. Beebe on disturbance exist. The treatment is therethese
affections. Dr. Rogers has himself fore constitutional or local; often both maj
written the paragraphs on the treatment be required. Any disorder of metabolism,
of Graves' disease by the anti-serum. or disease of the kidney or liver, must^l)t
In the nervous diseases, Marie's new dealt with by appropriate measures. *^'^
^
;

ABSTRACTS.
hyj,e,nc pnncples. Where the circulation Ichthyol in the form of a
isdeectue. loL as
has a
evidenced Imosi
by liability to a specific action on the
ch.lbla.ns and
circTaion
the other ajfs
conditions, the pa- the most useful of local
t,entshould>f
remedies
possible Amon^
spend the winter in other topical applicationrwhich
a warm clnnate. The mrbe
diet must becareful- found beneficial in indi^dua
ly regulated c2s so
are re
as to minimize the risk of sorcin (10 percent, in collod on )
disordenns: the
salfcvHc
d,;,est,o„ or loading the in- acid (3 to 6 per cent, in collodion) and
vor bl ^ r'T^' ^'"^t
f f° - f- Pyrogalic acid, applied in the
vorable orm of
soil for infection.
a
Salol in doses plaster. These applications
often grams,
should be used
three times a day, may be when the disease s very chronic
given after each
Resorcin
meal; salicin and bismuth m particular is apt to cause blisTerhig if
m.abletorin pill are often useful. They used in strength; it should there may be combined oe eve
with quinine, but this be applied to inflammatory
drug
patches
should
led ne
not be given ,n cases where liniment is also useful, "
especially when
."^
''''^"^"''°"- '^o-bined with quinine internally
Dr Morr T rr^'^'^i'"" Sm
'" "'"^^y^,'^ .«"y particular pression by
iiLfi,
collodion he has f
not
benefi Cm found of
arsenic, which is recommend- much use. In the case of small patches,
Ir'.utl T T^ "'^ ''^?'^ ^-"'^ '*""^'' s^^irification or light T toucnes
or
of
elderly
th;
people, h.rgotm, the author says, thermocautery often give good results \
.^^''--t'-reisanyab- dressing of iodoform-- or a i.r;"f""", sallc"^ add
'^'''^"'^^•°"
•
l>f «T,r
f\^-e«
'cl'thyol plaster mull should be applied afterward,
mternallv. as recommended by Tnna; it In chronic cases he has used the Finsen
not only regulates the circulation, but acts light with success. In acutecases theli-ht
as an intestinal disinfectant and prevents treatment does harm, and its effects should
the formation of gas. In certain cases at always be carefully watched. These a-ents
the period of the menopause, when ichthyol which are apt to 'be injurious in the'early
nas tailed, he has given small doses of stages, are particularly useful in the later
opium beginning vvith l-3f»th,of a grain in stages, when there is thickening of the inpill,
three times a day, and gradually in- tegument. X rays have, in his hands
creasing up to doses of one fourth of a proved uncertain. Radium may be applied
gram. Adrenalin maybe of use for the to limited areas. In short, the'object
sameaim-
purpose In some very acute cases ed at in using these agents is to set up a
ot lupus erythematosus he has had good certain amount of local reaction Hence
results from the use for short periods of ex- they should never be used when there is
clusively meat diet washed down by copious acute inflammation. At present there are
draughts of liot water. This cleanses the no rules to guide us in the selection of the
imestnia tract by preventing the formation particular agent; one will succeed where
ot gas which is produced by farinaceous another fails. They must therefore be used
substances, and promotes the elimination more or less empirically
of waste products by flushing the kidneys.
In acute cases the meat and hot water may Meal Broths lor Infants.— -^y Stoeltzner
be continued for ten days at a time. Cal- ( Medizin Klinik ) has obtained "excellent
pum chloride hasbeen found by some bene- results, in the case of infants brought to
ncial 111 the treatment of chilb'lains, and on him with gastrointestinal symptoms due to
me ground of its alleged action on the cir- a diet of flour foods and sugar, by putting
-ulation It might possibly be of advantage, them on a mixture of milk and meat broth.
lie 1 High frequency current is often of ser- Bretonneau in ISIS first attempted to feed
tjvice, chiefly in promoting metabolism and young infants sulTering from atrophic
naintaining a healthy state of the intestine, chronic gastrointestinal symptoms on milk
n general terms It may be said that the pa- mixed with broth instead of with water'
•lent should lead.'a healthy outdoor life as since that time the system of inrant feedar
as circumstances will allow. In regard iiig has never fallen into absolute disuse in
335

j
^^j:^":^''^:^'^,^^. !
i,,,^-, ^f treatment the !
THE CHARLOTTE MEDICAL JOURNAL.
pLc ».ed„c,o„ -o»„»di„||. as ^ did Bretomieau, only for atropine mtants, °^"" "^
;} j^
others for any infants for wW^rease^^^ ^^^gl a^h else began to go np, and ,
ii;S"£;r:nd';%.inS;\^;;i^aTer, the further increase left nothingto be de- .
have all advocated the dilution of milk by s'^^ed ^^
^^^^^ .^
broth, Monti for cl-^ren with ncket^ and
f J-^J^^^^f^^^^^^l belong to the hospit-
V. Huttenbrenner even for new-born cuu ""i
dren. I"
^^'--->^„^f-S^!f:Tm:;k^ eS.o/Ld'\[reiT;Ltmed in conoida
mixture ^^"^P^^^'^^f
J' fj^^""'^"^ °o^^ ^ erin, that the symptoms due to a flour-food
'^J. 'results were so clear that I
'?'"""Td r.tof miTsug^^ - indication for the milk and J
of cream, and o.^s gramnies oi mii^ s
,„»nt liroth diet Further information is i
cases of "tabes mesenterica," or atrophy Journal.
caused by a diet. He reports fourteen such xubercle Bacilli in Cascatcd Lymph I
cases one of them dating back to 190.5, the ^lands.-Weiss (Muencher Med. Wochen- i
'
other'thirteen belonging to the years 1907 gchrift). The investigations of the writer
and 1908. The broth used was made from ^gre limited to the study of caseated lymph [
beef or veal, and was of ordinary medium glands in children, more especially mesen- (
strength- sugar was never added to the ^^^-^^ ivmph glands; in two cases, the bron- i
mixture' The relative strength of milk and ^-^^-^^^ lymph glands were studied. The I
'
of broth in the mixture varied according to
yj^^^^ staining of smear preparations gave
the case. The average age of the children exclusively negative results, while the Gram i
was five months, with an average weight staining resulted positively in every case, i
of 40.55

ABSTRACTS. 337
spinal fluid of epileptics. Later Donatli cases of normal puerperium, and that these
injected whole brain into the little animal streptococci may be haemolytic, yet in 70
intraperitoneally with no effect. He in- per cent, of the cases in which typical
jected animals with 10 per cent. sol. cholin haemolytic streptococci are found in the
and neurins and got typical fits. Buzzard lochia in the first days of the puerperium
and Allen did the same with the following fever will be present, while in cases in which
conclusions: 1. Repeated small injections during the first days they are found in
produce neither fits nor paralysis. 2. Larger masses and in pure culture, fever is almost
doses produce fits, but the dose must be very invariable. The examination of the blood
much greater than is ever found present in may also show the presence of infection, if
thecerebro spinal fluid of epileptics or para- the organisms are found in large numbers
lytics. 3. It is impossible for the fits of and on repeated examinations; the blood
epilepsy to be due to this cause. Handels- culture gives, if possible, conclusive eviman
injected guinea-pigs, and concludes as dence as to the bacteriological etiology of
follows: 1. Subdural, or intracerebral in- the disease, and also shows the severity of
jections produce fits which are not quite the infection. In discussing the prognosis,
like epileptic fits. 2. The symptoms were Zangemeister dwells upon the importance
only produced by doses much higher than of the signs at the beginning of the puerthe
amount found by Donath in the human perium, and considers that absolute sleepcerebro-
spinal fluid. 3. A single intra- lessness on the first night almost always
venous injection of cholin, even in a very goes before the outbreak of a severe infeclarge
dose, produced no efi'ect. Handels- tion. The greatest importance amongst
man next reviews the many chemical meth- prophylactic measures is given to the limiods
which have been used for the detection tation as far as possible of internal e.xamahd
estimation of the salt. He reviews the inations and of operations during labor;
work of Molt, Halliburton, Gunprecht, where these are necessary, rubber gloves
Donath, Otolski, Hammarslei, Salkowski, are to be worn. In addition to the avoid-
Maruzzi, McLean, Stauck, Rosenheim, ance in every w^ay of infection, the meas-
Kaufmann, Kutciier, and many others. He ures of prophylaxis include the absence, as
criticises the methods and modifies tliem. far as possible, of anything tending to
His chemical investigations led him to the lower the resistance of the organism, as,
following conclusions: "in all probability for instance, long-lasting narcosis, severe
no cholin is present in the cerebro-spinal loss of blood, intense chilling of the body,
fluid or in such small quantities as to be etc. The uterus after the birth should be
chemically unmeasurable," and he there- empty, and be kept empty, but if part of
fore concludes that "probably cholin plays the membranes are retained their presence
no part in the production of epileptic fits in is less dangerous than exploration of the
man." uterus to remove them. Zangemeister looks
upon active local treatment as not only use-
Puerperal Fever.-Zangemeister ( Bei- less but dangerous; where svmptoms of inhefte
zur Med. Klinik.) defines puerperal fection show themselves it is to be rememfever,
deals with its causes, with the differ- bered that the bacteria are either already
ent paths by which the infective processes limited in the endometrium, in which case
may spread, and with the diagnosis, prog- such measures as washing out, curetting,
nosis, and treatment of the different forms etc., are useless, or that they have already
of the disease. The most important forms spread beyond the limit of the endometrium,
of lymphangitis puerpealis, for the diagnosis and local treatment holds out no prospect
of wliich the distinguishing facts are given, of altogether removing them and may lead
are (1) endometritis puerperalis, (2) para- to their further spread. Where there is remetrilis
exsudativa, (3) the most severe tention of placental remains, together with
form leading quickly to peritonitis and gen- fever, Zangemeister advises that if the ineral
sepsis; it is to be remembered that with fection be recent a conservative treatment
peritonitis there is often no very high tem- should be adopted; if possible, until either
perature, and the most sev.- re cases may the uterus spontaneously empties itself or
end fatally without rise of temperature, at least until the infection has limited itself
The diagnosis of thrombophlebitis depends and the danger of propagation of the infecusually
in the beginning on the presence of tion from operative interference is reduced
high fever without any localization or pain; to a minimum. From experiments on anithe
subjective condition is in contrast with nials it appears that in the severe cases
the high temperature. Bacteriological in- which might be expected to end fatally
vestigation is of great interest in the proof something is to be hoped from the method
of puerperal infection. Although it has of extirpation of the uterus, if the cases
now been slicnvn that streptococci are pres- can be diagnosed sufficiently early. When
ent in the uterus in three-quarters of the abscesses form the pus is to be evacuated,

338 THE CHARLOTTE MEDICAL JOURNAL
but the indication is not to incise before an uterus was still found fixed. The patient
unmistakable abscess has formed: special was not seen again until 15 hours after the
caution is to be observed before operating onset of labor. Pain was complained of in,
where there is an infectious pyosalpinx. and there was tenderness over, the lower
The author finds that incision and drainage abdomen; there was some external hsemorin
recent puerperal peritonitis has not been rhage; pulse 100. On examination no presuccessful.
Benefit is to be obtained in senting part could be felt, and the outline
suitable cases from compresses, cataplasms, of the os could not be made out. Campbell
painting with iodine, hot air, etc. The saw her two hours later. The patient was
hot-?ir treatment is useful in aiding the re- put under antesthesia in the cross-bed posisorption
of older exudates, but is not to be tion, the vulva washed, and the vagina
used until the inflammatory process has douched with a 1 in 2000 sublimate solualtogether
quieted down. General treat- tion. On inserting the hand into the vagina
ment is of great value. The serum treat- a large opening was found which led into
ment is considered. Fresh human normal the abdominal cavity, the hand passing beserum
has been found to have a good effect tween the posterior lip of the cervix behind
in cases of staphylomycosis and strepto- and the bladder in front. No remains of
mycosis. Large quantities of fluid are help- the anterior cervical lip could be felt. The
ful. Water is to be given either subcu- finger could be passed over the posterior lip
taneously in large amounts oris to be slowly and downwards into the contracted uterus,
injected, J 2 litre at a time, into the rectum which lay completely retro verted in Dougmany
times a day. Alcohol is to be recom- las's pouch. On passing the hand above
mended in small doses to meet symptoms the pelvic brim the foetus with the memonly.
The food must be easily assimilable; branes enclosing it entire was found lying
milk is especially useful; deficiency in food free in the peritoneal cavity. The memis
less dangerous than an excess leading to branes were ruptured and the foetus easily
dyspepsia. Adrenalin is to be given in extracted, the placenta and membranes becases
of peritonitis to combat the vasomotor ing subsequently removed by hand easily,
paralysis. In view of the fact that a rise The coils of small intestine tenditig to proof
temperature aids the organism in its fight lapse into the vagina, a number of strips of
against infection, antipyretics are to be ex- sterilized gauze were packed into the opencluded
if the general condition admits of ing so as to protrude well into the peritoneal
it. cavity above and to fill the vagina. Finally
»;„.„!„„i i„^..„i

ABSTRACTS. -,^q
in which, in anv event, '°."",'' '^^^''^
a '^"^ "'^tl^
recoverv^annerr ^" tl'e
,„ f .
ed to be probable, the useof a pneumoccS
X^^'"- and further he
'
n ne's to
^""f
vaccine has been coincident with a rap d p" ssibirbut W improvement. h
In some of these instances erate the amnlt t f^^' '° '^°^-
IS doubtful whether even frequent readings
uiy rate, in accord-
good. If the temperature then rises again, tinned. It follows from the article hat a
ZZ^- "'''' "" '^°'' ^°'' ^"'^ =^ '^'^^'^y preponderating amount of vege ariaV food
"' '" "^"'"^l °f i« t° be
h rtv °"^"V^°r "fV recommended to almost eve y one
dos7" f °dose is'lolV "Tr '"" "" ^e Japanese exemplify the fact
aose.
that a It a dose is followed by 'f Ho-
a rise in the pie on such a diet ma\- be
temperature
nossessed of th^
it has been too great. If a greatest bodily and me tal reHgth ai^d
temperature or on the symptoms we may is a great recommendation,
gue and
a larger
the
one
author
in thirty-six to forty-eight gives a table of relative costs which bdngs
«/__ . . „. °"t ''^'s cheapness clearly. The volume of
(BeS"" urv^l •" "T''V"-t--an„ a vegetarian diet may be diminished by a
\' -^ cliscussess the suitable choice of the
effec /f
items, and . the addi-
,
'^'^' "PO" people in tion of animal fat has nothing against t
ofdhLrvI ]T'^!rr
'•
esnecf« J
^ ^' '"'° ^""'*'""^ ^^''"^^' '^"^ ^''^ ^°^^' ^^^l^il- «iilk and cheese a e in
te^e' riancHet :,r'"r?r ''' ''°'^^'' "^^"^^ '^^^^f"'' ^'^^ -^ comparatively
oh!ea h y '? ' maintenance cheap. On a raw vegetarian diet .
on
an enor-
;^' ""^ '°" '"°"' percentage of the nutritive
juries to theTiiX ^^^f^Y'^V
material is
curred o 1, a mfxed'diel> r^ '\ "'' "'; ""^'-^--'^^d. The practical difHculties of a
vSrians a e .fi / , •;'^^,'^'^«^^^of vegetarian diet are considerable, but the
'"'^^ diet IS not necessarily
Suvrawver., monotonous.
.r'f"' /'u "'°'f Morecoike
n,?. '^^^'f *;
f°°'^^
'•7^^, ^^'''o eat over, on the author's view, it is not neces-
'''',/°°'^' ^''^ "''^^ '°
those who
^° ^^^'^>' altogether with
allou'f n
meat, nor
^-^^^'f
Ibutlr lon.v 1 "''f °^ """"' '^'"^' "' '"^"'^ *^ °"^ '^'^^^tive apparatus at pres-
,' S estio'' Tn "°'^" ^^•^"./S:gs. ent suited to a purely vegetable diet.
^"'"V The
.=""«"".' "^ P/^^eid nee- author's conclusions
isar n f ?
are: That the vegettmlen-rvvorW
^''-rf''^'^^"'^?^ '""^" '^'^'' "'^^l^^^'g milk, milk prepara-
^ l^e,f"thor finds tions, and eggs, supplies
hatan aZ , everything
f"'"''^--. need-
P/"'"^ "'^" ^''^^ f"' f°^ l^^alth; that it
which Which v^c
'f^"r has no disadvantage
was previously considered necessary as compared with a preponderatingly meat

340 THE CHARLOTTE MEDICAL JOURNAL.
diet; the proteid contents of the vegetarian costal element on the anterior limb of the
diet are sufficiently great. Probably no transverse process of the seventh cervical
specific difference exists between the use that is, on the interior root of the transverse
made by the body of vegetable or animal
proteid material. On the other hand, too
process we get an independent centre of
ossification, which may develop and assume
high proteid contents in the diet probably the importance of a cervical rib. As regards
is injurious to the health; the uric acid the aetiology of this condition, opinion is
forming bodies which are present in specially
large amounts in meat are most probdivided.
According to Planet, all animals
possessed at one time as many ribs as verably
injurious. It is not necessary alto- tebrae, but in course of time these have
getiier to avoid mpat, but it is well to con- dwindled down to the number of twelve in
siderably limit the amount taken. The man with only rudiments in the cervical
vegetable-milk diet is much cheaper than region. Some writers accordingly class the
the preponderatingly meat diet, but its ab- condition as a species of atavism. Others
sorption by the intestine is less complete, have laid stress on the frequency with which
The change to a vegetable-milk diet can several members of the same family are
only be gradually effected. Careful prepar- affected. For instance, Israel is of the
ation and cooking renders the vegetarian opinion that heredity plays some part, and
diet digestible and easy of absorption. that there is sometimes a history of degneracy
in some member of the family. Occa-
Suprapubic Pros.ateclomy Without gj^,,^,,^, ^,g^ jj^^ condition is associated in
Opening ttic Bladder.-Y an Stockum, ac-
^^^ ^^^^^ ^^^ ^^-^^ some other congenital
cording to 1 he Hospital, London, described
n^alformation. Formerly the condition was
two cases oi suprapubic prostatectomy sue-
^^^^^^ ^^ ^^.^^ but with the advent of
cessfully pertormed ^y.thout opening tire
Rontgen rays and greater precision in diagbladder
The author's method is as fol-
^^gj^ ^^^ condition has now come to be relows:
After making an incision above the
cognized as comparatively common. The
pubes and cutting down on to the anterior
^.^jority of cases probablv pass unrecogwall
of the bladder, this latter IS carefully
^j^^^ during life because no svmptoms
separated from the posterior surface of the
nianifest themselves. Of those which cause
pubic symphysis. I his having been done,
symptoms, the majority appear to be found
the retropubic tissues are stripped off the
i„ , females, the reason for this being
anterior surface of the prostate, and each
undetermined. The age at which svmplobe
ot the organ enucleated separately
toms are noticed is generally between twelve
after opening up the capsule by a vertical ^^^ ^^^^^^,^ ^^,- robablv to the activity
mcision a little to one side of the middle
^f the skeletal growth between these ages,
line. Whilst enucleation is proceeding, an
j^ ^1^^^^ ^^^^^ ^^^-^^ do not cause svmpassistant,
by means of a finger m the rec-
^^^^ ^^^ supernumerary rib probably is not
turn, pushes the organ well forward A large enough to project into the posterior
cathether is next passed into the b adder
1,^^,,^^^ ^nd there cause svmptoms due to
and tied into position. A gauze plug is
pressure or deformity. Cases which do
then put into the prostatic cavity, and a
„t symptoms, however, are very fredrainage
tube inserted into the suprapubic
^j diagnosticated wrongly, because
wound. The author IS of opinion, however,
jj^^ ^^^^ -^^^^^ examined for a possible
that the drainage tube is really unneces-
^^^^^ ^-^ ^^ account, for example, for the
sary, and proposes for the future to sew up symptoms of a neuritis in the arm. Hence,
the wound leaving only a small opening
before the introduction of radiographv, the
through which the end of the gauze plug is
condition was frequently discovered only
brought to tire surface. The catheter ,s
accidentally, or, if attention was bv any
left ,11 for about a fortnight. He claims
chance directed to the neck, the condition!
hat this operation causes less damage to
^^^ ^^ ^fj^.j mistaken for something else,
the tissues than that of Freyer, and reduces ^he condition is now more often recognized,
hemorrhage to a mmimum. ^^^ -^ becomes possible to relieve pain and
Double Cervical Rib —Donaldson, ac- to obviate further complications such as'
cording to the British Medical Journal, says possible aneurysm of the subclavian, °
that more or less well developed ribs are grene, or paralysis of the muscles of the
liable to be met with in connexion with the hand.
seventh cervical or with the first lumbar Hypertrophy of the Female Mamma.
vertebra. Turner and Gruber say "cervi- Batson (Edinburgh Medical Journal) recal
ribs may be either the unusually devel- ports one case of this rather rare lesion,
oped rudiments of the anterior traiisvere The hypertrophy began at puberty and was
process or rib of the seventh vertebra, or associated with pain and discomfort in the
merely unusually developed epiphysis." breast. At the age of 19, the patient men-
There is au independent development of the struated twice, but only very slightly; since
—

ABSTRACTS. 341
then there has been amenorrhea. Eighteen found in the region of the greater curvayears
ago an adenoma of the left breast was ture, one of which had perforated. 3. A
removed. Owing to the constant aching pain spinster, aged 42 years, had a large subthe
patient sought surgical relief: it was peritoneal myoma removed by subtotal hysthought
advisable to remove at first only terectomy. On the third day she had a
one breast, for the reason that occasionally sudden attack of epigastric pain, and 12
it has been noted that removal of one causes hours later she was very ill, with high temdiminution
in size of the other. As no such perature, rapid pulse, and distended abdoimprovement
took place, the other was also men. Thirty-six hours after the attack the
removed later. On examination the hyper- abdomen was re-opened and a septic fluid
trophy was found to be due to an increase was found coming from the upper part of
in the fat and fibrous tissue. the abdomen, containing flakes of clotted
Most cases of hypertrophy of the female milk. This pointed to a perforating ulcer
mamma begin at puberty and are associated of the stomach or duodenum, and the pawith
some sexual irregularity, usually tient's condition was such that simple drainamenorrhea.
Some cases are influenced by age of the abdomen was resorted to. A
by the u.se of iodine and thyroid extract, post mortem was not obtainable. Blandbut
probably the best course to pursue is Sutton adds that he has not gleaned much
amputation. It is advisable at first to re- information from reports of operations on
move only one breast in order to note tke the pelvic organs with such post-operative
effect upon the other. complications. In 1899 an interesting dis-
A Case ol Tubercular c"ss'on Rheumatism In a
on the "Treatment of Uterine Myo-
Chlld.-Genevrier
i"^ta"
( Annual de Med.
took
etChir.
place in Berlin. During the
Infantiles). The patient was a child three ,'^^'^^^'°"' ^°" ^°^'^o"' stated that he
years of age, who ^°^^
presented , a series of sue- ^ ^''O'"
^f^, P^J'^"* » perforating ulcer
cessive transient swellings, purely inflam-
°^ ^''^ stomach following hysterectomy for
matorv
^^yoina.
in character, at more
Olshausen
or less proalso
stated he recalled
longed intervals,
four
in the various
instances
joints. i The m which patients
f^ l^**"^
I author's assumption
had
of the probably
succumbed after such
tuberoperations
from
! cular type of
Perforation of
this articular rheumatism
the
was
stomach or small intestbased
upon the presence of Pott's deformity '"^'
of the spine; chronic bronchitis, with espe- Serum Treatment oi Cerebrospinal
cial involvement of the right apex, and the Fever.-Curne and MacGregor, in the Lonpositive
outcome of the ophthalmoreaction, don Lancet, analyze the cases of cerebro-
The immediate source of origin was referred spinal fever in the Glascow Fever Hospital
to the localization of tubercular toxins in between Mav, 1906, and May, 1908, in
the joints, by way of a latent tubercular which patients were treated with four'dif-
'"'•""^ferent
kinds of serum. The \
total number
I On of
Perforation
cases was 3,30 of
ol the Stomach
which
and 105 were treated
' Small Intestine as a Sequel to Ovarlo- with antimeningococcic serum. The benelomy
and Hysterectomy.— [i]3„j.i^ytton ^^^'''1 results obtained were a delay in any
(Jour, of Obst. and Gyii. of Hrit. lunp. ) of the fatal issues, and there were a greater
descril)es three cases of post operative "umber of
inrecoveries.
In most cases there
itestinal perforation. 1. Bilateral
vvas
ovariat
least one injection into the spinal
iotomy was performed on a stout multipara,
t^eca after withdrawal of cerebrospinal
aged ,3,1, , who was three months pregnant'.
^"'^- Repeated injections were usually
.The ovariotomy was straightforward, and subcutaneous; massive injections were nean
old unbiblical hernia '-essarily so. was treated at the The authors also state that
same time. The woman died eight days
the serum-treated patients, who survive the
llater, and ^""^^
at the post mortem two ulcers
^e" '^^y^ of illness, have a belter
iwere found in the jejunum, two metres
chance of life,
from the duodenum, one of which had perforated!
2. Right ovariotomy on a
Electricity
spin-
In the Treatment ol Cancer.
ster, aged ,30 years, was followed on the Leopold recently went to Marseilles to
jfiflh day by sudden seizure vv;th acute pain investigate the treatment of cancer by the
;)in the umbilical region and the develop- electric spark, a method advocated by Hart
iimentof peritonitis, to which the patient and reported by him at the Electric Con-
;teuccumbed on the eighth day. At the post- gres-s in Milan in 1906. Leopold savs that
|jmonem I examination there were the usual the written descriptions of the method give
I
[signs of septic peritonitis, including a quan- very little idea of the technic which Hart
I itity of offensive fluid, which trickled from has worked out in the course of several
I the upper part of the abdomen. On exam- years. He regards the fulguration is merely
luation of the stomach three ulcers were a preliminary or adjuvant to the kuife.

342 THE CHARLOTTE MEDICAL JOURNAL. |
The improvement realized even in advanced more frequent in the uterine body, tubes ,
cases is remarkable, relieving the patient of and peritoneum. The most frequent loca-
hemorrhage, pains and ichorous discharge
j
tion is in the tubes, where it is complicated
j
for a time at least. Disseminated nodules with tuberculous peritonitis, sometimes j
of recurring mammary carcinoma are ful- ovaritis. In the vagina it is generally ul- J
gurated each for five or ten minutes. This cerative, or infiltrating. On the cervix it |
softens the nodnles and prepares them for may form vegetations. In the tubes there
twenty or thirty minutes. The fulguration is a sac containing pus and detrius. Diagdoes
not lead to the formation of an eschar; nosis from other forms of genital lesions is !
the tissue merely turns brownish and ede- almost impossible during life. In case of ,
matous, with free exudation.— Zent. f. Gyn. tuberculous perionitis it is rather curable,
especially after an explanatory laparotomy.
Facial Paralysis, Treatment ol. in general the treatment should be a com-
Dr. F. Marsh reports the treatment of bination of operative measures with general
facial paralysis in two patients due to the anti-tuberculous treatment.— Le Progress
division of the facial nerve in the mastoid ^^ledicale.
operation. They show ( 1 ) that if division
of the facial nerve is recognized at the time
of operation, careful adjustment in the manner
indicated (the use of strands of chrom-
New Observations on the Mechanism ol
the Production ol Transitory Albumi-
nuria in Children by Experimenicized
catgut) will probably .esult in the
restoration of the function; (2) that if division
has not been recognized the wound
a
,/^tal
Lordosis.
,, •
t w j ,
^^°". obtained
^'l' f ^'f
transitory 'I
^Ibuminuna by lordosis m the horizontal
should be reopened and the nerve ends adjusted
at the earliest opportunitv; (3) that P°«'.t>°"- "^ ^^^^ ^ "^'^^ '" chmc of Milan a collection of 'J'f fetuses °^^'f''^^ fixed
if a careful adjustment has been made a
^ Position of lordosis at various vertebral
second operation should not be undertaken I"
^^^'^^'' and has experimented on rabbits and
within three or four months; (4) that this
method of adjustment should be tried be- ^"'"^'^ P'^^' ^"^ .^!^^* ''^ ^°",^^-
''f 'f,^^^^
r • t -.^i .1 u 11 elude any rotation of the kidneys on their
fore anastomosis with the hvpo. glossal or .• , r .l j .• r- n
, \r i A tt vertical axes from the production of albuspiiial
accessory nerves is attempted, the . . , , • ni j- .i
ii r I.- 1- i 1 ••£ • miiiuna by stasis of blood m the renal veins,
results of which are not always gratifying, t,, ^/ , .^. ^ c oi,ciiio.
'^ ihe vertical position is necessary to the
— British Medical Journal.
production of albuminuria. The stimulus
of the splenic
The Purgation Properties
plexus
ol Phenolph
must be reckoned with
'" ^^® production of
thalein.
albuminuria by lordosis,
as well as the vasomotor disturbances
Berthoumeau and Daguin discuss the in the vena cava ascendens and its branches
usefulness of phenolphthalein as a purga- at the level of the lordosis produced, and the
tive. It has grown greatly in importance compression exercised by the kidnev and
during the past few years and its harmless- liver disturbances.— La Riforma Medica.
ness as well as reliability make it valuable
in all patients. It augments by direct contact
the contracility of the intestine and in-
Subacute Meningitis a Complication ol
Respiratory Troubles in Children.
creases the secretion. A dose of two grs. .
„, . t^ ,r i
.dement Delfosse mentions subacute
will purge, whereas half that amount
me-
for
an adult will act as a laxative without pro- ""'S't's ^.^ ^ "° infrequent complication of
ducing abdominal distress. In children in
doses according to the age, it acts verv satisfactorilv
and is inoffensive.-La "
Presse
Medical
P"e^umonia and purulent pleurisy ,n in-
^^"''- ^ he organisms that most frequently
responsible for this complication are
fJ^
pneumonoccus and the bacillus of
Pfeiffer. The child generally gives a his-
Genital Tuberculosis in the Woman.
Ch. Lenormant finds that genital tuber-
1°''^,^ frequent respiratory or digestive
troubles, or of the eruptive fevers. The
micro organisms seem to be especially viculosis
occurs in about three percent, of all
operations for laparotomy for genital conditions.
It is rarely primary, and then occurs
rulent in the cases in which we have this
complication. The cerebrospinal fluid is
always turbid, the more so in the severe
in cases of genital infection by coitus with cases, and there are present the microorgana
husband affected with genital tuberculo- isms and polynucleated cells. The cerebral
sis, the wife having some solution of con- lesions are most marked on the convexity
tinuity of the mucous membrane. It may of the cerebrum. The prognosis is very
attack any portion of the genital system, grave, and treatment has little effect on
It is rare in the vagina and cervex, where the disease.—Journal des Sciences Medi- I
there is a pavement epithelium. It is much cales de Lille. i
i

ABSTRACTS 343
Antilormln in the Detectton of Tubercle a,it branch of „iedicine.-From American
Medicine, October, 1909.
Dr. O. Seemann has employed antiformin
for the purpose of facilitating the detection ^**^ Viscosity of tlie Blood and tlie Worlc
of tubercle bacilli in pus, urine, exuda- «J the Heart.
tions, stools and organs. Antiformin is a Giovanni Galli savs that the molecules of
mixture of eaudejavelle and sodium hy- the blood are subject to attrition in different
drate. c,nd owes its action to oxidation pro- individuals, due to the presence of various
cesses. 1 he author has found that it acts colloidal substances. These substances are
best in 1., per cent, solution. If sputum is subject to great variability, according to
diluted vvith fi teen to twenty times its vol- the amount of water in the blood and of fat
ume of this solution, the pus soon becomes molecules, and these varv with the distance
homogeneous, and in from ten to forty-five from a meal. The composition of the blood
unimtes a clear fluid with a sediment, which varies with age, sex, and constitution. In
can be removed by centnfugalization, is polycythemia and plethora and viscosity is
obtained. If there is no special hurry to greatly increased and yet health is good,
obtain a specimen, it is wise to wash the In anemia the viscosity decreases markedly,
sediment, with distilled water, to remove Compensation comes through the vasomotor
the excess of alkali, so that the bacilli may nerves and the regulating mechanism of the
adhere to the slide better. If any difficulty heart. Increased viscosity of the blood
IS exi)enenced in getting the specimen to does not produce cardiac hvpertroph v. The
adhere, a little of the fresh sputum may be temperatureof the body, especially in febrile
applied to a clean slide or some albumin conditions, has also an influence on the viswater
(1 part of beaten up egg white to U) cosity we have a strong heart impulse and
of distilled water and 1 per cent, of formal- inelastic arteriis there will be o^reatly iudehyde
solution) may be employed. Tuber- creased heart work, andv/ce versa.— Rivista
cle bacilh are not killed in 1.5 ]ier cent. Critica de Clinica Medica.
antiformin after one hour, so that the method
can be used for animal injection as well Treatment ol Boils and Carbuncles.
as lor microscopical specimens. I he method
can further be applied to examine blood
^'" '^"'^
for
or carbuncle need be painful, nor
tubercle bacilli. This may prove of use should the
in treatment cause pain, according
differentiating between typhoid fever, miji- ^" ;} Osier Ward, of London, K. C.
ary tuberculosis and sepsis. The bacilli "^^ treatment which he employs is simobtained
from the antiformin fluid are found I''^- ^^ pledget of cotton soaked in carbolic
pure culture, all other bacilli having sb'^'erin is applied to the boil and covered
been
"
dissolved.—Berl. "'''^'' klin. Woch.
gutta-percha tissue and a bandage.
As soon as pus shows, the epithelium is
Pediatrics Changes Hands. gently turned back and the glycerin reap-
It is with no little gratification that we P''^'^' As soon as a slight cavity appears
learn that Dr. W. E. hitch has purchased ^°°^^ °^ ^''^ glycerin is gently inserted by
Pediatrics and will henceforth
"^^aiis
edit
of
this
a simple glass
well
syringe, and again
known publication. t'le
Dr. I'itch has
poultice
long
of glycerin is applied. In two
been °'' connected with medical journalism ^^^^^
as ^^^^ ^^^ slough separates, and after
iditor of Gaillard's Southern Medicine, and °"^ ^""'^ poultice of glycerin the cavity
le will bring to Pediatrics a ripe experience
speedily closes, with the minimum of scar,
Joth as editor ""'^^'' and publisher. He is a grace- ^"^ dressing. The hygroscopic ac-
Ful as well as a brilliant writer, and ''""
has
°^ ^'*^ glycerin relieves the tension—
:ontributed extensively to medical "'^ ^^"^^ litera- °^ *^^ pain—very speedily, and it
lire.
need never recur.
We understand that Dr. Fitch contem- Ward has never had occasion to use any
lates many changes in Pediatrics and with other treatment. He has never seen a car-
staff of collaborators which includes buncle spread when once this treatment
nany ol the country's foremost pediatrists, . ..,, , . i j
his excellent
'"^^
journal
^"«""' '''" ^"'^
is sure to achieve
^^'
new ^^ ^"^" ^"^ ^^''^^^
uccess in its special field. Dr. Fitch is a '" ''^^ '" '"« own cases.
rue Southern gentleman, and his name on (^"e very serious case he saw recently in
he editorial page is ample assurance of the consultation—that of a butcher with a carigh
and honorable plan on which Pedi- buncle 6 in. by 4 in. between the shoulders.
tries will be conducted. If the sincere -n. . . . i -u j u j .
rv>H ,t;„i,^. f .1 fir.., 1 ooa
he treatment described above
wishes
was adopt- "^
of the many friends of both
'ediatrics and Dr. i'itch' mean e".
anything
the spread of the carbuncle was promptly
lere can be no doubt of the good work arrested, and a quick recovery ensued.
at will be done in an exceedingly import- British Med. Jour.
—

344 THE CHARLOTTE MEDICAL JODRNAL |
Excretion of Veronal-Sodlum. fije rest must be very complete when the |
P. Fischer and J. Hoppe found that traces temperature is high and must be continued I
of veronal appeared in the urine, when as long as there is the slightest trace of I
veroual-sodium was given per mouth, in fever. The patient must be carefully tau^Iit |
forty minutes; per rectum, in thirty min- liow to avoid relapses.— British Medioal i
utes; and subcutaneously, in fifteen min- Journal. I
utes. Sleep will set in about the same time. or. Cook and tbe North Pole.
Veronal is detected in the urine as follows: ,^ „ , . , . ^ , , ,.
200 Cc. of urine are precipitated with lead
^r Frederick A. Cook has discovered
acetate, and the latter removed with sulphu-
^he North Pole, it is said. Hovvever, to ;
retted hydrogen. After filtering, the urine establish it beyond doubt it vvill be neces- j
is evaporated to 60 to 80 Cc, decolorized f^-^y ^°' ^''"^ to furnish further proof than 1
with animal charcoal, and diluted to 100 ^is interviews in the public press. These ^j
Cc. Salt is then added and the fluid sha- have been interesting and some o the most i
ken out with ether. The veronal is recov- Prominent scientists of the world have con- I
ered and weighed after the ether has evap- ^^^''^ '" ^'^' ^'"^ '^ would seem at this j
orated. If given continuously, it was found time that we have no right to challenge his I
that during the first four days a small "^^"^ «'"^%lie, ^''».«7« ^ deterniination to ;
amount of veronal remains in the body; P^f^ al of the information which he has ,
later, however, the excretion runs parallel before the authorities of the Lniversily of ;
with the amount taken, so that with rela- Copenhagen. . ,
.
,
I
Robert Peary, an explorer also claims |
lively small doses, and where the kidneys
are normal, there is no danger of intoxica-
^° ^^''^ discovered the North Pole at a later
^'^^e than the one given
lion. With
by Dr. Cook m his
larger doses, particularly in the
interviews,
aged, and where the kidneys
which is April
are
21
affected, 1908 Al-
greater care is necessary, since the excretion |^°"g'^ the expense of Peary s expedition I
l^asbeen paid by the Government and he is »
is not so uniform, and a cumulative effect
is possible.-Muench. Med. Woch. a public servant possessing knowledge that I
the people have a right to know, yet he |
„ .^ ^ sulks and acts like a sorehead, which in
The Temperature as a Guide to the ^.^^^^^^^ ^^^ ^^^ characteristics of men of
Treatment and Prognosis ol
Phthisis.
wisdom. The people are disappointed in
him and even if he has been at the North
S. V. Pearson emphasizes the necessity Pole his name will never possess a value to
of a close study of symptoms in each indi- the American people as if he had not shown
vidual case. This is notably true with re- a discourtesy to Dr. Cook. His demeanor
gard to temperature. It is recognized (1) resembles that of a spoiled child rather than
that with a miliary tuberculosis it is usual that of a man of mature judgment,
lo find a type of temperature continuous or Cook evidently is sincere and has acted
inverse; (2j with an acute caseating lesion the part of a gentleman, and if he be misa
remittant or markedly intermittent type taken and Peary is the only one who has
is found; (3) with a chronic fibroid lesion, reached the Pole, Cook will be respected,
constantly normal or subnormal is the rule, but Peary apparently will never be a popuwhile
(4) with a chronic fibrocaseous lesion lar personage with the American people,
either a normal, subnormal, or an elevated As to who is right we await the verdict of
temperature is found, according to the state the scientific authorities,
and stage of the disease. The author then The father of Dr. Frederick A. Cook was
passes to consider the method and time of named Koch, and the name was changed
taking temperature and the interpretation by error when he enlisted in the army; he
of the readings: There is, he says, no such was born in Germany and practiced media
thing as a normal temperature, unless we cine in New York. The younger Cook,
take into account tlie natural daily curve, who now lives in Brooklyn, was born in
and in making daily comparisons estimate New York in 1865, and graduated from the
every attending circumstance, as exercise, medical department of the University of the
.
diet, etc. He then takes up the peculiarities
of temperature in women with reference
City of New York in 1890, but was not ac-
lively engaged in the practice of medicine,
to menstruation, touches on rare and ambiguous
cases, discusses regulation of rest
Dr. Cook is to be congratulated upon his
achievement and we sincerely hope that all
and exercise, and instability and lack of claims he makes will be substantiated
elasticity in temperature. In treating tuber- Several other doctors have been promi niculosis
we should always remember the ob- nent in four expeditions: Drs. Kane, Hayes,
jecl we have in view. All cases cannot be
arrested. We must take a chance with
Richardson and Rae have made coiitribu-
lions lo Arctic literature.— Indianapolis >1isl
prolonged rest under suitable conditions Medical Journal.
j

I harmless.
I peculiarly
Calcium Salts In Skin Diseases.
Dr. Bettmann has obtained remarkable
benefit in a certain proportion of itching
skin affections from internal administration
of calcium lactate in a 5 per cent, solution,
one or two tablespoon fuls an hour before
meals, three times a day, for three or four
weeks. His experience with seventy cases
showed that the remedy failed to influence
the affection in the majority of cases, but
in others the effect was marked and encourages
further trials of this simple medication,
which his experience has shown to be
It proved efficient in conditions
rebellious to other measures, especially
ill the "toxicodermias." In senile
pruritus, in particular, the effect was marked.—Muiichener
medizinische Wochenschrift.
Ovarian Opotherapy.
Paul Dalche makes use of ovarian opotherapy,
or the treatment of irregularity and
deficiency of the ovarian function in a number
of conditions. The indications include
ovarian distropliies, shown by flashes of
heat and cold, headache, insomnia, and
such troubles; hyperactivity of the ovaries;
ovarian ataxia, with irregularity of mens"
struation; cephalagia of puberty: polyglandular
syndromes, consisting of variations
in tiie functions of the suprarenals
and thyroid; genital accidents, including
amenorrhea, dysmenorrhea, and metrorrhagia;
some cases of chlorosis and anemia;
goiter and Basedow's disease; localized
obesity; psychoses; chronic rheumatism
after the menopause, and surgical
menopause. It should be in the form of
ovarian powder, powdered corpus luteum,
peptonized ovarian substance, orglycerinated
extract of ovaries. The treatment must
be continued for a long time in order to get
the best effects.— [.a Ciynecologie.
PoslrubeoIIc Diphtheric Conjunctivitis.
E. Weil! and O. Mouritiuand describe a
small epidemic of diphtheritic conjunctivi-
tis following measles, witnessed by him, in
which Ihe cases were all fatal. There are
two kinds of diphtheritic conjunctivitis—
less severe one, in which there is a false
membrane involving the lids alone and a
severe form, in which there is no false membrane,
but the ocular and jTalpebral conjunctiva
are both involved, and the inter-
stitial inflammation generally causes ulceration
and perforation of the cornea and loss
of the contents of the eye. The Klebs-
LoeflBer bacillus is found in the exudation.
Tbe severity of the measles bears no relation
to the occurrence of the complication.
There is rarely a pure culture of diphtheria
a
ABSTRACTS 345
bacillus but staphylococci or streptococci
are present with it. Treatment is of no
avail, and the children died in the cases
seen by the authors.—Archives de Medecine
des Knfants.
Tbe Ovular Theory oi the Pathogenesis
of Eclampsia.
E. Opocher, after careful examination of
all the clinical and experimental material
with reference to the cause of eclampsia of
pregnancy, concludes that there is not sufficient
proof of the theory that the poisons
producing the convulsions are generated by
the metabolism of the fetus. To consider
the eclamptic poisons as the products of the
fetus is contrary to the dictates of physiological
obstetrics and of observation. The
placenta would not be capable of the neutralization
of these products in cases of
pregnancy going on to its end without
eclamptic manifestations. Although the
placentar theory is attractive from a theoretical
standpoint, it is not proven practically
by experiment or observation. The
theory that is best substantiated practically,
and that best accords with modern knowledge,
is that of the production by the maternal
system of antitoxines which prevent
the appearance of eclamptic symptoms as a
result of systemic poisoning.—Folia Gynsecologica.
Euqulnine In IVIalarla of Pregnancy.
Although it is known that quinine may
induce and intensify labor pains, yet many
authors state that the drug may be given
for an accidental malarial infection during
pregnancy without danger. The possibility
of a miscarriage must, however, always be
taken into consideration. In some cases of
pregnancy there is so marked an idiosyncrasy
toward the drug that its administration
is followed by very severe symptoms,
lunanuel Grande recommends euqninitie
where pregnancy is complicated with malarial
infection, since it is better tolerated
and is not likely to induce uterine contractions.
The drug, furthermore, is virtually
tasteless, does not injure the stomach or
intestines, is less likely to affect the nervous
system, and is not so apt to set up an urticaria.
In a number of cases reported, all
far advanced in pregnancy, euquinine
proved a most efficient drug for malaria
without in any way interfering with the
well-being of the patients. Further experiments
will be necessary to determine if
euquinine can stimulate the nerves of the
uterine plexus or the smooth muscle fibers
of the uterus itself.—Gaz. degli Ospedali e
delle Cliniche.

Miscellcincous.
THE CHARLOTTE MEDICAL JOURNAL.
Appendicitis and Adnexitis.
Henry Hartraaini describes appendicitis
accompanying adnexitis as Ijeing conveyed
by way of the peritoneum, there being no
direct connection between these structures
by way of the blood-vessels or lymphatics.
In the woman the appendix frequently descends
into the pelvis by pressure of the intestines
and of the corsets. Diagnosis is
somewliat difficult before operation. Pain
is generally located lower down in adnexitis
than in appendicitis. The history of the
case is of value. The absence of a history
of menstrual troubles and ascending infection
is in favor of appendicitis. The picture
of peritonitis is more marked in appendicitis,
the expression is more anxious, the
sensibility of the abdomen and the distension
are greater. Temperature is more elevated
and the condition is progressive, while
after a time in adnexitis it is regressive.
Treatment demands immediate operation
as soon as a diagnosis is arrived at.—Annales
de Gynecologic et d'Obstetriques.
Treatment of Some of the Severer
Forms oi Headaclic.—Harris (Brit. Med.
Jour. ) in discussing this subject classifies
the causes of headache as A, Superficial.
1, Diseases of brain coverings; a, scalp; b,
pericranium; c, bone; 2, reflex visceral neuralgias
of the scalp. B, Deep. 1. Reflex
cortical neuralgia. 2. Toxaemic. 3. In
creased intracranial pressure.
Diseases of the brain coverings are due to
morbid processes as rheumatism, syphilis
and tuberculosis and should be treated as
such. Reflex visceral and cortical neuralgias
are best treated by rest and anti-neuralgic
remedies as phenacetin, pyramidou
and that class of drugs. Toxamic headaches
are treated by establishing a regular
daily habit of the bowel. Increased intracranial
pressure causes the most severe
headaches and are usually only relieved by
the use of the trephine. If due to meningitis,
lumbar puncture may bring relief or
leeches applied to the temples or back of
the ears. The treatment of migraine he
divides into local and indirect by lowering
general blood pressure. The first includes
trephining, lumbar puncture, leeches to the
scalp, fomentations, hot bottles or ice bags.
The second includes nitroglycerine and
nitritis, opium, aconite, chloral, phenacetin,
antipyrin, purgation, diaphoresis and a hot
bath. Harris has had good success by applying
leeches to the .scalp, giving 10 grains
of Dover's powders, with a hot drink containing
'6 grain of pilocarpin and keeping
the patient warmly wrapped so as to promote
pefspiratiou.
Modification of the Original Wasserman
Test for Syphilis is published by Bauer in
the Deutsche Medizinische Wochenschrift.
The requisites of the test are, besides the
serum of the suspected individual, some
normal human serum; an alcohol extract
of the liver of a syphilitic foetus or infant;
fresh guinea-yig serum; and a suspension
in saline solution of sheep's blood corpuscles.
The two human sera are first heated
to 56° C, and then four small test-tubes
are prepared in the following way: One
contains the patient's serum with five times
the quantity of liver extract and of the
guinea-pig serum; the second has normal
saline solution substituted for liver extract,
and the third and fourth resemble the first
two, but contain normal instead of suspected
serum. After incubatioji at blood temperature
for an hour the sheep's blood suspension
is added to each. Hsemolysib occurs
in the third and fourth, and more
slowly in the second; whereas, if the patient
is infected with syphilis, the first rube
shows no haemolysis. One of the problems
connected with these serological tests for
syphilis is to determine precisely at what
interval after the incubation of the disease
the serum reaction makes its appearance.
On the analogy of the Widal test for typhoid
fever some such latent period would
be expected, and the point is one whose
elucidation will be observed with interest.
The claims that have been made on behalf
of the infallibility of the Wassermann reaction
have been great, but if extended research
really proves that the method gives
absolute assu.ance whether a patient does
or does not harbour the virus of syphilis
within him, it is difficult to name a more
important recent bacteriological research.
As yet, however, experts seem chary of
committing themselves quite as far as this,
and rightly so until more work has been
done.—The Hospital, London.
Dr. Livien discusses the identification of
the spirochseta pallida and the detection of t
specific antibodies in the serum of people ^
infected with syphilis. No serum therapeutic
treatment had been found effective.
Mercury and iodides remain the chief reme- i
dies. He states that mercury is best ad- •
ministered by injection or inunction, and
that atoxyl, given in efficient doses, has
proved experimentally to produce similar ;
results, but is dangerous to the optic nerve.
|
The diagnosis should be certain before!
treatment is started. Spirochseta should I
be found, or time given for the serum-test, I
or the appearance of the roseola. In most]
of tne cases where ihunctions and injections f
are employed local treatment is nnneces-ji/
sary. Mercurial plaster should be used to

ABSTRACTS.
:over chancres on the lips or face. Noso- point.s in favor of this method are said to
,hen,s a good dust.uff powder, and ortho- be: 1. That it is an efficient method of
orm may be used in painful cases. Ma- skin sterilization. 2. The sur-eon can be
ignant forms of the disease responded best absolutely certain that it has been applied,
o injections of calomel. When inunctions .3. It is quickly and easily applied. 4. It
!,7P.^"d/"'P'^"'- '"ay l^e saves the patient the suffering of Zmw ..Sh
a prepara-
|iseful ly added. The iodides are most use- tion which is at present verv lengthy and
ul m the tertiary lesions, but act well in very disagreeable. 5. It obviates the ne-
Pa*'^'^^^
"''''''' °^ shaving, which is
't^lrT.7 f"^^°"'^^''>' '"?'^"T unpleasant at
|r throat. lodism may be removed by daily the time and causes considerable irritation
dministrat.on of 1,. grains of sulphanilic afterward. 6. It saves an enormous amount
c.d in / ounces of water. In sensitive of labor upon the part of assistants and
ases lodip.n IS a useful subst.tute.-British nurses, with conseqnentiv a lessened exled.cal
JournaL penditure. 7. It saves the cost of prepara-
..T^ • ^°^^' niaterials • „ w and dressings. 8. It can .
be
It IS a well recognized fact that salicylic used in emergencv cases where preparation
cid, the drug invariably indicated in rheu- by the usual method is impossible
latism, is also the best bowel antiseptic. ^__^_^
Vhile the salicylic acid prepared from the The Symptomatic Expression Called Exatural
oil is not depressant to the heart, ophthalmic Goiter in its Relation
he synthetic salicylic acid on account of to the Function of Reproduces
iini)urities is both depressing and irrita- tion in the Woman.
ating, and hence should never be given in- , „• j r
rnally. ^- I i"ard, after giving the history . of an
Salicvlic acid
'"^^^esting
is best
case
administered
observed
in the
by him, in which
orm of sodium '^ symptoms
salicvlate
of
as it is then
exophthalmic
abgoiteraporbed
as a sodium P^-'^ed
salt and
whenever the
is also
reproductive
more functions
fl'stiirbed, gives it as the result of his
cceptable to the stomach. Small doses of Y'^
le natural sodium "'nervations
salicvlate
that the
frequentlv
syndrome called ex-
•dministered "P''/lialmic
have a
goiter
cumulative
has
action and
an etiologic relation
,an be long tolerated
ovulation
without and
discomfort
not with
or V pregnancy,
without any unpleasant or undesirable ^°T' '''^
. harmonious rhythm of the
[.mptoms." reproductive functions is re-established the
'*>'"''''0'"e Tongaline disappears.
fulfills
It
j all these conditions
would be prema-
Soroughly and is an ideal
^°
vehicle
^^^ ^^*' engrafted on
for
a
the
nervous
^"I'f
ministration of the ^'^
natural
autointoxication '
salicylic
resulting
acid T "^^J^''^'^
irom a derangement of an internal secretion
Sterilization ol the Skin of
of
^
Operation the ovaries, not the thyroid.—Annales de
ireas.-Stretton ( Brit. Med. Jour. ) applies (b'necologie et d'Obstetrique.
b the skin a solution of iodine consisting of
«ie part of liqu. iodi. fort. ( B. P. ) and three ^ Supporter that Supports.
^"^,. °f< equal parts of methylated spirit A perfect binder and supporter has been
na distilled water). The writer commenced long in making its appearance, buttlieconle
use of this method m minor cases, but sensus of opinion by those seeing the exhi-
as soon so well satisfied that he extended bition of the '
-Storm" Binder and Support
to others. It is carried out as follows: at the recent meeting of the A. M A at
wide area of the surface to be operated Atlantic City was that perfection had at
bon IS painted on very freely, especially last been reached. Many who had been
^er hairy parts, and allowed to soak in. previously unconvinced by the advertiseis
again painted immediately preceding ments of this invention of Dr. Storm in the
!ke operation. After the stitches are insert- medical journals, where they have appeared
I they are painted over for a margin of an for some time, were delighted with the
ch all round. The first and only dressing practical demonstration of its value. The
usually made on the eighth day: the unsolicited expressions of approval and
tches are then removed, and the line of satisfaction from those who are using them,
cisioii Willi a margin of one inch is paint- and which Dr. Storm is constantly receivwith
the iodine solution. If for any ing, speak more loudly than all else: for,
ason the wound requires to be inspected after all, the iiomely old adage is as potent
an earlier date, it is painted as above de- as ever, that the "proof of the pudding is
ribed. No previous preparation of any in the eating." If you are in despair for
nd is undertaken—no bath, no scrubbing, an abdominal binder that w/// support and
Id no shaving. The latter is an import- yet not cause discomfort m the wearing.
It point because it saves the patient a and will in fact be so comfortable that your
od deal of after-discomfort. The chief patient will rather wear it than not, try one
347

34S THE CHARLOTTE MEDICAL JOURNAL. j
i
i
of these unexcelled supports. Write to Dr. and, if possible, by the extraperitoneal \
'
Katheriue L. Storm, 1612 Diamond Street, method.
Philadelphia, who is the inventor, and she Dislocation of the Semilunar Bone Ij
will give you full particulars.—From The Fensterer (Beitr. z. Klin. Chir.) says that
Woman's Medical Journal, Cincinnati, O., the chief diagnostic signs in dislocation of'!
August, 1909. the semilunar bone are a circumscribed andj
painful prominence in the palm in front of
The Reflexes in Infancy and Cbild- the palmar margin of the radius, with a
j
hood.— Bychowski ( Deutsch. Zeitschrift fur corresponding depression on the dorsum of
Nervenheilkunde) says that the examina- the hand, marked restriction of motion,
tion of the reflexes in children under one particularly of palmar flexion, and impossiyear
of age showed the constant presence bility of completely extending the finger, i
of the patellar reflex, which is more marked, If there is a history of strong force applied i
as a rule, than in adults. The Achilles to the hand we should look for signs noli
tendon reflex, on the other hand, was found only of fracture of the radius, but always (
to be practically always absent during the keep in mind the possibility of an isolated :
first half of the first year, becoming more injury of the carpal bones, which can be
frequent in the second half, until it is fairly confirmed by x ray examination. In recent j
constant about the beginning of the second dislocations of the semilunar an attemp: ;
year. The abdomino-parietal reflex like- should be made to obtain reduction withou 1
wise is not congenital, appearing gradually operation. If this does not succeed, two i
in the course of the first year of life. The plans may be followed—either to at once ;
cremaster-reflex is often absent up to the secure reduction by cutting down upon th« i
fourth or fifth month, after which time it is dislocated bone or by waiting for somt i
active and constant. Babinski's reflex pre- months until we are convinced that thert ;
serves the spinal type in the first periods of has been no improvement in motion andne |
life (first and second year), during which relief of the accompanying discomfort. Ii
time it is positive. About the beginning of that event the luxated bone should be ex
[
the second year it undergoes transformation
from the spinal into the cerebral type, and
disappears.
tirpated. This has been done 3S time:,
among the 85 cases recorded in the litera i
ture. The operation by removing the me
Treatment of Hematocele after Ectopic
Pregnancy.—Esch (Munch. Med. Wochensch.)
says that every hematocele should
be removed by early operation in order to
chanical obstacles to plantar flexion give
^ prospect of good functional results evei
jn chronic cases.
Two Interesting Cases.
prevent serious complications, especially Dr. Geo. Selkirk Jones, Ph. D., L. S. A.
secondarry hemorrhage, decomposition of in an original article, first printed in Medl
its contents, suppuration, peritonitis and cal Reprints, London, says: "I am desir
pressure by the tumor upon the adjacent ous of placing upon record the two follow
organs. In the last sixteen months nine- ing clinical cases, which have come withii
teen cases of extrauterine pregnancy have the sphere of my professional occupation
been treated in the Gynecological Clinic of The first was that of a lady, the subject o
the University of Greifswald, including t\vo
of freshly ruptured tubal pregnancy and
a periodically recurring hemicrania of a de
cidedly neurotic type, upon whom the usua
fifteen of hematocele. All these recovered remedies had ( ad iiauit-aiii ) been tried, wit:
after operation, with the exception of one
case in which diffuse peritonitis had developed
prior to admission. Thd abdominal
occasional benefit alternated with disap
pointment. This led me to persevere
Antikamnia tablets, one every two houi
route, with Pfannedstiel's incision, was pre- for eight doses. This case having secure
ferred as affording a clearer view of the for me a meed of confidence, I have labele
parts in hematocele. This enables the it, mentally, as my first success with thi
operator to separate adhesions with less preparation,
risk, to avoid injuries of the adjacent parts. The second one is that of a man age;
to more thoroughly control hemorrhage, forty-five, the subject of asthma of a pu
and also to remove all remnants of the preg- monary type and associated with gastri
nancy. Simple vaginal incision with drain- troubles, for whom I was in the habit (
age was reserved only for abscess cases, prescribing alkalies. In this case I
and in these removal or irrigation of infec- now observing the gradually increasin
tious material was avoided to prevent ex- evidences of the benefit of Antikamnia <
tension or the process. If, notwithstanding Codeine tablets, which, up to the time <
all precautions, the general condition of writing, have not failed or fluctuated i
these patients become worse, abdominal their analgesic and stimulating action upc
section should be attempted as a last resort, my patient's asthmatic condition.
1
,

AUEVKTISE.MliNTS. 349
A considerable proportion of all
gastric disorders take their incep>
_tion in insufficiency of muscular
'action. Their correction calls for
measures restoring tonicity of the
stomach muscles ; for this purpose
GRAY'S GLYCERINE TONIC COMP.
is of exceptional value. Its use not
only increases muscular power, but
through improving the blood supply,
materially promotes glandular
and therefore secretory activity.
As a consequence, indigestion,
flatulency and distress are promi/tly
overcome.
The Dose. A tabUspoonfal in 'aaier
before meals.
Samples and Clinical Data
THE PURDUE FREDERICK CO;
298 BRO.\L>\VAV. NEW VORK CITY
I Notes
Officers of the North Carolina Medical Society.
?rciiideiit. Jas. A. BiutoiikIih. Aslieville.
Piesldeui. E. J. Wood, Wilininiflou.
•Prenldeiit. Jiio. Q. Myers, Ch.irlotte.
rd Viue-Fiesideiit. L. D. Wharton. Smitllfleld,
lecret.-ir.v. I>. A. Sl:iiit»D. HlKb Point
'reaaii
. H. D. Walker, Elizabetb City.
COUHCILLORB (3 TEAIIS TERM).
t Dl'tricl, Oscar McMnllan, Elizabeth City.
I{. A. WUIttaker. Kinstou.
FranW H. Russell, WilminirtoD.
E. T. Dlckerson, Wilson.
J. F. UiRtasm'th. Favelteville.
Huberi A. Kovster. Raleigh.
C M. Stronc Charlotte.
J. B. Smith. Pilot .Mountain.
I. M. Taylor. .Morpaiiton.
Orator. Cyrus Thompson, Jacksonville.
Essayist, R. V. Brawley, Salisbury.
Leader of Debate. D. A (iarrison, Gastonia.
Committee on Public Policy and Lesrisiatiou : R. H. Len-is,
Raleigh : J. A. Burroughs, Asbeville (ex-oMcio): Geo. G.
Thomas, Wilmiugton; .Albert Anderson, Raleigh.
Committee on Publication : D. A. Stanton. High Point
(.exofficw); H. A. Royster. Raleigh ; R. L. Gibbon, Char-
ommittee on Finance: G. T. Sikes, Grissom ; I. Fear
Elizabeth City : Wm. .Tones, High Point.
ommittee on Obituaries: C. A. Julian. Thomaaville
P. McFayden. Randleman; J. W, McGhee, Raleigh.
Medical Society of the State of North Carolina meets in Wrightsville, June 21, 1910.
The Tri-State Medical Association of the Carolinas and Virginia (onlv members of
state Societies eligible). Next Annual Meeting: Richmond, Va. Date of meeting
•ebruary 8, 1910. President, Dr. I.eGrand Guenv, Columbia, S. C; Secretary-
.reasurer. Dr. J. Ilouell Way, Waynesville, N. C.
INE\A/ ORLEANS ROLYCLIINIC
>OSt Graduate .Medical Department Tulane University of Louisiana. Twenty-third
Annnual Session opens November 1, 1909, and closes May 28, 1910.
Physicians will find the Polyclinic an excellent means for posting themselves
upon modern progress in all branches of medicine and surgery. The specialties
are fully taught, including laboratory and cadaveric work. I'or further information,
address:
„,, ,. „ NEW ORLEANS POLYCLINIC
ostoffice Box 797. New Orleans. Louisiana

350
THE CHARLOTTE MEDICAL JOURNAL.
Review of Southern Medical Literature True, it is, that the condition increases
as long as the water causing it is continued,
however, as yet, its mysterious nature must
New Orleans Medical and Surgical JournaU be admitted; immunity, of course, exists.
September, 1909.
Primarily, the intluetice is upon the gland
Clironlc Interslllial Nephritis.— Dr. F. and its function, the other conditions are
M. Thorn hill believes that most the secondary; consanguinity has been charged
with il, though heredity from goitrous par-
preparations of iron are more or less difficult
of assimilation, tend to produce constienta.t;e has more'force.
^
pation and to interfere with digestion, which
Pellagra.— Dr. C. C. Bass quotes the folJ
is already weak, and in many cases becomes
l..\viiig under Diagnosis and Prognosis: /
a prominent and troublesome feature. The
111 most of the cases the diagnosis is very
sense of weakness and weariness experi-
ea^v ;ifterone is at all familiar with the
enced by some patients is not always a
disease. There is no other disease present-
symptom of anemia, but is due to impaired
ing ihe syndrome of the characterislic der-
elimination, and the accumulation of effete
matitis, digestive disturbances and the dematerial
in the system, particularly the
p^gg^,^,„_ From j. rom scurvy, acrcdynia, acrcciynia, purpura,
muscles, and obviously iron instead of reg^^.jijpj^^,
multiforma and allied conditions,
lieving this condition would aggravate it.
^^^ location on backs of haiies, lower fore-
The preparation easiest of assimilation with
^^^^^ ^^^^ ^^^^ dorsum of feet; character of
the least tendency to constipate and obstruct
siji„ igsion, a dermatitis followed by vesithe
avenues of elimination should therefore
^.^jj^jj^jj qj. degeneration with pigmentation;
be selected. Either the common tincture
s..jii,,ation and diarrhea; no pain or swelling
or the iodid, the former when administered
^^ hemorrhage of gums; the depression and
in connection with the spirit of nitre makes
j^jg^oj-y ^f (;orn eating, indicate the diagan
efficient diuretic which is all the more
^^^^^^
apt to be indicated when anemia is present.
^^^^ ^^^^ ^^^^g recover. Ten per cent.
Basham's mixture is, perhaps, the most
^^ ^^^ rural population of large sections of
universally prescribed preparation of iron
jtaly and Roumania have pellagra. Though
in Bright's disease at the present day and ^^jg '^jajority finally die, others appear to
no doubt much harm has resulted from its
j-g^Q^^j. a,,^ remain well. It seems quite
indiscriminate use. Some doctors seem to
certain that if the patient is not removed
expect their patients to take it as freely and
from the cause of the disease it continues
yparently with as much relish as those
^^ ^^^^^ -^^ season nntil a fatal termination
who are in the habit of drinking Dr. Pepper
is reached. Most of the cases reported in
and Coca-cola at the modern soda fount.
this country have died, but the disease was
Cretinism.—Dr. J. D. Bloom points out jj^j recognized and maize withdrawn until
that the relationship, cretinism and myx- too late to hope to get brtUiant results. Just
edema, can scarcejy be disputed from a Jjq^^ much the prognosis would be changed
standpoint of cause' the difference is to time
\^y treatment does not seem clear from the
of life; the thyroid treatment is equally bene- literature.
ficial in both instances, therefore the cause
wben Is Gonorrhea Cured?—Dr. A.
must be common to both or independent.
Nelken says that men, desirous of marry-
It has been agreed too, that drinking water,
ing, are constantly consulting as to whether
since the change of water retards or stops -^
^^^ ^^ ^^ ^^.^^^ ^ ^^^^^
m a measure the growth, ,s of tangible ^ ^ ^^^^^ ^'i^^ ..^.orningdrop" of mucocause,
for it is said ^^^^ ^°"tiguou com-
.
^^,^,,,j g,„,^i,„ i,,3 become an obsession,
munit.es enjoy an exemption, notwithstand- P
^^.^^^ examination
ing living under the same conditions save
'^^^^^ (^ ^^^ ,.e,cles. The urethra
water supply Ihe source and character P^^^^
^^,.^j^ ^1,^ urethrometer andusuof
the water has na urai y been questioned
^rethroscopic examination made,
it IS known that soil water alone influences ^'^> J pathological signifithis
condition and that neither snow wate ^^o
g
^^p^^ ^top all injections and
or that secured from rain produce it. This
^xAoWc indulgence in moderation,
one fact IS the one alone tenable so far ^
^^ ^j^^ ^^^ ^f ^ ,,,,|k nothing new has
chemical composition has varied m almost
l^\l^^^ ^^^ ,„ i,,.t,„t injection either
all instances and this truth has led to the "^""^ "i ' ,.,,., . ^,.^„„
belief of a contagion, which is the idea be- of nitrate of silver or bichloride of mercury,
ing adopted. A second examination is made in another
The goitre-genic substance is practically
.j^reek, and if the smear is still free from
something to be learned, the mere fact of
^qjjqj,^^.^! and there is no frank pus dis-
boiling the water used in these districts -
then one is justified in advising the
where it prevails endemically, making the cuar^e, men uuc is ju=
fluid innocuous, is significant.
patient that he can safely marry.

REVIEW OF SOUTHERN MEDICAI, LITERATURE. 351
Soiitheni Practitioner, September, 1909. /^p***^:S®«S«S5;c:$.*$SSSSg5:.5SS§3=55.|^.
Trealmenl of
'
Pruritus Ana, With a % ^__,
\
'
\ f\\\^^

The symptoms of all
THE CHARLOTTE MKDICA.L JOURNAL.
Catarrhal Conditions
are favorably influenced by the combined
mild, soothing, sedative, antiseptic and astrin
gent action of
\

TABLE OF CONTENTS FOR NOVEMI
Table of Contents for November, 1909.
Original Commanicationa.
CoDstrvictive and Imppralive
Operative Surgery,
Extraoi'dinarily Unique
(:i-,cs, with Successful
Results, by Ur. Russell
Bellamy, VVilmington. N.
C 289
The Duty of The Doctor to
Ills Municipality, by Roy
K. F.annagan, M. D.,
(Jharlottesville, Va., 292
A Cursory Review of Pulmonary
Tuberculosis, by
Bittle C. Keister, A. M.,
M. D., Roanoke, Va. 296
Sexual Hygiene, by FI. C.
Buck, M.D., Friars Point,
Mississippi, 301
Examination and Diagnosis
of Diseasi'M of the Anus
and Rectum, bv E. H.
Terrell, M. D.", Richmond,
Va., 303
Mercuric Cataphoresis vs.
RadiothfM-apy and Excis
ion in the Treatment of
Cancer, by AmedoeGrnngor,
M. D., New Orleur.s,
La 305
Chronic Alcoholism, by Geo.
B. Simpson, M. D., Parkersburg.
\V. Va 308
Sterilization of Habitual
Criminals, by Chas. V.
Carrington, M. D., Rich-
• motid, Va., 309
Editorial.
Surgical Sht-ck, 311
Typhoid Fever 311
Structure of Opsonins, 312
Leprosy 313
Uric Acid and Gout, 314
Standard Oil vs. Hookworm 315
S. A. L. Itailway Surgeons, 316
Conference on Pellagra, ..
.
317
Guilford County Physicians
and Prohibition 318
American Public Health
Association 319
Editorial News Items, 321
Marriages 324
Deaths, 325
The Trained Nurse, 325
Review of Southern Medical Lif
eratare 'J;>0
Book Notices.
The Diseases of Children,
by Henry Enos Tuley, M.
D., 332
Philadelphia General Hospital
Reports, Vol. VII,
1U08, 332
Studies in Rabies. Collected
Writings of Ivathaniel
Garland Keirle, A. M.,
M. D., D. .Sc 332
Text-Book of Hygiene, by
George H. Rohe. M. D., 333
Manual of the Diseases of
the Eye for Students and
General Practitioners, by
Charles H. Hay. M. D.,.. 333
Physiology for Beginners,
by Walter Moore Coloman,
A. I'..,
333
The Practice of Medicine,
by James Tyson, M. D.,.. 334
CRAGMONT SANATORIUM
BLACK MOUNTAIN. NORTH CAROLINA
A PRIVATE INSTITUTION FOR TREATMENT OF
TUBERCULOSIS
Booklet on request
I.J.ARCHER, M.D.
Tetany and Exophthalmic
Goiter, by Drs. John Rog-
ers and Silas P. Beebe. . . 334
Atlas and Epitome of External
Diseases . of the
Eye. by Professor Dr. O.
Haab, of Zurich 334
Abstracts.
The Treatment of Lupus
Erythematosus, 334
M»at Broths for Infants,.. . 335
Tubercle Bacilli in Caseated
Lymph Glands, 338
Cholin and its Connection
with Epileptic Fits, 336
Puerperal Fever 337
Vaccinal Immunity in
Childhood, 338
Rupture of an Incarcerated
Retroverted Gravid Uterus—Recovery
338
Treatment of Lobar Pneumonia,
338
Vegetarian Diet in Health, 339
Suprapubic Prostatectomy
without Opening the
Bladder 340
Double Cervical Rib 34o
Hypertrophy of the Female
Mamma, 340
A Caseof Tubercular Rheumatism
Id a Child, 341
On Perforation of the Stomach
and Small Intestine
as a Sequel to Ovariotomy
and Hysterectomy, 341
Serum Treatment of Cerebrospinal
Fever, 341
MEDICAL DIRECTOR
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A Time-Tested Ethical Emulsion
of Cod-Liver Oil
Justpure
FRESH
COD-LIVER OIU ,
emulsified by a process that facilitates
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IDple wilK literature lent on request. Sold by drugaUtK
called for, these to be made under the same
conditions each time.
On the line of leucocyte counts in medical
cases would mention typhoid. Here
leucopenia is the rule. Leucocytosis means,
in previously simple cases, the development
of some complication, particularly perforation
and hemorrhage. A count made immediately
following a suspected perforation
would necessarily prove or deny but, coming
on as it does as a result of the developing
peritonitis, a rising count soon after
would be of confirmative value.
The Relation ol Gall Bladder Affections
to Diseases of the Stomacti.— Dr.
H. G. Walcott says that his experience,
together with the literature on the subject,
leads to the belief that even in these cases
of cholecystitis in v^fhich the symptoms are
so slight as to escape detection, that an associated
peri-cholec3'stitis often exists and
adhesions of greater or less extent with the
adjacent pylorus, duodenum and colon
takes place. These adhesions are not sufficient
to produce complete obstruction but
do in some cases interfere with the normal
peristalic waves to such an extent as to produce
a stasis of food in the stomach with a
resulting atonic dilitation of that organ,
with the resulting symptoms. Adhesions
with the colon often tend to produce both
constipation and obstipation. In all probability
the inflammation of the gall bladder
THE CHARLOTTE MEDICAL JOURNAL.
reflexly tends to increase the acidity of the
stomach, for in these cases in which there
are no adhesions and no dilitation of the
stomach, the acid is increased. The conclusions
to be drawn are that in all cases of
gastric disease in which you find a continued
tenderness in the gall bladder, even
if the history of other symptoms of cholecystitis
are absent, you will save time and
reputation by placing the patient in the
hands of the surgeon for a gall bladder
operation. The remaining symptoms and
pathological conditions in the stomach and
intestines can then be treated with more assurance
of success.
Tc.y Medical Journal, Septembc 1909.
Some Remarks on the Pathogenesis of
Tuberculosis.— Dr. T. Y. Hull has observed
sudden improvement follow an intestinal
hemorrhage in typhoid fever. This observation,
together with the discovery that the
blood possesses decided germicidal power,
which, outside of the vessels seems greater
than within, led to the belief that many
bacilli were destroyed during the hemorrhagic
process. This destruction of bacilli
within the tuberculous foci is probably true
only to a limited extent, and it could have
little or no effect upon the patient if it were
true. A more probable reason for improvement
lies in the fact that tuberculosis is
both a toxemia and a bacteremia. During
a moderate hemorrhage a large number of
bacilli and their toxins are swept out of the
body. The blood, thus relieved of a certain
per cent, of its load of bacteria and toxic
substances, is able to recover its loss of
blood corpuscles much more rapidly than
the bacilli can multiply and elaborate their
toxins. This increase in the relative proportion
of blood corpuscles to micro-organisms
increases its bactericidal power, thus
rendering the conditions less favorable to
the invading bacteria, and more favorable
for recovery. In this light the old practice
of "blood-letting" had some basis in truth.
The Southern Cliuie, Sepieml>e/\ 1909.
Local Anaesthesia by Beta-Eucalne.
—Dr. L. B. Bouchelle says that the solution
can be prepared by any druggist or preferably
by the operator himself. It should be
prepared as follows: Boil o'-; ounces of
distilled water or filtered rain water in a
clean glass vessel, add to the water after it
has boiled a powder containing beta-eucaine
3 grains and sodium chloride 12 grains and
let it boil two minutes longer. Then remove
from fire and let cool to blood heat
and add 10 drops of a 1 to 100 solution of
adrenalin chloride. The boiling sterilizes
the solution and does not hurt the beta-

REVIEW OF SOUTHERN MEDICAL LITERATURE.
eucaine. The adrenalin is damaged by the
boiling and as it is already sterile it is not
necessary to boil it. The solution should
be carefully made and if the operator does
not make it himself, lie should caution the
druggist not to boil it after the addition of
the adrenalin. The syringe and needles
should of covirse be properly sterilized but
as any alkali will spoil the solution they
should be boiled in water and not the usua
soda solution.
Tirginia Medical Scwi-Monthlp, Scfit. lOti
1909.
Local Anesthesia In Major Operative
Work.— Dr. K. M. Hasbrouck describes
the technique as follows:
It is a good idea to precede the operation
with quarter grain morphine given hypo
dermically. This quiets all nervousnes'and
apprehension, and while it is not
necessity, I have always found itsinfluenc>
for good. All of the preliminary work an
most of the subsequent work will be di ;
with the weaker solution, 1-1000, and \\\
first step is that of skin infiltration for \\.
initial incision. This is one of the nn
important steps in the method, and unle^thoroughly
done, pain is produced at
outset and we lose the confidence of our
patient, and this confidence once lost, let
me assure you, is :iever regained;—failure
in tiiis first stage may defeat the whole procedure.
I'or this purpose two or more hypodermic
syringes are kept busy, the empty ones be
ing kept filled, while the others are in use.
Remembering that our solution is non-toxic
we use it freely along ilii.' entire line of incision,
just barely beneath the skin, producing
a wheal ahead of us as we ad\ance, and
then deeply kneading the tissues so as to
disseminate the fluid. (Jn cutting down we
will find the tissues blanched and bloodless
and entir.'ly without sensation. On reaching
the deeijer structures knowledge of
nerve distinction becomes of prime importance,
for by availing ourselves of Crile's
method of nerve blocking, the sensory nerves
are picked up one by one, and injected with
a few minims of the one per cent, solution,
after which the entire field becomes insensible
t

356
THE CHARLOTTE MEDICAL JOURNAL.
in cases of low arterial tension, functional bility, after a sustained observation and
or organic diseases of the heart, or when a management, show marked improvement
heart Ionic is indicated, digitalis, strophan- and come to permanent relief. These pathus,
adonis, or nitro-glycerine, may be tients place upon a skimmed milk diet with
combined with the bromides with benefit, or without lime water. Order a saline purge
In anaemic, debilitated, or neurasthenic in the early morning usually in the form of
cases, combine bromide of soda with glyc- magnesia-citrate. Keep them on the milk j,
erophosphate of soda. Iron may also be diet for some time. When the precordial |1
given with benefit in such cases. A com- pain is relieved and not excited by more or ,'
bination of bromides with adonis vernalis less exercise, prescribe a more liberal diet. ;,
and codeine gives good results in some External Accidental Hemorrhage in a ji
cases. Bromipin (bromine and sesame oil) Case ol Normally Situated Placenta.— ;
and bromalin are remedies of some value, j^j. q Marshall says that his treatment J
especially in feeble or asthenic cases. Bi- consisted in two things: first, checking of 1
borate of soda, as an anti-spasmodic, is a hemorrhage; second, induction of labor. If I
valuableremedy when given with bromides, the uterus is healthy and we prevent the h
Belladonna, similarly administered, some- ^lood, which is being poured out from be- •
times proves efHcacious, when the bromides ^j^jj ^he placenta, from escaping out of the ::
alone fail. What is known as the Fleichsig uterus the pressure inside will become equal J
treatment—the opium-bromide method— ^o the blood pressure and hemorrhage will I
seems to.be more beneficial in the early ^ease. We can be assured that the uterus 'j
Stages or in young subjects than it is in con- ^g healthy if the physical look of hemorrhage
firmed cases. Horse nettle (Solanum Cario- jg ^^^^ ^^^j ^he fact of its being external. ,
linese) has value in some cases, and others The vagina was immediately tightly plugged :,{
have been benefited by the so-called intesti- .^j^h tampons. This did two things:—prac- •
nal antiseptics—beta-naphthol, salol and tically it stopped hemorrhage and brought i
other drugs of this class. Occasional doses qu labor. This coming on gradually did i^
of calomel and salines have apparently ^^^ increase shock from which patient was <
some influence, certainly in lessening the already suffering, but on the contrary, al- i
mental hebetude and irritability. Likewise, lowed "her time to rally from the collapse i
diuretics—the bromides being eliminated caused by loss of blood. The patient was i
chiefly by the kidneys—should be freely igft i,i ^gd for two hours. Then with as- (
given. Baths are useful adjuvants, in fact gistance from another physician she was
indispensable in encouraging needed bodily given an anesthetic. Packing was removelimination.
Hypochlorization, that is, the g^ ^jj^ cervix found to be dilated the size
suspension of sodium chloride from the diet, of g_ standard watch. Further dilatation
using instead the bromide salts, preferably was rapidly made with hand, and the memthe
sodium, with the food, has had good branes ruptured. Forceps were applied, '
,
effect in quite a number of cases. and fetus delivered but soon died. Placenta
was taken and uterus massaged. Patient ,
Treatment of Angina Pectoris.-Dr. A.
G. Brown believes that the attack in the
P^^^ to bed and given a dose of ergot (hypo- ,:
usual case can be treated with the follow- derrnically). Later gave stimulants and ,
, r T c c 11.- t^^^ smal doses of ergot. Patient recovered in :i
mg agents for relief of pain: chloroform, , , .. t ^ ^ i
f
° , ., ., ,. '^
1 , ,
, A^„,J the usual time, about two weeks.
'
amyl nitrite, morphine, chloral hydrate,
bromide potassium or sodium, nitroglycerin,
sodium nitrite. Absolute rest in recumbent
Vi>si'iia l\Icdical Semi-Monthly, Aug. 27, \\
\
i
i
position, application of hot packs to chest, 1909.
sipping of a cup of very hot Epsom salts Uncenariasis.— Dr. J. R. Perkins gives J
solution. Those cases showing acute dila- the following treatment: ji
tation of the myocardium, with or without 'fhe most popular drugs used are thymol, ;.
great pain, should be stimulated by simul- male fern, and betanapthol. Thymol hasL
taneous use of strychnine, spartein, caffein, given excellent results in my cases, and I j
camphor, ammonia, and should not be de- have had no occasion to use the other reme- I
pressed but sustained, depending more upon dies mentioned. It is very necessary to j'
topical applications and gastrointestinal have the intestines empty and clear of mu- i
elimination of possible etiologic factors. cus before beginning treatment; if not, re- |l
If the case is one showing no marked suits will be disappointing. Some authors 1
cardiac vascular, or visceral lesion, and not
attributable to glands of internal secretion,
advise starving the patient the day before,
j;
giving calomel and podophyllin, and next,'
look for the main cause in the gastrointes- morning a large dose of salts, followed in a ;•,!
final tract. In these cases a strict diet, a short while by the thymol. This has upset:
j
limitation as to quantity and a selection of the stomach and produced such nausea that |:|
the kind of food used, will in all proba- the thymol could not be retained. Whenli|
:
i!

REVIEW OF SOUTHERN MEDICAL LITERATURE.
treating a case, allow three glasses of milk
the day before; and in the afternoon give a
large dose of salts, which usually acts well
on account of the small amount of food in
the intestines; early next morning begin
with the thymol, giving from ten to twenty
grain doses every h(jur till four or five doses
are taken. Usually, within a short time
after the last dose, the bowels begin to act
and the worms appear in the stools.
In case no action is produced in a short
time, it is best to give another purgative.
By this time the patient is weak and nauseated,
and salts may not be retained. In
such cases, a bottle of cold citrate of magnesia
'.effervescent) acts just as well, is
more palatable, and better borne by the
stomach. If the thymol is too irritating to
the stomach, give one-eighth to one-fourth
grain of cocaine l^efore giving first dose.
No food should be allowed the day of treatment
till four or live hours after worms begin
to pass.
Treafment ol the Acute Diarrhoeas ol
Infancy.- Ur. J. B. Xowlin says that after
the stomach and bowels have been washed
out, morphine 1-100 to 1 20 grain with
atropine 1-250 may be given every two
hours to check the vomiting and excessive
peristalsis. This should be given by the
physician and the effects carefully watched.
The hyperpyrexia should be treated with
te:
Sulpho
Lyth in
WITH I
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u. s. p.
1
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J
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Cbolagogue, Biliary and
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Effective in all conditions produced by
Hepatic Insufficiency.
Effective in arresting, preventing and counteracting
bacterial invasion of the gallbladder.
Hence it is indicated in
Cholangitis, Cholecystitis and
Cholelithiasis.
Ivffective in Typhoid Fever, as a preventive
and curative agent, being an Intestinal
Antiseptic.
Effective also in Toxemia of Pregnancy.
Sample, literature and clinical reports upon request
LAINE CHEMICAL CO.
Manulacturing Chemists.
NEW YORK.
Dependable Analgesia
No one demand on the physician's skill is so frequently met
as that for the relief of pain. To respond promptly, safely and effectively is, therefore,
one of the most important details of practical therapeutics, and experience has
demonstrated time and again that no remedy has a broader field as a dependable
analgesic than
MENAI^GIN
This reliable product not only promptly relieves pain, but
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PHKNALGIN is invaluable in LA GRIPPE. RHEUMATISM and GOUT.
Samples on request.
THE ETNA CHEMICAL CO.
NEW YORK CITV

358 THE CH RLOTTE MEDICAL JODRNAL
hydrotlierapy. Stimulants are e^ dv called to cleaning out the uterus. In acute sal- ,:
for of which brandv, in small doses fre- piugitis, of gonorrhceal or other origin, even i
queutly repeated, is the best. Port wine before pus has formed, the tubes will aland
claret may also be given. The only ways drop low down behind the uterus, so i
other druo- that he has ever seen do good is that they can be very easily gotten at through ;
mercury Either as calomel placed on the this incision, and then swabbed out with |
tongue'or as bichloride in 1-100 grain doses carbolic acid or tincture of iodine, or other- i
every two hours. If collapse be present, wise treated conservatively. This opera- i
the child should be placed in a pack, the tion may be done more than once on the !
temperature of which is 100 degrees, and same patient if there is a re-accumulatioii .
kept at this by pouring on hot water -very of the pus. In cases which are not entirely !
twenty minutes. At the same time, hypo- relieved by this treatment, it is much easier ,
dermoclysis should be gi-en, to which caf- and safer later on to do a complete opera- i
feine, 1-6'to 1-2 grain, is added. Ether and tiou by the abdominal route,
camphor may be given hypodermically.
Alcohol should not be given m this stage
If the hot pack is not used, a hot mustard
,rf,is,_Dr. T. E. Mitchell says that in the i
treatment of iritis three indications are to be :
^^^^ .^^ ^^^^^ ^^ follows: (1) Relieve i
bath should be given, the child being kept ^^ ^^it; te the pain; (2) keep the pupil j
in the bath until the attendants hand is dilated in order to prevent posterior adhes- !
reddened. In using either the hot pack or .^^^^ ^^^^ pupillary false membianes as a :
the bath, cold cloths should be kept on the ^^^^^ ^f i„flammatorv exudates; and (3)!
child's head. The ears should be stopped ^^^^^.^ ^^ ^^^^ therapeutic agents as are I
with cotton during the bath, and the eyes, indicated the constitutional disease of which ;
if open, as they generally are in this condi- ^^^ inflamed iris is but a local manifesta- i
tion, should be covered with moist gauze. ^.^^^
Food, as a rule, does not enter in the treat- ^^'^ ^ routine procedure, which should be ;
ment of the acute attack, all efforts tor the jjj^^ ted just so soon as a diagnosis is ,
first twenty-four hours being directed to ^^^^^^ the eye should be anesthetized with i
keeping the baby ahve.
^ ^^^^ p^^ ^^^^ solution of cocaine, fol-
Atlanta Journal-Record of Medicine, August, lowed by a few drops of a three per cent, i
iggg solution of atropia at intervals ot fave min-;
Pelvic operations in the Female per ^tes for half an hour. The above sugges-
Vaginam.-Dr. W. L. Cook thus describes tions should be carried out by the physic an ,
vdyiu^.:,^;:;E e^ient course of the dis-i
StlittSe^ru^L^P^^^^^^^^^^
the vaginal sheath, then introduce the and with as much frequency as may be
finger, and boldly, but carefully, dissect necessary to maintain a wide and uniform,]
along the posterior surface of the broad dilatation of the pupil. \
ligaments and uterus, breaking into each
^.^^^ ^^^ ^^.j^ ^^^ ciliary muscle thor-ij
pocket of pus as it is encountered. This j ^i • n f », „ (i,^i:
^ 1 1 ..,1 r . r , f , „^ ouo-hlv under the influence of atropia, the';
may be done with perfect safety, so tar as ""»"'.)' "'
|i
, ,. j i
infecting the general peritoneal cavity is pain is by this alone greatly relieved on th«^i
concerned, as there are always sufficient broad surgical principal of putting an inj
adhesions above to prevent this, and the flamed organ at rest. However, should th(i
pus escapes by the side of the finger as fast
continue, applications of moist or dr))!
as it is liberated. After thoroughly evacu- , ... , n Y
ating all the collections of pus, the opening l^eat will be of service.
_
in the vhgina should be well stretched, to Owing to the fact that the majority of all;
permit of good drainage. Now pack the cases have a specific origin, and because o,j
pelvic cavity well with 5 per cent, iodoform ^j-j^ additional fact that mercury is suppose^
gauze, which has been washed in a 1-4000
^^ ^^^^ ^ salutory effect on plastic formsoli
bichloride solution. Allow this gauze to . ^ . ,, ^- i -r*- ~.-',
remain in place four or five days, then be- inflammation generally, antisyphilitic remejl
gin to remove it, taking out a small piece dies should be resorted to without delay,
^j
each day until it is all removed, when the In rheumatic iritis, besides the local treatji
pus cavity will have almost closed up. A jjjg,,^ already outlihed, we have recourse t|!
small wick of gauze should be left in for a
^^^^ well-known anti -rheumatic thera;few
days longer to keep up the drainage. . ,. ,. -j i- i * r ^iki
This plan of treatment should be used in all Peutics as salicylic acid, salicylate of sod
cases of puerperal sepsis that do not yield and the alkalis generally. ,
; !

ABSTRACTS. 359
DOCTOR: OUR
RESPIRAZONE
is a Prescription that does not disappoint in the treatment of
Spasmodic Asthma and Hay Fever
Its action is primarily on the mucous and serous structures of the nose, throat
and lungs, which are the tissues involved in Spasmodic Asthma, Hay Fever and
Croup. RESPIRAZONE Relieves Asthma promptly and effectively by allaying
Hyperesthesia, relaxing muscular tension and subduing inflammation by reso
lutiou, rationally meeting the pathological requirements of these cases.
Another superior prescription is our
FEBRISOL LIQUID
FORMULA: Each Fluid Dram Contains chemically pure:
I'lienacetine 2 grs. .^cetanilide li gr.
Salol
Cit. Caffeine
i
i
" Tartaric Acid |
"
Soda Bicarb. S
^- *•
[''ever and pain are the ever present conditions at the sick bed, and to
promptly subdue the one and relieve the other is the desideratum of every clinician.
I'"ebrisoI has solved the problem how best to do this.
I'"ree samples to the ])rofessioii upon application.
TME TILDEM CO/V\PANY
Manulacluring Pharmacists,
NEW LEBANON, N. Y. ST. LOUIS, MO.
'^ulf States Journal of Medicine and Surgery frequently accompanied by severe nervous
and Mobile Medical ond Surgical Jour- symptoms, delirium and coma; the prostra-
, //(//, Aui^usl, 1909. tion is nearly always profound. Gastro-
On Some ol the Clinical Methods oi intestinal derangement, such as vomiting
investigating Cardlo-Vascuiar Condi- and diarrhoea may predominate; cough and
lions.— Hy Dr. 1'". L. Barker, Baltimore, expectoration may be absent. Though the
Maryland. respiratory rate is high, there may not be
much dyspnoea. Heart's action is very
weak; temperature is seldom high; may be
The Alabanui Medi.al fournal, A,,^. 1909.
normal or even subnormal; the course is al-
The Early Recognition ot Pneumonia W'ly^ nrotracted
ind the Dillerentiation Irom Abdominal P'"i '**^i«:"-
Apicall'neumonia.-This is supposed to
Conditions. Dr. T. C. Donald says that ,
here are certain clinical varieties of pneu- ^'^ ]''°'^ '" '^^'''^''^" ^"'^ ^^^ ^«^^-
'^""I'T"
.
,., , , .
De inum and hvperpvrexia are more comuouia,
although some are due to organisms , ,. . • ,. r .j ., ,
,..,., 1 •
1 J mon; delirium in this form is said not to be
'
tber than the pneumococcus, which deserve
, ,,
., ,. I-- 1 J au unfavorable symptom.
ur consideration: I-irst, wandering pneu- ,,
'
. .^ . .
,
,, ,
,,,, • • .1 . f t ., "i- Central pneumonia '^
is usually simplv an
Qonia. Ihis is that form of the disease .
.
,
ij . \.- u u u
• . . , ^ J r . r .1 incomplete consolidation, which has begun
bat lends to spread from one part of the . ., j . r .i i i .u
. •
,, c ,, . .1 m the deeper part of the lung; you have the
ting to another; of this vanetv there are ^
,. . , , .., ,f , r
• ,-.... i 1 • .1 clinical symptoms, with the absence ot
wo distinct types—one in which the in- ,
. , i ^ ^-i , .
. , 1 ,. . physical signs until late.
*^ ' amniatory process travels by direct con- ^
Inuity to neighboring parts, the other in
rhich the di.'^ease affects different regions We call the attention of our readers to
f the same or different lobes, as lime goes the advertisements of the Robinson-Pettet
Second, the asthenic or senile pneu- Co., Louisville, Ky., which will be found
lonia. This is characterized by gradual, on another page of this issue. This house
isidious onset, often without chill, or any was established fifty years ago, and enjoys
rodromal symptom. In bed-ridden paents,
it may pass unnoticed until the disa
widespreads reputation as manufacturers
of high character. We do not hesitate to
ise is far advanced. This form of pneu- endorse their preparations as being all they
loiiia is often located at the apex, and is claim for them.

360
THE CHARLOTTE MEDICAL JOURNAL.
A-S-Phen, formerly known as Ther- Vroi&ssor Yir^s&x ( BericJite der Deutsche)
mol, has been proven by extensive chemi- Gesell., Vol. 37, p. .3076\ states: "in th

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has been recommended by the
Leading Medical Specialists
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ny*^^Worthless Substitutes
' ^^Preparations "Just as Good"

362 THE CHARLOTTE MEDICAL JOURNAL
THE CHARLOTTE SANATORIUM
Corner West 7tli & Church Sts. Charlotte, N. C.
D. A. Tompkins. President. E. C, Register, M, D.. Vice-President,
W. D. Witherbee, M. D.. Secretary.
private hospitaliiicor-
A p o r a t e d
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The buildiii-
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The most Improved hydrotherapeutic apparatus. Complete Electrical Equipment,
Sun parlors, two Surgical Operating Rooms, Electric Elevators, Vacuum Cleaning
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nurses.
CHIEFS OF THE DIFFERENT
Medicine Surgery
EDWD. C. REGISTER, M. D. G. W. PRESSLY, M, D.
Nervous Diseases
J. P. MUNROE, M. D.
Diseases of Digestion
C, M. STRONG, M. D.
Eye, Ear, Nose und Throat
E. R. RUSSELL, M. D.
DEPARTMENTS
Cancer and Skin Diseases
W. D. WITHERBEE, M. D.
Genito-Urinary and Rectal Diseases
A. I. CROWELL, M. D.
Anaesthetics
W. 0. NISBET, M. D.
A. M. WHISNANT, M. D.
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Ct-TrtFf LOTTE, P«J. C
Abdominal Supporters.
Abdominal supporters are universally
used by surgeons and physicians. Dr.
Katherine L. Storm, of Philadelphia, has
designed a supporter so much in advance
of the ordinary bandages that she has given
the profession an invention of very great
merit. It has received the highest praise
bj' eminent men, and is in very general use.
It is surely worth while to have a bandage
that will hold in place, for instance, parts
that have been stitched, thus enabling the
patient to get out of bed a few days sooner
than otherwise. Dr. Storm advertises the
supporters in our columns, and we trust
many of our readers will ask her for descriptive
circulars. Address Dr. Katherine
L. Storm, 1612 Diamond street, Philadelphia,
Pa.—Medical Council, May '09.
Danger Due to Substitution.
Hardly another of all the preparations in existence
offers a wider scope to imposition under the
plea of "jnst as good" than the scientifically standardized
Eucalyptol.
The most recent fraud practiced in regard to this
product is an attempt to profit by the renown of the
firm of Sander & Sons. In order to foist upon the
unwary a crude oil, that had proved injurious upon
application, the firm name of Sander & vSons is
illicitly appropriated, the make-up of their goods
imitated and finally the medical reports commending
on the merits of their excellent preparation are
made use of to give the desired lustre to the intended
deceit.
This fraud, which was exposed at an action tried
before the Supreme Court of Victoria at 1 elbourne,
and others reported before in the medica literature!
show that every physician should see that his pat-
ent gets exactly what he prescribed. No "just as
good" allowed.

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WRINGERS WII.I, BE PROSECUTED,
The "Storm" liinder may
be used as a SPECIAL support
in cases of prolapsed kidney,
stoniach, colon and in ventral
and umbilical hernia; as
a GENERAL support in pregnancy,
obesity and general
relaxation; as a post-opEra-
TivE Binder after operation
ii[>on the kidnej', stomach,
bladder, appendix and pelvic
irijaiis, and after plastic operations
and in conditions of
irritable bladder to su pport
the weight of the viscera.
: and sale of the "Storm" Abdominal Supporti
possible. Only responsible parties need apply.
Illustrated folder giving styles, prices and diagram for measuring and
partial list of physicians using "Storm" Binder sent on request
KATHERINE L. STORM, M. D., 1612 Diamond St., PHILADELPHIA.
All. (ikliKRS MI.I.KI) WITHIN 24 IIOIRS ON RECEIPT OF PRICE.

THE CHARLOTTE MEDICAL JOURNAL.
DR. MORSE'S SANATORIUM
REAR VIEW OF SANATORIUM FROM PARK.'
A reBued countr\- Sanatorium, with all the conveniences
of a cit\'; hot and cold water, bath, toilet, electric belis, etc.
The location, in the heart of the Flue Ridge, is one of unnsual
beauty. I\Iiles of graduated walks, for the control of exer-
cise, forming spacious "park." Climate unsurpassed. Cui-
sine excellent. All rooms permit of veranda sleeping. Cot-
tages adjacent . Close
personal contact with physician in
charge. Two mails dail)\ Telephone connection with W.
Chimney Rock, N. C.
U. Telegraph service. CHIMNEY ROCK.
DR. STEEDLY'S PRIVATE HOSPITAL
FOR
Abdominal Surgery and Diseases of Women
SPARTANBURG, S. C.
SCOPE OF WORK limited exclusively to surgical affections, in either sex, oi
the- abdominal walls (hernias, tumors, etc.) or of the abdominal organs—stomach,'
intestines (including rectum), liver, gall bladder, spleen, kidneys, pancreas, anc
urinary bladder—and to all affections of the female pelvic organs.
OPERATING AND STERILIZING ROOM EQUIPMENT is the best obtainable
FURNISHINGS elegant, comfortable, and homelike.
ONLY GRADUATE NURSES in attendance upon patients.
TERMS: For room, board and general nursing— private rooms from $25.00 t(
$50.00 per week; double rooms from $15.00 to $20.00 per week.
Anaesthesia and surgical dressings in operative cases, $10.00. Charges for profesi
sional services according to the nature of the case and the circumstances of the patient
For further information address
MRS. FRANCES M. MONTGOMERY, Superintendent, or,
J. H. HUNTER, Resident Physician.

ADVERTISEMENTS.
St. Luke's Hospital
1000 WEST GRACE STKEET,
=RICHiVIOND, VA.
s^A^vc; Ai TA.T^IvOI«, jsi. r>.
Both
Owned and personallyconducted
by Dr. Stuart McGuire for the exclusive
use of his private patients.
Buililing erected for the purpose
to which it is devoted, and combines
llie comforts of a home with the
conveniences of a modern sanatori-
Location in residential section
convenient to all parts of the city
by means of the street c?.r service.
Capacity for sixty patients, single
and double bed rooms. No wards.
Designed especially for surgical
and gynecological cases. No contagious
diseases, in.sane or colored
patients received.
Cost of bed, board and general
nursing from $14 to $18 per week
For further information, address
the vSecretary.
BROADOAKS |
SANATORIUM f
Morganton, |
North Carolina. i
A Private Hospital for the #
Treatment of Nervous and Men- ^
tal Diseases, Inebriety and Drug; ^
tiablts m
A home for the Permanent Care
of SELECTED CASES OF
CHRONIC NERVOUS AND
MENTAL DISEASE.
Medical Officers reside in the SANATORIUM and devote their
whole time to its service. New addition just completed admits
of thorough classification of patients, and gives better faci-
lities for the care of all. Billiards, Tennis and other diverting
amusements.
Complete equipment for Hydrotherapy now being installed.
Correspondetice with physicians solicited.
I

XXII THF CHARLOTTE MEDIOAL JOURNAL
An Interesting Point in the Treatment voluntaryevacuationsof feces and urine con- i
of Typboid Fever.
tinned. On January 18 at noon A-S-phen i
By Henry C. F. Kellner, M. D., Philadelphia, Pa., (more generally known as thermol) in five- '
Visiting Physician to the Roosevelt Hospital.
g^^j,, doses every hour was added to the i
One of the greatest problems that has treatment. Examination of the urine show- i
confronted the medical profession in recent ed enormous numbers of typhoid bacilli S
years is the discovery and proving of an present. i
antithermic and antiseptic agent which will From the time of beginning the adminis- j
act in typhoid fever with comparative quick- tration of A-S-phen the temperature never •
ness without at the same time unduly de- rose above 101.3 degrees, the respiration i
jjressing the heart action or lowering the gaii ed in depth and fell to 24 per minute, i
'
i
,
i
vitality of the organism. It would seem
the duty of all the members of the profession
to make accurate observations, and,
from time to time, reports upon remedies
and the pulse became fuller and stronger, i
alihough counting at 100. The general 5
symptoms abated, and the patient slept ;
quietly, with very little restlessness. On
presented for their approval, in order to
secure legitimate conclusion as to the merits
of these drugs and compounds, with a view
January 21 the temperature fell to 99, the i
pulse to 94, and the respirations to 20. A ;
specimen of urine sent to the laboratory
j
to establishing their degree of value, and showed a marked decrease in the number !
'
thus, whenever possible, adding to the arma- of typhoid bacilli.
ment of the physician. The temperature diminished daily but i
In a number of cases of typhoid fever gradually, a few tenths degree marking the (
occurring recently in my charge at the improvement in the averages for each day. ]
Roosevelt Hospital of Philadelphia, I have With corresponding favoring changes in i
been interested to note the results from the pulse and respirations, normal conditions
use of a certain agent which seemed of un- were established on February 2. At this
usual qualifications, and which I herewith
report for comparison and investigation,
The following typical cases give the salient
time bacteriologic examination of the urine
showed the typhoid bacillus present in very i
small numbers. February 10, reports showed i
features observed in administration:
Case 1.— F'ritz M— , aged 26, a Russian
practical elimination of the typhoid bacillus
from the urine, and on February 12 the pai
tailor, was admitted to the hospital January tient was discharged as cured. 1
12, 1909, with a temperature of 104 degrees. Case II.—Ethel P— , aged
22, a seam-
pulse 100, respirations 24. His tongue was stress, was admitted to the hospital January
badly coated, and the characteristic rose 13, 1909, with a temperature of 105 degrees,
spots of typhoid fever were present on the pulse 104, respirations 24. She complained
abdomen. He was given ^ sponge bath of of great malaise, and showed all the classic
iced water, and the ice cap was ordered to symptoms of typhoid fever, which were conhis
head. His diet was restricted to milk firmed by a positive Widal reaction and the
and iced water, and a routine pepsin-hydro- determination of the presence of the bacillus
chloric acid mixture was prescribed in tea- in the urine. She was placed upon a milk
spoonful doses everj' three hours. diet, and a pepsin-h^'drochloric acid mix-
There was the usual reduction of tern- ture reinforced by one-thirtieth grain of
perature following the sponge bath, but it strychnia sulphate every three hours, was
rose again to 104 degrees by noon of the ordered, with a teaspoonful or whisky. She
following day, the patient lying semicon- was given a hot cleansing bath, and four |
scious and restless. There was a marked hours later was sponged with iced water,
loss of sphincter control, the feces and urine She made considerable complaint of pain
passing involuntarily. The Widal test was in the abdomen, and some tympanites were
positive. To quiet the exhausting restless- present. The bowels were ordered irrigated
ness and the cephalic symptoms complained with iced water at intervals of four hours,
of, the patient was given a capsule of caf- The first irrigations relumed clear, but
feine citrate two grains and phenacetin five later a yellowish tinge of the water was obgrains,
early in the afternoon, the dose be- served. Under this treatment the temperaing
repeated at nine in the evening. Re- ture ranged from 102 to 105 degrees, with
peated spongings with iced water brought full rapid pulse registering 110 and respirathe
temperature down to 101 degrees dur- tions at 24. On the day of her admission a
ing the next twenty-four hours. This treat- capsule of quinine sulphate two grains,
ment was continued with the substitution phenacetin three grains, and salol three
of one-thirtieth grain of strychnia sulphate grains, was ordered every four hours,
for the plienacetin-calTeine capsule. On January 16 capsules of A-S phen, five^
From this time until January IS the tern- grain doses every two hours, were ordered
perature was from 101 to 103, pulse from 95 substituted for the quinine-salol-phenacetin
to 108, respiration 36, shallow. The in- combination. From this time the average
'

Balttmore^Md.
Pine Rid^e Sanitoriiini.
Banili
Treat;
and rulmonury '1'
ADVERTISEMENTS.
)f the daily temperature showed a gradual
esseningof a few tenths each day, althouEh
he pulse and respiraiions evinced but little
uiprovement, other than a steadying of the
mlse. On the ISth, the patient was given
cleansing bath. Shortly after it was
oticed that the fingers showed decided cy n
losis at the tips, and in the fear that this
ymptom might have been due to tliemedi
alien employed, the use of A-Sphen was
lisconlinued, and the customary pepsin
fiydrochloric mixture substituted. With this
hange the temperature showed a distinct
ise, from lol degrees to 104, and by l

XXIV THE CHARLOTTE MEDICAL JOURNAL
constantly to the head and the bowel irriga- She was placed on a liquid diet with dessert- i
tions of ice water were continued at inter- spoonful doses of an acid pepsin mixture i
vals of every three hours. every three hours. The usual cleansing-
The following day the temperature lay bath was also given. Her temperature rose •
between 101 and 103 degrees and the pulse steadily from the hour of admission, and at ]
at 112. The cold spongings did not seem ') o'clock that evening registered 10,3 de- i
to agree with the patient, and external ap- grees, with a pulse of 92. She was given a i
plications were confined to the use of the cold sponge bath, and within a half-houi ;
]
;
,
ice cap and the hot cleansing bath. There the temperature had fallen to 101 .2 degrees. «
seemed little gain beyond the status quo Tlie treatment and conditions remained i
ante, although there was a slight lessening praclically unchanged until the morning ol
of the daily temperature average. There January 31, the patient showing a tempera ;
was no amelioration of the subjective symp- ture curve of from 99to 101.5 degrees. The !
toms. rose spots appeared on the abdomen, and i
On January 30th an examination of the the positive Widal reaction confirmed the I
case record showed that the cyanosis of the diagnosis of typhoid fever. The patien i
fingers apparently had no relation to drug began to show emaciation and the charac
medication, since it had appeared with regu- terislic sores appeared, necessitating daih
;
i
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i
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i
larity after each cleansing bath, even when cleansing of the mouth. On the mornin'
the temperature of these was sufficiently of the 31st the ice cap was ordered to th( !
high apparently to exclude the slightest head, and albumen water added to the diet
danger of unfavorable reaction. The gen- The course of the disease showed but littk
eral condition of the patient did not seem interruption, the pulse remaining betweer
satisfactory, and A-S-phen was again order- 80 and 88, and the temperature showing i
ed in five-grain doses every two hours. From somewhat lower curve, between 99.2 anc
the time of its resumption the improvement 101.3 degrees. On February 4, atnoon, the "
!
in temperature and respiration became mark- temperature was 100.3, pulse 80, respira
ed and the patient's general condition im- tions 20. Bacteriologic examination showec i
proved, although the pulse continued rapid, the typhoid bacillus present in the urine ir
still registering 100 and over. The patient large numbers. The treatment was changec j
:
i
!
i
i
i
j
slept better, and took and retained nourish- to A-S-phen in five-grain doses every twc
ment more satisfactorily. There was less hours, huprovement in general aopearanct
complaint of subjective symptoms. Within was almost immediate, the temperature fol i
one week, on Felaruary 6, the temperature lowing the change in medication, only onci ,
was nearly normal. A week later a dis- rising over 100 degrees, when a cleansinf
tinct rise of temperature was noticed, sev- bath was given. It remained normal will I
eral times reaching 103 degrees. This, how- a slight recorded rise late in the day to 99
ever, was attributable to a large abscess and once 99.4. Upon February 11, oiif
which had begun to form upon the back, week after the inauguration of the treat
and to a local vaginal condition, shown by ment by A-S-phen, the temperature remain
a greenish-yellow fetid discharge. These ed normal the entire day and thereafteri
conditions existed nearly ten days, but with The bacteriologic report showed practical i
their improvement under appropriate treat- elimination of the typhoid bacillus from thil
ment, the untoward symptoms vanished, urine. The patient was pronounced cure(
During this period heroin in doses of one- and was discharged from the hospital oi
twenty-fourth grain was given every four February 12.
hours. After the evacuation of the abscess Case IV.— Helen K— , aged
on February
22, a domes
2?-> the temperature never ex- tic, was admitted to Roosevelt Hospital oi
ceeded 100 degrees, and remained usually January 21 with a temperature of 102.1, in
at 99. Conditions practically normal as creasing within the hour to 103, pulse 88|
regards temperature and respiration were respirations .52. Her skin was very dry aiiii
established February 28, but the pulse con- burning, tongue coated, and she complain|
tinued at about 100. By March 4 the pulse ed of headache and general malaise, Sh!
;'
also began to dryp, registering at that time was given a cleansing bath, followed by
88. On March 9 a moderately full diet was sponging with iced water. The routinl
allowed, and from this time until March IS, pepsin-hydrochloric acid mixture was ordei|
when the patient was discharged as cured, ed in dessert-spoonful doses every thre
progress was rapid and uninterrupted. hours, and she was placed on a milk diet
IS a domes- The next morning the characteristic ros|
Case III.—Anna S— , aged
tic, was admitted to the hospital on Mon- spots were observed on the lower part of th;
day, January 18, 1909, complaining of gen- chest, and a positive Widal reaction com
eral malaise, and exhibiting hebetude with pleted the diagnosis of typhoid fever. Th
a low form of nervousnessr Ilerpulse count day after admission her temperature rose tj
was 72, temperature 98.3, respirations 21. 103.4 degrees, pulse 96, respirations 24. 0;
: !

ADVERTISEMENTS.
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3fllumnf#^
ALT
WITH
REPRESENTS THE MOST
VALUABLE COMBINAvTION
^ OFTONIC AND RESTORATIVE
KNOWN TO MEDICINE
EISNEFL- MENDELSON CQ.> New York
Dr. F T. Meriwether's Private Hospital
24 Grove Street
AsHeville, N. C.
For Surgical and Gynecological Cases
.ludcrn in respects Trained Nl
1 Asheville's superb climate; centrally located, but on a quiet and retired street.

XXVI THE CHARLOTTE MEDICAL JODRNAl
Januarj' 23 irrigations of the bowel with ice also furnish a guide. If the amount sliould
water were begun. Encouraged by the become too profuse, the dosage of the dnio; j
favorable results in other cases, five-grain should be diminished in accordance. i
capsules of A-S-phen were ordered every A point frequently made against mam- of i
two hours. The rapidity of the pulse in- the various plienetidin derivatives is that |
creased, ranging from 100 to lOS, but the they unduly depress the circulatory system, j
highest point reached in temperature after In Case II it was feared that A S phen was I
the administration of the drug Tas begun depressing in the effects from the indication '
was 102, and the expected gradual decrease of cyanosis observed on the extremities of ;
in the daily averages of temperature by a the patient's fingers. Discontinuance uf :
few tenths of a degree began. Normal the drug with continued observation poinled
temperature was reached January 31, and unerringly to the fact that this cyanosis had
the pulse thereafter soon slowed to 72, and no relation whatever to the use of A-S-plien, j
from that time improvement was rapid, but was caused by the baths administered j
without any complications whatever until to the patient in the routine treatment.
February 11, 190'->, when bacteriologic re- A valuable indication may be observed i
port showed absence of the typhoid bacilli in the slight effect upon the pulse rate in the i
from the urine, and the patient was pro- use of A-S phen, even in the weak circula- ,
nounced cured and discharged from the tion of the patient who exhibited the symp- |
hospital. torn of cyanosis. This slight effect was
In the cases recited above diagnosis was especially noticeable in view of the fact that i
established not only by the clinical symp- the temperature showed steady decline un- |i
toms of rose spots, characteristic tempera- der its administration. An agent having ^\
ture, etc., but laboratory methods establish- so conservative a mode of action, conjoined ,!
edthe Widal reaction and also the presence with the remarkable bactericidal power, as
of the typhoid bacilli in the urine. Later shown in the rapid disappearance of the 'i
laboratory examinations showed the rapid typhoid bacilli from the urine, would seem .
decrease of the typhoid bacilli from the of great value in this disease. The cases <
specimens of urine submitted, and in each quoted as typical show milder and shorter i
instance their eventual disappearance, courses under the conditions of very high ]
There would seem here the possibility of temperature and great prostration upon adan
agent invaluable in preventing the mission. They are reported in the hope of i
establishing of "typhoid carriers" who are stimulating further investigation in this most i
becoming recognized as no inconsiderable interesting line of research,
factor in the spread of the disease. If there [This is another item in the rapidly ac- >.
is available a sure and ready means of cumulating evidence from the practice of i
eliminating the bacilli from the secretions, closely observing, scientific physicians,
a great danger will be obviated. This is showing the great usefulness of this drug in ;
ventured as a suggestion for investigation typhoid fever, pneumonia, and certain other i
in this line of preventive medicine. The systemic germ infections —Ed. Medical i
rapid elimination of the bacilli from the Council.] _^ I
urine in Case I is a remarkable confirma- Tlie Standardization of Digitalis.
tory point. This man was at the point of Houghton, in a recent issue of The Lou- '
death, but improvement followed in quick don Medical Lancet, reaches the following I
relation to the clearing up of the urine. conclusions: .
The gradual but steady reduction of the 1. It has been shown by numerous labora-
temperature curve must be noted. There tory workers that it is impossible to deterj
|
was no possibility of harm, such as might mine the value of the heart tonics of the ,
have followed the abrupt reduction. The digitalis series by chemical assays. !
entire effect of the drug seemed to be in the 2. It is a well-recognized fact that the ,
line of assisting the forces of nature to bat- toxicity of these products warrants that ;
!
j
!
i
i
tie with the invading bacilli. This result
encouraged me to use the drug in various
febrile cases in my private practice, in inevery
effort should be made to present preparations
of them of as uniform value as
possible.
i
creased dosage. I'rom m}' experience, I
am led to recommend the plan of a steady,
3. Experiments upon animals have demonstrated
conclusively that the variation in
even increase of the daily amount of the the physiological action of some of these i
A-S-phen administered. Within three days products is extremely great.
I believe that the system should be able to 4. It is urged that there be appointed an
accommodate 120 grains a day. Particular international committee to determine and I
attention should be given to the evidence of recommend the best method of physiologi- i
shock from a too sudden reduction of ex- cal assay of the heart tonics of the digitalis <
cess of temperature in reaching this daily series and an international standard "heart
amount. The amount of perspiration will tonic unit," to express the physiological .j
.
;
|
(
|

fflflN ITi WEflKEJT UNK-
IT 15 NOT CNOl/GH
'0 Do THE DlGfSTlNS
'OK The SroMflCrt
« jMoytD Pf?OPERLY I
'EED iheD/GESTIVE
!)ELL5 la order
lidt THEY May Do
Jicir Own Work-
,
fl MAN IS NO 5T)?0K6£fj
THflH HIS JTOMflCM-
The N(]CLTo-fNZYnE5
] FEED THE Cells
) dnd dJ found m.
Peptenzy/^e
AAflKES IT
Different
from All olher
DIGE5TIVE5
ADVERTISEMENTS.
CCEPT
No SUBSTITUTE
Interested
Send tOR Samples si LiTCffflTURE
^
REED & CARNRICK I
^l-iSGtRnnHiA Avec/e(?6ey City Nd I
OLD TAYLOR
TTLED IN BOND
E.H.TAYLOR JR. & SONS.
DISTILLERS FRANKFORT. KY
FORMULA:
Benzo-Salicyl. Sod. 33-33; Eucalyptol
.33; Thymol .17: Salicylate Methyl, from
Betula Lenta .16: Menthol .08; Piui Pumil-
i' ni> -16: Glycerine and solvents q. . 480,

XXVIII THE CHARLOTTE MEDICAL JOURNAL.
value of the pharmaceutical products of erable antiquity, and was put forward by 1
this series. some of the older Italian writers, who dis- i
;
(
5. The author puts forth a method of cussed the advisability of the operation in
physiological assay, which is the result of the moribund state before death actually
nearly fifteen years of laboratory study, for occurred. A number of modern cases of
|
\
(
consideration as a possible solution of this this kind has been recorded with a good re- !
problem. suit of the child.
Post-Mortem Caesarean Section.
The performance of a post-mortem Caesarean
section may fall to the lot of any
This operation is undoubtedly one of practitioner, and it is essential that he i
great antiquity, although it is difficult to should have clearly in his mind the condistate
at what period of time in the world's tions which would render such an underhistory
it was first performed. The /ex acg-fa taking justifiable. These may be postuof
Numa Pomilius, by which it was enacted lated shortly as follows: that the child
that in the case of a pregnant woman near should be viable and alive, that not more
;
]
|
full term dying undelivered that body than twenty minutes should have elapsed '
should be opened immediately after death since the death of the mother, and that the i
and the child extracted, shows that it was possibility of a rapid delivery by the i
known to, and practiced by, the Romans natural passages should be out of the ques- i
With the spread of Christianity and of the tion.
rite of baptism, which gave to the life of An interesting case in this connection I
the unborn child an increased worth, the recently has been the subject of a coroner's
operation again came into favor, and in inquest in the town of St. Laurent in Can- i
the first half of the eighteenth century ada. A woman suffering from an abscess i
Pope Benedict issued a precept in which in the brain died during labor, and at the i
the indications for, and the precautions to order of the priest in attendance a midwife (
be observed in, its performance were duly performed post-mortem Caesarean section, I
set forth. it is said with a razor, and extracted a liv- *
As Hubert remarks, the Roman Catholic ing child who survives. The matter natur- i
Church reproduced the injunction of the ally occasioned a good deal of comment in ;
/fx rif^/a in the following decree of its ritual: a small town, and in view of the rumor i
"Si mater praegnans mortua sit, fructus which prevailed that the woman was not
quam primum caute extrahatur." At the dead at the time the operation was per- i
present day post-mortem Caesarean section formed the midwife was held by many to :
holds a definite place in the medical art and have committed murder. A post-mortem i
should undoubtedly be practiced in all cases examination, however, cleared up the cause ;
in which the chance of delivering the child of death and all the parties concerned were i
alive is present. In some countries indeed, exonerated. The performance of such an i
'
i
i
I
for example, in the German States of Ba- ope ation by anyone but a properly quali- '
varia, Wurtemberg, and Saxony, the /ex fied medical man, especially in a case in
?rgia is still in force. In France and Eng- which the patient was not dead at the time i
laud the matter is left to the discretion of of the performance, might well expose the
the attendant physician, and as a natural persons concerned to a charge being preresult
in these countries the operation is
undertaken very infrequently.
ferred against them of manslaughter, if not
of murder.—The London Medical Lancet.
Modern statistics are, however, much
more encouraging—for example, 14 cases OiWicullics ot a Second Cesarean Sec-
collected by Bauer, 10 children were born ««" Repeated in tbe Same Woman. ,
I
,
:
i
alive, and of 28 cases collected by Dicke A. Brindeau enumerates the possible comduring
the years 1875 to 190.3, 28 children plications of Cesarean section that may
were delivered alive, of whom 19 survived, render a second section more difficult and
The researches of Breslau and Runge dangerous in the same woman. Several
have demonstrated that the fetus is most operators have repeated the operation one
likely to survive for some length of time or more times in the same woman. The
i
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'
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after the death of the mother when this has difficulties are hernia and eventration which
taken place suddenly. In cases of high rarely occur; adhesions; thinning of the
fever or of acute septic poisoning the fetus uterus at the point of the cicatrix; and adnot
infrequently dies before the mother, hesions of the placenta to the cicatrix.
The suggestion that in order to minimize Adhesions are quite frequent; they may be
the risk to the child the operation should be so slight that they are easily separated, or
performed on dying patients before a fatal so firm that it is impossible to enter the
issue actually results has found favor recently
amongst various obstetric writers.
This suggestion is one, however, of considuterus
without opening the peritoneal cavity.
The intestines may be involved in the adhesions,
or they may simulate ventrofixa- ;
;
j

ADVERTIESMENTS,
HUMAN HANDS
HAVE NO PART IN MANUFACTURING
{Inflammation's Antidote.)
From the moment the ingredients are placed in the spe-
cially designed compounding machine until the nurse removes
the finished product from the sterili'.ed container at
the bedside, every move in the making is done by machinery
and under the most rigid antiseptic precautions. By pre-
venting exposure it is possible to conserve to the highest pos-
sible degree Antiphlogistine's hygroscopic properties.
No plastic dressing can be mixed in a mortar box witli
a hoe or in an ice cream freezer or even with a druggist's
mortar and pestle and possess any scientific value. Its hygro-
scopic and osmotic qualities are necessaril}' ruined, owing to
absorption of atmospheric moisture.
In iisiug .A.ntiphlogistine, the ORIGINAL and ONLY
antiseptic and hygroscopic plastic dressing on the market,
the physician knows that he is getting the BEST. Years of
experience, specially designed niachiner}', a perfect container
and the knowledge how, when and why, enable the originators
of Antiphlogistine to turn out a remedial agent which
in kind has never been equalled in the histor}- of pharma-
ceutical manufacturing.
The wise medical man who believes in ORIGINAL pro-
ducts, wliich are alwavs the BEST products, prescribes,
ANTIPHLOGISTINE
i Inflammation's
Antidote.)
THE DENVER CHEMICAL MFG. CO.,
NEW YORK

—
XXX THE CHARLOTTE MEDICAL JOURNAL. I
tiou. The uterine wall may be so thimied ralysis affecting the thoracic region will i|
and friable that the removal of the uterus produce a scoliosis with the convexity to- ji
becomes necessary. Adhesion of the pla- ward the healthy side, while paralysis af- li
centa over the cicatrix is a rare complica- fecting the lumbar region will give a curva- '\
tion.— L'Obstetrique. ture with convexity tiiward the paralyzed li
side. Consequently, a paralysis of dorsal ij
Puerperal Eclampsia and Leucocytosis ^^d lumbar region at once will give a dou- "
oi the Cerebrospinal Fluid
^le curvature.—La Presse Medical. ]
Maurice Vilhiret and Leon Tixier de
scribes a case of eclampsia occurring before. Treatment oi Postanaestbetic Vomiting.
during, and after a six months' abortion. The most rational way to treat and pre- ,i
in which careful examination of the cerebro- vent nausea and vomiting after anaeslhesia ;
spinal fluid showed that there was present appears to be to pi omote in every way the i
a leucocyte reaction in the fluid. There elim.ination of the circulating anaesthetic,
was no other toxic condition, and no nerv- That is to say, the patient should be kept i
ous or infectious condition present. There warm so that the skin may act freely, and i
was no nephritis. The arteiial tension re- renal secretion should be helped. For this ':
mained normal throughout, and the albu- purpose saline enemata are of great value, ;
min disappeared rapidly after the cessation and one should be introduced slowly as 1
of the convulsions. Had there been uremia soon as the patient is back in bed. In some j
the tension would have been high and albu- hands large quantities of saline solution are \
minuria maintained for some time. The introduced under the skin slowly and for \
author states that there are a certain num- long periods of time after severe operatio-is, :^
ber of cases of eclampsia in which hyper- and it is claimed that not only is shock ditension
of the blood vessels cannot be con- minished in this way, but after- vomiting is
sidered a cause of the ccnvulsious, and in much less frequent. While elimination is '
these the presence of leucocytosis is in favor thus going on, the less put into the stomach
of a toxoinfectiue origin for the convulsions, the better. There is no call for anything i
—Gazette des Hopitaux. at all except through thirst, and this gives J
. .„ . .^ ^ . little trouble if enemata of subcutaneous in- ;
Antibacterial Sera m^the Treatment ol
j^^^,^^,^ ^^^ ^^^^ Washing out the mouth )
with lemon juice and water is pleasant for j
Bandi says that therapeutic sera, in dis- the patient and helps to allav feelings of i
tinction from antitoxins, contain specific thirst. Preventive treatment with glucose, «
principles which opposes themselves to the based on chemical theories explaining de- >:
'
vitality and reproduction of the bacteria,
The author's serum is agglutinating and
laved chloroform poisoning, has been given
atrial at St. George's Hospital; the results
-'
]
sensibilizing. Bacilli of diphtheria in con- do not show any marked alteration of the i
tact with this serum when injected under ordinary percentage of cases of after-sick- .|
the skin are rapidly destroyed by the phago- ness.— J. Alumfeld, in London Medical !
cytes and undergo endocellular breaking Press and Circular.
down. It seems best to produce a polyvalent
serum making use of different cul-
Tincture of Eucalyptus in Hemorrbage.
tures of diphtheria bacilli, as is done with A. Todd White calls attention to the value
the streptococcus, so as to utilize differences of this remedy in cases of hemorrhage. He
of morphology and biology in these germs, was sent for to see a patient who had a tooth
The specific amboceptors obtained from the extracted three days before, and had had
larger animal serum may be complemented persistent hemorrhage from the socket.
by the use of alexic blood serum of man. The usual remedies were applied without.
La Riforma Medica. On the third day tincture of eucalyptus was
Scoliosis Following Infantile Paralysis.
applied and the hemorrhage almost immediately
ceased. The next day the patient's
M. P. Desfosses advances the theory that brother cut his foot and the hemorrhage
the cau.se of scoliosis is not osseous, but is
due to a primary atrophy of the muscles of
was profuse. Having some of the eucalyptus
left he applied it the wound, and the
j
i
'
:
,
the back, accompanied by atrophy of the hemorrhage immediately stopped. Later j
vertebrae. One of the principal causes of the author was asked to see a case in which
scoliosis is infantile paralysis, affecting the persistent hemorrhage followed the applicamuscles
of the thorax and lumbar region, tion of a leech to the gum. The usual reme-.
The musculature of the back is very com- dies—alum, tr. ferri perchloi, ice, etc.—
plex, very difficult to study in its different were tried unsuccessfully for twelve hours.;*
groups, and hence not well understood. He applied tincture of eucalyptus, and the. I
There is a functional independence of the hemorrhage ceased within five minutes anP
dorsal and lumbar regions. Infantile pa- did not return. It is most useful on lint
.
'
|

ADVERTISEMENTS.
after circumcision or otiier minor operations.
He is of opinion that tlie internal
use of calcium chloride combined with the
external application of tincture of eucalyptus
will stop any form of hemorrhage.
British Medical Journal.
Modern Treatment of SypblUs.
Dr. Lievin recently discussed the modern
treatment of syphyilis, especially with regard
to the respiratory passages. He referred
to the recent advances in syphiologv,
including the identification of the spirocbata
pallida and the detection of specific
antibodies in the .serum of people infected
with syphilis. No serotherapeutic treatment
had, however, been found effective.
The chief remedies were still mercury and
iodides. Mercury had been proved by Neisser
by experiments on anthropoid apes to
assist the organism to defend itself against
the spirochieta and also to kill the microbe.
AtoNyl was found experimentally to produce
the same results, but if given in suf-
Jficieutty large doses to be effective it was
'dangerous to the optic nerve.
[ In regard to the administration of mer-
[cury, Dr. Lieven opposed the oral method
fand advocated inunction and the subcataleous
or intramuscular injections. He
:ompared the advantage of soluble and inioluble
salts for injection. His preference
—
If a young mother conies to
yon and says that she cannot
make 3IeUiu's Food agree with
her baby, don't tell her to try
some other food, but tell her to
change the milk.
The Mellin's Food is aU right.
The milk often is not.
MeUin's Food
wUl perfectly modify good milk
so that it will agree with a baby.
Literature and Samples on request.
MeUln's Food Co., Boston, Mass.
was for calomel so far as effectiveness was
concerned, but he reserved it for the malignant
forms, the salicylate being more suitable
for the routine treatment. These salts
should be avoided in case of Bright's disease
or diabetes. He considered inunction to be
the method which combined the greatest
therapeutical effect with the least danger.
It was belter tolerated if combined with
baths of soap and sulphur. The secretions
of the sebaceous and sweat glands rendered
it capable of being absorbed and of circulating
in the body as an albuminate.
Stomatitis was best combated by bru.shing
the teeth after each meal with a paste
of salol and chlorate of potossium, and by
rinsing the mouth every hour with a solution
of aceticotartrate of aluminum. Iodides
were most useful in tertiary manifestations,
but were also effective against secondary
vegetating patches at the entrance of the
nasal passages and on the floor of the nose,
lodism was often removed by the daily administration
of" IF, grn. of sulphanic acid in
seven ounces of water. Sajodin or iodipin
might be substituted for those who were
very sensitive to iodides.
Dr. Lieven thought that there was not yet
sufficient evidence in favor of treatment by
means of the various arsenical preparations.
Before treatment was commenced the diagnosis
should be certain, and in doubtful

XXXir THE CHARLOTTE MEDICAL JOURNAL
cases the spirochjeta should be found or nerve centers, producing a physiologic contime
given for the serum test or for the ap- dition which induces natural sleep and repearance
of a roseola. Inunctions or injec- pose.
tions should then be given, in most cases no As an antipyretic it has a remarkable
local treatment being necessary. Changres field of usefulness, inasmuch as its effecton
the lips or face might be covered with iveness is not impaired by any depressing
mercurial plaster; those inside the nose or tendencies. It acts, first— by increasing
mouth should not be cauterized, but simply the superficial circulation, thus favoring
dusted with nosophen or, for pain, ortho- heat radiation from the surface of the body,
form. Secondary ulcerative patches might and second—by direct influence on the
be painted with a concentrated solution of higher centers, especially the heat centers,
chromic acid and over this a 10-per-cent. promptly controlling any elevation of the
solution of silver nitrate to form an adhe- temperature.
sive scab. At the end of the first year It has valuable properties as an antipeiodides
were given. After the healing of riodic and greatly enhances the action of
tertiary lesions under iodide of potassium quinine and similar remedies as a useful
(the most rapid remedy ) iodipin injections synergistic.
along with mercurial inunctions were use- Because of its effect on glandular strucful.—Tbe
London Medical Lancet. tures, especially the liver. Phenalgin is a
Pbenalgin: Its Chemistry.
Among the recent triumphs of modern
valuable eliminant, and this accounts for
j^^ superiority over opium and its derivates.
Moreover, no habit is ever produced by
pharmaceutical chemistry Phenalgin stands Phenalgin, and it can be taken indefinitely
out conspicuously as a safe, efficient and with a constant maintenance of its anodyne
always reliable analgesic. It is an ammo- influence.—Canadian Journal of Medicine
niated coal-tar product, the result of a special
process which unites the ingredients in
and Surgery, July 19U9.
an active form, and admits of their inde- Treatment of Gastralgla.
pendent vet correlative action when taken
into the body. E. Farroni says that the causes of gas-
More than ten vears of clinical experi- tralgia are numerous, and hence the treatence
bv thousands of active practitioners ment must vary with the cause. Among
all over the world has demonstrated that
the addition of ammonia to phenylacetamide
( Acetanilidumj under the conditions
observed by the Etna Chemical Co., in the
manufacture of Phenalgin, correct the depressing
effects of the Acetanilidum to such
an extent that it becomes stimulating in its
character, and that though the effect of the
Ammonia which is combined in the Phenalits
causes are the various diseases, organic
and functional, of the stomach, diseases,
of the liver, kidneys, appendix, lungs, and
heart. Overeating may cause false gastral-
gia. All forms of malnutrition which result
i" intoxication may be added to the causes
oi gastralgia. Also all the exanthemata
and infectious diseases. Hyperchlorhydria
and achlorhydria may both be the cause of
gin is transient, it is sufficiently important pain in the stomach. External topical apto
show that Phenalgin is one of the safest pHcatious in the form of heat, cataplasms,
andbest Analgesics, Antipyretics, and Plyp- etc., and internal hot drinks are of value,
notics, ''especially valuable in Uysmenor- '^'''e introduction of the sound to relieve
rhcea, " known to the medical profession. distension when there is spasm of the cardia
Unlike the coal-tar synthetic, Phenalgin is of considerable value in gaseous dislenis
a stimulant rather than a depressant, sion of the stomach. C^astroenterostomy
To quote Hofheimer— "It stimulates the may be needed in some severe cases with
pulse rate for a short time after taking, and anatomical changes in the stomach. Acethen
the heart's action gradually slows tate of lead and nitrate of silver are useful
down with a strengthening of the first im- i" gastric ulcers which give severe pain,
pulse." It is as an analgesic, however. Alkalies are to be used in hyperacidity and
that its action is most marked, and it is acids in fermentations due to lack of acids,
without a peer in this respect. It exerts a Antiseptics are useful in the fermentative
selective uction on sensory nerve cells, ob- cases. Sedatives may be necessary to refunding
their capacity for receiving and lieve pain and relax spasm. Farroni theretransmitting
painful impressions. As has fore contends that we do not possess any
been previously outlined, Phenalgin thus specific treatment for gastralgia, and he
prevents refiex'action in the vasomotor sys- says that it is necessary first to diagnose the
tem and removes the tendency to hypere- cause of the paiu and then to use such apmia
and congestion.
propriate means of relief of the cause as the
Its anodyne and hynotic influence is due practitioner may be able to apply.—Gazetta
to its tranquilizing effect on the higher Medica di Roma.

VDVERTISEMENTS
Instantaneous
Is the relief from the stinging pain of inflammation and eczematous
eruptions about the muco-cutaneous margins when RESINOL OINT-
MENT is applied. And a permanent cure is effected b}' this remedy
with greater facilit}' in all skin afTections where a local application
is indicated than by any other method. As a dressing for Burns,
Carbuncles, etc., there is nothing that approaches it.
RESINOL SOxAP is the adjunct to the Ointment, and renders
the necessary bathing of the parts an aid to the cure, where application
of water and other soaps usually increase the trouble.
Resinol Ointment and Resinol Soap
arc genuine comforts to Phj'siciau and Patient alike.
Send for samples and try them.
RESINOL CHEMICAL COMPANY
BALTinORE, MARYLAND
Inleclive Infantile llcocolllis. -Bush, coiiibiiiatiou of remedies consistently effectin
the .Australasian .Medical Gazette, deals ive. A form of treatment successful in one
with the lactic acid bacillus method of treat- instance utterly fails in another. The author
inji this stale. has tried to use the Pharmacopoeia intelli-
The lactic acid treatment may be used in gently, he states, but has found it woefully
several different ways, and prepared by dif- lacking in many, indeed in the majority, of
ferent agents. The process was allowed to the severe cases. The writer has used many
proceed for 9 to 12 hours in milk diluted 1 drugs and combinations of them on a numiu
4. There was usually clotting in this ber of cases, giving each a sufficient time
time, and the acidulated milk seems to be to work its way, and has finally come down,
taken very well by children. If considered or back, to a mixture of magnesia sulphate
necessary, the time may be extended. The and corrosive sublimate, with the occasional
author has 'tried another way in cases in administration of a dose of castor oil, and
which the above did not seem to suit en- careful dieting, pinning most faith to the
tirely. The milk was first peptonized, and last. Complications must be met with the
then clotted milk whey was added to the appropriate remedy, and should straining
required proportion. These are the only be marked or persist, he uses opium in small
ways in which the author has administered doses. Bismuth, as a routine, is absolutely
this treatment, but it may also be given in useless, and, indeed, he thinks harmful,
the form of pure lactic acid culture as a causing irritation. It is passed in the momedicine
in prescribed doses, but it seems tions in a practically unchanged condition,
better to give the curdled milk, as by this often resembling curds, and most surely
means food and medicine are conveniently cause irritation. Bismuth is generally reand
pleasantly combined, and greater facil- garded as acting mostly as a mechanical
ity is afforded of iiUroducing a larger quan- protection and astringent. But he believe^
tity of the curative agent. it has a deeper action than this. When it
In regard to drug treatment, he believes does any good it is passed in the black conno
hard and fast rule can be adhered to. dilion. Here, again, it would seem that
Individual cases, of course, require particu- there is some interaction between the agent
lar treatment, but he freely confesses that and the natural intestinal secretion, and in
iu his hands he has found no remedy or the absence of the latter the bismuth is

XXXIV THE CHARLOTTE MEDICAI, JOURNAL.
powerless to act. The change is evidently trentment, and assuming also that the treatsome
interaction with sulphur, and taking ment prescribed is correct, failure can rethis
view he has tried giving sulphur and suit only from want of proper application
bismuth in two mixtures, the former pre- of treatment, or want of perseverance in
ceding the bismuth, generally, lie admits, treatment, or, what is more likely, from
with little or no result. !)oth
He gives an occasiot.al dose of bismuth Failure from lack of perseverance is largesimply
as a test, and when it is turning the ly due to ignorance on the part of the pafeces
black he gives it as treatment, and tient. Infected women, as the author has
has generally found it successful. But the indicoted in the case of men, must be edutrouble
is that it is so often not turned cated up to the point of fully realizing the
black. gravity of the disease, and the importance
The writer mentions lavage of the rec- of being, if possible, absolutely cured. Once
turn. Plenty of boiled water to drink should this is achieved, one could imagine they
be allowed, and if the indications point to would persevere with treatment as long as
the need of alcohol, he uses it in appropri- is desired. Failure from imperfect applicaate
doses. tion of treatment is a more difficult matter
The Prevention ol Pelvic Disease In to deal with, as it seems quite impossible
Women.— II ardie, in The Australasian Med- for the patient herself to carry out tlie medical
Gazelle, in writing on infections by the ical instructions in a satisfactory manner in
gonococcus says let us suppose that a wo- her own home. Yet she naturally objects
man has contracted the disease, and that to another doing what she can do but imils
treatment has to be considered. What perfectly herself. Here is a dilemma, the
the author advocates for man applies with solution of which bristles with difficulties all
equal force to woman, applies, indeed, with round. If the medical man suggests a nurse
greater force, because of the greater diffi- or private hospital, objections are at once,
culty in establishing a cure, and the greater and for obvious reasons, raised, and if, as
risk of subsequent complications. Here an alternative, he proposes to take on himagain
the practitioner is not often consulted self work that really belongs to another, he
until the disease has extended into the uter- accepts the position not from choice, but
ine cavity. He is convinced that, unless from a sense of duty.
the symptoms are very acute, many women Briefly put, gonorrhea is a common cause
have gonorrhea without consulting a medi- of pelvic disease in women, because in some
caiman at all, and seek advice only for cases it receives no treatment whatever, besome
of its remote effects. This is p 11 the cause in others it is too far advanced before
more to be deplored, as, if neglected, it is medical advice is sought, or if not too far
almost an impossibility to cure the disease, advanced there is imperfect application of
If the case be seen in the early stage, it treatment, and because the patient, being
is always essential that the disease should ignorant of the issues involved, gives up
be treated thoroughly, and yet under ordi- attendance and treatment when the cure of
nary conditions we know that this is not, her disease is more apparent than real,
and cannot well be done. We all know Some of these obstacles the medical man
how this is usually done, by the patient cannot, for the present, overcome, but if he
visiting her medical attendant at irregular conveys to those patients who suffer from
intervals, and doing her best to carry out gonorrhea a realization of its possible conhis
instructions at her own home. The sequences if neglected, the time will come
treatment may possibly be successful, but by a process of direct and indirect educaprobably
not. No doubt the acute symp- tion by way of compound interest, when
toms disappear, and the discharge may women, who become the victims of it, will
also apparently disappear. Taking it for seek advice early, and will not give up
granted that she is cured, the patient gives treatment until authorized to do so by their
up treatment, and no more is heard of her medical adviser. Knowledge of the possiuntil,
in the course of time, it may be years, ble sequelee of gonorrhea on the part of
she may seek advice for some pelvic disease women seems to be the key-note, if not of
that is removable only, and perhaps not its prevention, at least of the successful
even that, by the surgeon. In the mean- application of treatment in the future, betime
she may have given gonorrhoea to an- fore it has invaded the inner pelvic organs,
other. This is a highly unsatisfactory state We are sometimes asked by a man or
of matters, and the author asks us to con- woman who has had gonorrhea or syphilis
sider if anything, and what, may be done whether, and when, he or she may safely
to obtain better results, marry. So far as syphilis is concerned.
Assuming still that the case is in the Hutchinson considers marriage allowable
acute stage, and that the disease has not after a period of two and a half years, proaffected
parts beyond the reach of medical vided the patient has received a thorough ;

ADVERTISEMENTS
The Success of Listerine is based upon Merit
The manufacturers of Listerine are proud of Listerine—because
it has proved one of the most successful formulae of modern
phcirmacy.
This measure of success has been largely due to the happy
thought of securing a two-fold antiseptic effect in the one preparation,
i. e., the antiseptic effect of the ozoniferous oils and ethers,
and that of the mild, non-irritating boric acid radical of Listerine.
Pharmacal elegance, strict uniformity in constituents and
methods of manufacture, together with a certain superiority in the
production of the most important volatile components, enable
Listerine to easily excel all that legion of preparations said to be
"something like Listerine."
"The Inhibitory Acrion of Listerine," a 208-page book, descriptive of the
antiseptic, and indicating its utility in medical, surgical and dental
practice, may be had upon application to the manufacturers,
Lambert Pharmacal Company, Saint Louis, Missouri,
but the best advertisement of Listerine is
course of treatment during that time. Kelly"
and others advise a period of four years,
during the last twelve or eighteen months
of which there must he no manifestation of
the disease. The (|uestion is one of grave
concern, because, important as syphilis is
from the jjersonal aspect, it is still more so
from tlif hereditary point of view. A man
^iio trifles with syphilis, and does not persevere
with the treatment 7)rescribed, incurs
a responsibility that only a lunatic would
Care to bear, and for which he should be
[segregated as a menace to the well being of
the race.
As regards gonorrhea the question is also
lot easily answered, on account of the
lifiBculty (if definitely declaring that the dislase
has been finally eradicated. Xo hard
ind fast period of time can be approximate-
y fixed u])on, but if the medical man is
atisfied, after naked eye and microscopic
xamination, that the disease appears to be
ured, and allows a further probationary
eriod of, say, six or twelve months, durig
which quarterly examinations are made
rith negative results, the author thinks he
r she may safely marry. lixperts alone
an tell us when and how examinations
lould be made. One would imagine they
lould be made under conditions that are
kely to bring a latent disease into activity,
ich as, in woman, just after the menstrual
eriod, and in man after he has had, by
>ecial advice, a glass or two of whisky.
mSTERIlt
—
We are also told that the smears should be
taken not only from the os uteri, but from
the glands of Skene and Bartholin in woman,
and from the glands of the urethra in
man.
Tlie Role of Human Contagion in Infantile
Tuberculosis.
J. Comby finds that tuberculosis is a disease
that generally begins with aerial infection,
from infected members of the infant's
family. Prophylaxis should deal with removal
of all tuberculous members of the
family from the surroundings of infants,
rather than with the sterilization of milk
and the destruction of slightly infected
cows. Milk, unless full of bacilli, will be
digested and do no harm. But the grandparents
who have chronic bronchitis and
asthma, really tuberculous, will infect the
child from their sputum. Children are born
neither with tuberculosis nor with a predis-
])osition to it. Remove the children of tuberculous
parents at an early age from their
home and bring them up in healthy surroundings
and they will grow up healthy.
Leave them with their parents and they
will contract the disease. Pallor, emaciation,
and narrow chest are symptoms of
latent tuberchlosis, not predispositiun to it.
The measures taken against bovine tuberculosis,
and to prevent the use of tubercu.
lous milk, during the last twenty years have
not diminished tuberculosis among infants.
—Archives di Medecine des Eufauts.

XXXVI THE CHARLOTTE MEDICAL JOURNAL.
THE PINES, Black Mountain, NortK Carolina.
A private Sanatorium specially equipped for the treatment of early
Tuberuclosis.
Besides the main building also have tents and cottages specially construct-
ed to insure thorough and constant ventilation. Altitude 2,800 feet. Situ-
ated in pine grove of twenty acres.
Rates on arplicatinn.
CLYDE E. COTTON, M. D.
T^K^k UT7'rs*£kJo
P^vate Hospital and Sanatorium
1 lie liygeifl 101 West Grace Street, Richmond, Va.
DEVOTED EXCLUSIVELY TO MEDICAL AND NERVOUS DISEASES
TC^XTENSIVE improvements and additions have just been completed, which make
-*--' The Hygeia now the largest strictly private Medical institution in tliis country. All
approved Hospital facilities for arw^e cases, and full Sanatorium facilities lox chronic
cases. Equipment: Baruch Therapeutic Raths, Electricity, Vibration, Electric Light,
X-Rav, Nauheim Baths, A^assage, etc., together with laboratory methods of diagnosis.
-Jsuai Rates. Descriptive booklet.
J. ALLISON HODGES, M. D,
I
THe Telfair Sanitarium,
GREENSBORO, N. C.
Nervous Diseases, Alcoliolism
and Drug Habits.
Location picturesque and retired. Fresh air, sun
shine and quiet. The new sanitarium has 31
rooms. Most modern appliances, electrical, vi
bratory. and hydro-therapeutic
Our treatment meets individual requirements
with avoidances of suffering or inconvenit-nce
The Telfair Sanitarium furnishes an ideal I10111.
for nervous patients who may be in need of
chan.ne of environment and the advantages of tb
most improved electrical and hydro-therapeuti
appliances.
For detailed information write for circular anreprints
in Journals.
Clinical Results Prove Therapeutics S
nasarcin
, reported by thousands of successful practitioneis, demonstrate that
VALVULAR HEART TROUBLE
ASCITES AND ANASARCA
EXOPHTHALMIC GOITRE
7 " '"""""_'"""• '^
BRIGHT'S DISEASE
_
Gives Is.elief in cirrhosis of the liver
Tria
requc
Use A in any obstinate case and note results.
;

SOUTHERN MEDICAL SOCIETIES.
MISSISSIPPI VALLEY MED. ASSOCIATION.
res., J. A. Witherspoon, M.D., Nashville,
Tenn. Vice Pres. Louis Frank, M. D.,
Louisville, Ky. Second Vice Pres.,
A. E. Sterne, M. D., Indianapolis, Ind.
Secy., Henry Enos Tulley, M. D.,
Louisville, Ky.
reas. S. C. Stanton, M. D. Chicago, 111.
ext Meeting St. Louis, Mo,. Oct. 12, 13,
and 14th 1909.
)UTHERN SURGICAL and GYNECOLOGICAL
ASSOCIATION.
nnual meeting at Hot Springs, Va., Oct.
5-6, 1909.
W. D. Haggard, M. D., Sec,
Nashville, Tenn.
Stuart McGuire, M. D., Pres.,
Richmond, Va.
SOUTHERN MEDICAL ASSOCIATION.
nnual meeting at New Orleans, La. Nov.
9-10-11-12, '09.
scar Bowling, M. D., Sec. Shreveport, La.
Giles C. Savage, M. D., Pres.
Nashville, Tenn.
EDICAL ASSOCIATION OF THE SOUTHWEST.
nnual meeting at San Antonio, Texas,
October, 1909.
. H. Clark, M. D., Sec, El Reno, Okla.
Jabez N. Jackson, M. D. Pres.,
Kansas City, Mo.
U-STATE MEDICAL ASSOCIATION OF THE
CAROLINAS AND VIRGINIA.
nnual meeting at Richmond, Va., Feb. 8,
1910.
J Howell Way, M. D., Sec,
WaynesviUe, N.C.
LeGrand Guerry, M. D., Pres.,
Columbia, S. C.
SDICAL ASSOCIATION OF THE STATE OF
ALABAMA.
nnual meeting at Birmingham, Ala., 1909.
J. N. Baker, M. D., Sec,
Montgomery, Ala.
B. L. Wyman, M. D., Pres.
Birmingham, Ala.
FLORIDA MEDICAL ASSOCIATION.
anual meeting at Pensacola, Fla., April
7-9, 1909.
J. D. Fernandez, D. D., Sec,
Jacksonville, Ma. •
J. F. McKinstry, Jr., M. D., Pres.,
Gainesville, Fla.
MEDICAL ASSOCIATION OF GEORGIA.
inual meeting at Macon, Ga., April 21,
1909.
jaude A. Smith, M. D., Sec Atlanta, Ga.
Thos. D. Coleman. M. D., Pres.,
^
lAugusta, Ga.
»S5:S:$:?S-^5tSi$ie:$:»:.;s; .:c

EACH FLUroOUNCE CONTAINS
Tinct. Euphorbia Pilulifera. 120 minim!
Syrup Wild Lettuce, 120 minims.
Tinct. Cocillana. 40 minims.
Syrup Squill Compound, 24 minims.
DOSE : H TO 1 FLfrDRACHM
Cascarin fP. D. & Co.), 8 grains.
Heroin hydrochloride, 8-24 grain.
Menthol, 8-100 erain.
Syrup Cocillana Compound
is an uncommon cough syrup, as a perusal of the formula will show,
and one of marked efficiency. It is of especial value in acute bron-
chitis with unusual irritation, and in chronic bronchitis when secretions
are scanty and hard to expel. It is pleasant to the taste. It is attractive in appearance.
It is mildly laxative.
Syrup Cocillana Componnd was devised especially to meet the needs of the
prescription writer. Its name does not suggest its therapeutic uses. It is not known
to the public as a " cough syrup."
Mm
Physicians who administer our
Supplied in pint and 5-pint bottles.
Antidiphtheric Serum and
Antidiphtheric Globulins
may do so with full assurance of their purity, potency and uniformity. Our antitoxins
are prepared with scrupulous care. They are rigidly tested. They are supplied in the
most satisfactory syringe-containers ever offered to the medical profession.
Our Antidiphtheric Serum and Antidiphtheric Glohulins are marketed in the
same style of package and at the same price per given number of antitoxic units. The
Globulins, a highly concentrated product, occupies a relatively smaller container than
the older serum.
600, 1000, 2000, 3000, 4000 and 5000 units.
Parke, Davis Si Company
Laboratories; Detroit, Mich., U.S.A.; Walkerville. Ont; Hounslow. Eng.
Branches: New York, Chicago. St. Louis. Boston. Baltimore. New Orleans, Kansas City. Minneapolis, U.S.A.;
London, Eng.; Montreal. Que.; Sydney, N.S.W.; St. Petersburg, Russia: Bombay, India;
Tokio, Japan; Buenos Aires, Argentina.

Charlotte Medical Journal.
A SOUTHERN JOURNAL OF MEDICINE AND SURGERY.
:S" Charlotte, N, C, December, 1909, ..ril.^
Table of Contents. Page 225.
Elixir of Enzymes is a
combination of digestive ferments
acting in an acid medium.
Elixir of Enzymes is a potent and
palatable digestant, a splendid vehicle for
iodids, bromids, morphia and other nau-
seating drugs.
Elixir of Enzymes is an effective remedy
in disorders of the stomach and intestines.
Elixir of Enzymes is convenient and reliable.
Elixir of Enzymes curdle milk, and may be used in making curds and whey.
ARMOUR^COMPANY
(fnicrrd al ihe Post-Office al Charlotte, as second-class matter.]

Mulford's
Antitoxin
and the New Syringe
\
Metal Plungeril
^--Sf Flexible Joint
Every dose furnished in this
Perfected Syringe
Advantages of New Syringe :
ASEPSIS, contamination impossible.
Positive Working: The metal plunger screws into the rubber plug, adjusting
pressure and making action positive.
Metal flnger-rest with rubber guard at top of syringe prevents any possibility of
syringe breaking or injuring operator's hand.
Needle attached with flexible rubber joint permits motion of patient without
danger of tearing the skin— a great advantage in administering to children.
Our new adjustable rubber packing possesses great advantages; it is readily
sterilized, does not harden, shred, absorb serum or become pulpy.
Simplicity and accuracy—no parts to get out of order.
Mulford's Antitoxin is Accepted
Everywhere as THE STANDARD
The higher potency enables us to use much smaller syringes.
Minimum bulk—maximum therapeutic results
Brochures and Working Bulletins sent upon request
H. K. MULFORD CO., Philadelphia
New York Chicago St. Louis Minneapolis San Francisco

ADVERTISEMENTS.
lo Meet IhreatenincAnemia
In Nursing Women
-CORD.EXT.OL.MORRHUAE COMP
IS THE BEST RED CORPUSaE FEEDER
IN THIS CLASS OF CASES.
Particularly adaptad to waak digestive organs usually accompanylne oregnaney. II is palatable,
a powerful blood-lormino agent, and a reliable hemoglobino-genetic.
Each fluid ounce of Hage, 's Cordial of ihi: Extract nf Cod Liver Oil Compmind repramts the extract
'hlainable from om-third fluid ounce of Cod Liver Oil (tlie faltv portion being eliminated) 6 grains
Calcium Hypophosphite, S grains Sodium Hypopluispkite, with Glycerin and Aromalics.
>?*a^SUPPLIED IN
'^*ii:»*-J6 o/ Bottles
,/• ' r\, ' only ^
%ithnm0ntkf!md((h DISPENSED BY
AiMT LOUIS, MO.
WINTER COUGHS—
the stubborn kind—whether of bronchi-
tis, phthisis, laryngitis— whether acute
or chronic—whether in adults or children
—arc promptly relieved by
Angler's Petroleum Emulsion
Expectoration becomes free, pulmonic
congestion is relieved, respiration is made
easier, and the troublesome cough is
checked—cured,
Simple, icni upon rc>i»e,.. ANGIER CHEMICAL COMPANY, BOSTON, MASS

THE CHARLOTTE MEDICAL JOURNAL.
I SANMETTO frWWWWWW^^Wf^WW^.
GEN ITOURINARY DISEASES. ^
A Scientific Blending of True Santal and Saw Palmetto with Sootliing Demulcents ^
''
in a Pleasant Aroniatl c Vehicle
A Vitalizing Tonic to the Reproductive System.
SPECIALLY VALUAL EIN
PROSTATIC TROUBLES OF OLD IWEM-IHRITABLE BLADDER-
CYSTITIS-URETHRITI3- "E-SENILITY.
00SE:-One Teaspoonful Four Times a Day.
'f OD C. .£M. CO., NEW YORK,
CAMPHO-PHENIQUi: |

c
ADVERTISEMENTS.
BOyiNINE
Reconstructive Food
and Tonic
BOVININE represents the most valuable combination of
Food and Tonic elements known to the medical prolession.
BOVININE has proven clinically to be most valuable in
aii forms of Tuberculosis.
BOVININE enables the nerve cell to assimilate its specific
dements, which it fully supplies.
BOVININE promotes the metabolism of fat and albumin
in muscle aud blood, thereby restoring the bodily
health, strength and normal powers of resistance.
BOVININE supplies fnll and complete nutrition'through
its Food and Tonic properties.
THE BOVININE COMPANY
75 Wgst Houjiton St.. New York City 3
The Standard of Therapeutic Efficiency.
XOT OXLV FOR TIIF, LAST YEAR BUT FOR THE LAST QUARTER
Ol- A CENTURY HAS HAYDEN'S VIBURNUM COMPOUND GIVEN
DI'I'ENDABLE RESULTS IN THE TREATMENT OF
Dysmenorrhea, Amenorrhea, Menorrhagia, Metrorrhagia
and other diseases of the Uterus and its appendages.
Tliere has been no necessity for any change in the formula of H. V. C. because
its therapeutic efficiency has made it "Standard" and so recognized by the most
painstaking therapeutists and gynecologists from the time of Sims.
Unscrupulous manufacturers and druggists trade upon the reputation of Hayden's
Viburnum Compound, and to assure of therapeutic results insist that the genuine
H. V. C. ouh' is dispensed to your patients.
SAMPLES AND LITERATURE UPON REQUEST
NEW YORK PHARMACEUTICAL CO. ii8^r«T^r
lAYDENS URIC SOLVENT of Riieumalism. Gout and other conditions i

THE CUARLOTTH MEDICAL JOURNAL.
g~ ~s
Dependable Analgesia
No one demand on the physician's skill is so frequently met
as that for the relief of pain. To respond promptly, safely and effectively is, therefore,
one of the most important details of practical therapeutics, and experience has
demonstrated time and again that no remedy has a broader field as a dependable
analgesic than
i15i=i;HWI«
This reliable product not only promptly relieves pain, but
it does so safely and with never a danger of creating a drug habit Its composiiion
not only obviates circulatory depression, but goes far toward overcoming spasmodic
conditions that tend to congestion and inflammation.
PHENALGIN is invaluable in LA GRIPPE, RHEUMATISM and GOUT.
Samples on request.
THE ETNA CHEMICAL CO.
NEW YORK CITV
CORYZA
ponds'extract
For acute colds in the nose and throat a weak
solution of Pond's Extract, slightly warmed, is
mirable. It relieves irritation and distress and rapidly
reduces discharge.
r'AI TTION-^^'''-""^''^"^"'*'''''"'""'^'"-^'^'''^"^''"'"'""'''^'*' '^"''''^'^
K.n.yj 1 "-"'• ^.,„„dcc< by prescribing POND'S EXTRACTe^ci^
POND'S EXTRACT CO., New York and London ,

ADVKRTISEMENTS.
A.II the
i« ^mdL® from.
•Mm Nmturml
Samples by Express Prepaid - MellTer DrugTJmpaT^yTst.Lou
1910 ANTIKAMNIfl TABLET CflLENDflR
EVERY Physician in the
world will receive a
copy of this beautiful
Calendar on January 1, 1910
and in the meantime we
hope he will remember that
"Antikamnia Tablets" and
"Antikamnia & Codeine
Tablets" are giving just the
'same excellent results that
they have given for the past
twenty years.
ifiliHIMJliKilW-WKiliLJjyfmBlUfSli^'ff.j

THE CHARLOTTE MEDICAL JOURNAL.
KEEP IT IN MIND
WHEN PRESCRIBING SALINE CATHARTICS THAT
ABBOTT'S SALINE LAXATIVE
— just purified niagiiesiuni sulphate (epsom salt) 60 per cent in
effervescent combination— stands without a peer. 1 o this;
prove it for yourself, and there you are—one of many thousands
of pleased users.
Fermentation of the alimentary canal (auto-intoxication) is
the cause of over 90 per cent, of all uon-coutagious sickness.
"THE CLEAN-OUT, CLEAN-UP AND KEEP-CLEAN"
i\ es immediate results—paves the way for llie applicatism of cu-
SALINE LAXATIVE I
You are urged to give these preparations a trial—to specify tlieni oil your prescriptions. They
are in the trade ALMOST everywhere. If your druggist cannot supply you, send direct. Per
dozen, either kind or assorted: small |,J.ou, medium, I4.IIO, large .$8.00. In less than halfdozen
lots 20, 35 and 75 cents respectively, ^(.ash with order, delivery prepaid.
Samples to interested pK ysiciaLi\s oi\ request, mentioning this journal.
THE ABBOTT rtLKMLOID/tL CO /V\ 1=A IN "V
Manufacturing Chemists
M.-iin;Ofnoe and Laboratories RM \/ EINSVWOOD, C::hlcago
NEW YORK, 251 Fifth Avenue SAN FRANCISCO, 571 Phelan BIdg. SEATTLE, 225 Central Bld^
Emblem's First Event
EMBLEM
WINS!
George Heil, motorcyclist of 30 days' experience,
makes perfect score in F. A. M. Endurance Contest.
THE KIND OF MACHINE FOR THE
ORDINARY KIND OF MAN TO BUY
Emblem Mfg. Co.
Angola, N. Y., U. S. A.
DISTRIBUTORS.- Manufacturers Supply Co., 418 Arch St., Philadelphia, Ta., for Delaware, Maryland ||
and Southern New Jersey; John T. Bill & Co., Los Angeles, L'al , for Southern California; Ballou ;]
& Wright, Portland, Oie., for Oregon; Meredith & Guthrie Co., Salt Lake City, Utah, for Utah. i]

ADVERTISEMENTS
DR. STEEDLY'S PRIVATE HOSPITAL
FOR
Abdominal Surgery and Diseases of Women
SPARTANBURG. S. C.
SCOPE OF WORK limited exclusively to surgical affections, in either sex, of
the abdominal walls (hernias, tumors, etc.) or of the abdominal organs—stomach,
intestines (including rectum), liver, gall bladder, spleen, kidneys, pancreas, and
urinary bladder— and to all affections of the female pelvic organs.
OPERATING AND STERILIZING ROOM EQUIPMENT is the best obtainable.
FURNISHINGS elegant, comfortable, and homelike.
ONLY GRADUATE NURSES in attendance upon patients.
TERMS: For room, board and general nursing—private rooms from $25.00 to
S50.00 per week; double rooms from Sl.5.00 to $20.00 per week.
Anaesthesia and surgical dressings in operative cases, $10.00. Charges for profes-
sional services according to the nature of the case and the circumstances of the patient.
For further information address
MRS. FRANCES M. MONTGOMERY, Superintendent, or,
J H. HUNTER, Resident Physician.
We l-iirnish a GradiiatLtl Tube for the I se .,f
KELENE IN GENERAL AN/ESTHESIA
Also as a I'reliniinarx- !o ICther. ICach Tube Contains .SO c.c. and Costs $1.60
'^E.^Sl:' KELENE
1 PURE. CHLORIDE Ol' liTHYL)
Automalic Cap. No Effort, No I^oss of Time.
See Gold Medal Awarded at the Jainestowii Exposition.
PL KB
ORTABLE
k u/riCAi
Write to Sole Manufacturers foi
Particulars, Clinical Reports, etc.
FRIES BROS.. ^^T^?;^r.%S?lT'^'' NEW YORK
92 READE STREET,

VIII
THE CHARLOTTE MEDICAL JOURNAL
OLDEST MEDICAL COLLEGE IN THE STATE
SESSION OF 1908-1909 BEGINS SEPTEMBER 15, 1908
W. O. NISBET, M. D.
Professor of Diseases of
the Digestive System and
Dean of the Faculty.
JOHN P. MUNROE, M. D.
Professor of Neurology and
Practice uf Medicine.
I. W. FAISON, M. D.
Professor of Pediatrics and
Clinical Medicine.
E. C. REGISTER, M. D.
Professor of the Principles
and Practice of Medicine.
B. C. NALLE, M. D.
Professor of Physical Diagnosis
and Clinical Medicine.
R. L. GIBBON. M. D.
Professor of Practice of
Surgery.
G. W. PRESSLY, M. D.
Professor of Principles of
Surgery.
A. J. CROWELI., M. D.
Professor of Rectal Diseases
and Genito-Urinary Surgery
and Secretary and Treasurer
of Faculty
FACULTY
E. R. RUSSELL, M. D.
Professor of Diseases of the
Eye, Ear, Nose, and Throat
W.D.WITHERBEE, M.D.
Professor of Dermatology,
and Materia Medica.
C. M. STRONG, M. D.
Professor of GyuEecology.
C H. C. MILLS, M.D.
Professor of Obstetrics and
Clinical Gynecology.
C. N. PEELER, M. D.
Professor of Anatomy and
Superintendent of Dispensary.
R H. LAFFERTY, M. D.
Registrar and Professor of
Chemistry and Physiology.
L. B NEWELL, M. D.
Professor of Patholopy.
WM ALLEN, M. D,
Professor of Bacteriology
and Assistant in Pediatrics.
C, A. MISENHEIMER.M.D.
Clinical Professor of Surgery
J. P. MATHESON, M. D.
Clinical Professor of Diseases
of the Eye, Ear, Nose and
Throat and Professor of
Yygiene.
College
For Catalogue address
A. J. CROWELL, M. D., CharloUe, N C.
|N. Y. ROST GRADUATE!

ADVERTISEMENTS,
Fairchild's Essence of Pepsine
The Gastric Juice Extract,
THE
to Promote Toleration of Potassium Iodide
results of laboratory investigation concerning the physiological
and chemical relation of gastric juice and potassium iodide have
been entirely confirmed by clinical experience in the use of
Fairchild's Essence of Pepsin, the gastric juice extract, as a vehicle for this
important drug.
Any ordinary dose of the iodide combined with this Essence shows
perfect compatibility. For instance, in a mixture representing five grains
(in saturated solution) to a teaspoonful of the Essence; there is no precipi-
tate, the enzymes are not thrown out of solution, are not injured. Such a
mixture will exhibit ( i) the characteristic action of Fairchild's Essence
upon milk, and (2) under the U. S. P. test, the standardised proteolytic
action of the original Essence.
As a vehicle, it is found that the Essence agreeably masks the taste,
and certainly promotes the tolerance and physiological effects, of the
iodide.
Circular suggesting the various methods of using Fairchild's Essence in
administering potassium iodide will be sent to physicians upon request.
Fairchild Bros. & Foster
New York
STAFFORD WATER
Noted for Its Remarkable Remedial Properties In
PARENCHYMATOUS NEPHRITIS,
ACUTE NEPHRITIS, ALBUMINURIA,
and Its Therapeutic Value and Efficiency in
Diabetis. Chronic Interstitial
Nephritis and Cystitis.
For Sale: THEO. F. KLUTZ & Co., Salisbury, N. C.
For Literature write
S. M. PURCELL, Salisbury, N. (;.
liURWELL & DUNN CO., Charlotte, N. C.
I). P. FRIERSON, Charleston, S. C.
PATRICK McINTYRE, AsheviUe, N. C.
MURRAY DRUG CO., Columbia, S. C.
COLBURN, MORCAN 6l CO.. lessees
VOSSUIKG. ___----- MISS.

THE CHARLOTTE MEDICAL JOURNAL.
COCO-EMULSION,LILLY
*II Chocolate and Cod Liver Oil
Liver Oil Emulsions.
—
A New Departure in Cod
^ Strength —Same as the ofBcial emulsion—contains 50
per cent, finest Norwegian Cod Liver Oil.
^ Falatability—Coco-Emulsion is free from the unpleas-
ant fishy odor and taste which characterize ordinary emul-
sions. Repeatedly it has been shown that patients who could
not take other emulsions would thrive on Coco-Emulsion,
Lilly.
*|f Digestibility—Free from benzoates and salicylates—the
minimum quantity of alcohol is used to prevent rancidity
and mould; the sugar content is just sufficient for palatabil-
ity
—
causes no intestinal disturbance.
^ Send for a sample— It is Palatable—we ask you to taste it
and see for yourself. Address request to Indianapolis.
*|[ Supplied by the Drug Trade.
ELI LILLY & COMPANY
INDIANAPOLIS NEW YORK KANSAS CITY NEW ORLEANS
PRUNOIDS
AN IDEAL PURGATIVE MINUS CATHARTIC INIQUITIES
A real advance in the therapy of intestinal constipation.
SENG
A STIMULATOR OF DIGESTIVE PROCESSES
Used alone or as a vehicle to augment and aid the natural functions of digestion.
CACTINA FILLETS
CEREUS GRANDIFLORUS IN ITS MOST EFFICIENT FORM
A persuasive Heart Tonic to improve Cardiac nutrition.
SULTAN DRUG CO., St. Louis.

ADVERTISEMENTS.
W LgLtest Scientific
|
Achievement
in preparing Cod Liver Oil for
administration is
Waterbury's
Metabolized
Cod Liver Oil Compound
PLAIN. ALSO WITH CREOSOTE AND GUAIACOL)
Not an emulsion, but pure Norwegian Cod Liver Oil,
Metabolized (or predigested) and compounded with
Barlej' Malt extract, Glycero liypophosphites, and
Aromatics. Nothing extrated from the oil. Has
no equal as a tissue building touic.
Dispensed in full 16 oz. unlettered bottles.
Samples and literature upon request,
^ WATERBURY
**^ CHEIVHCAL COMPANY.
Home Office. Des Moines. Iowa
17 Pearl St.. New York. Toronto, Canada

THE CHARLOTTE MEDICAL JOURNAL.
NEURILLA FOR NERVE DISORDERS NEURILLA
If Patient suffers fromTHE BLUES (Nerve Exhaustion), ^
Nervous Insomnia, Nervous Headache, Irritabitily or
General Nervousness, *ive four Mmes a dav one
teaspoonfur N E U R I L LA
Prepared from ^Scutellaria llateriflora.
Fassi llora Incamata and Aromntics.
DAD CHEMICAL COMPANY, NEWYORK and PARIS.
MALIGNANT GROWTHS.
At the Atlantic City Meeting a Prominent Surgeon remarked:
"/ a'/// not quarrel with the Alexander Treatment as to whether it is my
knife and my skill, or Oleum Creosyn Comp. {Alexander), but I do
know that when I use Oleum Creosyn Comp. for six weeks before and after
an operation, I never have a recurre7ice."
"n|"3lllts°-°°*
Palliation 85 P«r Ceivt.—We relieve pain iu nearly every instance.
""'""' case, o ma lgna,ncy.Hit
Odors 95 Per Cent.—We remove disagreeable odors in case. of open sores.
Arrest of Growth 60 Per Cent,
Apparent Cures 24 Per Cent.—Tills Is the average of ten years' i-eports from physisians who
have used Oleum Creosyn Comp, (Alexander). Ninety per
cent, of their patients, however, were pronounced inoperable
and incurable before coming under their treatment.
ig ten years we have never experienced a recurrence. Many physicians use Oleum Creosyn
unection with surgery.
Pure Food and Drag Act, of 1906, No. 12,912. No morphine or other deleterious
drugs.
The fullest investigation of Olfum Creosyn Comp. [Alexander] i solicited.
Fiirniihed to and administered hj Physicians only.
THE ALEXANDER COMPANY, 118 West 49th Street. New York City
On May 24th and 25th, 1907, there was submitted to physicians of New York City and vicinity 14 postmalignant
cases, together with their histories. (10 showing microscopical verification], treated AND apparently
CURED by the Alexander Method during the past 8 years. Many of these former patients were accompanied
by their medical advisers. All are well to-day Information concerning these cases will be
gladly furnished, also a chart record of 100 CASES TREATED SERIATIM,
Since 1900 thousands of ..hysiciaus h
such as to warrant the statement that i
in the therapeutics of mallignancy.
TENT COTTAGES WITH OPEN FIRE PLACES j
':
FOR TUBERCULAR PATIENTS
In the midst of the forests of the beautiful Blue Ridge Mountains of North Carolina-;!
seventy-five miles south of Asheville, at an altitndeof 3, 8.S0 feet. Climate unsurpasse(}J
The fall season being long and sunny and the winters agreeably mild and equable. i 1
Tents supplied with electric bells; our own water works system with baths, toilets S
'
'•
etc. Completely equipped Laboratory, X-Ray machine, etc. Graduate Nurse in chargj-J
Terms, S60.00 a month for board, milk, eggs and medical services. Best of reference!'
Address
DR. MARY E. LAPHAIVI,
Highlands, North Carolinj i
WANTED.— Success Magazine wants an ener- i
getic and responsible man or woman in Charlotte, unvc i rini s i "^OYS rniiiMRiA I GIPLS I COLUMBIA
Rirvn BICYCLEF F RE DFi i1
N. C, to collect for renewals and solicit new sub^
scriptions during full or spare time. Experience Greatest offer out. Get your friends to subscrit;'
unnecessary Any one can start among friends to our magazine and we will make you a present','
and acquaintances and build up a paying and per- a $40.00 ( olunibia Bicycle-the best made. Ask fiij
manent business without capital. Complete outtit ,. , , ^^^ , . , ,. ,, _ ,,ti_i'
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Magazine, Room 103, Success Magazine Building, to Start." Address "The Bicycle Man," 29-31
New York City, N. Y. 22d Street, New York City, N. Y.
i
^

BUFFALO
ADVERTISEMENTS. XIII
ALBUMINURIA OF BRIQHTS DISEASE
l&l
ini PREGNANCY AND SCARLET FEVER
LITMIA
SPRINGS
WATER
DR. JOS. \\Q\J\, of Nezv Orleans Ex- President of the State Board of Health ^/Z^z/m-
««a,says; "I have preprescribed BUFFALO LITHIA WATER in affections of the
•idneys and urinary passages, particularly in Gouty subjects, in Albuminuria, and in
rritable condition of the Bladder and Urethra in females. The results satisfy me of its
xtraordinary value in a large class of cases most difficult to treat."
DR. GEORGE BEN JOHNSTON, Richmoyid, Va. Ex-President Southern Surgical and
'rynecological Association, Ex- President Medical Society of Virginia, and Professor of
'iynecology and Abdotninal Surgery, Medical College of Virginia: "it is an agent of great
alue in the treatment of the Albuminuria of Pregnancy."
DR. J. T. DAVIDSON, M. D., New Orlea?is, La, Ex-President, Nezv Orleans Surgical
nd J/edical Association, says:"\ have for several years prescribed BUFFALO LITHIA
Va ter in all cases of Scarlet I'ever, directing it to be drunk ad liditum,v/Hh the effect of
slievingall traces of Albumin iu the urine, and have found it equally efficacious in
(nial diseases ret[uiring the use of alkaline water."
HUGH M. TAYLOR, M. D., Projessor of Pradicr or Surgery and Clinical Surgery,
Jniversity College of Medicine, Richmond, fa.- "I have used, with good results BUF-
'ALO LITHIA WATER in Uric Acid Diathesis, U.out, Rheumatism, Albuminuria of
'regnancy. Scarlet Fever, diseases of Women, Renal and Vesical Calculi, and Cystitis,
d in manv instances with ^/c'"?/ benefit."
Medical Testimony on request. For Sale by Druggist generally.
UFFALO LITHIA SPRINGS WATER CO ,
'
BUFFALO LITHIA SPRINGS. VIRGINIA.
The PHYSICIAN'S VISITING LIST for 1910
Lindsay &. Blakiston's)
The Standard for 5Q Years
"tits: Calendar, 1910-1911; Tables for Calculating the Period of Utero Gestation; Signs; In-
Hty; Metric System of Weights and Measures; Conversion of Apotheraries' Weights and
into Grams; Treatment of Poisoning; Dose Table (official and unoflficial drugs in English and
^ ^letn); Asphvxia and Apnea; Comparison of Thermometers. Visiting List: Ruled and
\;es, with blank page carrying amount, ledger page, and special memoranda columns.
KKCORDS for Obstetric Ivnga'gements, Deaths, Birtha; Addresses of Patients; Nurses; Accounts
I i^li Accounts, General Memoranda.
REGULAR EDITION
•#• Cotert with Pocket and Pencil, Qilt Kdgee.
nts weekly $1.0(
.>
POCFCEX SIZE
'
i„
') Jnnnarv to June ) ., „,
j Janua ry to .T.1
I July tc
—
PERPETUAL EDITION (Without Dates)
—
ing space fur over 1300
MONTHLY EDITION (Without Dates)
{:S?-Re'HiiriniroiiIy one writing- of patient's name
Pocket and Pen
,
«APK WITH AN X SIZE AND STYLE DESIRED. SIGN AND MAIL THIS PAGE TO US, WE WILL
PROMPTLY FILL THE ORDER AND SEND YOU THE BILL LATER.
P. BLAKISTON'S SON & CO.,
Publishers,
Philadelphia

THE CHARLOTTE MEDICAL JOURNAL.
"fJ^iiiST^^^J^Tiisn DEAR DOCTOR;
THE
SNSION
REMEDIES
Have you some chronic cases which are giving you trouble and not
yielding to your present prescriptions? Have you cases which you
consider incurable, like Dialjetes. Bright's Disease, Paralysis, Loconiotor
Ataxia, Chorea, Epilepsy, Arthritis Deformans and other diseases
which are down in the text-books as incurable? Let us advise vou to
.'e these cases Biochemic Treatment. Not the abortive twelve-salt
system oF Schuessler and his followers, but the full, complete system
as represented solely in the Ensign Remedies. We add to the twelve
salts found in the ashes of the dead body those other elements which are necessary in the process
of life and the healthful operation of the various organs of the animal body We get results—that
is the point. We do not suppress disease, but eliminate it. We change the disease state; most
systems are content with removing disease products and getting rid of distressing symptoms. We
obtain the latter through a curative action. We supply deficiencies and restore functions. We
follow the natural law and thereby get exact results Biochemistry is a science.
We have reports from doctors which would sound extravagant to any one unacquainted with
our system. One doctor from North Dakota says: "I have cured hopeless, given up cases; I have
cured cases pronounced incurable except through the use of the surgeon's knife, and I have
cured cases which the surgeon would not dare to touch," A doctor from Indiana reports the cure
of arthritis deformans, impotency, sexual weakness, varicocele and hydrocele in his first report.
And so it goes all over the world, for we send remedies to all countries. A doctor in Bahia Brazil,
reports astonishing results in a large number of cases; another from Godavari, India, is getting
started in good shape and is very enthusiastic over results in a district where malaria is v ery destructive.
And so we could multiply cases enough to fill volumes.
But what we want is to have you test the remedies for yourself. You can do this readil y and
at little expense. Send for some of our literature and read what we have to say. It will pay you
in cash by giving you professional success far beyond your expectations. Success in practice
means financial success. The Ensign Remedies will get you the business. We do not expect you
to sell them as Ensign R medies, but to prescribe them upon indications which we furnish.
WRITE US TODAY
Ensign Remedies Co., Department o. Battle Creek, Mich.
CANADIAN OEFICE : WIINDSOR, OINT.
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ADVERTISEMNTS.
I PROF ESSIONAL CARDS |
DR. QEORQE W, PRESSLY
Hi) Chaulotte. N. C.
I
/p
Practice Limiied td sukgiiiiy
DR. \V. O. NISBET
Diseases of Digestion
Offices: 9 North Tryou Street
Phones: Office, 21. Residence, 1196.
Office nHours;
8:00 to 10:00 a. tn., ii;oo !
:io p. ni. ; 3:00 to 5:00.
Huiirs by Appointment.
* DR. JOHN R. IRWIN.
*
* Charlotte, X. C.
K Siiecial attention jv>veu to Abdominal
%
Surgery and Diseases of Women.
ANDREW J. CROWELL. M. D.
Chaki.oTte, X. C.
'ractice Limited To Genito-Urinarj' anc
Rectal Diseases.
Hours: 8.30 A.M, to 12. M.
4 to 6 PM. SuTiday by appointment.
DR. A. M. VVHISNANT.
18 S. Tryon St., Charlotte X,C.
Office Hours:
8:,30 a. m. to 1 p. m., and 3 to 6 p.m.
Sundays by appointment. Practice
limited to F.ye. F.ar, Xoseand Throat.
E. R. RUSSELL. M D.
J. P. rvIATHESON. M. D.
221 S. Tryoii Street, C .-AKi.O'l"rR, N. C.
Hours: 9 a. in. to 1 p. ni., and 4 to 5 p. ni.
Suiulays 9 to 10 a. m.
Special hours by appointment. Practice limited
to the Eve, liar, No.se and Throat
Phnne 41S— 6S7.
An Advertisement In
TME STATE"
COLL'MBIA, S. C.
^ell it. The reason is evident. The Stati
covers its State. Write for rates.
JOHN P. MUNROE, M. D,
SPECIALIST IN NERVOUS DISEASES,
Offices Charlotte .Sanatorium. Charlotte, N. C.
CONSULTATION PRACTICE.
Will meet physicians in adjacent towns and
country for consultation in general medical
cases.
W. n. WITHEKBEE, m O.,
CHARLOTTE. N. C.
lice limited to treatment
.Skin Diseases.
Cancer ati
Office, Charw Sanatorium.
CHARLES M. STRONG, M. D
Diseases of Women and Surgery.
Office Charlotte Sanatorium, Phone .s:
Residence 609 S. Tryon Street.
Phone 144.
DR, CHARLES H. 0. MILLS
Realty Building, Cliarlotte. N C.
Pr.irtice limited to GynecoloKN' nnd
Obstetrics.
DR. GEO. \AJ. PRESSLY
Xow has his office at the Charlotte
Sanatorium and does all his work there.
I'RACTICE limited to SURGICAL C.-\SES.
DR. ED\A/IIN GL/\D/V\OIN,
SPECIALIST
IN
TUBEKCULOSIS
Southe-i-n i=»ine-s, IN. C
TIII

THE CHARLOTTE MEDICAL JOURNAL
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FLEXNER'S SOIUTION

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F. H. STRONG CO.
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ECTHOL may be depended upon to promptly
produce tangible results.
BATTLE & COMPANY
LONDON 8T. LOUIS PARIS
-\

THE CHARLOTTE MEDICAL JOURNAL.
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THE CHARLOTTE MEDICAL JOURNAL.
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j
j
1
The Charlotte Medical Journal
Vol. LX CHARLOTTE, N. C, DECEMBER, 1909.
j breakfast of one roll and one and a half
i glasses
( ed by tube one hour after ingestion. The
I
I of
I
I
I acidity,
Results of Stomach Analyses in hands and wrists in the
Pellagra.*
following August.
An analysis at this time gave; HCI, 4; total
By Dr. W. O. Nisbet, Charlotte, N. C. acidity, 28; mucus, no excess; bile absent;
T desire to report results of the motility,
analyses
normal. Patient still living.
of stomach contents of ten cases of pellagra. Case 4.— j. E., adult male, age 31; na-
All of the cases were given the tive
Ewald-Boas of N. C. History of mild alcoholism
and of spring dia.rhoeal attacks for several
of water, and contents were removyears;
mouth, stomach, bowel and cord
signs present when seen in August, 1908.
acidity was estimated by Topfer's method Analysis; HCI, 8; total acidity, 33; mucus,
titration. A detailed account of
in
the cases
excess, ferments, diminished; motility,
will not be given; only the stage of the disease
and the points bearing on the stomach
secretion will be mentioned. My experience
is limited to twenty-five cases of pellagra,
and in only ten of this twenty-five did
I succeed in getting test meals.
Case 1.— Miss W., native of Alabama,
age_29. History of diarrhoea in spring of
19n7. I saw patient first in September,
19u8, and found pre.sent hand and wrist
eczema, bald tongue, burning in stomach
and diarrhoea, ana! excoriations, slow mental
action, despondency, but with reflexes
about normal; emaciation to an extreme
degree. Only one test was made of stom-
acli contents and showed HCI, 0; total
50; ferments not estimated; mucus
f in excess. Hile was present during the
I periods of severe vomiting. Motility not
tested. Patient died October, 1908.
C.VSE 2.— .Miss C. age 26; native of S. C.
First seen in September, 190S; gastro-intestinal
and mental symptoms marked and
eczema beginning on knuekles. Patient
gave history of sore mouth, nausea and
diarrhfca in the spring of the preceding
year. Analysis of stomach contents; HCI,
4; totol acidity, 28; mucus, in excess; ferments,
coagulation of milk delayed. Motility
not tested. History of presence of
bile during severe vomiting, Died six weeks
later.
Cask .5.— Mrs. R,, age .3.5; native of S. C.
Flad been very neruous for twelve months,
and had raw mouth and tongue in the past
spring, Saw first August, 1W8, and presented
characteristic gastrointestinal signs
with staggering gait, but no hand eczema;
analysis stomach contents; HCI, .i.S; total
acidity, 80; ferments, normal; mucus,
no excess. 'JMiis patient got better
during winter, but had a return of symp
tonisthe following April; still no hand erup
tion. At this time a second stomach analysis
showed; HCI, 10; total acidity, 40; mucus,
no excess. The eczema appealed on
*Read before the I'ellagra Conference held in
Columbia, R. C, recently.
normal ; bile present during periods of vomiting.
There was improvement during winter,
but in May symptoms returned in increased
severity and with the presence of
the typical eczema of hands, arms and
elbows. Analysis at this time gave the
following: HCI, 0; total acidity, 24; mucus
in excess; motility, normal. Patient
died the following September.
Case ,S.— Mrs. W., age 36; native of
N. C. Eczema and gastrointestinal symp-,
toms, marked; locomotion and reflexes,
normal; mental action, sluggish. Result
of analysis HCI, 4; total acidity, 18; mucus,
no excess; motility, normal; ferments, normal.
Patient improved under arsenic but
had a mild recurrence the following spring.
Case 6.—Mrs. P., age 34; native of
N. C. Gastro-iiilestinal symptoms, with
insomnia and vertigo appeared in fall of
1908. Analysis at this time gave HCI, 24;
total acidity, 56; ferments, normal; motility,
normal; mucus, excess. In June, 1908, the
above mentioned symptoms returned in
acute form along with decided hand eruption.
Specimen of contents at this time
gave no reaction for HCI, but there was
excess of mucus. Patient died six weeks
later.
Case 7.— Mrs. K., age ,58; native of
N. C. Sore mouth, burning stomach and
periodical diarrhoea appeared in September,
1907. Analysis at this time gave HCI, 39;
total acidity, 76; mucus, not in excess;
motility, normal. Patient improved under
arsenic and cold weather, but in .\pril had
a return of symptoms, with the appearance
of hand eruption in addition. Analysis;
HCI, 20; total acidity, 42; mucus, no excess;
motility, normal. A third analysis
in October gave result; HCI, 8; total acidity,
22; mucus, in excess; motility, normal.
Case 8.— Mrs. M., age 37; native of
N. C. Sore mouth and gastro-intestinal
signs first appeared in April, 1909. Insomnia
and despondency for two years. In
August, in addition to above symptoms,
began to walk unsteadily and noted also
the appearance of "sunburn" on knuckles

.
366 THE CHARLOTTE MEDICAL JOURNAL.
and back of hand. Analysis at this stage ture, the patient has had an attack of t}'showed
IICl, 18; total acidity, 40; ferments, phoid fever some time previous to the benormal;
mucus, no excess. ginning of his gall bladder trouble. We
Case 9.— Mrs. B., age 29; native of are all familiar with the digestive troubles
N. C. Hereditary specific history. Nursed which so frequently follow typhoid fever,
a sister who died of pellagra. Six months and I believe that a great number of these
ago developed red tongue, distress in stom- so-called digestive troubles are due to a
ach and nervousness, with despondency, cholecystitis produced by the typhoid
At present has still the above symptoms bacilli.
and beginning eruption on knuckles. An- Gall bladder disease is much more frealysis;
HCl, 20; total acidity, 50, mucus, quent in women than 'men, and is much
no excess; motility, normal. This case may more likely to affect women who are fat,
clear up under specific treatment and prove over forty and who have borne numbers of
not pellagra. children. I am inclined to believe that gall
Case 10.—Mrs. M., age 39; native of bladder disease in men is rare. I remem-
N. C. Has had diarrhoea and indigestion
for two years. In April of this year develber
seeing but a few cases,
Symptoms.— The most constant and charoped
marked diarrhoea, gastric distress and acteristic symptoms of gall bladder disease
a red mouth and tongue, and case was pro- are pain or colic, chronic digestive troubles,
nounced pellagra by consulting physician,
At present time she is a typical pellagrin,
chi'.ls, fever and sweats; jaundice and tumor
may also be present. The pain of gall
Analysis; no IICl nor total acidity; excess bladder disease comes on suddenly without
of mucus; bile present. regard to diet, exercise or time of day. It
Summary
is very severe and lasts from a few moments
Cases 1, 2, 4, 6, 7 and 10 show a marked ^^ six or eight hours, or even longer, and
diminution in the acid factors of the gastric
^^ a rule disappears as suddenly as it comes
o"juice
in the late stage of the disease.
^^ >.« l°^fed m the epigastric or mid
l»>e region,
Cases 1, 2, 4, .5 and 10 show
from two to four niches
excess
below
of
mucus during
ensiform cartilage and radiates
the pellagrous upward and
periods.
Cases3, 4, 5, 6, 8 and 9 show normal
backward to back and shoulder blades,
especially to the right,
motility, while in 1, 2 and
dtf^enng from the
10 motility test
was not made P'^'" °' appendicitis, which radiates down-
Cases 1, 2, 4 and 10 show
ward rather than upward In some
presence
cases
of bile
^he
during severe vomiting pam is in the region of the gall bladder,
periods.
This series of cases is too small to allow
^^t not so frequently as we would suppose,
considering the
us to draw any
pathology of the disease,
definite conclusions, but the
indications are that in pellagra, as in all
^^1^^ P^'" '" some cases is located at Mcadynamic
and asthenic diseases, the HCl
Burney s point. This was so incase No.
and
which I
ferments of gastric juice progressively am reporting today, and made the
diagnosis impossible until
diminish
an exploratory
laparotomy was done.
Gall Bladder Disease, With Report of The pain of gall bladder disease is ac-
Two Cases. companied or followed by nausea
Dr. L. A. Crowell, Lincolntou, N. C. vomiting. We have those same symptoms
in appendicitis, but in gall bladder disease
The term gall bladder disease is used
these symptoms of nausea and vomiting are
preference to gall stone disease in this paper
'''^'^^^- C^;'"^, fever
because the writer believes that we
and sweats are
have "^l'^ other symptoms that sometimes appear, es-
infectious conditions of the gall bladder
and Pecially in those cases where the infection
bibary passages accompanied by. a
°''
formation of plugs
«'°"e 's located
of mucous and m the common or hepatic
insipis-
^^^^s.
ated
In those cases in vvhich the trouble
bile as a result of said infection which
^^ confined to the gall bladder, the consti-
give rise to the same obstructive symptoms
tut'onal
as gall stones and demand the same
symptoms are likely to be very
opera-
'^'^^tive
procedures
I" ^^^^t, the patient may have no
for their relief.
Etiology. ~l believe that all gall bladder
symptoms except pain, which may not be
severe,
trouble, stone formation and
with slight tenderness m region of
dust trouble
^^'^ have their origin in an
ladder. t is well alvvays to look with
infection of the gall
bladder from
suspicion
bacteria of the colon group
on all cases of chronic digestive
and in the vast majority of cases from
doubles which have resisted all ordinary
the
typhoid bacilli. In all the cases I have
methods of treatment, for a great many of
^l^ese
seen, and in most of those found
symptoms have been found to ongin-
in literaate
from gall bladder disease.
*Read before the Lincoln County Medical Society Jaundice at one time was considered
November ist, 1909. very important symptom in arriving at
-

ORIGINAI, COMMUNICATIONS 367
diagnosis of gall bladder disease, but we iiig, Sept. IStli. and discovered a tumor in
now know that we can have a grreat deal of region of gall bladder extending downward
trouble in the gall bladder and biliary pass- as far as umbilicus. Patient continued to
ages wilhout having jaundice as a symp- have pain in right side with nausea and
torn, and the surgeon who waits to see the vomiting, with slight elevation of temperayellow
flag and other grave symptoms, such ture, until admitted to the hospital on Tuesas
clay colored stools, enlarged liver, etc., day, Sept. 21st.
makes a great mistake and will miss the at any time.
Patient had no jaundice
opportunity of curing the majority of peo- Diagnosis at time of admission was tumor
pie who suffer from gall bladder disease. of gall bladder with the probability of stone
Tumor as a symptom of gall bladder dis- in cystic duct. She was immediately preease,
without jaundice, would point to either pared for operation, which was done Wedan
infection of the gall bladder cystic duct, nesday, Sept. 22nd. Patient was placed on
with plugging of cystic duct by thickened table with head raised six or eight inches
or insipisated bile and mucous or stone in above her feet. At the same time a sand
cystic duct, while tumor
would suggest malignancy.
with jaundice bag was placed under back at or a little
In some cases above level of liver. An incision beginning
of gall bladder disease ih^ symptoms are so at costal margin and extending downward
vague and misleading that despite our best 5 inches along outer border of right rectus
efforts it will be impossible to make a diag- muscle was made. The gall bladder was
nosis wiihout an exi)loratory section, but I found and brought into wound without any
believe with the proper interpretation of a trouble. Palpation of gall bladder showed
thorough and carefully taken history that it to be moderately full of fluid. Examinthe
majority of the

368
THE CHARLOTTE MEDICAL JOURNAL.
thiid day when it reached 99 1-5. She left bladder was palpated and stones were found
hospital on 25th day with wound entirely therein. It was brought up into the wound,
healed and in perfect health. incised and 400 stones removed. The tech-
Case II.— Mrs. C ; aged 46: mother nique in this operation was similar to that
of six cliildren; oldest chitd 22 vears old; in case No. 1, except in this case drainage
youno-est 14 months: had an attack of tv- in subhepatic space was omitted. Bile bephoid"fever
seventeen vears ago. gan to discharge one hour after patient
Her health was good until about three was put to bed and averaged three ounces
years ago when she began to have periodi- per day for nine days when tube was recal
attacks of pain in stomach and right moved. Patient has had no chills nor
side of abdomen. These attacks would sweats since the operation. 1-istula healoccur
everv four or five months at first, but ing very rapidly and patient will be able to
have become as frequent as one a month leave hospital in a few days,
during the last twelve months. Attacks are I neglected saying that this patient had
sudden in onset, disappearing in the same had no jaundice with anv of the attacks
manner. They are always accompanied except the last, when her conjunctiva was
by nausea, vomiting and elevation of tem- slightly liuged.
perature which some times reached one ^^^^ clinical Studies oi. Pellagra.
hundred and six. 1 hey usually lasted
three or four days and left the patient very "^

—
ORIGINAL COMMUNICATIONS. 369
Dr. Petit, in an official report, says of the of disposition from slight depression to
conditions of the peasantry in the pella- hypochondria, melancholy and suicidal
grous district of Gironde; "They are slov- tendency, self depreciation and delusions,
enly and sleep in their clothes. Maize refusing of food, mania, restlessness, apathy,
enters largely into the food of the people, or catalepsy. Disturbances of sight and
which includes a little rye bread, sour most hearing are common, mutism is frequent
of the time, a few sardines and rancid (see second case ), and terminal dementia.
lat'd." These latter terminations are found in about
We have pursued the disease symptoms 3 to 5 per cent, of the cases,
supposed to be due to the use of spoiled 4- The cutaneous symptoms are not found
maize for many years. Let us consider early in the trouble. Instead of being the
these due to rancid fats,and their derivitives, initial symptom, the erythema of the dorin
diets for a short time, and the disease sum of the ieet, forearms and hands
will appear to be an exception to the usual symmetrical—resembling sunburn, little or
methods of germ infection. It puts the dis- no swelling, a red blush becoming deeper
ease in a class.by itself, so far as I know,
in which "chemical"—to use an old term
in color, sharply defined, which appears
late in the disease. The affected surfaces
or germ decomposition of fat is the very be- soon become dry and scaly, leaving the skin
ginnins of the after troubles. To the lay- dry, sometimes cracked and fissured, or
man, it makes no difference beyond erapha- eczematous. Skin manifestations have been
sizing the necessity of being more particular found in chronic digestive disturbances
as to wliat is used for food. To the doctor, from time immemorial. Two forms are
it changes materially the "line of march." recognized: The acute or typhoidal, which
It gives him a l)ase of treatment which, I runs to a fatal end in a few weeks, with
hope to show, will reward his advice and fever, delirium, and uncontrollable diarprescriptions
with full and complete sue- rhoes, due to acute rancid fat intestinal
cess. If it will do this, the truth or error toxaemia, and the mild or chronic or reciirof
the theory is not of material importance, rent, which results in inflammation of the
although it will be more satisfactory, if both sheaths of the dorso-lumbar intervertebral
agree. nerves as they emerge from the spine: In
The diet of a hard working man or wo- disturbances of the auditory, optic and
man should consist daily of an intake of gustatory nerves and those of general sensabout
7 oz. of albuminates, 2 oz. of fats, ation, with skin involvement, shown in
and 21 oz. of starch or carbohydrates, with erythema, eczematous inflammations and
water and mineral salts. These should be gangrene, equally hopeless and helpless, as
moderately free from agents of decompo- are the final terminations in disturbances in
)n—prepared artificially for easy and the use of nitrogen and hydrocarbons. Thus
rapid digestion and placed in a stomach completing the cycle. I notice three subthat
is in fair working order, to avoid a divisions in this latter form: Pellagra
tremendous number of evil consequences, proper; pellagra sine erruptione, and pseudo
should these conditions not be met. pellagra. This second type runs for twenly-
The symptoms of pellagra are: five years or more. With each recurrence,
1. Gastro-int^stinal; nausea, acid dys- anemia, debility and emaciation increase,
pepsia, sour or bitter vomiting, constipation and the other symptoms advance. The reor
diarrhoea, stomatitis, with more or less currences do not occur at regular intervals,
red mucosa, apthous ulcers, distressing sali- and, excepting in the typhoidal form, the
lion (with thick pasty saliva) and patients have no elevation of temperature
pyrosis. unless it is due to some complication. We
2. Nervousmanifestations; vertigo, pains now try to locale the initial disturbance in
and "swimming in the head," roaring in the fat contents of the food.
the ears, symptoms from the upper, middle The first argument against other infective
and lower regions of the spinal cord, ten- sources is the admitted failures in treatment
dernessover the dor.solumbar intervertebral based upon them for nearly one hundred
spinal nerves, as they emerge from the spine, years. Let us abandon a trail that has aldecrease,
or loss, of' leg reflexes, increase of ways terminated in the grave, and explore
reflexes of the upper extremities, spastic new fields.
symptoms, disturbed sensations and sphinc- First, we note that these patients avoid
terparalyses, sclerosis of the lateral columns fat in their diet as a source of serious disof
the cord, lesions of the posterior columns, comfort. Some of them have learned to
and degeneration of the posterior roots, in avoid corn also for the same reason, allong
continued disease. though they do not know that a large per-
3. Mental symptoms; confusion, weak- centage of corn is fat, sometimes approxiness
of judgment and will, anxiety, dis- mately ten per cent. I suppose that vegeorientation
as to time and place, alteration table fat is exposed to the same laws of de-
—

370
THE CHARLOTTE MEDICAL JOURNAL.
composition as that derived from animals, results will be more or less pronounced as
The infective decomposition of the nitro- the trouble is more or less acute and progenous
portion of our foods (either before longed.
or after ingestion) results in the fotmation In April, 1904, I began keeping brief
of leucins, ptomaines, etc. These, when records of cases. About a year ago, the
taken into the stomach, produce high tem- frequency with which the word pyrosis" i
peratures running from 104 to 11.5 F. It appeared in my notes attracted attention, i
is usually an acute process and the high The meaning of the term "pyrosis" in my
j
temperature suspends vital functions, unless mind was the eructation of air or fluid from
quickly relieved. Chronic incomplete oxi- the stomach to the mouth of more or less
'
dation'of nitrogen tends to inflammation of
fibrous structures of joints, aponeuroses beacid
reaction, and cardialgia, due to rancid
and volatile acids in the stomach and
,,
ji
tween muscular layers, and of the heart duodenum. This definition resulted from
and lungs. Also to troubles with the kid- a long continued personal suffering with
neys and arteries, and the optic nerve, these symptoms about forty years ago, m |!
terminating in hopeless, helpless, arthritis spite of varied combinations of medical .
deformans. The defective digestion and talent and remedies used at that time. The ;i
assimilation of starch results in an use of these words was steadily increasing ';
acetous fermentation, with its attendant in my records. I, with many others, attend- |i
distention of the digestive canal with ed the first pellagra conference held in Co- <
gases sweet or slightly acid, with slight lumbia a year ago. We inspected the nu-
disturbances of temperature, colics, etc., merous patients present. They were all in j|
of slight importance, unless it becomes the advanced stages of the disease, and 1
chronic and terminates in diabetes, or every one will recall the helplessness and ;
other troubles of that kind, and skin in- hopelessness presented by them. I had been i
volvements of carbuncle and furunculosis. taught that the eruption ou the posterior 'i
It is usually easily remedied, unless mixed surfaces of the forearm and hand, nearly ]
with a rancid decomposition of the fats, symmetrical, was the initial symptom, which ^j
which soon overshadows it, and controls appears to be the generally accepted con- •the
situation. To mv mind, the products elusion at the present time, although pellaof
starch decomposition are not as apt to gra without the eruption is mentioned. This ;;
contaminate the fat contents of food as vice initial symptom had never yet appeared m ,
versa. When rancid fat gets into the stom- my work. September 7, 1909, it came in
j
ach the conditions become exceedingly what I called "my awakening case." It
^
troublesome. The complete and permanent was of Mrs. S., aged 30, white, blonde,
removal of the resulting volatile fatty acids married, mother of four children, last con- i
is a task requiring time, patience, reflexion, finement four years ago. She had been i
and pure remedies well handled and a dizzy six months, pains in upper, left ant. ^i
proper diet, and recurrences or relapses are thorax, going to shoulders and arms, and ;i
frequent and long continued. The fatty in throat, fair appetite, costive, slight fever,
acids resulting from the germ destruction "pyrosis," salivated (not Hyd.) high col-
of fats are oleic, stearic, magaric, but the ored urine, frequent dysuria, last period |<
vo/a/i/c fatty acids, of which there are nine three weeks ago, three days, no pains or j
derived from fats and oils, headed by distress, diarrhceic attacks at times, roaring ,i:
Butyric acid, which saturate the body and in the ears, mental confusion, dry scaly ':
its fluids like chloroform and ether, are of eruptions on lower two thirds of backs of (
first importance, and must result in lessened forearms and hands, to the metacarpopha- jd
alkalinity of the body generally. In Brande langeal joints. This has appeared "\the .(
and Taylor's Chemistry, published about same location three or four times. The jl
187.5, a' short note mentions the ingestion, skin at site of eruption is decidedly darker )
by Dr. Lared, of Butyric. acid, experiment- than elsewhere on the body. She does ,
ally with the incident production of pyrosis housework, is not out in the sunlight, has ;i
been in bed six or eight weeks and lives on ,:
and'cardialgia.
I wish particularly to draw vour attention corn. She has severe pains in back ot head ,<
to these svmptoms produced by this experi- and neck, the muscles of which seem stiff |f
ment as'l think they are prominent symp- and act slowly, with pain. The pupils were JM
toms 'found in the early stages of pellagra, moderately contracted. She has lost about 1
A condition resulting should be one of de- forty pounds in weight in the last two or j.^
cidedly reduced alkalinity of all the solids three years. The pulse rate is /6: 1 . 9.S6 10; ;>1
and fluids of the body. This is shown by Sphyg. 100. She is sahvated {not mer-j^
the fact that all these patients were free curial) and markedly depressed. She has,i
users of bicarbonate of soda, self prescribed, steady "burning" in stomach, throat and |i
in spite of their expressed fear that its use mouth. In the latter two cavities thCja
tended to "eat out the stomach." These mucous membrane is intensely
4. A^A („ n«..,f .^,.1 fiia ct/^tTid^li " Thf^cp Tiiiicniis membrane is intensely red. II
j
}
J
j
j

ORIGINAL COMMUNICATIONS.
!...v.ed Ihe case to Dr. Buchanan the next reflexes absent. Has lost forty pounds of
Arter examination, he said: If this flesh in six or eight weeks (which I think
n IS not sunburn, I think this is a required muchlongerthan that ). "Pyrosis,"
pellagra. Ihe lady had not been mouth always sore, cardialgia, pupils mvi
.o he sunlight at all. otic, good habits, soles of feet slightly more
next case. Miss W., was white, sensitive than in a case of locomotor ataxia
aged forty-five, house-keeper, all (at an apparently similar stage), which
e croupy She thought that three came into my mind and might have relomhs
previously, while eating chicken, a mained there but for that word "pvrosis "
one had lodged m her throat. This swell- etc. He has lived on cornbread and bacon
i so rapidly at once that breatliing became good, bad, and indifferent, all his life and
ibored. She had no cough, but pain in cannot remember when he did not 'have
er throat ,n swallowing solids. The at- "sour belching." This was his onlv visit
riiding physician could find no foreign to me, so I cannot report progress. Please
ody 111 the throat, but began treatment for notice how the word "pyrosis" occurs in
iberculosis of the larynx. She had diar- these records. The case of complete, sure
loea in May, June and July; has not men- pellagra determined my investigation of the
ruated for two or three years. No blad- records of cases in which this word occurred
it troubles, always nervous, "pyrosis," so frequently as to attract mv attention and
)ur stomach, cardialgia, voice a whisper, this is the result. In five years about 3u0
J cough or ex pectoral ion, no loss of weight, cases of "rancid fat" had presented
doubted the diagnosis of tuberculosis. I do not think that every case in which
lie showed evidence of past tubercular "pyrosis" is present is pellagra, or that they
oubles at apices of lungs, but they were will all become pellagrous, as the stomach
net now. The throat and mouth were in- disturbances will limit the diet of these pansely
red. Pulse 84, temperature 99.8. tients instinctively, reducing suffering and
le was treated as were the other pellagra, prolonging tlie early stages of the trouble,
rancid fat patients, and in three weeks even bringing about a convalescence, which!
;r pulse was 72 and temperature 9,S.C, at 7 however, does not confer immunity. But,'
m., while she was gaining rapidly in in such a case, u-Aai the clijiician detects inery
way. The treatment will l)e detailed vo/vement of nerve cells or nerve fibsrs, or
ter on, but to it was added the static nerve sheaths, then it is a case ofpellagra witholet
discharge, and the arc light to ex- one the eruption. When he detects involverior
of neck, which gave rapid and pleas- ment of the skin, then it is complete pellagra.
Lilt improvement. I could then find no The germ appears to be in the fat, not in
:ns of active tuberculosis. the patient primarily, and the treatment of
We turn now to the case of Mrs. O. B., tiie patient for original germ troubles will
10 consulted me June 29, 1906, white, age be at best only modifying. Remove the
r,married,oiie child six years ago. Nursed germ laden fat from the diet, care for the
|iild three years and lost flesh and strength acid condition developed in the patient,
larkedly. Her menstruation always regu- clean out and keep clean the body of the
|r from confinement. Each period seven patient inside and out, see that clean nourlys
in length, with i)rofuse losses and lit- ishmenl, such as the patient needs, is pro-
^ pain. For eight years, back ached vided. Help the case along with proper
Jieii she was overheated. In micturition medication and satisfaction will result.
IS delay in starting urine. Slight uterine This brings us to the treatment. I do not
pcorrhnea, bowels regular, color of pass- recommend any formula, or cut and dried
;es normal^ anorexia, "Pyrosis," nausea treatment, but a plan which any physician
id cardialgia. Pulse 100, every day head can carry out to suit the case. A review of
hes, frontal or right side. Uterus retro- the various treatments used in pellagra by
;xed and prolapsed. Intense tenderness those who have had the largest number of
er right dorsal and lumbar intervertebral cases to care for shows the universal ten-

372
THB CHARLOTTE MEDICAL JOURNAL.
late of copper, will succeed or not remains associated arsenite of copper, arsenite t
for future determination. strychnia, and hyosyamine (which is adde
I had treated what I now think were the to control pains in the intestinal canal), tb
earlier symptoms of pellagra, as the condi- patient is given the compound sulpho-ca:
tions of the patients appeared to require, bolates, with other laxatives, if necessarj
The diet was adjusted as best we could, and until the digestive tract is as germ free
all of the patients were cured or relieved it possibly can be made. Then the abov
and satisfied, although recurrences were medication is reduced in frequency to man
frequent. My Rx for my advanced case tain what has been gained, and each mefj
was more developed than for the group of the patient takes is preceded or foUowec
symptoms, which I had previously met. or both, as necessary, with sodoxylii
'ihe principal change was: to the more (which is a compound of Sod. sulpho-ca;l
chronic disease an acute treatment was ad- bolate. Sod. sulphate. Sod. bicarbonat(
justed /(^ (^d-rf, then the treatment was made Colchicine, Juglandin, Xanthoxylin, wit;
as chronic as the disease. I find a com- aroraatics), or with sulphide of arsenic, an^
plete change in my remedial measures since the diet is prescribed. This is free froii
1904. The arsenates are used more than hog fat, hog meat and corn, (because of i'
ever, of which arsenate of copper, or strych- fat contents). Shredded wheat, oatmeal
nia and quinine are more frequent ingredi- eggs, chicken, fresh buttermilk, vegetablcl
ems of ray prescriptions. properly prepared, are staples used, and I
I wish to insert a few words regarding the think the soy bean would be an excellei'll
arsenite of copper, which heads, to my addition to the pellagrin's diet. If the cor'i
mind, the list of destroying agents for the dition of the patient demands fat, this ii
germs producing decomposition within the used in the shape of oil inunctions. Alk; !
human body.
line baths give great comfort to the patien »i
In about 1873, one Harlow I^ee, aged 20, 1 will read the formula used in my con i:
worked in a drug store, which did a tre- plete case of pellagra and the results frorfl
mendous business among the farmers in the time to time, and you can judge for yo\i

ORIGINAL COMMUNICATION. 373
Iter in every way." More strength, sleep very complete pellagra without eruption,
tter, good appetite. Ordered Bovinine, and one case apparently complete in all its
o teaspoonsful after meals. Former medi- details. My definition of a "pellagrin." lotion
continued. September 28: Gaining day is a person who has been saturated with
pidly in strength, cheerfulness and rest- volatile fatty acids. He or she must ever
Iness, belches sweet gas occasionally, afterward pay the price of eternal dietary,
Another fact present in all these cases after
ginning this method of treatment was a
and intestinal antiseptic vigilance, or suffer
acute, sub-acute, or chronic attacks of vascontinuance
of the use of bicarbonate of rious kinds.
da, of their own free will). Eruption can The criticism has been offered that "ranfelt,
but not seen. Begins again her cid fats" "has been threshed out over sixty
;ht household duties. Seems thoroughly years ago, and nothing was in it." This
nvalescent in three weeks oi care, asout- "re-threshing" has been done unwittingly,
led above. She has slept as satisfactorily and more comfort, relief and curative sucr
the last three nights as ever in her life, cess for the sick has been found than ex-
;tol)er 2'): She seems well except stiffness perts have been able to offer so far as their
muscles of back of neck, and slight ten- recorded experiences show.
^
mess along eleventh and twelftli dorsal
.ervertebral nerves on both
Ectopic GesSallon-Wlth
sides. Eats
Report o! a Case
°* '*•* Abdominal Type.
d sleeps well. Will she continue to im-
to the
Charleston General and McMillan Hospitals.
3Ve'' Time will tell. ^^ John Egerton Cannaday, 51. D Surgeon ,
Referring to late-stage cases, in the hos-
;al, in which I have little experience, I Extra uterine pregnancy is productive of
II only suggest that, in addition to a one of the gravest emergencies the surgeon
ronic treatment, as outlined, with a diet is called on to treat. This abnormality was
lited in fat, tliat the different electric probal/.y first described by Albucasis, an
)dalilies can be used to advantage, and, Arabia.i p'.nsician of the eleventh century.
ioretically, arc' light baths will show value Laie;" d^s^ribed by Riclanus. .Abdominal
assisting the blood to return to the normal section probably first done for this condition
Dporiions. by Nufer in the year fifteen hundred Mau-
Also. 1 would like to suggest the com- riceau in 1669 clearly described the condinsatory
tonic action on the nerve cells, tion. Demeiris in 1836 gave the world a
It have not degenerated, by the llawley classification used today. Lawson Tait
itnal lymph. It ought to accomplish was the first surgeon who had a wide operainders
in such cases. In the typhoidal live experience in this condition and he was
3e, 1 would like to suggest sodoxylin able to set his brothers an example of sucbbott
>, Strych. Arsen., Atropine, Copper cess to follow.
sen. rapidly to effect: as diet—none—un- The frequency of this condition varies
the patient is better, then a fat free diet much with the individual statistics of differbest
suits the case. ent operators. Some claim as many as one
Before closing, I must mention the case out of every hundred cases while others
Mrs. McCi., from Mississippi, who con- have found only one in twenty thousand.
Ited me September 20, 1909. White, mar- In latter years there has been an apparent
d, fifty years of age. Recorded symp- increase in the number of cases. This is
ns were; Roaring in the ears, one year, probably due to several causes, among
first at night, but for the la.st month both which may be mentioned more knowledge
[ht and day, although worse at night, concerning the subject, growing popularity
ontal head pains every day also, for a of operative treatment, probable increase of
ir. Anorexia, caustive, constant pain gonorrhoea, and the commonness of aborder
right scapula, gastric flatulence, tion. There can be no doubt that in former
fer eructations, lumbar pains, brown col- times many cases went unnoticed and that
id spaces on posterior surfaces of fore- even now cases are not infrequently overns,
evidently the remains of an old pella- looked. The true nature of many cases of
iic eruption, which had been present haematosalpinx, haematocele and blood
fre for four years. The same plan of Cyst of the ovary is misunderstood.
atment, as previously outlined, gave Formerly many cases of ectopic pregnancy
ick relief to the symptoms.- In some were considered to be primarily abdominal,
ics, an insufficiency of liver or pancreatic Latterly, since we have come into a more
ion will be shown as they progress, call- exact knowledge of the subject, the second-
: for medication and diet adjusted to such ary form has been considered the rule and
iditions. These notes show that I have the primary form the exception in abnormal
i, in four years, about 300 "rancid fat" pregnancy. Nearly all cases have followed
;es presenting more or less of pellagrous tubal abortions. A few writers on the subnptoms.
Among these were 12 cases of ject have gone so far as to deny that such a

374 THE CHARLOTTE MEDICAI, JOURNAL.
thing as primary abdominal pregnancy ever at the upper portion of the tube. The ovui
occurs. is usually surrounded by the amnion an
The most trustworthy statistics on the the chorion, The latter being fixed by i
subject tell us that eight and one-half per villi to the mucous lining of tlie tube. Ov
cent, of all cases of eccyesis are abdominal ing to the comparatively brief stay of tl
in character. In the primary form the ovum ovum in the tube a true placenta is ni
i
|
falls into the peritoneal cavity and becomes
fixed there. The secondary form arises by
usually formed there. A hyperplasia of tlj
tubal tissues forms a sort of pseudo decidij
rupture of a salpingocyesis by which either the uterine extremity of which at times |
the fetus alone or the whole product of con" found open in continuation of the uteriij
ception is thrown free into the abdominal cavity. Bv reason of the loose attachmej
cavity. At the time of occurrence of the of the chorionic villi, they are easily lacer|i
tubal abortion the placental attachment to ted causing hemorrhage which often prj
the tube must remain in whole or at least in duces rupture of the tube. Tubal abortid
part undisturbed until new attachments and is apt to occur before the end of the secoi
a new circulation can be formed.
Etiology.—The specific cause of an indimonth.
The conception product seldoi
escapes from the end of the tube and usual <
vidual case is exceedingly obscure. Gen- is freed by rupture. In a few cases ruptu
erally speaking whatever condition that prevents
the passage of the ovum to the uterus,
does not take place and a fleshy mole
formed similar in nature to that which j
but which does not prevent the passage of sometime formed in the uterus. The y
the spermatozoon to the ovum may bring mary abdominal form occurs when t,'
about this state. Most cases occur between ovum becomes fertilized in the abdoraiiij
the twentieth and thirtieth years of life. To cavity. Occasionally the ovum becoiu;;
classify causative factors we ha^'e malform- implanted on the fimbria ovaries, or it m ;
ational (congenital or otherwise) anH path- become fixed to the bottom of the Cul i
©logical conditions of the tube. Under the Sac or Douglas, either of the iliac fossae !
first class we have diverticuli, etc. Under
the second class are any and all inflammato
the intestines. Tuliolsk^; reports a :|
markable case in which the attachment w
tory states which will result in hyperplastic mainly to the under surface of the liver, t
or neoplastic tissue, these conditions lead- case going nearly to term.
ing to obstructions of the lumen of the tube. The surface of attachment in the beg I
The ciliated epithelial lining of the tube ning is necessarily small but the placet;
may be destroyed and the walls of the tube after it begins to form rapidly radiates a
infiltrated. Inflammation bands of peritoneum
may distort or compress the tube,
becomes attached to numerous points. 1:
peritoneum under the ovum becomes mui
Thick mucus in the lumen or the external congested and thickened, a sort of cyst w j
pressure of an abdominal growth may block is formed which contains many blood v
the way. Recurrent cases are rare, A sels. This surrounds the ovum and for J
large number occur in women who have a false decidus while within the uterus .1
been relatively or completely sterile. The true decidua is formed,
average time elapsed since last pregnancy The secondary form may occur after' il
was four and one-half years. Occurs most rupture of an extra uterine or intra-uter !|
often in multiparous women. It is more pregnancy and the escape of its contents ii*
likely to follow a full term pregnancy than the abdominal cavity, provided the circu-i
a miscarriage or an abortion. It is gener- tioii and nutrition is maintained the embiu
ally conceded that extra uterine pregnancy continues its growth in whatsoever part '!(
is due to mechanical defects of some sort, the abdomen it has lodged. Fetal ms :!
As in many respects abdominal pregnancy branes are developed about the ovum wli]
is but the variant of a general type I will the placentan may or may not change tj
consider the subject of ectopic gestation as site and attachments. In the uterus fi
a whole. changes are much the same as in nori I
Pathology.—Under the primary forms we pregnancy. For the first three or ft!
have (1) ovarian (2) abdominal (3) tubo- months changes of the endometrium ;i|
ovarian (4) tubal which is divided into am- hypertrophy occur after that the uterus
pullar, isthmial and intestial. All in ac- mains practically at a standstill, Absc-i
cordance with the location of the conception tioii is the fate of the fetus that has b'i
product. The ovum develops usually to- extruded into the abdominal cavity un i
ward the outer end of the lumen of the tube, conditions favorable to a continuance of i'
As it grows tiie sides of the tube expanding circulation remain. The escape of the f«»i
become much hypertrophied and assume a from the tube usually happens between 'i
spindle shape. The growth is not regular eighth and twelfth weeks. J
and even, and some parts may be thin and The termination of metacyesis in m
easily ruptured. This usually takes place treated cases when not fatal, as mji
; ! !

ORIGINAL COMMUNICATIONS. 375
)f them are, often insures for the patient a menstrual function. The return of the
.ife of invalidism. The fetals parts, in event menses is indicative of fetal death. The
3f the survival of the individual, may ulcer- rectum may be irritable and pulsation can
ite into the bladder or intestines or through often be elicited by vaginal palpation, The
:he abdominal wall. The presence of a most typical system is metrorrhagia coinciiead
fetus acting as a foreign body will dent with the symptoms of pregnancy tn its
nost naturally bring about numerous adhe- early stages. If associated with this there
jions with the varying results that follow is a discharge of decidual tissue one should
n their train. The sac containing a living expect extra uterine fetation.
)r dead fetus is apt to rupture sooner or False labor may be premature happening
ater. The woman may succumb at once at the seventh or eighth month but usually
rom severe hemorrhage or d-e later from makes its appearance at term, rarely after-
;he anaemia produced by successive hemor- wards. At that time the patient has interhages.
If the ruptured cyst contains a mittent pains analogous to true labor pains,
lead or petrified fetus death from peritonitis The cervix does not become obliterated but
s almost certain to follow. It is quite pos- dilates sufficiently for the entrance of one
jible at the end of a primary or secondary or two fingers. After the decidua is expellibdominal
pregnancy for rupture of the cyst ed the pain ceases and does not return unmd
escape of the fetus to take place with- less there has been a rupture of the fetal
JUt provoking either hemorrhage or peri- sac. The signs of labor will disappear and
onitis. The final fate of the dead fetus is milk will come in the breasts.
luite variable. If death occurs duiing the The symptoms of rupture are sudden and
irst inoiitlis the fetus may be completely severe pain radiating over the abdomen,
ibsorljed. At a later jieriod this disappear- rapid, weak pulse, air hunger shock and
ince cannot take place. Suppuration and other concomitants of hemorrhage. There
Darlial liciuefaclion, conversion into adipo- is at>l to be nausea, hiccough and extreme
:ere, muniificatiou or calcareous infiltration tenderness of the abdominal walls. The
jvhh the formation of a lithopaedion may escape of the fetus from the tube without
esult. The cyst may especially in old cases much loss of blood is marked by severe pain
ilcerate or rupture through the abdominal referable usually to the side, tenderness of
.vail, into tlie intestine, vagina, bladder, the abdomen and often a temperature rise.
iterus or by various channels. The great- The rupture may be spontaneous or provok-
;st number the first named channel and the ed by some slight trauma,
emainder following in the order named. Physical Diagnosis.—The os and cervix
The symptoms are divided into those are often soft and either firmly confined by
common to all varieties and those peculiar adhesions or pushed entirely out of their
;o individual varieties. Of the first class natural position by the rapidly enlarging
ire the reflex symptoms that belong to all cyst. Fetal pulsations may be felt through
lormal pregnancies. The nausea and vom- the vaginal wall and the fetus can at times
ting are commonly severe and begin usually be outlined in the same way. There are
:arly in pregnancy. Two symptoms spe- two tumors, one of which is usually situated
:ifically point to extrauterine gestation. io the right or left of the median line. A
rhey are the bloody discharge and the ab- sulcus between the adventitious body and
iominal pains which are as a rule colicky the cervix can be made out. In some cases
ind sharp, they start from the region of the the fetus is palpable through the abdominal
(umor and radiate downwards and out- wall. On manual examination of a cyst
frards. These pains may be in about the containing a dead fetus of considerable size
ijrst and second month aud last throughout crepitation of the bones may be obtained,
breguancy. The acme of their severity is The uterus remains stationary in size after
^bout each menstrual period and there may the fourth month. Fetal heart sounds and
pe an intermission of entire freedom from movements are discernable after the fifth
Ihem between the periods. During these month.
Utacksof pain the abdomen may be swollen Diag/tosis.—The diagnosis is nearly alind
tender to the touch. The pulse is ac- ways difficult and cannot be made with cer-
:elierated but there is no temperature rise, tainty during the first period. At that time
rhe bloody disciiarge from the uterus occurs the diagnosis of probability constitutes an
in a majority of cases. This .phenomenon ample reason for surgical interference. It
8 usually accompanied by pain and the ex- may be taken for ovarian cysts, fibroid tu-
Julsioii of the decidual membrane. This mors, several forms of salpingitis and hemiischarge
is due to rupture of the decidua, atocele. It may possibly be differentiated
s sero-purulent, coffee colored or red and from the.se by the history, the malposition
nay be apparently so profuse as to call for of the uterus and by the disturbances of
he tamponade. In the primary abdominal pregnancy. In the second period of pregype
there may be no disturbance of the nancy diagnosis is not so difficult but it is

376 THE CHARLOTTK MEDIOAL JOURNAL
nearly always impossible to distinguish one moment's notice and it is highly importani i
variety from another. In making a diag- that the patient be in easy reach of compe- }
iiosis we have what we can elicit from, the tent surgical skill at all times,
story of the patient in her own words, her It is nearly always best to approach these''
replies to minute questionings, and aphysi- pregnancies by a median laparotomy. Com-ii
cal examination. After the escape of the plete removal of fetus, membranes and pla- i
fetus from the tube and the beginning of the centa is highly desirable. By reason oi'
secondary abdominal type, the acute symp- dense adhesions great danger of hemorrhage'!
toms may subside, but there are apt to be or dangerous condition of the patient the I
recurrent attacks of pain. An apparently above procedure will at times be impossible I
normal condition necessarily tends to throw under such circumstances the edges of the i
the physician and patient off their guard, opening in the sac should be sutured to theH
The diagnosis is naturally difficult because parietal peritoneum and the sac carefully;'^
of the irregularity of the symptoms, the fre- drained. The placenta in such cases willij
'
i
quency with which it is stimulated by other come away gradually by fragments, and in
conditions, and the ease with which the two or three weeks its exfoliation will have
bleeding with or without expulsion of the
decidua may be taken for an ordinary aborbeen
complete. Surgical intervention',
should take place as early as possible aftett:'
tion.
more
Probably there are few conditions the death of the fetus. If the cyst in suchji
plain to the careful observer than a case is in the Cul de Sac—vaginal section i.t'j
typical case of exfetation but comparatively appropriate: after the extraction of fetus andi!|
few cases are typical. The diagnosis of placenta the cavity had best be packed withi|i
abdominal pregnancy is rather rarely made a five per cent, iodoform gauze. I wish toi
prior to false labor, for the reason that the urgently emphasize the absolute necessityl'i
physician's attention is seldom called to the for removal as early as a diagnosis can be]
ca.e- We should regard sudden collapse made and the stringent indications for im-;;
associated with pallor and other symptoms mediate operation when we see a pregnantji
of intra abdominal hemorrhage in any woman showing symptoms of intra- abdom-iji
woman having a possibility of pregnancy inal hemorrhage. «
as prima facie evidence of ruptured etopic Report of Case.—In connection with the J
pregnancy. A period of amenorrhoea usually above I will report the followihg case. The*
precedes the bloody discharge which does patient, S. J., a young married woman 28i
not correspond in nature nor necessarily in years old, was referred to me by Dr. C. W.'i
in point of time with the natural monthly Lemon of Claremont, W. Va. Shehadnot^
bleeding. Important points relative to the been under the immediate notice of the atbleeding
are the color, the persistence and tending physician much of the time. He
presence the of membrane of pieces of mem- had been called on occasionally to prescribe
brane. Among the most chaiacteristic for abdominal pains of a rather vague and
symptoms are the variable period of amen- indefinite character. The patient was of a
orrhoea, irregular uterine hemorrhage, pel- comparativefy ignorant and unobservanti
vie pain and discomfort, and the shedding type. The true nature of the trouble had
of the uterine decidua. so far gone undetected. The woman con-
Prognosis.—Abdominal pregnancy means sidered herself pregnant about six weeks
death to the fetus in nearly all cases and to when she entered the hospital March 28,
the mother in one half the cases. Clubfoot 1906. She, according to her statement, had
and other deformities are apt to be present been suffering a good deal from indigestion
in the child owing to the deficiency of am- associated with nausea, her monthly periods
niotic fluid and 'the pressure on the sac had been irregular and painful for some
walls. The outcome in untreated cases not months, and that the lasl month had been
ending fatally, is chronic invalidism. especially painful.
Treatment.—The first reported, definitely On surgical examination I found a large
planned operation after a specific diagnosis mass posterior to the uterus which apparwas
performed in 1SS5 by \'eit of Berlin, ently extended up well into the pelvis, a
Immediate operation is advisable if a diag- uterus which in enlargement appeared to
nosis can be made during the first period or reseml^le closely that usually found about
even if there is a suspicion of exfetation, the fourth month of pregnancy. This organ
which is backed by good circumstantial was low in the pelvis and fixed in its posievidence.
After the fifth month has elapsed tion. There was considerable pelvic tenand
the fetus is still living if its preserva- derness, fetal heart sounds could be heard
tion is deemed desirable the woman should and the case was diagnosed as one of afe'
be kept very quiet in order to minimize the dominal pregnancy. The heart, lungs atfd
chances of rupture and to give her an op- kidneys were normal so far as could be as^
portunity to go to term. This pregnancy is certained at the time. Several times there
like a mine—ready to explode without a was an evening rise of temperature but oin

ORIGINAL COMMUNICATIONS. 377
no occasion did the temperature rise above Summary.—The greater actual frequency
100 I- The stools were regular, . percentage of ectopic pregnacy than the number of ob-
Df hemoglobin about normal. As the pa- served cases would lead us to believe—
tienl was quite comfortable when in a sit- The usual irrevelant and typical nature
ting or lying position and as she was quite of the symptoms. The difficulties in the
desirous of prolonging the pregnancy I de- way of making a diagnosis and neccessitv
jided to keep her under observation for a for a careful study of the cases, in which
time. Seven days passed without a particu- this condition might be susy^-cted both in
lar event, although the patient suffered some this present and past aspect.^. The importand
wasoccasionally nauseated. The even- ance of studying the character of the utermg
ot the seventh day the patient had a ine discharges. The association of this
very severe pam in the abdomen but did with pelvic pain and discomfort and the
not mention it for fear of having to undergo signs of pregnancy.
an operation. The next morning about The advantage of prompt operation, re-
7:30 trouble began. The abdominal pain moval of blood and other debris by dry
was agonizing, the symptoms of haemor- sponging without irrigation, thorough herbage
were typical and severe in character, mostasis and the closure of wound without
The radical pulse became almost impercep- drainage.
tible. Adrenalin in saline solution was ad- The "principles enunciated above have
ministered every fifteen minutes hypoder- been followed in more than a dozen cases
matically— 7.SII c.c. of saline solution was of ectopic gestation without a single death.
administered by Iiypodermoclysis. The patient
was prepared for operation which was The Russianizing of the American Medbeguii
at S o'clock a. m. At this time the ical Profession—My Contentions
pulse was running from l.SO to IGOpermiii-
Proven.
ute, respirations 4S to .S4 per minute. An- By G. Frank Lydston, JI, D., Professor of Geuito-
Dther 7.S0 C.C. of saline was administered
during the operation which lasted for .It
Trinary Surgery in the Illinois State University,
*^"'^"^^' Department, Chicago,
tninhtes. Operation .Median laparotomy. The entire profession is aware of the bat-
The fetus, its cyst wall and the placenta tie I have been waging against the political
were removed as rapidly as possible. The despotism which now controls the A. M. A.
;ilacenta had been ruptured and there was The independent journals and the inde-
,1 great deal of free blood in the abdominal pendent medical societies are our only retavity.
Some of it clotted, indicating pre- course in the battle for liberty and reform,
[k'ious hemorrhage. The tubal attachments In furtherance of the reform movement, I
ii the pregnancy were slight indicating submitted a paper to the Mississippi Valley
ther a primary abdominal pregnancy or an Medical Association. In this paper I en-
;arly rupture of the tube. The placental deavored to prove that something was rotten
inplantatioii was extensive including right in the medical Denmark, and tiiat Amerilua
left pelvic walls, rectum, posterior sur- can medicine is ruled by a selfish and desace
and fundus of uterus, omentum coils potic political ring which gives the rights
)f small intestine, sigmoid colon, bladder of the membership at large not the slightest
ind parietal peritoneum of the abdominal consideration. Fair play, I claimed, was
.vail. Injuries to bowel were repaired and a word unknown to the vocabulary of the
.lenuded areas covered so far as practica- medical Czar and his minions. My paper
,)le. The blood was removed hy dry spoiig- was put on the preliminary program. Later,
'ng and the wound of the abdominal parietes the Program Committee objected to it on
rlosed by layer sutures of chronic gut with- the ground that "The Russianizing of The
•)ut drainage. The fetal development would Profession" probably was an attack on the
iidicate that tlie twenty-second or twenty- sacrosanct powers of the A. M. A. (How
;hird week of growth had been attained, did they ever guess it?) The committee
iPhe fetus was ten inches in length and demanded a copy or abstract of my paper,
veighed one pound and two ounces. The This I refused to submit to them, stating,
ord was twelve inches in length. As the however, that my paper was "as strenuous
)lacenta was removed piecemeal, it was an attack as I knew how to make on prinlifficnlt
to get a correct estimate of its size ciple, on the political ring which controlled
fUd weight. . the A. M. A."
I Another hypodermoclysis of saline solu- The paper was put on the permanent proion
was administered. The pulse gradu- gram—No. ,"^0, next to the last paper on
lly fell to one hundred and twenty that the last day of the meeting. Its rightful
ftemoon. Improvement was rapid and place was No. 17, on the afternoon of the
onvalescence without noteworthy event, second day. Having put the paper on the
atient left the hospital on the thirteenth program, no committee had a legal right to
ay ajter the operation well. exclude it. This is obvious to any one who

37,S
THE CHARLOTTE MEDICAL JOURNAL.
knows the simplest principles of law. Not- count— Drs. Sitnmons and McConuack. :
ing the crooked work of the Program Com- The provisions of this document gave uiul- i
mittee, I at once telegraphed Dr. Arch tiple offices and despotic power to the chief i
Dixon' of Henderson, Ky., who had been factor in reorganization, who, strange to;
assigned No. 17, and asked for his place on say, was formerly an advertising newspaper ,
the program, which he kindly gave me. specialist and is a "regular" by virtue of a 1
The Executive Committee then promptly diploma obtained by "arrangement." 1 he
convened and excluded my paper alto- two men who wrote the Constitution and
oether My friends immediately got to- Bv- Laws hold the only high-salaried offices :
gether and asked me to read the paper of the A. M. A. Their combined salaries!
independently. I consented, with the amount to $17, 310.0.T per annum. One of ,
proviso that I should change the title tlicin holds three offices. Editor, Secretary!
to "Despotism in American Medicine." and (Wneral Manager, and has the power 'i
I then asked the Chairman of the Commit- and temperament of a Czar. He was at ,
tee of Arrangements if there was any objec- one time Chairman of the Council of Phar-s
tion to my friends' plans and he replied macy and Chemistry, thus holding foui .:
that there was not. My friends engaged offices'.
^ , ,
and paid for a room at the Southern Hotel, The Constitution and By-Laws of the A. .
the Association headquarters, and the paper M. A. was irregularly adopted, as shown t
was announced. When the time set—3 by Dr. W. H. Sanders, ( Medical Record, t
p_ m.— arrived, my friends were informed June loth, July 1st and 1/th, 190d. ) Som;»
rhat they could not have the room, as all of the State machines, following the ex-«
the rooms were under the control of the ample of the parent Association, threw lega.^
Committee of Arrangements. A room was restrictions to the winds and re-organizec J
finally engaged at the Planters' Hotel and with total disregard to membership rights J
the address delivered. I submit to the pro- All protest was smothered by exclusiorj
fession the following questions, viz: from the Journal of the A. M. A., which isj
1st. Am I right in contending that free controlled by the Czar and his machine. }
speech and liberty of opinion is denied the Power is always corruptive, and growsl
rank and file of the A. M. A.? by what it feeds on, hence it was but nat i
2nd Is the A M. A., as at present con- ural that the machine which now controli'
ducted, a despotism?
the A.M. A. should have grown more anci
3rd, Is the Mississippi Vallev Associa- more despotic as time went on. Abuse o
tion, of which I am one of the oldest mem- power was to have been expected and ha: I
bers, a free and independent association, or occurred. Members—even whole societieij
a satellite of the A. M. A.? —have been robbed of their rights. Oik,-
4th. Is there anvthing in my contentions man, Dr. H. B. Young, of Burlington t
which I have not a right to advance as a Iowa, was declared ineligible to read i|
member of the A. M. A. and a free born paper and illegally expelled from the A. M
American citizen? A. in 1901, because he opposed the plans oj
.5th. Is the A. M. A. "American?" the machine in Iowa. "Harmony" in thi.j
6th. Is there anything in rav contentions A. M. A., it seems, consists in submissioiii
to which any fair-minded man could not to the will of the machine. " Unification 'C
listen, or which is not conducive to the best apparently means submission to one mai.i
interests of everybody save the political power.
machine which runs the A. M. A.? The Secretary General-Editor-Manage|
ABSTRACT OF PAPER REJECTED BY THE M. of the A. M. A. has abused his power. H|
V. A. OCT. 12th, 1909, AT ST. LOUIS has abrogated the rights of members an.j
MEETING.
has persecuted those whose policies difTerej
The average American doctor is either from those of his machine. Hehastriedti
too busy or too indifferent to safeguard his injure the private business and credit cj
own interests, hence he has ever been the members of the A. M. A. He has prosbo
dumping ground for the gold brick in- tuted the Journal to his private animositi€,l
dustry. The most colossal gold brick ever and to vulgar, every day politics. He ha.j
handed him was the scheme of reorganiza- dealt partially with the friends of the mal
tion of the A. M. A. in 1902. This was chine and opposed representation of m
speciously fair and full of promise, on the rank and file. He has published ofTensiv|
surface, but served to conceal the designs advertisements without rebuke. He ha,.
of a cabal of self-seeking politicians whose used his position for the political prefe:j
chief ambition was power, place and politi- ment of himself and satellites. As mattei^
cal prestige for themselves. . stand, the rank and file have no medium d?
The Constitution and By-Laws under protest or criticism. In all of his overtactJil
which the A. M. A. is now operating, was the Czar of the A. M. A. has had the su]|
written by two men—the third did not port of the machine which he constructe(jb
:
I

ORIGINAL COMMUNICATIONS --n
^U.: rather than „u..ers, should be ^SfHi": olrSelli^Ir^^rir^^^f
^'^^ ^"^^ '^°^'' enhance the
";^j;t:r a":,et^r"7r"'^?^-^""^- iTbiHtvof
onthepnncplesofnlonopoIy,poIi- 7th. The President, Secretary
money^mak.ng. Trustees
rhe reports of and other inn portant officers shouidSe S-
ed
Uarle ^re ahLn . H ^''%r"- by ballot of the naembers in
at lar^e
attendance.
are alxsurd, and would not The nominations should
ued
be
by made
bus.uess
on the
. men. We have a first dav and the voting done at
isn.ess of over
the
i.OO.UOO
place
per year and an of re.?lstration on thesacceedin
pense account 'davs
of over
This
S.^.Oi. 000, yet item- would put a premium on attendance Tle
an t"rirthe7acr,r;""l"r\'''°''r «^--V-at-home^ and those who we"e oo la an th,s lb the fact that nobody but
y
the to vote would thereby have only
.asurer themselves
,s nud^r
tl^emselves
bond. Possibly the pres- to thank if things went wron^
^'^d number of nominations for each
•nresj;^^^
office
2 present official''" othcials? Th'',"'"^°"°^'- Those who venture by petition
^"-^ ridiculed and 9th. Bonds
,ZT'T^ should
'I'f "^^'^^V"^
be provided for all
' '' '!,''"' "^"''^
a the ran^ rfiT "T"'' "P°" whose shouldLrs rests financfal
at the rank and file are not permitted to responsibility. At present only the Treasu;e.their
sentiments, '-riie Kin- can do urer is under bond.
^wronff.- Rut the rank and file are wak- 10th. Full itemized accounts of our busi-
? up and things must change. The A. ness and financial affairs should be render-
A^ must reform . its machine or a new ed the members yearly. The machine of
d democratic association will be the an- the A. M. A. is power drunk and money
er to the rjuestions which the rank and mad, and sooner or later the notorious inare
; insistently asking. 1 he control of surance scan lals are likely to be duplicated
- '^^•.;'^: ''^y^';' ^° ^''^ members,
,
'P"*"' by something nearer home. Human nature,
whom It rightfully belongs. It must be- be it essentially corrupt or primarily pure
Me Aniencan in deed and principles requires a check system. The weak ones
wel as in name. It should return to the in the present regime may not a' vavs resist
rh Ideals of our medical forefathers and temptation: the strong ones will not live
.se striving for monopoly—monopoly forever, and who can guarantee the strength
ich can only be unjust, oppressive and or honesty of their successors? We have
trictive of our liberties, both as physic- established a "Kingdom of the Dollar" that
s and men. is ^n Q^r ^^^^^^ ^u^j j,j ^^^^ kingdom hun-
My conteiitions for reform in the A. M. gry-eyed Graft sooner or later will crowd
are as follows himselt onto the throne and sit beside Amst.
TheConstitutionandHy-I.awsshoukl bition. Remember, that we have a biisiness
so amended that the reins of power will of about $500,000 per year, and an expense
taken from the hands of the Secretary, account of over $300,000. Both items are
nd. The offices of Business .Manager, rapidly increasing.
xetary and ICditor should be separated. Hth. A membership committee should
ird. The offices of Secretary and Editor be appointed to hold office only one year.
uld be filled by regularly educated medi- At present the Secretary General is here
men of clean professional records who absolute dictator.
not cogs in the present machine. There 1 2th. A certain amount of space in the
Iways a. possibility of a change of nam;s columns of the Journal should be set apart
^lotoj masters. for free criticism, queries and comments by
til. 1 he personnel of the Board of Trus- the rank and file. Criticism of the policies
i should to a certain extent be changed- and methods of the Association should be
le of the present incumbents are mere especially invite 1. T.iere is at present an
«ls and cogs
department of query and
in the comment.
present machine. f^.^^^^
Ml 'n.» ., K f r , ,,, 1 Ills department is a joke. If you do not
tU. Ihe number of 1 rustees should be think so, send in a kick, against the mareased.
The A. M. A. has outgrown chine and see what will happen to it. Ask

380
THE CHARLOTTE MEDICAL JOURNAL.
Dr Youn^ and the members of the Dubuque I'nh. If we are to continue to have d
'
and Des Moines County Soeieties.
' House of Lords" let us carry out our Bntj
13th. The Editor should not be the Busi- ish imitation to its logical ultimate:—by 9^\
uess Manager of the Journal, but a cul- means let us have a House of Common|j
tured, scholarly, scientific regular physician If we wish to pretend an American virtue
who devotes his time solely to editorial though we have it tiot, let us have a Houal
work. Under proper conditions and restric- of Representatives as well as a Senate. Givii
tions and a suitable salary, the present us also a Presidential veto.
'
S
Editor would make a good business Man
ager, if he were not allowed to obtrude him- Infant MortaHty.* |
self into the ethical, political, editorial or
r,, si Geo. T. Grinnan. M. D., Richmond, Va.1
professional limelight. Exeunt Czar and Lecturer on Diseases of Children, Medical Colenter
employe. Speed the day! lege of Virginia, Richmond, Va.
|
14th. The initiative and referendum -[-1,^ object of this paper is to call atten,
should be adopted as a protection for the
^j^,„ ^^ ^j^g j^rge infant mortality which i
suffrages of the members at large.
g^ gjonificant as to be a subject of discus
l.Sth. Provision should be made for fairgion'in
newspaper articles and in the cur
ness in elections. They should be so ar-
^gj^j magazines. Medical journals all ove,
ranged that no less than two candidates
^^^ world are discussing the question o|
would be nominated for each office. This lowering infant mortality. Various socjf'
would in future prevent the choking off of
^jgg^ i,oth in this country and abroad, ar.'
nominations and the machine selection of
discussing plans for the instruction of thos
•
officers.
having charge of infants. The campaigi]
16th. No meipber should be expelled
against infant mortality in Germany ha|;
without a fair trial and a full hearing, the aroused such general interest that on Juii^
proceedings being published verbatim et
4^ 1909, an institution for the repression c;
literatim in the columns of the Journal, infant mortality was opened in Charlotteu:
This plan will obviate such damnable out-
\yQxz, Germany. The German empress |
rages as that perpetrated by the General protectress of this institution. The object
Secretary-Editor-Manager and his machine of this institution, which has raised S400 i
upon Dr. Young. 000, are as follows: 1 . The
|
practical an
17th. The Constitution should provide
that no person holding an office of trust or
scientific investigation of the question pe:
Gaining to the nutrition and care of infant:
|
legislation in the A. M. A. or in a State as- I
as well as the care of mothers. 2. The co
sociation shall be eligible to serve as a mem- lection of data on infant mortality, an
|
ber of either the State or National Houses organizations for the care of infants in \\\
of Delegates. / again assert that the A. M. ^
German empire and in other civilized com
A. is un-American in its present operatioris,
j^-j^g 3 ^^ make the results of scientif
and call attention to the disqtdeting political
j^,,^ practical investigations available 1.
spectacle of tho Treasiirer and Trustee of the
jjjg public by its publications, and to offi;
A. M. A.—men holding offices offinancial information and counsel to officials and
trust aud responsibility—seri'ing as delegates
public and private associations as well
to the body which elects them a?id voting for private individuals.
themselves. In the A. M. A. a man may Reduction in infant mortality has n
serve as Treasurer, or Trustee, Delegate been noted in anything like the ratio th'
and Elector in both the State and National reduction in mortalitv for other ages h
electoral bodies and vote for himself twice, progressed. During 1907, 3.S1, 046 childn
Beginning with the Council of his local died during the first year of life in German'
Society, he may vote for himself three and two-thirds of these died from distur'
times. ance of nutrition. Of every thousand bor'
18th. To strike directly at the root of the ^^^^ hundred and eighty-five died duri)
political evils which have cast their male- jj^g g^gj yg^^ of life in Germany. In F
volent spell over the A. M. A., delegates ^.^^d and Wales, the mortalitv in 1S

ORIGINAL COMMUNICATIONS. 381
ffivehuiidred midwives, less than 10% nourishment and employment which pre-
^I.t''^^' , vent women from nursing; and to educate
These women determine the feeding, and mothers to realize not only the importance
e responsible for much unnecessary wean- of maternal nursing, but als-'o the value of
g. No instruction as to mfant feeding or sanitation, infant feeding, infant hvoieiie
irsnig IS given. No caution as to the dan- and the proper care of'lheir infants and
r of cow's milk in hot weather is given, themselves.
Right here it must be said that removal Illegitimacy is a factor in high infant
)m the breast is done constantly by medi- mortality. In Glasgow in 1873, the death
1 men without adequate investigation, rate of legitimate children was 154 per
le fact that immunity to disease is greatly thousand against 293 per thousand for illehanced
by nursing is not sufficiently rec- gitimate children.
"•zed. We have little idea of the large number
With the tremendous advance in our of infants "farmed out" to die. Amonoowledge
of medicines, there should be a the negroes, baby farms have done an ex"irked
decrease in infant mortality. The tensive business here in Richmond. The
mthly Dullelin of the Health Department death rate of negro children in Washington
Richmond, Virginia, shows that infant is seven times that of white children. The
)rtality under two years of age, due to white people of the South have sacrificed a
;turbance of nutrition, increased 10 per large number of their children by turning
It. during the first six months of 1909 as them over to the ignorant, but kind, negro
npared with the first six months of 1908. mammy or nurse who cannot raise her own
July, 1909, there were 229 deaths in child.
:hmoiid. Of these, 34, or l.=5 per cent., It is important for us to determine what
re due to diarrhea in infants under two diseases occasion the largest mortality of
irs of age. Twenty-three, or 10 per cent. , the first year. Statistics furnished by Pro-
re due to tuberculosis for all ages. Nine, fessor W. Pransnitz, of Gratz, are very in-
3.9 per cent., of the deaths were due to structive. He recorded the causes of death
ihoid fever. of 1,000 children in the first year, accord-
In June, 1909, there were 213 deaths in ing to the German statistics, for 1900. For
city of Richmond, of which 39, or 18 every 1,000 births, 225 deaths occurred in
cent., were due to diarrhea in infants the first year. Of these, 84, or more than
ier two years of age. Eighteen, or 8.4 one-third, were caused by stomach and
cent., were due to tuberculosis for all bowel trouble. Diphtheria, croup, whoop-
;s. There were no deaths from typhoid ing-cough, measles and scarlet fever toer.
gether account for only one-twentieth of
t has been estimated that 1.50,000 deaths the entire mortality: tuberculosis, inflamilt
annually in the United States from malion of the lungs and other inflammatory
erculosis, and that .lOO.OOo infants per- ailments of the respiratory organs for'about
annually during the first year. In one-tenth; congenita] weakness and dence,
the tragedy is well pictured in the bility, 32, or 14 per cent.; other known disnch
chart, familiar to every child-spec- eases, 68, or 30 per cent.; unknown, S, or
St, called the "Kiffel-Tower." Here, we 3 per cent.
e a contrast in morbidity between chil- Comparing the different races, we find
1 suckled and those fed upon artificial the following table:
fl. Among the former, the ratio of deaths „k..th-rate under one year per one
ains comparatively constant until we
:h July and August when it rises to a
thousand living.
siderable, hut not startling, degree, fallshortly
afterwards and remaining as at
^
Kuglaud
1876-1880
145
1893-1902
152
untU the close of the year. With arti- I'rance 16.3 158
il-fed infants, however, it is always sub- r'russia 205 199
to leaps and bounds. When July is Italy 249 173
:hed, the leap is frightful, reaching 255 Switzerland 189 145
100(1 born. United States 166 165.4
reat credit is due Xathan Straus who A glance at this table shows that the
inteeii years ago began his campaign linglish-speaking races have made scant
inst impure milk. Splendid results have progress with infants under one year.
1 acliieved, and milk reform is gradu- I wish particularly to emphasize overspreading
over the entire country. Pure crowding as one of the causes of high in-
: is only one factor. .More important fant mortality. The following table shows
. to supply a substitute for breast-milk, the density of population in England and
encourage breast-feeding and render it Wales during 1851 to 1866, both for all
ible; to remove the conditions of under ages and for children five years of age:

S2
THE CHARLOTTE MEDICAL JOURNAL.
DENSITY PER SQUARE MILE
166 1S6 379 1718 4499 12359 65823
RATE FOR ALL AGES
16.0 18.1 21.9 24,8 28.0 32.9 38.6
RATE FOR FIVE YEARS
37.3 47.5 65.0 82.1 94.0 111.9 139.5
The mortality in the cities is about double
that ill the country districts, and the above
table shows that city life is an important
factor in hi, 1909). Dr. Neumaii, in Berlin, gathered
statistics in regad to room space. He
found that out of 2,701 infant deaths, 1,792
occurred in one room dwellings, 745 in two
rooms, 122 in three rooms and 43 in large
dwellings.
The mother who has to go out to work
will make a poor nurse. There was a great
falling off in infant moitality in England
during the American Civil War from 1861
to 1865. During this time cotton was not
shipped from America to England in usual
quantities, and the women there who were
forced to do a large portion of factory labor
were forced to remain at home. As a result,
factories in large numbers were closed.
Although 24 per cent, of the population
became objects of charity, the death rate
was low. After the close of the war, the
factories were re-opened, and the death rates
rose to their usual height.
Meinert has gathered statistics to show
that it is not solely the excessive temperature
or the lack of cubic space per capita
in the home that causes the high mortality.
A temporary total cessation of spontaneous
ventilation in the houses arising from their
construction and occurring only under certain
barometric conditions constitutes the
decisive factor. The number of cases of
infant diarrhea decreased at once with a
strong wind and increased rapidly as soon
as the wind fell again.
Dr. James Wood, of China, told me that
he was able to reduce infant mortality 40
per cent, by removing a large number of
infants to a higher elevation in the surrounding
hills where the air was not so hot
and there was more wind.
The influence of prosperity on the mortality
of infants due to ailments of the stomach
and bowels has been studied by Professor
W. Pransnitz, of Gratz. He divided
the deaths into four classes, (1) rich, (2)
middle-class, (3) poor, (4) destitute; and
the percentage of deaths from these diseases
has been calculated for each class. By this
means, it was shown that in Gratz, for example,
in the last fifth of the past century
not one child died in a rich family: while
in the second class about 4 per cent., in the
'
third, 3() per cent., and in the fourth, 6C'i
per cent, fell victims.
The campaign against infant mortality;
must be along the lines adopted for tuber-
culosis. It should be a much discussed:
subject, and literature dealing with it must j
be sent to families in which births are rej
ported. The midwife must be supplied witb I
the proper literature and she should receive I
proper instructions herself. Certainly 5(
per cent, of the deaths among infants is i
preventable, audit is within the power oli
medical men to save something like 100, OOC I
lives in each year.
In 1908, the English parliament passed a:
law for the protection of infants and chil-
dren. In England no child can be adoptee;
without a permit. In 1909, a bill was ini
troduced in Congress to form a Federa i
Childrens' Bureau to deal with the facts o\
birth rate, infant mortality, physical de I
generation and other juvenile matters. Thit(
bureau bids fair to be of great value to the|
country. ,
Sir Thomas Browne must have had in j
mind infant mortality when he said, "Foij
the world I count it not an Inn, but ar
Hospital, not a place to live in but to di«j
in." i
We who hold so tenaciously to life, anc i
hold with Socrates, "life is worth living,', j
should use our best efforts to protect th«(
lives of helpless infants who have no say as J
to their fate. ;
The Surgical Treatment of Hepatic )
Ascites."
By \V. Lowndes Peple, M.D., Richmond, \"a., Pro I
fessorof Histology and Assistant to the Chair j
of Clinical Surgery, University College of |
Medicine. j
1 have selected the foregoing subject pri |
marily to aflord an opportunity to bring be
fore the Academy a case which seems typi '{,
cally illustrative, and yet presents manj, i
puzzling features. Since several among u:i
have had an opportunity of a more or lesi,^
critical study of it from time to time, i ,
seemed well to present it in its entirety U],
to the present date, with its clinical find i
ings and the subsequent history (which
have, fortunately, been enabled to follow) i
so that we may thresh it out here upon thi;
floor, and thus clear up the obscurer points
j
I
I
Hepatic ascites is regarded as a seepagt I
of serum into the peritoneal cavity, due t(
resistance offered to the flow of the porta' |
blood through the liver from deposits o'j
fibrous tissue within the liver structure
Let it be borne in mind that the operativt |
procedures to be reviewed are not intendec i
to deal with cirrhosis of the liver, but an; I
*Read before the Richnioml Academy of MedijfJ
I
cine and Surgery, September 21, 1909.
1
;

ORIGINAL COMMUNICATIONS. 383
i
designed for the relief of ascites, its most etes. By some otliers, the omentum is imdistressing
result. Hence, we shall not at- planted within the rectus sheath,
tempt to set forth a classification of cirr- Of the various modifications, the one prachosis,
which varies numerically with the ticed by Narath, from its rational simplicity,
number of authorities consulted, nor with seems deserving of especial attentioi). He
the theories of etiology. makes a small incision, rulls out theomen-
The operation is designed to offer me- turn and stitches it to the areola tissue just
chanical relief by establishing a collateral beneath the skin. He then closes the wound
venous anastomosis between the portal and around the artificial epiplocele tight enough
systemic vessels around, instead of through, to avoid hernia and not too tight for conthe
liver, presupposing that the ascites is striction. He claims that the collateral
due to mechanical failure of the normal circulation is best established through the
blood channels. When we chase back our superficial veins, and states that a very evimemories
and recall the broken derelicts dent enlargement of these veins can be
whom we have tapped from time to time noted within five days. Its advantages are
till death claimed them; when we remem- that it can be quickly done under cocaine
ber that such men are actually or prema- anesthesia, with little or no shock, either
turely old; that the conditions producing one or both sides of the median line at one
cirrhosis have also crippled their kidneys, or at two sittings. Its disadvantage is the
hearts and blood vessels; and that tempo- possibility of hernia through the imperfectly
rary recovery would only mean one more closed fascia.
plunge into dissipation, the field seems far
from promising, and we naturally ask the
The after-treatment of these cases is com-
paratively simple. The pelvic drain used
question, "Is it worth while?" by Morrison has been abandoned by most
A closer study of the subject will answer operators. The abdomen is bandaged tightly
this definitely in the affirmative, for it will
be found that many men with years of usefulness
before them, women with no alcofrom
chest to hips. The diet is dry with as
little fluid as possible. The bowels are kept
open with saline laxatives. Usually, from
holic history at all, and children faroftener one to three subsequent tappings are needed
than one would suppose, are subject to cirr- before the collateral circulation is properly
hosis of the liver.
The jirognosis, in the light of statistics.
established.
Case.—E. S., white, aged 18, works in a
also far from encouraging. The mor- tobacco factor>' as packer of boxes. Her
tality varies greatly with the groups of cases father died of heart disease and paralysis;
collected by different investigators. A fair mother living and healthy. She is the
summary, in the words of one writer, isthat youngest of three children. The first died
one-third die within a month, one-third are suddenly at the age of five months; the seegreatly
benefited and one-third are slightly ond is 24 years of age, normal in every way,
improved or unaffected. The immediate is married and has three healthy children,
mortality, which was very high in the early She was a large, healthy baby, but had a
cases, has been greatly reduced and will rather full abdomen. She developed norunquestionably
be still further improved by mally up to the age of three or four when
abetter selection of cases for operation and growth and development seemed retarded.
a wiser selection of operative procedures to She went through the diseases of infancy,
suit the individual case.
Operations.—The operation as originally
but was never seriously ill. She attended
school up to the age of 12, and was bright,
described by Talma and popularized by quick and capable. She had one scanty
Morrison and Drummond, consisted in a menstrual period at 15, but has not menlinear
incision near the median line begin- strualed since, though she has had backning
a little below the ensiform cartilage, ache and pelvic pains at times.
Through this the abdomen was mopped dry In 1906, three years ago, she stopped
of fluid and the anterior surface of the liver work on account of feeling tired and badly,
and spleen scarified with gauze by rubbing, and went to visit relatives in the country.
The omentum was then stitched to the
parietal peritoneum of the anterior abdo-
She soon noticed that her waist was enlarg-
ing and that she became tired and even exminal
wall and the wound closed. This hausted from slight exertion; also that her
procedure has been variously, modified by lips and fingers were blue. There was some
other operators. Schiassi fixed the omen- swelling of the feet and ankles at this time.
turn between the peritoneum and overlying She was treated by Dr. W. H. Parker and
muscles, and sutures the sjjleen to the pari- was soon able to return to work,
etal peritoneum. Von luselberg fixes the In May, 1907, she was .seen by Ur. Harry
gall-bladder to the anterior abdominal wall. Baker who says that she had at this time a
Ito and Omi leave in gauze drains or plugs, marked dyspnea upon the least exertion.
causing the intestines to adhere to the pari- Her lips were purple and her face and body

,iS4 THE CHARLOTTE MEDICAL JOURNAL. []
badly mottled. She was unable to climb ment of the bony structures and fatty and ij
stairs or to lie down at night. Her liver muscular tissues." n
was hard and extended down to the um- The abdomen, after tapping: The liver
bilicus. There was no ascites, no swelling is seen to extend down almost to the umof
the feet and legs nor any detectable les- bilicus. The left lobe is plainly palpable
ion of the heart. well below the costal margin. The liver !
Under treatment, the dyspnea and cya- feels hard and smooth. Its lower border is
nosis disappeared. She could lie down at sharp and clearly defined. The spleen can- •
night and, for a short time, was enabled to not be felt. Measurements: Around the ;
return to her work in the factory. The im- iliac crest, 28/^ inches; around the umbili- '
provement did not last long, however, for cus, 27/2 inches; around the liver, one inch J
her symptoms returned and fluid began to below the xyphoid, 29/'2 inches. The veins 4
accumulate in her abdomen. of the abdominal wall are not much en- .
I saw her some three or four months later, larged. f
in the spring of 1908. She was enormously Negative History.—She has never had \
distended. Her face, hands, arms and body nausea, spitting or vomiting of blood, hem-
were deeply cyanosed with a peculiar orrhoids or jaundice. There is no history
j
^
blotched or mottled appearance. She suf- of tuberculosis or malaria; no history or \
fered greatly with dyspnea, and had been signs of specific trouble. She has never
unable to lie down for some time. There suffered much pain except after tapping,
was no swelling of the feet nor edema any- when it is acute and of a cramping characj
^
'
where, nor could I detect any heart murmur, ter and in the pit of the stomach. Her i
First, 1 tapped her, removing four or five bowels have moved fairly regularly, and i
gallons of fluid. Second. In the fall. Dr. the kidneys are normally active.
M. E. Nuckols tapped her, getting about Diagnosis.—Hypertrophic cirrhosis of the «
three gallons. Third. In December, I re- liver.
moved four gallons. Fourth. In February, Operation (two days after tapping): .
1909, just prior to operating, I removed two Under chloroform anesthesia, a right rectus i
gallons. incision was made a half-inch to the right >
Examination.—A small, poorly developed of the median line from the costal margin c
girl of quick mentality and bright and to the umbilicus. A half-gallon of fluid \
cheerful mien. Though actually 18, she was evacuated and the abdomen mopped 1
does not look to be over 13 or 14. Her as dry as possible. Palpation of the viscera a
figure is slight and singularly girlish. She revealed an infantile uterus with diminutive J
is 4 feet, 10^4 inches in height and weighs ovaries; normal kidneys and spleen enlarg- -j
90 pounds. The breasts and vulva are ed probably one-third. The intestines were J
small, undeveloped and child-like. There normal in color, their vessels not engorged;
j
is absence of pubic and axillary hair. The omentum very small, very thin and scanty ;
two lobes of the thyroid are somewhat en- of fat; the vessels did not seem to be en- i
larged and rather harder than normal, larged. There are no adhesions, no tuber- ;
There is no exophthalmos. Temperature, cles nor evidence of peritonitis. :
97 1-5° to 98 3-5°; pulse, 60 to 72; respira- The liver is of a dark, purplish color, not '<
tions, IS to 20. Urine normal, except a much harder than normal to the touch. I
trace of albumen. Blood, red cells 6,000,- There are no nodules upon it nor hard areas I
000; white, 4,400; hemoglobin, 85; color within its substance. The margin presents !
index, 70. Differential count shows noth- a peculiar fringy appearance like a mina- <
ing abnormal. ture cockscomb. A small wedge was ex- \
The heart, examined by Dr. W. -S. Gor- cised from the margin, which I present i
don before tapping: Right heart enlarged, mounted for microscopic inspection. The j
left but sligntly; no murmur can be detect- anterior surface of the liver was now rubbed •)
ed; examined by Dr. J. G. Nelson after lightly with gauze, which readily provoked '.
tapping, "shows general hypertrophy, es- a free oozing of blood. On account of the i
pecially the right ventricle. The valves very small size of the omentum, it was de- i
are in excellent condition. The muscle is cided to make the liver anastomosis as broad i
normal except for hypertrophy. The heart as possible. Turning back the abdominal (
sounds are slightly accentuated, especially wall, a matter easy of accomplishment in
the pulmonary second sound. The condi- its relaxed condition, the parietal perito-
tion of the heart may be accounted for by neum was stitched to the oozing surface of \
the liver from the upper angle of the wound j
prolonged increase of resistance in the gen-
eral circulation due to accumulation of ^^ the lower margin of the liver 1 -3 inches ^
. ,, from the incision on either side. I he pen- :
toneum was next closed from above down-
The lungs: "Slight general hyper-reson- ward, the stitches including liver tissue,
j
anceof breath sounds due to lack of develop- thus making an attachment by three rows _
^
j
j
j

,
ORIGINAL COMMUNICATIONS, ."iS.S
of sutures^ 1'. inches apart from the costal simple plan, such as described bv Xarath
marg.n above to the free border below, should be done with local anesthesia.
Before closing the pentoneum below, the .5. That abdominal drainage is unnecesomentum
was turned up and fastened to the sary, but mopping the cavity thoroughly
pentoneum below the margin of the liver, dry "
is very important
The wound was closed with tier sutures. 6. That the patient be cautioned against
Convalescence was uneventful. She was the wearing of tight bands or belts about
?l'Tu ^
, n'l ,'^' '^ ""l ^°'-'^'' ^^P^ ^^*^'''^- '^^ ^^'^'^t ^^^^' lea^'i"? tlie hospital, lest the
On the 10th day she was given potassium superficial anastomosis be interfered with
iodide beginning with 5 grains and going a point to be especially emphasized when
up to 1.-) grains, three times a day. She the patient is a woman
has continued _this up to the present time. As to the case under discussion, I am not
On March 1/th, measurements showed prepared to say whether the cirrhosis was
one-half inch gam at the umbilicus and due to a primary heart lesion or not. I do
little or no fluid present. She left the hos- not believe it was specific. The iodide was
pital on March 21st, and has reported at given empirically. lam not prepared to
my office every two or three weeks since establish a relation between the cirrhosis
that time. She goes wherever she wishes, andher peculiar, undeveloped physical coneals
heartily and seems perfectly well and dition or, in the event of such a relation exhappy.
She IS still troubled occasionally isting, to state which is the cause and which
with dyspnea on exertion, and is, at times, the result. It is upon this point, especially
cyanosed. She chills very quickly, show- that I desire the help of the Academy.
ing poor circulation. The liver is some- I do not regard this patient as cured, but
what smaller, measuring two inches less remembering that seven months of almost
below the xyphoid. The abdomen is one complete relief have followed an operation
inch smaller around the umbilicus. which was preceded by nearly three years
On August 25th I gave her thyroid ex- of invalidism growing progressively worse,
tract, three grains three times a day. On latterly threatening her life and requiring
September 20th she came to me with sev- frequent tapping to make life endurable, I
eral quarts of ascitic fluid and lips cya- do claim that this operation is entirely jusnosed.
I put her on a dry diet, stopped the tified even if nothing more is gained.'
thyroid extract, gave her a tablespoonful 10I)0 West Grace Street.
of Epsom salts daily, and in three days the
ascitic fluid disappeared again. Repair oS Recent Lacerations oi the
Pathologic report on excised specimen. Perineum'^
by Dr. !•:. Ouy Hopkins. Capsule thick- '
„,. ^.,,,,,,, ^ ^^^, ^ Richmond, V,,.,
ened and congested. Perilobular connective rrofesssor of Cynecology. Medical College of
tissue increased in amount and contains Virginia; Gynecologist, Memorial Hosnumerous
round cells and leucocvles. Bile P''^'- Surgeon, City Hospital.
!!,y.l' 7TZ'}-u\"^T'^ '" """"!''' ?^^% After rather an extensive opportunity for
nterior of the lobules shows 3 network of
observation, I am convinced that the anatnev
coniiec ive tissue following the cords
^^y, function and repair of the female peri-
•to the central vein. I he blood vessels are „,^^ f^,^ ^ somewhat hazy conception in
conges ed, more especiafly the branches o
the minds of many of the medical profesthe
porta vein. Ihe liver cells are normal
.j^,, ^ ^l^ii ^^t" attempt at this time to
in size, shape and structure.
^1^^^^^^ j„ dg^^i, ,1,^ ^^^-^^^ ^^ ^f „^i^
Pta>ruos,s.-Uyv^nrovh^

386
THE CHARLOTTE MEDICAL JOURNAL.
tallied than can ever be secured by a sec- able instrument, and the floor of the vagina *J
oiidary operation, no matter how skilfully inspected while the blood is sponged away.
it may be performed. This of itself is a The mucous membrane is often pelled off
sufficient reason for endeavoring to estab- quite extensively, and it requires considerlish
a technic that will make secondary able care to make out the exact limits and
operation unnecessary. direction of the injury. If the tear is a
For purpose of classification, I know of median one, it will extend up the mid line
no better division than that given by Pen- for a variable distance. If it is in one or
rose in his text-book first published some both sulci, it will be seen to extend upward
years ago. It comes more nearly to describ- in an oblique direction, diverging like the
iiig the anatomical injury than any 1 have letter \" if both are involved,
seen; and so far as my experience goes. In either case, the first step is to make
whatever may be the direction or extent of out accurately the apex of the tear or tears,
the tears of the mucous membrane or skin, and from the apex the suturing is corn-
all lacerations fall into one of these divis- menced. If there is only one line, this is
ions. closed; if there are two, a separate line of
This classification is as follows: Slight suture is used in each. The suture is a
median. Median involving the sphincter continuous one and should be absorbable,
ani. Laceration in one or both sulci. Sub- I am in the habit of using iodized catgut,
cutaneous laceration. If two sutures are used, they are tied to-
Median lacerations, even when very ex- gether when the point of divergence of the
tensive, do not, as a rule, in any way inter- tears is reached. The object of this suturfere
with the supporting power of the peri- ing is to restore the vaginal tube, and in
Ileum, or, rather, its function of c losing the doing this two important results are achievvaginal
outlet. The slight mec'ian practi- ed: First, the absolute restoration to their
cally causes no disability: and the median proper relation of the injured structures
involving the sphincter ani causes the pa- and, second, the accurate approximation of
tient to lose control over the bowel but does the walls of the vagina.
not induce prolapse. As regards the first, I am well convinced
On the other hand, lacerations in the that even in the most expert hands it is
sulci seldom if ever tear into the bowel, but often a matter of impossibility to identify
do cause prolapse, as they tear across the and approximate the divided structures as
supporting muscles and more or less perma- they lie retracted and distorted in a recently
iiently disable them. Subcutaneous lacer- lacerated vagina. But the picture is imme- 'j|
ations belong in this class. diately reversed after the vaginal tube has
Bearing these facts in mind, the object of been restored, when the injured structures
the operation is to repair the essential inju- will beobservedto fall together in an orderly
rv. All lacerations should be repaired, and quite intelligible manner. These vageven
the slight median. An immediate inal sutures are absorbable because their
repair, however, covers the period of twenty- only object is accurate approximation. The
four or even forty-eight hours, and it is whole line of suture is supported by non- .'j
often advisable to defer operation until a absorbable sutures (which will be describsubsequent
visit within this period, unless ed), and by the time the catgut has been '
everything is at hand to perform the opera- absorbed, sufficient union will have been *
tion properly, or to secure necessary assist- obtained to maintain the accurate approxi- '
I
aiice. Nothing is gained by operating mation. If chronic catgut is used, it re- j
under unfavorable conditions and inviting mains in the tissues so long that it invites
J
failure. The first requisite in repair is suppuration. '<
proper exposure of the parts and indentifi- As regards the approximation of the vag- I
cation of the exact nature and extent of inal wall, it prevents pocketing and leak-
the tear. For this purpose sufficient light age of the lochial discharge into the wound.
j
is an absolute essential The contusion In using interrupted sutures, it is often .j
and discoloration of the tissues are often so difficult or impossible to prevent thif, and I '!
great that it is only after a most thorough believe is a frequent cause of failure. ',
ocular examination that the physician can Having restored the vaginal tube accu- ;
make out which is mucous membrane and rately to the point of the hymen, we next .j
which is torn connective and muscular tis- introduce non absorbable sutures, prefer- \
sue. ably of silkworm gut, which remain in until |i
The hips of the patient should be brought union is firmly established, usually ten i
well over the edge of the bed or table, and days, when they are removed. By observ-
the feet properly supported. Then, under ing the injured structures, they can be in- ij
a good, strong light the vulva should be troduced in such a way as to approximate !!
separated, the anterior wall of the vagina them; but as a general rule, the following
retracted upward with two fingers or a suit- method should be followed. The first suture ')
'

ORIGINIAL COMMUNICATIONS. .'iS?
is commenced about one-c|uarter inch from ance coming on during the course of chronic
the marsin of the wound and on a level alcoholism and is due to accumulation of
with the posterior commissure. It passes toxic poison in the blood. These poisons
throu.^h the skin and underlying tissues, are of both drug and auto-origin. The pomaknig
a sweep outward, and is carried tency of these poisons is progressively inthrough
the levator ani. It is then carried creased bv a loss of the fluid element of the
m the direction of the anus, but great care blood bv excessive perspiration and by demust
be exercised not to pierce the bowel, ficient absorption of water from the stomana
in any case of doubt, one finger of the ach. In fully developed cases the volume
gloved hand should be introduced into the of circulating medium is pathologically debowel
as a guide. The suture is then creased. The brain is hyperemic in a large
brought out on the other side in the same majority of cases and eiiemic in a small per
manner. Two, or at most, three such su- cent. These conditions of the brain is an
tures effect proper apposition. essential factor in the immediate causation
We have now, only to consider tears in- of the delirium. In order to intelligently
volving the sphincter ani. For the purpose apply remedies to the control of delir?um it
of approximating this muscle, two silk- is necessarily to differentiate the hyperemic
worm-gut sutures are used which commence from the eiiemic cases.
on the skin, pierce the muscle and skirt The indications in treatment are, support
under the tear and come out on the other of vital fuctions, control or arrest of delirium
side in the same manner. The most im- and removal of poison from the blood.
portant point, however, is to protect the For the purpose of restoring the volume
suture line from infection from the bowel, of blood, supporting action of heart and
This may be accomplished in several ways, promoting elimination by kidneys normal
The easiest is to pass a third suture, skirt- salt solution is given by' rectum^ by hypoing
along just under the mucous membrane dermoclycis, and in severe cases intravenof
the bowel. When this is tied, it draws ously. This is pushed until the entire ardowii
the mucous membrane like a purse terial and venous system are filled with
string and acts very nicely. The mucous fluids to their utmost capacity, then, this
membrane may also be dissected up suffi- fluid is drained off by the bowel with large
Ciently to draw it down, when it is sutured and repeated doses of epsom salts, the idea
in this position transversely at the margin being to practically wash the poison out of
pi the anus. In ca.ses, where the tear ex- the blood by forcing fluids into the system
lemls up so high as to involve the septum, and draining the same off by the bowel and
|t will be necessary to suture the mucous kidneys. Calomel is given in full doses at
jnembrane with catgut in situ, and, as a the beginning of the treatment. Sparteine
rule, il heals very rapidly without infec- in doses of two grains is given every two to
pion. six hours for the purpose of giving addi-
I Tiie after care of the bowels is of great- tioiial support to the heart and promoting
;st importance. If the suture line is pro- action of kidneys. This remedy is classed
acted by mucous memarane as indicated, as our most reliable heart tonic and an eiBhere
is no reason why the bowels should cient non-irritating diuretic.
lot be moved early. Consec|uemly, I en- The free introduction of normal salt soluiea\nr
to secure a fluid stool on the third tion gives most reliable support to the heart,
lay by the administration of a saline. I dilutes and renders less toxic the poison in
)elieve that prolonged constipation is inad- the blood, improves the condition of the
isable, Wliere a large, hard, fecel mass patient in every respect and does much to
s formed, I do not believe it can be broken allay the delirium, but for the special purip
by any form of medication; and its pose of combating the delirium, in the hy-
>assage is very apt to cause very serious peremic cases, Ciolseminine is given in doses
rijury to the recently repaired muscle. of 1-2,5 grain every one to two hours until
The after care of tlie perineal wound is its full physiological effect is developed,
imple. The patient voids, and after each unless the delirium and unrest is sooner
oidiiig and bowel movement, the external allayed. This drug is a reliable cerebral
are bathed, and dusted with boric- sedative and motor depressant and is not
cid i)o,vder. Tlie stitches are removed on incompatible with drug indicated in the
lie tenth day. . hyperemic type of cases but should not be
3 west Grace Street. given in the anemic cases. Strychnia, a
~
drug, the effects of which are directly oppo-
Dellrlum Tremens-A New Plan ol site those of Gelseminine, is given for the
reatmcni.— Geo. R. Pettey, M. I)., Mem- control of the delirium in the anemic cases.
his, 'I'enii., at a recent meeting of the Strychnia is positively contradicted in the
outliern Medical Association, said. This hyperemic cases, but in the eiiemic cases,
dilion is defined as a functional disturb- by increasing the blood supply to the brain

3SS THE CHARLOTTE MEDICAL JOURNAL
it quiets delirium. Alcohol is reduced to a through whatever means that might seem
moderate quantity but not entirely with- best, the sufficient amount of money to pay
drawn during the delirium. Physical re- a pathologist to investigate this disease, I
straint is condemned. Opiates and other know of few other ways to benefit society
narcotic and sleep producing drugs are con- more. The time is now, before other vicdemned.
They are not only dangerous per tims succomb and the disease becomes more
see, but interfere fatally with the action of prevalent,
curative remedies. Gaston B. Justice, M. D.
This plan of treatment has been employed,
when indicated, in 4.50 consecutive cases There is a large class of post-nasal, pharof
chronic alcoholism. Some of these were yngeal, and throat affections due just now,
delirious when admitted, others developed and we do not know of any appliances
delirium after admission, but in no case did quite as well adapted for treating cases of
the delirium resist the treatment longer than this description as the Nebulizers and Com-
24 hours, and in most cases this symptom pressed Air Apparatus put out bv the Globe
was overcome in from six to twelve hours Manufacturing Co., of the famed "Health
from the beginning of treatment. Nodeath Town" of Battle Creek, Mich. Medicated
from delirium tremens occured in the entire vapor applied "on the spot" is the key-note
series of 450 cases. of the Globe treatments,—even to applying
the vapor to the middle ear when neces-
A Plea For An Early Invesllflation ol
sary,—under proper pressure, and with
Pellagi
vibratory impulses designed to manipulate
I have had in the past three months two the mucous membrane of the remotest parts i
typical cases of Pellagra and, doubtless, in of the air tract. With convenient air sup- ,
my past experience numerous others which ply—apparatus for which this Company |
were unrecognized. The fact I believe it also supplies—this method is held by a '
is even now more prevalent than imagined, large and growing number of physicians to i
One of my two cases died insane, the other be very satisfactory,—in fact, unapproach- .
is rapidly advancing towards a fatal termi- ed by any other non-surgical method. I
nation and without help at the present time Their catalogs and formularies supplied on ;
from medical science. And I feel nov? that request, :
the physicians should join together in the ;
effort to ascertain if possible, the cause ^he abdominal supporters on the market !
treatment of this disease In my opinion, ^^„ scarcely be numbered. Some are good i
there is no disease that demands the atten- ^^^^ ^^e bad, and some are indifferent. I
tionofthe Southern physician more Ihan No supporter vet offered to the profession
does Pellagra. In almost every county in j^^^ ^^^ ^^-^^^ ^^^j^ universal favor as "The |
this State, there is doubtless to be found storm", advertised on another page. There ,
numerous cases, and when we come in
'
is good reason for this. It was desi-ned i
contact with them one feels like throwing
^y a woman who is a phvsician. Dr. Kath- \
up one s hands in helpless despair, for
^^j^g j^_ g^^^.^^ ^f Philadelphia. This ;,
where is the cause ? What is the remedy ?
binder took the prize offered by the Wo- i
These are the questions that must be set- ^j^„,g Hospital of that city, and it is en- i
tied at an early period. As to fermented
dorsed by very many eminent physicians.,
maize being the causative factor, I feel
j^ j^ ^^gj^i ^^^^^ abdominal operations, in :•
sure It IS an error, and time and mvestiga-
^^^^^ ^^ displaced kidneys, gastroptosis, J
tion will explode that theory. But whatpendulous
abdomen, etc. We have tried
ever is the cause the physician must deit
in practice and can commend it highly. I
vise some method to ascertain it. I beg
j ]]^"psoN M D i
lieve the quickest ' '
and surest '
means to this '
'
'
^^ ^y ^^^ Medical Journal. J
end IS the employment of capable pathologists
for as long a time as will be necessary
to accomplish it. Funds, of course, will The Southern Surgical and Gynecologi-
be necessary and possibly the only way in cal Association will hold its next annual,
which to raise the amount is for the differ- meeting at Hot Springs, Va. Tuesday,
ent County Meical Societies of the different Wednesday and Thursday, Decemebe
Southern States to contribute their part of 15 16, 1909. under the presidency of Stuai*
the money necessary to employ this expert. McGuire, of Richmond. Those desiring ^
This question is of vital importance to all contribute papers should address the Sec-"
of us just now and steps, I feel sure, should
,et^r William U. Haggard, Nashville,
be taken at once to check this very fatal ' ^ ^ .^,, •,
, rr^-,
malady, and
^enn. Lewis C, Bosher, of Richmond, is
if the proper medical authorities
would appoint a committee to raise the Chairman of the Committee of Arrange-
from the different County Societies, or ments.

EDITORIAL. .389
Charlotte ture properly incurred in the business Medical Journal man
agement of the association and its journal,
Publislied Monthly. would be an utter physical impossibility.
EDWARD C- REGISTER. M. D.,
CHARLOTTE, N. C.
EDITOR Hence, the plan pursured by the Secretary
of the A. M. A. in having an audit
company, as is the established custom of
large business corporations, make at stated
Ttie RUSSI/\NIZIfNO OP THE '\MBRIC«N periods a systematic inspection of their
MEDIO

.ViO THE CHARLOTTE MEDIOAL JOURNAL
The present editor of the A. M. A. Journal, ed medical periodicals in this big country
and the present Secretary of the A. M. A, of ours, and can but cherish contempt for
should never have been placed in sorespon- an editorial policy or an editor, assuming
sible and honorable position, and those of that nothing shall be entitled to existence
our leaders responsible for his continuance in the domain of periodic medical literature
in these positions are without doubt derelict save and except such journals as are solely
in the performance of their manifest duty conducted by medical societies. If such
in not promptly replacing him with a com- an absurd theory should ever obtain full
petent Secretary-Editor who has lived cor- recognition with the profession, could it not
rectly "from his youth up", in the educa- with equal argumentative facility and contional
and the ethical traditions of our pro- sistency be applied to the issuing of textfession!
books of medicine as well ? Then would
Dr, Geo. H. Simmons should be retired ensue the interesting spectacle of a medical
as Secretary-Editor of the American Medi- society or its trustees or governing body
cal Association and the rank and file of our undertaking to say wlio should or should
profession should insist upon his retirement not essay the tedious and oftimes unproby
the business body of the Association, ductive financially task of writing and pub-
and should continue unceasingly such in- lishing a textbook of medicine ! !
sistence until the demand of an outraged Or if the policy of organization control
profession is heard, and a proper herald of of the mental tools t the journals, maga-
correct ethical professional principles and zines, books) of our profession be accepted,
practice placed in that important and re- then a single short step farther and associasponsible
position. tion of the remedies (,*see foot-note) the in-
To assume, as the trustees have, and the dividual physicians may use in his practice,
House of Delegates are equally responsible the kind of clothes he may wear, &c., &c.,
in that its membership have tacitly acqui- ad infinitum, ad nauseam! !! ! Can any one
esced, year after year, with this knowledge believe such a spirit of proscription would
before them of Dr. Simmons past history, be tolerated, much less systematically culthat
our great national medical organization tivated and propogated by a sane profession
should properly have an ex-homeopathist once aroused to the ultimate destination of
for its educational leader is an absurdity, such a policy of its leading journal in free
and the continuance of Dr. Simmons in that American States???
exalted position is a perpetual affront to the It is highly probable that a majority of
doctors of this great nation which should the gentlemen responsible for the continunot
longer be tolerated. anceof Dr. Simmons' continuance in official
That the Journal A. M. A. is accomplish- position and who have followed his successing
a great work is undeniably true, but it ful leadership, engrossed with the multituis
a fact that no one dare call in question, dinous affairs of busy professional life, have
that the same good work can better be per- jjot fully consideied whither such leadership
formed by one educationally, ethically, and trended, or critically viewed this most vital
traditionally, more in harmony with the matter from all sides. The Association
ideals of the best in American Medicine. Journal is an important factor in advancing
The A. M. A. Journal is right in many the interests of the medical profession and
of its positions, and yet vitally wrong in is doing much good work; but this feature
some of the most important policies. That of its editorial and business policy as dictathe
organization of the American medical ted by Dr. Simmons is unworthy of the best
profession should appropriately own and traditions of the profession, untrue to the
conduct for the benefit of its membership principles of our science and the proper
and the exacting of the science and the art conception of our art which in the disseminof
medicine, a great national medical weekly,
is perfectly right and proper and to be *A trite and intensely practical illustraexpected
and encouraged; but that the tion of how little dictation American phystudied
chosen policy, relentlessly pursued, sicians will submit to in the vital matter of
of that journal to crush out of existence all what they shall prescribe, and when was
other medical journals unless owned and seen a few weeks since when the Guilford
conducted by the component societies of the County (N. C.) Medical Society unaniassociation,
is radically wrong in theory mously commanded the druggists of that
and wholly inconsistent with scientific county, filling the prescriptions of the memideals,
bers of the Society, to not publicly exhibit
Gentlemen who have thoughtfully con- the said prescriptions of its members, on
sidered this subject in its varying phases call of the local authorities, unless such
and details, believe there exist appropriate exhibition was specifically authorized by
fields for both organization owned and the physician writing the special proscripoperated,
and privately owned and conduct- tion.

EDITORIAL. 391
ation of information or demonstration of science such as we have, reporting of course
scientific truth knows no metes or bounds from time to time the results of their labors
as regards whether the printed sheet is own- to an interested and appreciative membered
by a society, a corporation or private ship. It may, and should do all of this,
individuals, provided its conduct merits and more too as occasion evolves opportuprofessional
respect; utterly beneath the nity, (and I take a professional pride in
great organization of physicians in whose noting that it is doing this, for I am proud
name such policy is pursued, and last but of our great aational official organ in many
by no means least, it is petty and unbusi- respects!), but when its editor deliberately
ness like as well as sadly out of adjustment fosters a policy which stiffles all periodic
with the spirit of progressiveness which publications of medical kind, then we mav
characterizes alike the leaders of our pro- naturally look for the appearance in the
fessiou and the age in which we live. columns of a free and independent press of
A great national medical journal as the such fiery and impassioned attacks as Dr.
oflncial organ of the great national organi- Lydston makes in the article referred to
lion of the medical profession, is a necessity above.
and has its proyjer field of operations; equally No, our great national medical journal
true it is is, that great medical journals with should foster every influence for professional
ownership and conduct independent of the uplift, extending everywhere the helping
financial aid and suppo,t of medical socie- hand, instead of cultivating a narrow pro~^
ties, have their legitimate field of action, vincial spirit which says to the profession
Such independently owned and conducted and to the world, it is wrong for any man
journals are in existence in the various or men, saving a society, to own and conmedical
centres of the country aud there is duct a medical journal—a contracted tradesevery
evidence that they are giving equal union spirit which it pains an intelligent
oatisfaction to their owners and their pat- libera! minded man to think should ever be
reus as well, and that they will continne to cherished by any enlightened member of
be published. our profession, which, of all pro'"essioiis or
Again in some few of the states where avocations of men, stands m )s. firuilv for
there are large society memberships count- individual liberty of thought and freedom
ing by the thousands, it is perfectly i)racti- of action in all things.
cable to successfully operate local medical And we shall see the day in the not far
journals of lesser scope than our great na- distant future when those in control of the
tional weekly, as we see being now done A. M. A., will, in response to a constantly
with some degree of success in some four growing demand, sweep from the exercise
or fi\e of the states. However, as a matter of autocratic and despotic power the menof
practical business economy, such an un- tally contracted and spiritually deformed
dertaking, especially when proposed by Simmons and his suppliant sycophants and
those in official position in the national replace them with clearer minds which will
medical association, to be forced on every guide our great national medical associacomponent
society, large or small, without tion and its journal along broader and more
intelligent regard as to proper business con- sympathetic lines of thought to greater opsiderations,
is chimerical, and i)radent busi- portunities and influence in benefitting the
ness minded physicians there are who do profession and the people. W.
not hesitate to predict that in five years
there will be fewer medical society owned abiotrophy.
journals being published than are issued at Changes of greater or less definiteness are
present. implied by the term senile atrophy. Some-
Tlie policy of the Journal A. .M. A. needs what closely allied is a condition, recently
broadening. It may very properly enlarge, brought into prominence by Gowers, which
and should in fact, amplify all the varied has been termed abiotrophy. Ad ami says
opportunities afforded it for advancement that this is the condition of premature death
of the numerous interests of the medical of the tissues or portions of tissues, not as
professiem; not only in being the medium of the result of any immediate irritant. Postransmission
of the many valuable contri- sibly this should be regarded merely as a
butions to the current literature, and the conception and explanation of cell decay, ingeneral
news of professional life as is now asmuch as it appears to explain in a manner
done, but it may even with perfect propriety more satisfactory than any other the develfartiier
develop the fields of elTort lately in- ment of certain otherwise obscure condivaded
in undertaking through intelligently tions. There is a series of morbid disturb-
:onceived committees to i)rosecute studies ances of the nervous system in which cer-
,ind investigations of a considerable num- tain cells and systems of cells and the
Jer of the various problems ever facing the associated tracts present degeneration, and,
ievotees of an only partially constructed eventually, complete disorganization, the

392 THE CHARLOTTE MEDICAL JOUKNA. .
rest of the nervous system, apparently, manifest itself first in the upper extremities, j
showing no change. The development of It is the nerve centres controlling the groups |
these conditions is progressive. It is im- most commonly in use that first undergo |
possible to find any one factor or set of atrophy. A most suggestive example of i
factors to explain them unless it be sup- what may be termed general abiotrophy, •
posed that these cells have a shorter life throwing light upon these more specialized i
than have the other neurons, that they ex- abiotrophies has recently been adduced in j
hibit a premature senility leading to pre- Bardeen's studies upon the effects of X-rays »
cocious death. Such would seem to be a upon frog's spermatozoa. By subjecting
most satisfactory explanation of conditions the sperm to the rays for a few minutes it
like Thomsen's disease and other familiar is found that are capable of fertilizing the
paraplegias. In these diseases, for a time, ova; the individual life begins, but the larthe
mental and nervous conditions develop vae, growing, all die prematurely; none
in a normal manner. However, in a few survive beyond the second week. Appar- |
years one particular set of mscles under- ently there is cell axhauslion after a certain |
goes atropliy with corresponding paTalysis, early period. '.
and the motor centres governing these mus-
'
cles show localized atrophy of their cells. indig«nuri«^ its sigmificange.
Somewhat similar to these hereditary con- The presence in the urine of indican, or ij
ditions, are the nervous disorders which indoxyl sulphuric acid, has recently been i(
may follow long years after an attack of the subject of much discussion, whether or ».
syphilis, notably tobes or locomotor ataxia, not a proper significance has been ascribed 1
One method of regarding these conditions to the occurrence of this substance in hu- i
is to imagine that syphilis is a disease that man urine is as yet unproven. Investiga- i
is never wholly cured, that, once in the sys- tors, noting its association with various i,
tem, the germs continue to grow and to pathological processes, have forthwith con- I
produce their toxins, and that these toxins eluded that the indican stands in etiologic '
have, as it were, a cumulative effect until, relation. However, the possibility that the d
at last, owing to their continued irritation, indoxyl compound is nothing more than «
they bring about the death of certain groups evidence of some deeper metabolic perver- ••
of nerve cells which are more susceptible sion and not of itself necessarily of serious .-j
to their influence than are others. The import must not be forgotten. In discuss- •,
difficulty in accepting this view is that, in ing a paper on "indicanuria" by Dr. Judsuch
cases, we have no other sign of the son Doland, which appeared in the Journal
continued existence of the germs of syphi- American Medical Association recently,
lis. W^ do not find indications of gum- Dr. Heinrich Stern emphasizes his opinion
mata or other syphilomata. The Individ- that the pathologic significance of indican
ual is incapable of infecting others with has been grossly exaggerated. The fact
his disease, and, judging, by macroscopic that there occurs an increased production
and microscopic appearances, the disease of indoxyl compounds in certain conditions
is, and has been for years, arrested. It is does not justify us in ascribing to them
more satisfactory to suppose that, during toxic qualities, or that they stand at the
its active stage, there had been a certain foundation of a number of pathologic conamount
of irritation and intoxication of ditions. To cite a simple instance: They
these particular groups of cells. Or, again, have no direct relationship to so-called pyit
may be that there has been a general in- orrhea alveolaris; they are neither its cause
toxication of all the nerve elements to such nor its result. Inddxyl compounds are
an extent that, although the intoxication normal urinary constituents; they are found;
has been recovered from temporarily the in small amounts in every human urine,j
cells have, notwithstanding, been weaken- except in that of newborn and breast-fed'
ed so that now, under the normal strain, infants. Indoxyl is even contained in the
these cells, being called upon to perform secretion of infants who obtain besides liuno
more than the normal amount of work, man milk also some cow's milk and, evett
become easily exhausted and undergo pre- in these instances, it occurs in the absence
mature dissolution. This second possibili- of any digestive disturbances whatsoever.
ty is mentioned inasmuch as, while it is Increased amounts of indoxyl as found incells
in connection with the lower portion the urine allow but one interpretation,
of the cord controlling the lower limbs that, namely, that there exists some form
in general, first give out, there are cases on tryptic perversion. Some observers hold
record of those who, leading a sedentary that the trypsin of the pancreatic secresio
life, do not employ the lower limbs in induces or favors the production of indoxyUJ
walking to the normal extent, but use the Their contention is based on two facts, viz|
arms and upper extremities actively, and, the tryptic quality as regards decompositii
in these, the paralytic condition is apt to of the ingested proteid material, audi
•

EDITORIAL. 393
decrease of urinary indoxyl in case of an opportunities roR sainit/\ri^>«.
occlusion of the pancreatic duct. Clinical The present recognition of the value of
experiments and observations have demon- prevention is attested by the public attendstrated
that 111 the majority of instances of ance at tuberculosis exhibits and by the
so-called indiconuna there is insufficiency hearty co-operation by editorial boards of
tryplic function—and, consequently, ab- lay periodicals in accepting- articles upon
normal putrefactive processes and the aug- the progress of medicine. The public do
mentation of intestinal bacterial flora, not attend meetings in the tuberculosis
While it is possible that an indicanuria campaign. merely from curios'.iv or because
may occur with a process like pyorrhea of inexpensiveness to themselves, but bealveolaris,
and while it is even possible that cause they believe the work has a vital inintestinal
putrefaction may stand fiuence upon their lives and the lives of
in some more or less remote relationship to their friends, and that it concerns their per-
1 perverse
the condition, there is no reason whatever sonal interest. The people are I ready to acin
maintaining- that indoxyl, one of the ac- cept such teachings as are brought forcibly
cidental products of such putrefaction, is before them. This willingness to learn is
the true causative agent. Pvorrhea alveo- proved by the confidence held by editors
laris is ail exceedingly chronic and I progres- toward their readers. More from a sense
1 si ve affection: indicanuria, on the other of public demand rather than a willingness
hand, is essentially acute, or at least, a to become public benefactors do editors ac-
j
limited occurrence. It is scarcely possible cept proffered articles upon hygienic sub-
I
that the rather ephemeral indicanuria will jects. It is a common ! occurrence to see
^fi^iverise to the enduring pyorrhea. The articles upon preventive medicine classed
same contension holds good with all other in the magazines as of equal importance to
I affections which at one time or another those upon political, engineering, industrial,
j
I
have been accused of having indoxyl as or governmental .subjects. By publishing
their causative factor. The indoxyl com- these articles the editors are doing a worldpounds
are not toxic in themselves, they good. For this needed assistance in the
are of more or less accidental occurrence, work for which it labors the profession is
and may point to an occlusion of the small grateful. Yet with the publication of more
intestine with a secruase of tryptic function magazine articles, especially lay-written,
and an increase of bacterial activity. Kv- the public will universally be taught that
er\thing else belongs to the realm of spec- in other communities, if not their own. the
ulatioii. Indoxyl occurs not only in the
urine of carniverous hut also in that of
herbiverous animals. As a matterof fact.
practical application of hygienic principles
has saved many dollars and many lives.
Dr. II. B. Wood, in an article recently pubit
is present in the urine of some of the
herbivora in much larger quantities than
in any of the cariiivora. It occurs in enorlished
in the Iniv. of Penn. Med. Bui. thus
speaks of the dawning of a better day in
matters of health. He belie\eri the chief
mous amounts in the urine of the horse, reason for the scarcity of sanitarians is to
from which it is obtained for experimental
purposes. It may also be prepared from
be found in the fact that in the past there
has been little opportunity for work for
the urine of the dog, but, is purer when de- others than those having official connecrived
from horse's urine. In llie latter, it tions. And indeed the inducements have
is jjresent in larger proportion than in that been so little that many of those holding
of cattle. Tiie reason for this seems to be official civil positions were not able to acthe
large cecum of the horse which per.nits complish much or have cared little about
additional and more complete disintegration the development of the work, and hence
Of the ingested material, Indoxyl does not the sanitary conditions of the country have
occur in the urine of the rabbit, as a general
rule, but Stern found it therein in the
suffered. Often owing to their official po-
sitions, many of the present sanitarians are
presence of artificially induced obstipation, not able to give the directions which are
While indoxyl appears in the urine in apt to be wanted; being limited in influence
larger amounts after a diet rich in animal by the laws which define their authority,
food, it never attains pathologically that in many cases they cannot direct in all
proportion in the human being which is lines.
normally present in the urine of the hor.se That there is a growing demand for civil
This, he suggests, is evidence that animal sanitarians, or whatever they may be term-
'ood and the ensuing putrefactive processes ed, there cm be uo doubt. At present,
irenot
practically all medical
the only source of indoxvl commen
who have fol-
'
'
, , ,
, , .
, ,
rounds and that vegetable ingesta and ferneiitHt
ion processes innv •;>• il-;p ir. In.lilowed
that bent are government officials in
j,,^ p^j^^j^ j^^^,,,, ^„^^ ^,,,^i„g Hospital
Service, occupy official positions in a com-
:an production. mon-wealth or municipality, or belong to

394 THK CHARLOTTE MEDTCA T. JOURNA]
the teaching staff of a medical college, and book, say that bruises or contusions, par
thus are hampered by agreements or work ticularl\' those involving the bones, are not
preventing outside activity. The demand infrequently followed by malignant tumors, '
for medical graduates specially trained in and it is noteworthy that these tumors are ,
public health lines is soh growing that it most apt to be of the connective tissue type
tends to become a serious consideration be- —sarcoma, osteo-sarcoma, chondroma, &c.
|
i
i
!
;
i
cause the supply is not ready to meet the Epithelial tumors, on the other hand, are
demand. The opportunity is here, yet is more frequently developed at the seat of renot
recognized by the recent graduate, who,
not realizing the overcrowding of all other
peated injury or long-continued irritation.
Thus, epitheliomata are common in the J
medical branches, seeks to emulate the bril- mouth, near a rough ulcerated tooth, on the ]
liant achievements of his teachers in the lips of pipe smokers, at the edges of chronic i
other departments. ulcers, on the skin of workers exposed to !
The duties of the various chemical or mechanical irritants; in \
sanitarian require
to be a sociologist, an economist,
him
a statis- cicatrices; at the orifices of the stomach and
tician, and a diagnostician, and that he at the anus. Finally, the frequent occurshall
have some knowledge of engineering, rence of carcinoma of the liver with cirrlaw,
chemistry, and entomology. The fore- hosis, though less easy of interpretation
most duty is educational, advisory. It is than many instances of the association of
mainly through public instruction and not tumors with chronic inflammation, is worthy
legal enforcement that the people will appredate
the value of prevention. Practical
of notice in this connection.
ever, be remembered that
It must, howunduesignifij
i
demonstrations of the ravages of tubercu- cance should not be attached to the occa- <
losis and their preventi(jn have more influ- sional association of tumors with trauma, ;
ence than the simple trite statement that it prolonged irritation, and chronic inflamma- .
is cheaper to prevent tuberculosis than to tion, since in the great majority of cases (
care for its victims. The people must be these conditions are not follov/ed by tumors, |
shown that it is cheaper to furnish a town "or, furthermore, has it ever been possible ij
or a single house with pure water, unpol- to induce genuine tumors experimentally |
luted milk, or other foods than to pay for under these readily secured coudilions in n
an epidemic. Places maintaining danger- animals. The bearing of trauma upon the jj
ous conditions cannot afford to take the origin of tumors is to be held in mind in ji
risk. If resorts want the support of the estimating the influence of sex, since males
people and the profession, they must sup- are in general more liable to injuries than
ply conditions which are truly health-giv- females. The relatively common developing.
To exterminate mosquitoes not only ment of tumors in pigmented and other
!
i
\
:<
means the obliteration of a pest and a dis- naevi of the skin illustrates the significance P.
ease, but a marked increase in realty values, of local malformations as predisposing fac-
With most people the whole subject of pub- tors in the origin of tumors, although it
lie health is a matter of money expendi- should not be forgotten that many of the
ture, that plan which is the most economi- complex tissue growths often reckoned
cal being accepted." To the general towns- among tumors and called teratomata are
man what may seem a hardship must be really embryonic rudiments of another inshown
to be the better plan, as the closing dividual. While such rudimentary emof
every school to check an epidemic of bryos may be large and present such divermeasles.
These are but some of the duties sity and arrangement of tissue as to render)
of those who accept the opportunity to work the character of the growth obvious they
for the public health. may, on the other hand, be very simple in
character, as in bOGAU rftGToas
some of the so-called der-
IN BT10I.0GY OF
TUMORS. moid cysts. 1 hese are all to be regarded
. ., .• 1 . r , , rather as malformations than as genuine
Among the many et.olog.c factors which
^^^ g^^.^^^l ^,^3^^ 1^^^.^ been recorded
are looked upon asimportant.n considering „ ^^^.^^ j^,^^ .„^^. j^ i ,^^^^ has been a
the development of tumors, the idea, from •
'
i i j- i I c ^^ r j j
, . ,
• . •,,.,: mechanical displacement of cells heterotOr
which escape seems impossible that trauma
^,-^_f,„^ ,,hich in their new situation tu.
stands in positive causative relationship ni
^^^^ j^^^,^ developed. These cases, which
many instances has persistently imposed
^^^^ ^^^^ -^^ ^ ra^^^^x^ parallelled by ex-
Itself upon the minds of observers. Cer- - •
•
i -n . .
.
. , ^ ^^i^ociviria. ^ci
, .
penments in animals, illustrate an importtaiiily
an iinposnig array of instances can » i c •» i ^ r. ,•
, ••: ^ , . ^.. .''^ ' =ia.i..ca^aii
ant class of congenital tumors, often cystic
be cited in wlucli tumors, and esoeciallv i . i • i < i <
' ,.
, , r^„ coucumuy jjj character, which arise from embrvonal
malignant tumors, follow local injuries
either mechanical or toxic, or are associated
with chronic inflammatory processes. Delacell
displacement, or, as is the case in many
„f ^^^ j^^^^, ^j tl,^ ^^.^^ at the side of
bronchial clefts, from an imperfect closure|
field and Prudden, in their excellent text of embryonal openings.
—

[
! his
I to
DK. RUSSEUU MOVES TO ftSHEVIbUE. , , , ,
instructor
r^ T- D -J Ti „ and the students , r
will also miss
UT. li. Keid Kussell, who for a number of him Be it
years has resided in Charlotte '•
where he de- Resolved, Aho that the medical frater-
voted his attention to Diseases of the Eve, nity of the citv of Cliarlotte loses a brilliant
Ear. x\ose and hroat, has decided to re- member, a man who honors and is honored
move to Asheville^ On January 1st, 1910. by his fellows: who has consistently upheld
he will open his office in the latter city and the highest ideals of the profession; whose
there engage in the same special line of attainments are eclipsed bv those of no other
work in which he has won so enviable a man in this Southland and whose success is
reputation, bmce coming; to Charlotte, Dr. recognized and deserved. Beit
Russell has been prominently identified with '-Resolved, lastlv. That in our loss the
many phases of the development of modern city to which he goes has gained a citizen
CharloUe. One of the prime movers in the who has always manifested the utmost pride
establishment of ihe Presbyterian Hospital in civic progress and improvement and a
he has been deeply concerned in its welfare, doctor who is an ornament to his profes-
His connection with the North Caroli -a siou."
Medical College has contributed in no small It is wholly uunecessarv for us to express
degree towards making that institution a our belief in his success in his new home
success. One of the organizers of the new That is assured ere he has begun. We have
Charlotte Sanatorium he showed immense onlv to wish him "God speed." May he
pride in this up to date hospital. Eiithusi- live' long and prosper,
astic ill every idea which means civic betterment
and improvement, Dr. Russell never ^"^ "^^^ °^ """^ PHYSiGmrs.
lost an opportunity to aid in carrying for- Volumes could be written on the topic of
ward any movement which would contribute "The Duty of the Physician" and still a
towards making the city thoroughly mod- great deal be left unsaid, for so manifold
ern, sanitary and clean. are the duties of the doctor that to chronicle
Genial, open-hearted, whole-souled he is them all would certainly be a most difficult
the pers

396
THE CHARLOTTE MEDICAL JOURNAL.
tent that patients are constantly put to the tion of politics from medical boards, and |
unnecessary expense of specialists. urged tlie association to demand that the \
Everj' physician should have a specialty, laws of the States included therein be so J
even though not practicing it to the entire changed as to make it obligatory on the j
exclusion of his general work. This is, I respective Governors to select members of j
think, especially true outside of the large State Boards of Health from a list of com- \
cities where, ofttimes, many things render peteni physicians recommended by medical •
the services of an exclusive specialist im- men. He said that he believes that the I
possible to obtain. With the several men facilities for medical education which we |
of a community doing general work usually, have in the South are more than sufficiently I
but each one making himself extra profic- modern for our youth to obtain all the ad- ]
ient in some one or two branches, inter- vanced instruction they need to equip them "'
change of patients can be brought about in for ilie practice of the profession. Our cola
cordial manner, and without jealousy, leges are numerous, manned by capable ^
and the patients accordingly benefited by faculties and provided with the most scienspecial
work, well done at moderate terms, tific apparatus. We have men teaching in
which under ordinary circumstances the our schools who are surgeons and special-
'
patient would have been unable to obtain, ists c>t international reputations. i
During the special treatment, the patient
for any other ailment is referred to his original
physician, as also after the special
treatment is finished.
I" his address Dr. DuBose emphasized
^
the (opportunities open to medical men in
the South. He drevi- attention to the fact
that many talented young men, feeling that
Another duty of the physician is to do broader fields and better facilities were ofeverything
possible to avoid putting our fered, have followed the paths of greatness
profession on a purely commercial basis,
Money is a necessary commodity the way
away from home. Greater honor is to him
who makes opportunity arise around his
thiugs are constituted just now, but still
our duty to attend to and heal the "sick
and wounded" must be considered first,
Lack of funds on the part of the patient
must not mean lack of interest on the part
of the doctor. Our poor patients must receive
the same care as we would give the
nativity and becomes a worthy son on the
soil of his birthplace, who stays among his
own and adds to their uplift. For him who
adopts as his home this Southland, let every
act of fellowship make him feel so much at
home that it becomes a reality.
Attention was called to the necessity of ^'
well-to-do. Perhaps when all is done and
said we may find that our ultimate reward
legislation for the regulation of the business
of opticians in the annual address of the
is as great or greater.
chairman of the ophthalmology section, Dr.
Alex. W. Stirling, of Atlanta, and was
SOUTHBRPS MEDiCAu ASSocmT.or.. ^^^^^-^^ approved by the gathering of spec-
The Southern Medical Association held ialists who were his auditors. He urged
its 4th annual meeting Xov. 9-11, in New that the doctors throughout the South do
Orleans, La., under the presidency of Dr. their utmost to induce the Legislatures of
Giles C. Savage, of Nashville, Tennessee, their States to introduce similar bills, so
The attendance, though small, when con- that opticians might be controlled b)- the
sidered in relation to the number of doctors State authorities and be compelled to underin
the profession of the component States,
was nevertheless satisfactory, representing
as It does the flower of the medical profesgo
tests as to their ability,
Pellagra and tuberculosis received a large
amount of discussion. A number of excelsion
of several Southern States. City lent papers were heard on both subjects,
attorney, Garland Dupre, of New Orleans, Of particular interest were those of Dr. \V.
eloquently extended the welcome on oehalf J. W. Kerr, of Corsicana, Texas, Dr. C. C.
of the city. Dr. E. M. Hummel, chairman Bass, Dr. D. Harvev Dillon, Dr. Geo. Dock,
ofthe committee of arrangements, expressed Drs. H. P. Cole and G. J. Winthrop, Dr. J.
the pleasure felt by the doctors of New M. King and Dr. O. L. Pothier.
Orleans because of the presence of the Papers of value on tuberculosis were premembers
of the Society. Dr. W. W. Craw- sented by Drs. Wallace J. Durel, W. C.
ford, of Ilattiesburg, Miss., responded. Gewin, George Brown, Arthur W. Ralls,
The annual oration was delivered by Dr. H. P. Cole, Herman B. (Ressner, S.
Isadore Dyer, of New Orleans: the address Sheperd, Randolph Lyons, John A. Watin
medicine by Dr. John A. Witherspoon, kins, Benjamin B. Simms, H. L. Suth
of Nashville, Tenn.; the address in surgery
by Dr. Francis G. DuBose, of Selma, Ala.,
and the address in ophthalmology by Dr.
Alexander \V. Stirling, of Atlanta, Ga. Dr.
Witherspoon made a plea for the eliminaland,
R. F. Evhridge, J. A. Storck. J. C.
Moore, W. L. Champion, William Lilterer
and Roy Van Wart.
In the Section on Medicine Dr. George
Dock, of New Orleans, was elected cl

man and Dr. li. Eugene Mitchell, of Birmingham,
secretary. Papers were read bv
Drs. Frank A. Jones, L. R. DuBose, J. R.
Rathmell, Sidne}- K. Simon, \V. W. Butterworth,
E. yi. Hummel, Marion McH. Hull,
R. M. Van Wart, Isaac L. Kemann, Allen
Eustis. George M. Xiles, A. B. Cook.- and
Sea'e.
In the Section on Surgery Dr. E. Denegre
Martin was elected chairman, and Dr. Jere
L. Crook secretary. Papers were read by
Drs. Thomas P. Lloyd, \V. T. Black, A.
Jacoby, Isadore C ^hn and W. F. Westmoreland.
Dr. E. C. Ellet, of Memphis, was elected
chairman of the Section on Ophthalmology
and Dr. U. S. Bird secretary. Papers were
read by Drs. Carl A. Fox, Hilliard Wood,
W. h. Simpson and W. Scheppergrell.
The following resolutions were carried
by acclamation:
A lesolutiou by Dr. Fred J. Mayer, of
New Orleans, endorsed the hygienic work
being done by several Southern States
through medical boards and by instruction
in the schools, and advocating the co-operation
of the physicians in it.
A resolution by Dr. J. H. Whiteexpressed
the api'.reciation of the association to
Mrs. Russell Sage and Andrew Carnegie
for their donation of 51,0ii be
named for his mother. One fourth of the
gift to hospital is to be used to provide accommodations
for negroes.
The Mobile Non-Sectarian Infirmary Association
have succeeded in getting $60.-
000 subscribed for, toward the erection of
the proposed institution in Mobile, Ala,
The bond issue was for only S50,00(), twenty
years, six per cent bonds, but this has been
over subscribed by $10,000.
A site on Spring Hill Avenue has been
secured, where the building will be erected
soon. The site and building, when complete
will be worth $80,000.
At a meeting of the Iredell Anti-Tuberculosis
Society, held in Statesville, N. C,
the first week in November, the organization
of the society was completed by the
election of a board of directors, and the
adoption of a constitution and by-laws.
The directors elected are; Drs. J. E. Mc-
Laughlin, H. F. Long and T. E. Anderson:
Messrs. J. A. Hartness, E- S. Millsaps,
R. R. Clark, T.J. Conger. R. B. McLaughlin,
William Wallace, Rev. J. H. Pressly,
Prof, D. Matt Thompson and Mrs. A. L.
Coble.
The attendance was large, was much enthusiasm
was manifested. Drs. Anderson

and Hoiick made short addresses on the
tuberculosis situation, which were very in-
terestin.s;.
Dr. J. W. Suoimers, formerly of Davidson,
N. C, has moved to Charlotte, N. C,
to practice his profession. He has been
living: in Davidson for the past seven years,
where he has built a large practice for himself,
and made many friends there. Dr.
Summers graduated from the North
Carolina Medical College several years ago,
and two years ago he took a post graduate
course at the New Orfeans Polyclinic, and
he has located in Charlotte to continue the
practice of his profession. Dr. Summers
has his office over Blake's Drug: Store.
The Third District Medical Association
of Georgia met in Vienna, Ga., on November
the 17th. A very interesting programme
was carried out, and many papers of importance
to the profession were read and
discussed, among which papers on Pellagra,
the American Hook Worm, and organized
work in controlling tuberculosis. In the
evening, the local physicians entertained
the visiting members at a "turkey dinner."
This association meets semi-annually,
and an election of all the officers was held
at this meeting. The meeting was well
attended by the physicians of the fifteen
counties which make up the Third District.
The annual meeting and banquet of the
Petersburg Medical Facultv were held November
ISth in the hall of the A. P. Hill
Camp, in Petersburg, Va. At this meeting
the following officers were elected for the
ensuing year: President, Dr. L. S. Early;
Vice-Presidents, First, Dr. W. P. Hoy; Second,
Dr. H. A. Burke; Corresponding Secretary,
Dr. J. R. Beckwith; Secretary and
Treasurer, Dr. William C. Powell. Court
Medical—Drs. S. A. Hinton, J. Boiling
Jones, Frank W. Haines, W. H. Crock ford
and D. D. Willcox.
After the business of the evening had been
transacted, the faculty adjourned to the
Chesterfield, where the banquet was spread,
and remained in social gathering until midnight.
Drs. E. C. Davis and L. C. Fischer, of Atlanta,
Ga.. have recently opened a private
hospital on 30 Crew Street. Especial attention
will be given to Surgical, Gynecological
and Obstetrical cases, though a limited
number of medical cases will be accepted.
This l)uilding was especially designed for
a private hospital, and is well located on a
quiet residence street and is equipped with
modern appliances for the care of patients.
:-HE CHARLOTTE MKDICAI. JOtTRNAL.
Dr. W. X. King, a former North Carolinian,
but who has been practicing medicine
in Texas for the last several years,
doing a large and lucrative surgical practice,
has recently moved to Durham, N. C,
where he will have charge of the surgical
work in the new Watt's Hospital.
Dr. King has had splendid training for
his work both in this country and in Europe,
and it gives us a great deal of pleasure to
welcome him back to North Carolina.
The Tri-State Medical Society, composed
of the Slates of Mississippi, Arkansas and
Tennessee, held its annual meeting in Memphis,
Tenn., Novem'oer 16 and 17- An attendance
of two hundred included many of
the most prominent men of the States
named.
At the annual meeting of the Medical
Association of the Southwest, at San Antonio,
Texas, Nov. 9-11, thefollowing officers
were elected: Dr. G. H. Moody, President,
San Antonio; Dr. T. Howard Hill, First
Vice President, Kansas City, Mo.; Dr. C.
E. Bowers, Second Vice President, Wichita,
Kansas; Dr. D. A. Meyers, Third Vice President,
Lawton, Okla.: Dr. A. J. Vance,
Fourth Vice President, Oklahoma City; Dr.
F. H. Clark, Secretary-Treasurer, El Keno,
Oklahoma; Executive Committee: Dr. Grover
Burnett, Kansas City, Mo.; Dr. J. S.
Bassell, Wichita, Kansas.: Dr. E. S. Lane,
Oklahoma City ;
Dr. J. A. Foltz, Fort Smith,
Ark., and Dr. E. H. Carey, Dallas, Texas.
Dr. C. E. Bowers, Chairman of Arrangements
Committee, Wichita, Kansas.
The next meeting place will be Wichita.
Kansas, during October of 1910.
At the regular bi-monthly meeting of the
Mecklenburg County Medical Society, held
in Charlotte Dec. 7, the annual election of
officers resulted as follows:
President, Dr. A. J. Crowell; 1st vicepresident.
Dr. F. O. Hawley: 2nd vicepresident.
Dr. L. B. Newell: 3rd vice-president.
Dr. C. A. Misenheimer; secretarytreasurer.
Dr. Robt. Lafferty: Delegates to
State Society, Dr. S. M. Henderson, alternate
Dr. C.-A. Misenheimer, Dr. E. C.
Register, alternate Dr. W. O. Nisbet.
At this meeting Dr. Crowell presented a
paper on "Traumatic Nephritis" which was
discussed at length bv the Society.
Rex Hospital Formally Opened.
On November IS, the new Rex Hospital
in Raleigh, N. C, was formally opened and
dedicated with appropriate and impressive
exercises.
The speakers of the occasion were Major

.
EDITORIAL. 3^9
J. S. Wynne, Dr. A. W. Knox, president of many years her hospital has done a great
the Raleigh Academy of Medicine, Mr. work; the promise is that it will do yet
George W. Watts, of Durham: Dr. Hubert greater good.
A. Rov.ster, and Hon. R. H. Battle, president
of the Board of Trustees of Rex Hos-
Medical Society ol Virginia.
pital. There was a beautiful musical pro- The fortieth annual session of the Medigram,
appropriate selections being sung by
a quartette composed of Mrs. Horace R.
Dowell, Mrs. James McKimmon, Dr. Royscal
Society of Virginia was held Oct. 5-8,
'09, in the auditorium of the new National
Business College building of Roanoke, Dr.
ter and Mr. Snow.
The exercises opened with the national
Stuart McGuire, the president, presiding.
The attendance was unusually large.
hymn, ''Our Country 'Tis of Thee," sung
by the ([uartette. after which Rev. W. C.
Tyree, D. D., pronounced the invocation.
The new hospital, erected at a cost of
The meeting opened with prayer by Rev.
W. H. H. Joyce, after which Mayor Cutchin
welcomed the medical men to the city.
Dr. S. T. A. Kent, of Ingram, responded
$50,00(1, occupies the same plot upon which in behalf of the Medical Society. The
the old Rex Hospital was located, but cov- president then made his annual report, in
ers considerably more ground, taking in the which he referred to the fact that the sovacant
lot adjoining, which was owned by ciety now has 1,500 membership, the largest
the hospital authorities, and includes three in proportion to the number of physicians
separate buildings, connected by corriders, of any State. He favored an increase of
in the shape of the letter "H." These dues from S2 to $5 and the establishment
buildings are: the .Administration Building, of a permanent meeting place in Richmond
the Patients' Building and tlie Surgical Pa- or Norfolk, with preference for the former
villion, all of wliiih are so constructed that city as offering the greatest advantages,
in a few years there can be made, without
any break in the architectnral plan, a hos-
His reference to Dr. Landon Edwards as
the physician to whom the life of the sopilal
with over a hundred beds. ciety was due was greeted with applause.
Throughout the building is erected after Dr. A L. Gray, of Richmond, made the
the latest ideas in hospital construction, report of the executive committee.
The floors are all of hard wood and most of Dr. George Stover, of Richmond, of the
the walls are laid with soapstone finish, ex- legislative committee, reported on the efcept
those in the corridors and operating forts of the committee to secure the repeal
room which are hard cemert, with four coats of the special tax on physicians, and preof
enamel finish. The entire construction sented a resolution protesting against the
is semi-fire-proof, steel laths being used en- tax, which was greeted with applause,
tirely, and the plumbing is tiie most mag- Dr. Stuart McLean, of Richmond, re-
nificent feature of the whole building. This ported on the relation of the physician to
material itself cost several thousand dollars theplansof the States for the improvement
and it has been installed very satisfactorily,
Porcelain and china constitute the chief
of health conditions.
The constitution of the society forbids the
material and all exposed parts are of fine holding of entertainments for delegates, but
nickel plate. The whole house is screened a reception was tendered to the women visin
copi)er wire screen. Private telephones itors at Hotel Roanoke on the afternoon of
reach all over the institution so that all parts the 6th and an auto ride on the morning of
of the
tion
building are in direct communica- the 7th.
The officers of the society were as follows:
The system of ventilation is one of the President—Dr. Stuart McGuire, Richmost
important features, air being supplied mond, Va.
by means of openings which connect with Vice Presidents— Dr. O. C. Wright, Jarlarge
air shafts, running to the top of the ratt, Va.; Dr. E. T. Brady, Abingdon, Va.;
buildings.
Dr. Reid White, Lexington, Va.
Externally the building is a beautiful
structure, being l)uilt of red brick and trimmed
with pure Indiana lime-stone. The
Secretary—Dr. Landon B. Edwards,
Treasurer— Dr. R. M. Slaughter, Theo-
logical Seminary, \'a.
roof is terra colta tile, which matches thor-
^^^ seaboard Medical Association ol
oughly the general scheme. 1 he heating
viralnia and North Carolina.
is by the direct-indirect system, by which
air is conveyed fn.in the outside to each ra- This association was held in Norfolk,
diator. Va., December 7, 8, 9. The social features
The Raleigh people and the doctors of of the meeting consisted of an oyster roast
Raleigh especially, are very justly proud of at Cape Henry, lunch at the Board of Trade
an institution which occupied so important rooms, theatre parties and receptions. The
a place in the economy of that city. For ladies of Norfolk gave several entertain-

400 THE CHARLOTTE MEDICAL JOURNAL.
ments for the visiting ladies who attended Surgical Subject for Discussion — "Diagthe
session. nostic \'alne of Exploratory Incision,"
• The officers of the association were
President— Dr. Southgate Leigh, Norfolk,
Va.
First Vice-President— Dr. B. W. Hathaway,
Winfall, N. C.
Second \^ice-President— Dr. C. D.Kellaui,
Xorfolk, Ya..
Leader, Dr. D. T, Tayloe, Washington, N.
C.
Medical Subject for Discussion—Malaria'
liaematuria. Leader, Dr. J. W. Smith,
Hranchville, Va.
"Report of a Case of Gun-shot Wound of
the Abdomen," Dr. R. S. Primrose, New
Third Vice-President— Dr. B. F. Halsey, Berne, N. C.
Roper, N. C. "The Local Life Insurance Examiner,"
Fourth Vice President— Dr. R. L. Payne, Dr. B. M. Baker, Norfolk, Va.
Jr., Norfolk, \'a.
Secretary— Dr. A. K. Tayloe, Belhaven,
N. C.
Treasurer— Dr. Israel Brown, Norfolk,
"X'aricose Ulcers and their Treatment,"
Dr. Chas. W. Doughtie, Norfolk, Va.
"A Case of Exfoliative Appendicitis,"
Dr. Joseph C, Green, LaGrange, N. C.
Va. 'Amputation of Thigh LTnder Adverse
The following are the committees:
Executive— Dr. J. B. Sebrell, Chairman,
Norfolk, Va., Dr. E. l''. Corbell, Sunbury,
Circumstances," Dr. Lucien Lofton, North
Emporia, Va.
"Treatment of Urethral Strictures. ' Dr.
N. C, Dr. J. C. Goode, Cheriton, ^'a., Dr. A. D. Parrott, Kiuston, N. C.
J. C. Rodman, Washington, N. C, Dr. C. "Treatment of Twenty-two (22) Cases
Capehart, Roxobel, N. C.
Publication— Dr. E. C. S. Taliaferro,
of Intestinal Hemorrhage in Typhoid Fever
with Adrenalin Chloride Solution without a
Chairman, Norfolk, Va., Dr. Geo. H. Carr, Death," Dr. C. F. Eason, Hickory, Va.
Portsmouth, Va., Dr. C. B. Griffin, Winton, "Quarantine Disinfection," Dr. C. L.
N. C, Dr. I. Brown, Norfolk, Va., Dr. A. Pridgen, Kiuston, N. C.
K. Tayloe, Belhaven, N. C.
Censors—Dr. F. D. Drewry, Chairman,
"The Roentgen Ray in the Diagnosis of
Pulmonary Tuberculosis," Dr. James W.
Virgilina, Va., Dr. W. T. Griggs, Poplar Hunter, Norfolk, Va.
Branch, N. C, Dr. W. Mitchell, Lewiston, O "Brief Report of Some Recent Surgical
N. C. Cases," Dr. Armistead K. Tayloe, Wash-
Obituary—Dr. L. I-ankford, Chairman, ington, N. C
Norfolk, Va., Dr. J. T. Burbage, Como, N. "Sarcoma of Ovary, with Report of a
C, Dr. R. T. Sty 11, Newport News, Va.
Nominations—Dr. J. M. Gibson, Chair-
Case," Dr. J. E. Rawls, Suffolk, Va.
"Report of a Case of Lizard in Stomach, "
man, Suffolk, Va., Dr. J. R. Parker, Tyuer,
N. C, Dr. J. O. Joyner, Severn, N. C.
Invitations—Dr. Joel Crawford, Yale,
Dr. A. M. Burfoot, Fentress, Va.
"Report of a Case of Tubercular Bone
Disease," Dr. W. B. Barham, Newsoms,
\'a.. Dr. E. G. Moore, Elm City, N. C,
Dr. W. J. Adams, Norfolk, Va.
Arrangements— Dr. J. E. Sebrell, Chairman.
Dr. I. Brown, Dr. G. H. Carr, Dr. R.
L. Corbell, Dr. C. W. Doughtie, Dr. W. E.
Va.
"Tonsils and their Removal," Dr. W. E.
Driver, Norfolk, Va.
"Epilepsy," Dr. W. B. Murphy, Snow
Hill, N. C.
Driver, Dr. H. R. Dupuy, Dr. S. H. Graves. "Report of a Case of Severe Injurv to
Dr. C. R. Grandy, Dr. Jos. Grice, Dr. L.
Gwathmey; Dr. E. T. Hargraves, Dr. W.
Back," Dr. J. W. Smith, Branchville, ^'a.
"Advice as to the Treatment of Acute
L. Harris, Dr, D. L. Hirschler, Dr. Emer- Gonorrheal Urethritis," Dr. D. L. Hirschson
Land, Dr. E. A. Land, Dr. B. Lankford,
Dr. J.J. McCormick, Dr. H. Old, Dr.
R. L. Payne, Jr., Dr. J. G. Riddick, Dr. L.
T. Royster, Dr. C. A. Saunders, Dr, J. E.
ler, Norfolk, Va.
"The Great White Plague Among the
Blacks," Dr. W. T. Griggs, Poplar Branch,
N. C.
Sleet, Dr. J. R. Speight, Dr. R. S. Spill- "Malarial Hsmoglobinuria," Dr. IC. W.
man. Dr. R. W. Sturgis, Mr. H. M. Dick- Lassiter, Rich Square, N. C.
son, Mr. J. A Hall, Mr. A S. Martin, Jr., "Hookworm Disease," Dr. E. F. Reese,
Mr. Walter H. Taylor, Mr. T. S. South-
Courtland, Va.
gate.
The Hookworm Disease, "Dr.
following are a few of the papers
E- C. S. T:
.
ferro, Norfolk,
read:
Va.
President's Address to the Public and Pro- The Complications of Gonorrhea and
fession—Subject, "Cancer," Dr. Southgate their Treatment," Dr, C. W. Cowper, Nor-
Leigh, Norfolk, Va. folk, Va.
Oration — '
'The Student Doctor," Dr. W, "Some Remarks on an Unusual Heart
T. Parrott, Kiuston, N. C. Case," Dr. O. C. Wright, Jarratt, Va.

EDITORIAL. 40]
. ; .
ellagra," Dr. C. C. Werteubaker, U. of great prominence as a physician, and
^ H. S. also prominent in the different lodges in his
Repcrt and Exhibition of a Case of city.
Pellagra." Dr. Ivuerson Land, Virginia Dr. Fry graduated from the University
Beach, \'a. of Virginia, Medical Department, Char-
"The Double CatheterizingCystoscope in lottesville, Va., in 1S72, and since that time
Renal and \'esical Diagnosis," Dr. R. L. he has been engaged in the practice of his
Payne, Jr., Norfolk, Va.
Traumatic Retroperitoneal Haematoma,
profession.
with Report of a Case," Dr. E. T. Hargra\e,
.Norfolk, \ a.
^
rterine Descent, Its Prevention and
Cure," Drs. Gwathmey and Ruffin, Xor-
Dr. J. W. McLaughlin, of Austin, Texas,
aged 64 years, and one of the most promi-
neiit physicians of the south, died at his
home on'November the 1.3th, after a linger-
' ing illness, due to a complication of dis-
eases.
_
Marriages. Dr. McLaughlin was formerly president
University Medical School at Galveston,
Dr. Robley DunglesonBates. of Xewton. Texas, and was at several diilerent times
Va., and Miss /innie Walker Davis, of president of the Texas Medical Society.
Fredericksburg. \'a., were married at the He graduated from Tulane University of
home of the bride's brother, Mr. Hunter P. Louisiana 1903; Chicago Post Graduate
Davis, in Cumberland. Md., on November Medical School 1905; and from the Chicago
the 17th. Dr. Ustes is a young physician Polyclinic in 1907. Dr. McLaughlin will
of great prominence in Virginia, who since be greatly missed in state and throughout
his graduation in 1906 from the Medical the South.
College of \'irgiuia, has been practicing his
profession in Newton. ^r. A. F. Anderson, the oldest practitioner
in Chester County, S. C, died at his home
Dr. Robert Scolt Fitzgerald, of Rich- near Lowryville, on November the 1st. Dr.
mond, Va., and Miss Juliette Johnston, of Anderson's health had not been good for
Danville, Va., were married at Mill Brook, some time, and his death was not unexpec t
the home of Mr. and Mrs. \V. D. Hill, near ed.
South Boston, Va. Dr. Anderson graduated in 184.5 from the
Dr. and Mrs. I'itzgerald will make their Medical College of Georgia, Augusta, Ga.,
home at 2706 East Broad St., Richmond, and since that time he has been a veiy suc-
Dr. I'itzgerald has 1)ecome cjuite prominent cessful practitioner of his profession.
in his profession in Richmond since his
graduation in 19(l.S from the University Col- Dr. J. P. Poivcll. a nativeof North Caroliiege
of .Medicine, Richmond, \'a. na, but for many years a citizen of Gresham,
Ore., died at his home in that city recently.
Dr. Richard P. Bell, of Baltimore. Md., Dr. Powell was born in Ciatesville, Gates
and Miss Mamie Campbell (irasty, of Staun- County, N. C, October 4, 1822, and went
ton, \'a., were married at the liome of the to Oregon when he was ten years old.
bvi,i..'s mother on November the 24th. Dr. Dr. Powell was a practicing physician for
:~ a native of Staunton, but for the last many >ears, having graduated in medicini-ars
has been living in Maryland. from the Louisville Medical College. Louise
. r. Bell was educated in the academic ville, Ky., several years ago.
and medical and departments of the Univer-
sily of \irginia, and for the last several Dr. J. L. Mann, a premising young physiyears
has held a position with the Union cian of Anderson, S. C, died suddenly at
Protestant Infirmary of Baltimore. the home of his father, Rev. Coke D. Mann,
Dr. and Mrs. Bell will reside in Chatta- at West Union, S. C, on November the
nooga, Tenn., where Dr. Bell will practice 29th. Heart failure was the cause of the
his profession.
— rr^^jrrrT:
Deaths. .
""
death.
jjr Mann graduated from the Charleston
Medical College, Charleston, S. C, in 1901.
He practiced several years in Brancln ille.
Dr. Richard Watson Fry. a leading phy- S. C, and went to Anderson about a \ ear
sician of Roanoke, Va., for the past twenty ago.
years, died on November the 22nd, in the
JelTer.vm Hospital, following an operation Dr. N. G. Thomas, of Apison, Tenn, died
which was performed several days ago. at his home on November the Sth, after a
He wasfiflynine vearsof age, and a man lingering illness. Dr. Thomas formerly

4 02 THE CHARLOTTE MEDICAL JOURNAL
lived in Chattanooga, Tenn., where he i? toms without interrupting pregnancy in a
well known and highly esteemed. number of cases given up as hopeless, and
Dr. Thomas graduated in 186S from sent to the hospital to have labor induced.
Washington University School of Medicine, The finger will often serve as a dilator, and
Baltimore, Md. in every case the greatest care must be used
not to rupture the membranes. Rectal feed-
Dr.A.T Gotten, a well known and highly >"S: ".ay have to be used in desperate
esteemed physician of Raleigh, N. C, died '^^^^^^
in Rex Hospital in that citv on November
the 10th. Until eight years ago, when his The Alabama Medical Journal, Sepiembc>\
health failed. Dr. Gotten was one of the -^9(99.
most prominent physicians in Wake County, The Doctor aad Proprietaries.— Dr. C.
but at that time he was forced to give up L. Murphree says be ethical. A doctor i.s'
his practice. always shy of the druggist who attempts to
Dr. Cotten graduated from the College of practice near medicine over his counter
Physicians and Surgeons, Baltimore, Md., and conducts a gonorrheal clinic in his back
in 1879, and was granted license to practice room. You can be assured that the medimedicine
in 1884. After his graduation he cal profession appreciates good work and
was for a long time associated with Dr. will be quick to co-operate with anv phar-
Ilerndon, who was his first medical instruc- macist who is reliable and shows that he
tor. can be trusted. Though the doctors may
have surrendered and abandoned the phar-
Dr. Nathaniel Williams, one of the most mocopea in the past they now show a disprominentphysiciansof
Tidewater, Virginia, Position to return, and in many cases with
died at his home in Hampton, Va., on No- exclamotions of surprise and wonder, that
vembor the ISth. Heart failure is supposed they ever permitted themselvee to forget a
to b the cause of his death. He was sixty- pharmacopea and to grope m fields which
six vears old when he died. He was a
l^ave brought confusion and doubt,
medical student in Jelferson Medical Col- The Management ol the Heart in Conlege,
Philadelphia when the Civil War be- valcscence.— Dr. B. H. Hamrick believes
gan, and left college to become a surgeon that in convalescence from diphtheria the
ill the Confederate service. After the war heart should be examined regularly for
he returned to Jefferson College and grad- several weeks. Sudden cessation of the
uated from that institution in 1868. Since heart's action may take place as late as the
his graduation, he has been practicing medi- sixth or seventh week, due to neuritis of the
cine, in Hampton, where he has become cardiac nerves. This tragic termination
very prominent as a practitioner. would be most deplorable. At times the
... .^x— ^^ ~^.^ phenomena of heart failure are rather slow
Review of Southern iVledical Literature
'" '^^^'^ developments
come weak and rapid,
The pulse may be
or more rarely become
slow, while the extremities become
Awerican Practitioner a7id News, September, cold, the temperature falls and there super-
1909. venes in a few hours all the signs of col-
Pernicious Vomiting af Pregnancy.— lapse. So any symptoms during convales-
Dr. W. B. Doherty believes that as there is cence that point to the involvement of the
a toxemia present in the majority of these heart should be carefully observed, and the
cases, we should direct our measures ac- patient prevented from putting undue strain
cordinglv. Malpositions of the uterus must on the heart whatever. The importance of
be corrected, a catafrhal cervicitis treated this point cannot be too forcibly impressed,
with peroxide of hydrogen, Churchill's Tr. As a routine, where indicated, such drugs
of Iodine, or a solution of Nitrate of Silver, as iron, quinine and strychnine may be
10 to ,30 gr. to the ounce. Should the va- administered to advantage,
gina or cervix be hypersensitive, a solution
of cocaine 10 or 15 per cent, may be used. Journal-Reeord of Medicine, Sept., 190^.
If the cervix be stenosed and rigid, it Kidney oi Pregnancy.— Dr. J. B. Craumay
be dilated somewhat, though this pro- mers points out that if the kidney disease
cedure should be postponed as long as pos- exists before pregnancy, well marked symi)sible
owing to the risk of producing abor- toms will develop in the earlier months,
tioii. Edgar slates that he dilated the in- The appearance of the first symptoms after
ternal OS in primiparse, curetted the cervi- the sixth month usually justifies the assumpcal
canal, scraped the cervix free from tioii that the disease has had its origin durerosions,
applied pure carbolic acid to the ing pregnancy and is nothing more than
cervix and canal and relieved the symp- the temporary disturbance of that condi-

REVIEW OF SOUTHERN MEDICAL LITERATURE. 40.>
tion. It is always of paramount import- carry us far until we have recognized the
pnce ill any case of pregnancy to know equal if not greater necessitv for rational
what the condition of the kidneys may be. and phvsiological treatment of the skin.
hence in all cases the urine should be re- Linen, cotton and silk undergarments can
peatedly examined. If albumin appears in be made, and are made, so as to imprison
small quantity, and there are no casts, with air in their meshes. Such garments are
no history of a previous nephritis, and no every whit as warm as flannel to which
general systemic disturbance, dietetic and they are superior in their possession of those
hygienic management may be sufficient, absorptive and ventilating properties of
Meat should be eaten but every other day, which Annuel is so conspicuously devoid.
large draughts of water should be systematically
drunk, proper and adequate underclothing
should be worn, and laxatives
Virginia Medical Semi-Monthlv, Sept. 2Atli.
1909.
should be taken regularlv. „ .. ^ ,,^ ,^ ^^ ,^
Pellagra.— Dr. \V. \' . Drewry quotes Y)\-.
Notes Gathered From a Study of Three Bardin's findings on postmortem examina-
Hundred Cases ol Small Pox.-Dr. M. tion of a case as follows, the brain and
Cooke believes that small pox can be trans- spinal cord being sent to Dr. Flexner, of
mitted by the mosquito and sites the follow- Rockefeller Institute, New York:
in?:
During July, 1901, there were about two
hundred and fifty cases of variola in River-
Chronic pericarditis; hypertrophy of left
ventricle: very marked chronic fibrous myo-
carditis; cloudy swelling of heart muscle;
side Hospital, North Brothers Island. This chronic endocarditis. Chronic adhesive
island is situated at the foot of East i38th
St., New York City. At this time mosquitoes
and flies were numerous. During a
pleurisy, both lungs; atelectasis of lower
lobe, left lung; old, healed calcareous tu-
berculous foci both lungs; chronic passive
stiff breeze one day several mosquitoes and congestion both lungs; chronic passive conflies
were blown over to the Borough of the gestion abdominal viscera. Cloudy swell-
Bronx, about a mile away. This was fol- ing of the liver. Atrophy of iho stomach.
lowed by an epidemic of variola in that
locality. Was this epidemic caused by
Acute duodenitis. Chronic atrophic enter-
itis; acute enteritis with erosions. Chronic
either of these insects, or did the epidemic and sub acute colitis. Chronic appendioriginate
in some other way? It is reason- citis. Arterio-sclerotic nephritis, both kidable
to suppose that either might hav^ been neys. Arterio sclerosis and atheroma of all
the etiological factor. tli(,>ugh the author is the arteries, extraordinarily marked in the
inclined to l)elieve that mosquitoes trans- anterior coronary,
mined the disease. Flies that had soiled
,„,^^„„3, ,rritalion-Treatment.-Dr.
the.r feet with the .small pox pustules, etc., ^. ^ ^^^^.^^^ ^^^^ ^^ ^^^ ^,1 ^^
could easily carry the contagion. Mosqui-
^^^^ ourselves with the new fruits and
toes could also carry it in that way, but he
vegetables, and frequently tax our digestive
beheves that they transmitted it by inocu-
^ ^^^tus to the utmost; in fact, we ingest
lation Several times the author has been
^^^^ quantities of food as to give nature
mocuated by mosquitoes and as a result a
^ore than she can use in overcoming the
pustule would form This was not uncom-
„^,^^^i ^^^^^^ j„ ^1^;^ ^^y our bowels
mon in Riverside Hospita l.
become overloaded with unnecessary ma-
... ,, „ ,, ,, ,. .
GaiUards Southan Medicine,
c- ^.
Sept.,
,r,r,n
1909.
terial which fumishes au excellent culturc
^^gdium for the toxin forming bacteria.
Tubercle and Underwear.— Dr. L. Wil- Then follows the inevitable fermentative
liains says that if this demon is to be cheat- process, and toxins are made and thrown
ed, the cominunity must be purged of this out in large quantities, not only to irritate
preposterous heresy. 'I'he skin must be the intestinal mucosa, but, if allowed to retrained
by cold baths and exposure to other main, to be absorbed, causing a general
cold influences adequately to perform its autoinfection with the many accompanying
contractile duties. Underclothing must be symptoms and discomforts,
in consonance with physiological princi- When such a case is taken in hand early
pies: that is, it must be warm, absorbent it is usually an easy matter to combat it.
and ventilated. Nature did- not intend us My treatment in such cases is to rid the
to live in hot houses, neither did she impose bowel of its contents with draughts of a
clothing upon us. If we would live health- saline-effervescent laxative containing 60
fully and allow our children to develop per cent, of chemically pure magnesium
normally we must revert to natural condi- sulphate. Continue this at half hour interlions
so far as the exigencies of civilized vals in from one to three teaspoonful doses
life will ])ertnil us. The necessity for pure until one of more watery bowel evacuations
air is gaining recognition, but it will not follow. When assured that the bowel is

404 THE CHARLOTTE MEDICAL JOURNAL.
empty of ils irritating contents, begin giving
at intervals of two hours two tablets,
each tablet containing:
Zinc sulphocarbolate, gr. ss
Calcium sulphocarbolate, gr., j
Sodium sulphocarbolate, grs iiiss
Bismuth salicylate, gr., j.
Menthol, gr., one-fifteenth.
Dyspepsia—A Misnomer.— Dr. W. B.
Steward believes that after exhausting the
ordinary methods of examination it is well
to remember that the iluoroscope and X-
Ray photograph will often present to our
eyes the real cause of trouble. So perfect
have become the methods of this most wonderful
of our diagnostic aids that beginning
and advanced ulcers, cicatricial contractions,
masses, organic displacements, and
foreign bodies arerecognized with comparative
ease. By the administration of bismuth
salts prior to the X-Ray examination
it is possible not only to picture the size,
location, and condition of the stomach but
also the small intestines, the appeiulix sometimes,
and the colon. It is well worth the
time of every physician to read the most
interesting article presented at the recent
meeting of the A. M. A. at Atlantic City
on "X-Ray Evidence in Gastric Cancer"
by A. N. Crane, Kalamazoo, Mich., together
with the discussion that followed in
the section of the Practice of Medicine.
With such a scientific and comparatively
exact power at our command we owe it to
have such an examination made in our
doubtful but yet hopeful cases.
The Auieiican Practitioner and News, Aug.,
1909.
Spasms of the Larynx.— Dr. W. Cheatham
says that the paroxysms of laryngismus
stridulus probably differ only in degree
from the general convulsions that are also
common in rickety children. In most epileptic
convulsions there is laryngeal spasm
which causes the initial "epileptic cry."
During the paroxysms of hydroyhobia there
is also a spasm of the glottis.
Lastly, spasm of the larynx is met with
in certain general neuroses, in tetany rarely,
in hysteria occasionally. In the latter it
may occur in paroxysmal or more continuous
form. The paroxysmal form constitutes
one variety of hysteroid convulsion.
The continuous form is very rare. There
is tridor with inspiration and expiration,
the voice is feeble, and there may be hysterical
rapid breathing. The diagnosis
from hysterical abduction-paralysis rests
on the fact that the stridor in spasm accompanies
inspiration as well as expiration,
and the voice is more altered than in abduction-palsy,
in which also the loud whist-
ling inspiration contrasts with the almost
noiseless expiration. The laryngeal .symptoms
usually partake of the character of the
other disturbances that may be present: the
spasm is accompanied by other spasmodic
or convulsive symptoms: the paralysis, by
loss of power or of sensibility. It is probable
that some cases of supposed spasm
have been really instances of abductionparalysis.
Book Notices. \
Modern Materia Medica and Therapeutics.
By A. A. Stevens, A. M., M. D., Professor
of Therapeutics and Clinical Medicine,
Woman's College of Pennsylvania;
Lecturer on Physical Diagnosis in the
University of Pennsylvania; Phvsician
to the Episcopal Hospital and to St.
Agnes's Hospital; Assistant Physician to
the Philadelphia General Hospital; Fellow
of the College of Physicians of Philadelphia,
etc. Fifth Edition, thoroughly
revised in conformity with the eighth revision
( 190.5 j of the United States Pharmacopoeia.
Philadelphia and London: W.
B. Saunders Company. 1909.
This edition has been thoroughly revised,
and contains many important modifications
and considerable additions. The section
dealing with the action and uses of drugs
has been in a large measure rewritten.
ArticTes dealing with a number of the newer
remedies have been incorporated, and new
formula have been added where it was
thought they would make more clear the
therapeutic application of the drugs under
consideration. No doubt this edition will
be found equal to existing requirements,
and that it will prove as acceptable to students
of medicine as the former editions
have.
This edition is neatly bound in cloth, and
contains 67.5 pages of reading matter and is
well indexed. Price cloth, §3.50 net.
Exercise in Education and Medicine. By
R. Tait McKenzie, B. A., M. D., Professor
of Physical Education and Director
of the Department of Medicine University
of Pennsylvania: I'ellow of the College of
Physicians of Philadelphia and of the
American Academy of Physical Education;
President of the Society of Directors
of Physical liducation in Colleges; Sometime
Lecturer in Anatomy and Medical
Director of Physical Training at McCtHI
University; Lecturer in Artistic Anatomy,
Montreal Art Association, Harvard Summer
School, and Olympic Lecture Course,
St. Louis, 1904. With ,M6 illustrations.
Philadelphia and London: W. B. Saunders
Company. 1909.

BOOK NOTICES 405
.
1
This book is intended for students and from the standpoints of the symptoms, the
practitioners of physical training, for teach- disease, the bimanual and microscopic finders
of the youth, for students of medicine ings, and the general physical and nervous
and for practitioners, with the purpose to state.
give a comprehensive view of the space ex- The knowledge gained by studying the
ercise should hold in a complete scheme of diseases of women from fhese different
education and in the treatment of abnormal points of view gives a more distinct mental
or diseased conditions.
l^xercise has so many points of contact
picture and hirnishes logical co-ordinated
conclufions. Tliii second edition has been
with education, it is so intricately related thoroughly revised and the chapters on
to menial, moral and social training, each electricity and hydrotherapy have been enof
which alone is so partial and incomplete larged. Several chapters on Head Zones
that the progressive educationalist is now have been added as an aid to diagnosis, and
comijelled to study its bearing on all three, various other additions have not interfered
The author of this book has striven to, with the purpose of keeping this book withand
has well brought out the comparison in the limits which tend to make a practical
between medical science and exercise. It working compendium.
gives us a great deal of pleasure to recom- This volume is beautifully and neatly
mend tiiis book to instructors in colleges bound in cloth ur half morocco. It is well
and high schools. Indexed ard contains 702 pages, witli 150
This book contains 406 pages, with 34G original illustrations. Price: Cloth, $5.00
illusirations, iscarefully indexed and neatly net; half morocco, $6!50 net.
bound. I'rice, cloth S.^.50 net: Half Morocco
55.00 net. Surgical Diagnosis. By Daniel N. Eisen-
A Text-Book of Obstetrics. Bv Barton drath, A. B., M. D., Professor of Surgery
('"..ke Hirst, M. I)., Professor of Obstet- bi the Medical Department of the Unii:i
the University of Pennsylvania: versily of Pennsylvania ' College of Phyologist
to the I'loward, the Oillio sicians and Surgeons'; .\lieiiding Sur-
, and the Philadelphia Hospitals, geon to the Michael Reese and Cook
ir Sixth edition, revised and enlarged County Hospitals, Chicago. Second edi-
.r,li ^47 illustrations, 43 of them in col- lion, thoroughly revised and enlarged,
IS. Philadelphia and London: W. B. with 574 original illustration.s, 25 of them
Saunders Company, 1909. i" colors. Philadelphia and I^ondon:
This volume is the result of the experi- W. B. Saunders Company. 1909.
lence of a practice devoted for the last twelve 'I'l'e popularity of this book on Surgical
iyears exclusivclv to gynecology in both its Diagnosis is evident by the fact that the
Ibranches—obstetrics and gvnecic surgery, second edition has been called for by so
IThe author has served during this period as many people within two years after the
IcoiisuUing and attendant gynecologist and publication of the first edition. The text
Ustetrician in eight of the principal hospi- of the previous edition has been thoroughly
kals of Philadelphia. His experience in revised and much new subject matter has
obstetrical complications and operations »'een added. Every effort has been made
has consequently been exceptionally large, to include the newer methods of diagnosis
It has been the aim of the author to con- and to amplify those which were taken up
dense the text as far as is consistent with previously, especially the chapters on cystothe
comprehen'sive treatment of the subject, scopy and ureteral catheterization Many
The volume contains 992 pages, is well sections have been entirely rewritten,
indexed and is neatly bound in cloth and Many additions have been made m the
__lf morocco. Prices: Cloth, $5.00 net; section on acute abdominal conditions.
'^^^
lalf morocco $6.50 net.
section upon diagnosis of renal lesions
has been entirely rewritten in order to keep
Medical Gynecology. By Samuel Wyllis pace with the rapid advances of this field.
Handler, M. I)., I'ellow of the American This book is well bound, well indexed
Association of Olistetricians and Gyne- and contains 885 pages of reading matter,
cologists; Adjunct Professor of Diseases Prices: Cloth, $6.50 net;
of Women, New York Post-Graduate $,s.00 net.
Half Morocco,
Medical School and Hospital; Associate
Attending Gynecologist to the Berth
Israel Hospital, New York City. Second
revised edition, with original illustrations.
Piiiladelphia and London: \V. B. Saunders
Company. 1909.
The various topics, which are so thormghly
discussed iu this volume are viewed
Clinical Examination of the Urine and
Urinary Diagnosis. A Clinical Guide for
the Use of Practitioners and Students of
Medicine and Surgery. By J. Bergen
Ogden, M. D., New York, N. Y;, Medical
Chemist to the Metropolitan Life In-
surance Company, New York; Late In-

406 CHARLOTTE MEDICAL JOURNAL.
structor in Chemistry Harvard University
Medical School; Assistant in Clinical
Pathology, Boston City Hospital; Medical
Chemist to the Carney Hospital: Visiting
Chemist to the Long Island Hospital,
Boston, etc. Illustrated. Third edition,
thoroughly revised. Philadelphia and
London: W. B. Saunders Company.
1909.
The revision of this book vi'as undertaken
with pleasure on account of the pleasant
reception tendered the first and second editions
by teachers and students of physiological
and clinical chemistry, and also on
account of the real need for changing the
subject matter to conform to the advances
which have taken place since the publication
of the second edition.
A number of changes have been made in
the methods, and a special effort has been
directed toward bringing technique to a
higher degree of efficiency. Much of the
unimportant matter or the first two editions
has been eliminated, and the author has
intentionally omitted the consideration of a
number of subjects which are not of clinical
importance.
The subject of urinary examinations for
purposes of life insurance has been incorjjorated
for the rea.son that a very large
number of those who enter upon the practice
of medicine will be called upon to make
insurance examinations. In the portion of
this book given up to this subject, the methods
and lechtiique have been so condensed
as to be easily understood and quickly applied.
This volume is neatly houiid in cloth, is
well indexed and contains 427 pages, illustrated.
Price, cloth, $.3.00 net.
The Principles of Hygiene: A Practical
Manual for Students, Physicians and
Health Officers. By D. H. Bergey, A.M.,
M.D., Assistant Professor of Bacteriology,
University of Pennsylvania. Illustrated.
Third edition, thoroughly revised and enlarged.
Philadelphia and Loudon: W.
B. Saunders Company. 1909.
This book has been prepared to meet the
needs of students of medicine in the acquirement
of a knowledge of those principles on
which modern practices are based, and to
aid physicians and health officers in familiarizing
themselves with the advances made
in hygienic practices in recent years. The
rapid strides made in our knowledge of the
entire subject of hygiene has rendered such
a book as this one, based upon the more
recent discoveries, almost a necessity to students
of medicine. It has not been the object
of the autho-, in writing this book, to
treat the subject in an exhaustive manner,
the object being merely to give the general
principles upon which the health officer and.*
the physician work in their r spective ca-*
pacities in dealing with conditions whichf
are detrimental to health or which tend to
improve health. It gives the Journa
great deal of pleasure to recommend this
book to students, physicians, and health
officers, for whom it was prepared.
This volume contains 555 pages, is care
fully indexed and neatly bound in cloth
Price: Cloth, S3. 00 net.
Appropriately enough, both love and
politics figure in the plot of Mary Imlaw
Taylor's new novel, ' 'The Magnate of Para*v
'
dise"— politics being appropriate to the season,
and love to all seasons. The story is ,
published complete in the November Lippin- \
cott's, v.Tiich, by the way, is an extraordinarily
fine number. The scenes of "The :j
Magnate" are laid in the nation's capitol ,
and in a live town in Missouri. While the
name given to the latter is fictitious, the ,
place is quite likely to be recognized by
i
j
those who live or have lived there.
j
Like
other municipalities not confined to Mis-
souri,thetown isruledby apolitical "gang."
j
They are opposed by a young lawyer, who, ]
as District Attorney, undertakes to cleanse ;
the town's .'\ugean stables and replace the :
rule of might by the rule of right. L^nfor- i
tunately, Holland—the District Attorney— (
is in love with the ward of the Magnate of
Paradise, who is the head and the moving
spirit of the "machiner" All sorts of underhand
schemes are resorted to in order to
down the reformer, and thinks look dubious
for a while. Eventually, however, the citi- '',
zens awaken to the fact that Holland is ;
fighting their battles for them, and give i
him enthusiastic, if tardy, support.
'
The
Magnate and his henchmen are overthrown, i
and the very likable hero wins the very-)
lovable heroine. There are some intensely?*
dramatic scenes, and the interest is not per-ii<
mitted to lag for a moment.
j
Some remarkable short stories will be .j
found in this issue. One of them is "Mary
and Martha at Lunch," by Marion Hill,l
author of "The Pettison Twins." Thii
has rare originality and subtle humor, will'
a dash of pathos by way of seasoning
"Love and a Morning Ride," by Elizabetki
Maury Coombs, is a striking tale of
Southland. Other good stories are "A Deas<
Letter Come to Life," by Anne Warn*
"Lost—a Turkey," by Elliott Flower; "TH
Sight of the SouL" by Helen Talhot Port#
' and "Much Ado About Xuilung, by Tli
L. Masson.
Arthur Stunley Riggs, who has recentl]
been made a Fellow of the Royal Geograph
j

ABSTRACTS. 407
ical Society, contributes a delightful paper the adult. The ankles aud some of the
called "Snapshots Around Naples." The tarsal articulations, wrists and knees, were
authors who are represented in the depart- swollen and extremely tender. There was
ment "Ways of the Hour" are Rupert Sar- some deffusiou into the joint cavities, but
gent Holland, whose novel, "The Man in no grating on manipulation; there was also
the Tower" is having a big sale; Edwin L. much peri-articular swelling extending
Sabin, Joseph M. Rogers, and Ellis O. above and below the articulations. It was
Jones. soft and boggy to feel, but did not pit on
Then there are that never failing mine of pressure; the skin was slightly reddened,
amusement "Walnuts and Wine," with its Skiagraphs of the joints showed not the
plethora of jokes, jingles, and anecdotes; slightest changes in the bones. The lymp-
"Cynicisms of an Optimist," by Walter athic glands in the groins and axillee were
Pulitzer; and poetry by Charles Hanson much enlarged and cender, some being as
Towne, Clifford Howard, Walter S. Trumbull,
Clinton Scollard, and Mary Byerley.
—
A Treat for the Doctor.
large as a small walnut; they were elastic
and freely movable. There was some beading
of the ribs and general signs of rickets.
The heart and lungs were normal. The
A Fhiladelphian, who has since then for- abdomen was enlarged from flatus; the liver
tunatelv regained his health, was last year appeared of normal size; but the spleen exthe
subject of an extended examination by tended four finger breadths below the costal
specialists. margin and was unduly hard. The urine
"The examination seems to have delight- contained no albumin. Examination of the
ed Dr. Blank," said the patient to one of blood showed 30 per cent, haemoglobin, with
the doctors, when they were alone for a 1,000,000 red corpuscles aud .5000 leucomoment,
"fori have noticed that his eyes cyles to the c.mn. The temperature on adare
positively beaming. I assume, then, "I'ssion was normal, but began to fluctuate
that my case is not a grave one." daily; on September the 29th it reached
''^-^ "Well," iiesitated the physician add;e.-s- P., and though norm:. 1 in the morning
ed, "I hardlv feel justified in saying that, generally reached 101 1-. in the evening.
But I understand from Dr. Blank that he is '^^e jomt tro bles contniued, and by the
going to perform a number of interesting middle of October the temperature began to
operations on you."—October Lippincott's. ^^^o^ regular exacerbations lasting four or
five days, with intervals of comparative
.. . . j^i. 1 J- J.' 1
Abstracts Ot the Leading articles
of the month.
apyrexia. Thus from October 17th to the
22„d the evening temperature rose each
evening to 104° F., from October 22ud to the
27th it was normal; from October 28th to
A Case ol Rheumatlzed Arlbrilis In a November 7th, except for one day, it rose
Cbild aged twoand a hallyears.- Parkin each evening to 104° F.; after this ihe rises
son f British Journal of Children's Diseases) were less high, though from November 10th
ireports the case of a child aged 2 years and to the 17th it rose from 102° to 103° F. ; after
I
14 months. The personal and family history
were good; there was no history or evidence
lof syphilitic taint, or of tubercular disease,
this the fever abated. During the febrile
periods all the symptoms were much more
marked, the joint swellings increased, and
Three months before admission she began
[to sutler with pain and swelling of both
the spleen and lymphatic glands also become
larger. The child lay in a drowsy
wrists and the left ankle. She was confined condition and seemed to be suffering from a
to bed, and other joints, such as the knees general poisoning. After the temperature
and left ankle and elbows, became involv- fell the spleen and lymphatic glandslessened
ed. She took food well, but wasted consid- in size, and by January, 1909, appeared to
erably, and as no improvement occurred be nearly normal. The joint swellings also
she was brought to the hospital. On admis- diminished, leaving great muscular weaksion
she was pale, with an earthy tint of ness, but no tenderness nor adhesions. The
skin, anaemic and wasted, weighing only child was in much better general condition,
pounds. The skin was wrinkled and and the weight which had fallen to 18
inelastic, and there was a brown staining pounds, rose to 20 pounds.
of the deeper layers of the skin diffuse on
^^^^^ ^, Henoch's Purpura.-
the whole, but here and there with detached . „ . .
, , , . „ , ,
areas on the dorsal surfaces of both feet, Parkinson British Journal of Children s
(
Diseases.) mentions three cases. The fii
the front of the legs aud the front and inside
of the thighs, also on the adjacent part of the case was a boy, aged b years who suffered
Tower abdomen. This was identical in from pains in the legs and abdomen and a
character, though not in distribution, with purpuric rash over most of the body and
the staining seen in rheumatoid arthritis in limbs. The spleen could be felt. The urine

408 THE CHARLOTTE MEDICAL JOURNA; .
contained albumin and occasionally a trace follows: 1. In stenosis due to ulcers, as
of blood and casts. The abdomen was ten- well as cases of ulcer persisting- in spite of
der in the epigastric and right iliac regions, prolonged internal treatment posterior relroaud
there was occasional vomiting. The colic gastroenterostomy, with a circular
child was treated with two injections of double row of sutures, is the procedure of
horse serum without any improvement, but choice. In cases of relaxed and dilated
recovered and was discharged with the stomach, a prophplactic enteroanastomosis
urine still albuminous. Case 2 was a boy, after the method of Braun is indicated. 2.
aged 6 years, suffering from abdominal pain Following operation in cases of open ulcer
and vomiting. There were purpuric spots the administration of acid reducing remeall
over the extensor aspects of the limbs, dies, later combined with irrigation, as well
The abdomen was not tender. The urine as the careful selection of foods, is of imcontained
albumin and occasionally blood, portance. ,3. Resection is to be considered
In hospital he was suddenly attacked with whenever there is a suspicion of the maligabdominal
pain, and the abdomen was ten- nant character of a gastric tumor as well as
der in the left lumbar region. The pain for severe callous ulcers, especially when
continued on and off fornearly two months, neighboring organs (liver and pancreas)
occurring in crises every two days. Blood have been eroded. According to the con- ',
was found in the srools during most of this ditions present in each case, either the raditime.
Later the face became puffy, espe- cal operation of resection or the less dangercially
the lips and the eyelids, but the child ous gastroenterostomy is performed. Rebegan
slowly to improve. .The treatment section should be done after the manner of ,
was at first calcium chloride, and, later; Riede! (circular). 4. In nervous affections
three injection.s of horse-serum. Two fresh of the stnmach operatton iscontraindicated,
groups of purpuric spots appeared while the excejit an exploratory laparotomy, to de- J
child was taking calcium. The third case, termine whether an ulcer is present or not. }
under the care of Dr. C. Bolton, was a boy Among the one hundred and twenty four k
aged 6 years, who came into hospital with cases reported there were ten circular and i
severe pain and passing blood in the stools, segmentary resections and one hundred and (j
with a measly, non purpuric rash and cory- four gastroenterostomies. Of the former jj
za. The next day he passed blood and cases, two died, while the mortality in {|
mucus by the rectum. The abdomen be- ninety-six gastroenterostomies was nine
came distended, audit was thought that in- deaths. Of the seventy six cases of ulcer
tussuscejjiion might be present, and the ab- examined a year after operation, sixty-five
douien was opened, but none found. There were completely cured, eight had slight
were flecks of lymph in the peritoneum with gastric disturbanees and in two cancer had
some evidence of general peritonitis. He developed. In twelve cases of resection the
died next day. At the necropsy there was end-result was good, although two required
a general peritonitis, and on the small int°s- another operation for stenosis. In sixtytine
were about 1,3 hemorrhagic extravasa- one of sixty-fonr gastroenterostomies the
tious about the size of peas and projecting end- result was satisfactory. _„ ,
on both outer and inner surfaces of the in- '•
testine. About a foot from the ilo-ccecal Ttic Elficacy of the Anti-Gonorrlteic 1;
valve there was a collection of much larger Arhovin.—N a ge 1 (Zeitschrift f. neuere ij
heemorrhages. The small intestine wasdis- physik. Medizin) s^ys he has used arhovin -ft
tended with gas, and the larger intestine as for three years, with generally favorable |
far as the splenic fissure where for about six results, and considers it indicated in gonorinchesit
was quite dark from diffuse haenior- iheal diseases of the genital organs and
rhage, thickened and looked almost gan- urinary passages in the dose of two capgrenous.
The diagnosis lay between measles sules thrice daily. He also employed it in
and Henoch's purpura, the suspicion of in- the form of vaginal globules and bougies.
tussusceptioH not being verified. Dr. Park- Untoward effects from its use never occurred,
inson thought it was a case of purpura, but The duration of the arhovin treatment is, i
the absence of blood and albumin in the on the average, between two and six weeks, i
urine was unusual. The case supported a In acute gonorrhea he considers it especisuggestion
of Mr. H. Lett, made in the ally important to have the patient taking
"Reports of the Society for the Study of arhovin observe the dietetic and hygienic
Diseases in Children," that it is advisable requirements. His most recent observa-.
not to operate for intussusception in a case tions have certainly confirmed his earlier
of Henoch's purpura unless an abdominal conclusions. The chief effects of arliovi;"
tumor could be felt. are secretion lim.iting and analgesic; th
Surgical Treatment of Benign Gastric discharge becomes less and the pain
Affections— Busch (Archiv. f. Klin. Chir. ) urination disappears. The urine, at fir
from an analysis of 124 cases concludes as cloudy, becomes clear.

ABSTRACTS 409
Certain Bacillus Coll Inlcctlons.-Bris- doubtedly best to employ a vaccine precoe,
in The London Medical Lancet, states pared from the organism which is attackthat
in treating Bacillus coli infections it is ing the patient, and a vaccine can easily
necessary to discriminate between the severe be prepared in the course of three days,
and milder types of cases. Because the Inoculations should be given every seven
bacilli are found in the urine it is not neces- or eight days. The initial dose for an adult
sary at once to rush to vaccines, and even of 50,000,000 of dead organisms (e.stimated
in the more chronic forms where vaccina- according to the method ad\ ised by Sir
tion will be the best remedy, it is inexpedi- Almroth Wright) will be comfortably tolerent
to neglect all other measures and rely ated. The second dose should be half as
on this alone. Many such cases must have much again, and so on. It is also advisoccurred
in the past when the condition able to have a fresh vaccine prepared each
was less well recognized and the patients month, better results being obtained than
have recovered, and no doubt many cases when the same vaccine is employed conof
unexplained febricula may have been tinuously. This may be explained on one
instances of this condition. Therefore each or two grounds. Either the vaccine loses
patient ought to be treated according to the some of its potency or the organism is able
severity and duration of tlie disease. The to develop power to protect itself from the
milder forms will yield lo the well recog- alttibodies produced by the host as a result
nized treatment of an ordinary febrile at- of the vaccination. It will be remembered
tack, a uot bath, a mercurial page, rest in
bed, and reduced diet. Should the condition
not clear up at the end of a weekorten
days, then the sooner more radical meas
that this latter occurs in the case of trypa-
nosomes against which atoxyl is adminis-
tered. Whichever explanation is correct,
the fact remains that greater improvement
ures are adopted the more likely is the con takes place when the vaccine is freshly predition
to resolve. It should Ise remembered
that the Bacillus coli is an inhabitant of the
pared every month. It must always lae re-
membered that the condition, when once
intestine and in cases of constipation flour- well established, is very refractory, and it
ishes to a marked degree. Therefore it is is well to start treatment early and to carry
important to promote a fairly free evacua- it out energetically. The general health
tion of the bowels daily. Without such an must also be seen to and any abnormality
evacuation all other treatment will be un- should be rectified.
satisfactory. In the second place it is well
Tbe Treatment of Irreducible Intus-
to give some intestinal antiseptic to hinder
the growth of the organism, such as creo- susceptlon by Lateral Anastomosls.sote
or small doses of calomel (1-20 of a Parry (British Journal of Children's Disgrain
) after each meal. This latter drug eases) says that the method of treatment
in such doses has in his hands proved fairly was said in the text-books to be only apsatisfactory,
but some prefer to try to re- plicable to chronic cases. Two acute cases
place the Bacillus coli with a lactic acid were referred to, one of Mr. Parry's and one
bacillus by means of artificially soured of Dr. Rutherford's. On the tenth day in
milk. Seeing that many of the prepara- Mr. Parry's case, no trace of a tumor could
tions of lactic acid organisms contain no be felt, and this was verified by examinaliving
bacilli this is less certain than it ap- tion. Mr. Parry put forward, firstly, the
pears. The Bacillus coli flourishes in an simplicity aid safety of the method as comacid
medium; it is therefore advisable to pared with excision; secondly, fliat an al-
alter the reaction of the urine, which should ternative line of treatment was afforded to
be rendered alkaline by the administration that of severe manipulation in irreducible
of the drugs usually employed to this end, intussusception; and, thirdly, the disappearto
which urotropine in .S or 10 grain doses ance of the tumor. Mr. H. Stiles said the
may be added. This relieves the patient of paper was a landmark in the treatment of
many uni)leasant svmptoms and hinders irreducible intussusception. lie had bethe
proliferation of the organism. The come pessimistic on the subject. Patients
urine should be tested from time to time to had died after resection where he thought
see that enough alkali is being given, and recovery would take place. He had been
it is sometimes advisable to give rather more agreeably surprised that a good many cases
than the usual dose the last thing at night, had recovered where there had been ex-
This will often be successful in procuring a treme difficulty in reducing the intussusgood
night's rest without the use of ano- ception, and even after splitting the peridynes.
Should this treatment not be sue- toneal coat. The gangrenous cases were
cessful in diminishing the numbers of the very difficult, and his only criticism of the
microorganisms in the urine and relieving paper was that the treatment was hardly
symptoms it is advisable that inoculation applicable to those. He had had better reshould
at once be resorted lo. It is un- suits when he operated as quickly as possi-

4in THE CHARLOTTE MEUICAI. JOUKNA).
ble, and though the children often looked organs. These occur especially at the time
moribund it was wonderful, if the treatment when the bones have not sufficient strength
was properly carried out—no drugs and to suBtain the body. The exudative diaplenty
of saline by the bowel—how they thesis is an individual condition, in part
recovered. Once they had got over the hereditary, under favorable conditions reshock
he was no longer anxious about them, maining latent, but brought into action by
The writer thought tue method was very errors in diet in the nature of an excess of
sound. fats. The lesions affect the skin, mucous
Acute Lcucocythacmla in a Child Aaed
membranes and internal organs, there be-
Eight Years.-Lapage (British Journal of
i"S transient periods of turgescence. Only
by frequent repetition do these
Children's Diseases) says that the
causechanges
first
svmptoms of the illness were headaches, ^^^ '''^ permanent. The characteristic of
'^se manifestations is their
some wasting, and a slight discharge from
evanescence,
J
^j'^>the
ear, with drowsiness, and irritability if
-'^^P^^' at a very early age and lessen
afterlhe second
roused. After these svmptoms had
year of life. As to heredi-
lasted
.v "'Auences
for 7 to 8 days the child began to vomit and
we recognize advanced age
^f ot the progenitors, debilitating diseases, etc.
to complain of tingling and numbness of
the fingers of both hands. There was no
The 'l.athesis generally occurs among the
working classes, less often
historv of haemorrhage, m persons of
tonsilitis, diarrhoea,
^e'^^''^:
dropsv, fainting or impairment of vision,
^}'^ geographical tongue, lasting
=* On admission three weeks after the begin- ^^^ few days at a tune, is noted as one of
the manifestations of this state
ning of the illness the temperature was
accompa-
100°, and there were chains of enlarged
"'ed by no disturbance of health and apglands
in the axiUcE, the groins, the an- Pe^""S "-several member, of the sarne
terior triangles of the neck,' the glands be- ^^^'^'^y- ^^e tonsils and pharynx' are sub-
,
ing discrete and none of them larger than ^^''\ *« ^lie transitory periods of congestion
a
irritation the
pea. There was no cedema,
nose being stopped up
otorrhoea, or ^"^l
exophthalmos. A dyspnea being caused by the swelling,
slight degree of vomit- f?'f,
Collections of secretion
ing was present. The m the tonsillar
stools were loose, but
showed no other abnormality. The spleen "'y?^^ "^^7 occasion foul breath and anoreached
down below the brim of the pelvis, ^^,^1^- "y. ^ Peruiaiieiit hypertrophy
^"f
and the liver reached to one inch below the ° ^^ t°"«'^? ^"^^,?, ^'" frequent repetition
^.^'^^^^^- I.l'e extirpation of
costal margin. There were
such
signs of con- f ^^.f
'^
solidation at the base of the right lung.
"^^ advisable. Acute bronchial
^°J^^'\^
"=»^'^^' characterized
The reflexes were
by asthma, with lit-
increased. Kernig's sign
f
^^^
was present, but not well marked. fecretion and no physical signs come
Babin-
^"der this head.
ski's sign was present on
The conjunctival and
the right side,
^^^''^^^ mucosa,
The
and even the intestinal
blood count gave reds 1,600.000, whites
4,52,000, hb. 35 per cent., index
^^'^^"^ membrane may be affected.
1.1. There \ ariwas
an enormous number of large lympho-
°^« cutaneous eruptions occur, \ellowish
'^''^^t^.'
cytes. The blood was whitish
^^^ removal of vvhich leaves a wet,
in appearsecreting
surface,
ance, resembling blood mixed
may form on the infant's
with pus. It
was less coagulable than normal. Death ^^'^^P;, strophulus urticaria, and pustules
are
occurred one week
a" caused in this vyay. 1 hese
after admission. The
mam-
testations occur suddenly and disappear as
spleen diipinished in size during the last
quickly linlargement of the liver ,s an-
days of life; post mortem, that organ show-
°^^^' frequent manifestation,
ed'earlv fibrosis. The bone marrow
hxamina-
of the
femur and sternum was red in color, and '""/^ ^^^ ^'°°^ ^"^ """? '" "'^' °^ }^'^
that of the ribs apparentlv normal. Pneu- ^"''^ ^^^^ "° unusua phenomena. The
treatment of this condition exists in giving
monia was present in the lungs, and there
enough food to sus
were ecchymoses on am life, the foods
the visceral surface of
f"^>'
^^'^^ '^^"^^ formation of fats being cut out
the pericardium, sections of which showed
infiltration of lymphocytes. A terminal in- of the diet. If the infant is nursing, the
fection with streptococci and staphylococci mother must employ such a diet as will rewas
found.
Tlic Exudative Diathesis.— \^ e n t u r a
duce the amount of cream in her milk. The
child should have change of air at the same
( Kiv. di Clin. Fed. ) states that in infancy, time. Medicinal treatment is directed only
and especially in the nursling, several phe- toward palliating the local svmptoms.
nomena natural to that time of life and
others that are of a pathological nature The Diagnosis ol Beginning Tabes.group
themselves into a sort of exudative Kaiin ( Berliner Kliiiische Wochenschrift)
diathesis, determining oscillations of turges- speaks of the importance of early recognicence
in the various internal and external tion of tabes, because so much can be done

ABSTRACTS.
at this Stage to check the progress of the he is about to assume a new part that his
disease and produce apparent cures. friends dare hardlv speak to him for some
Among the earliest symptoms, the writer days before the first night. Orators are
says that the pains are very important, not subject to the same infirmity. Cicero cononly
the lightning tabetic pains, but even fessed that he could never mount the rostdull
boring pains, and at times trigeminal rum without a feeling that his knees were
and intercostal neuralgias. Slight bladder giving wav under him, In his "Sixty
irritability and inability to start the urinary Years in the Wilderness," W. H. Lucv
flow are significant. relates the fjllowing examples of similar
(Juite frequently, before the Argyll- Rob- nervousness on the part of famous speakers
ertson pupil can l>e found, there is a differ- of our own day; "On a night in June in
ence in the size of the pupils. Sometimes the session of 1877, I observed Bright seatmiosis
or mydriasis are present, but especi- ed on the front opposition bench for an hour,
ally the first. A slight paresis of the ocu- The subject was a proposal to abolish caplar
muscles, especially in relation to the ital punishment and Bright had evidently
abducens nerve, mavoccur many years be- intended to speak, and might, of course,
fore any symptoms develop. have chosen his own time. He missed his
The tendon reflexes are very important, chance, and deferred his rising till after
Often we find an increased knee jerk or a midnight, when the debate was about to
difference between the two sides, long be- collapse. Chancing to meet him at dinner
fore the Weslphal symptom develops. A the next night I made remark about his delos^
of the Ach:'les tendon reflex occurs layed interposition, when he told me there
quite frequently among the earliest mani- had come upon him a species of stage
festations of tabes. The reflexes of the fright that possesses all new members on
upper extremities are of much less signifi- first addressing the House. Even Mr.
cance. The hypotonus of the muscles of Gladstone was subject to this influence.
the extremities should be sought for in all This would be incredible to observers of
cases. his later manner were it not afiirmed by
Sensory manifestations can almost always his own testimony. In the diary of his
be found very early, if careful examination second session he records how, preparatory
is made, such as a decrease of the pain to making a speech, he silently offered
sense in the lower extremities, segmental earnest prayer for Divine assistance."
anesthesia on the trunk, especially near the Lord Beaconsfield, we believe, impassive
breast and back. \'ery characteristic are as he looked, was no stranger to the sensathyperestliesias
in relation to cold objects, ion.
Delicate tests, such as the inability to feel In this country, where platform or postthe
vibration of a tuning fork placed on the prandial oratory is forced by national usage
tibia, often enable the observer to detect or social exigencies on so many reluctant
early sensory disturbances. Any of these victims, speech fright naturallv is common
symptoms, especially with previous syphi- To some, indeed, public speaking is a task
litic history, are very significant. Among beyond their powers. They need not be
the more recent work, cyto-diagnosis show- ashamed of this. Many of the greatest
ing an increased lymphocytosis in the cere- masters of language might say with Albro-spinal
fluid, is a great aid. The Was- phonse Dsudet, when invited to deliver an
serman reaction should also be tried in all address: "jen'ai jamais pu proferer une
suspected cases. The cerebrospinal fluid, parole devaut une audience quelconque."
even in the earliest stages of tabes, shows But except to those who deliberately shun
an increase of albumen and globulin. social gatherings, there comes a time when
they are called on to make a speech.
Speech Fright— livery one knows what Wliat certain persons go through on such
stage fright is, and most of us who have occassions amounts to agony, and their
had to recite speeches at school or ha\e hearers suffer in sympathy or are irritated
taken part in private theatricals have ex- by their struggles. Charles Darwin tells us
perienced the unpleasant and often par- that, when he was a student at Edinburgh
alyzing feeling. It is not the raw novice "one evening a poor young man got up
vvjio sufTere most; it might almost be said and after stammering for a prodigious
that the greater the actor, the more fright- length of time, blushing ^rimson, he at
ened he is, especially at a first performance, last slowly got out the words, Mr. President
One of the most celebrated of living act- I have forgotton what I was going to say."
resses used to suffer so much on first nights The poor fellow looked quite overwhelmed,
that it was difficult to keep her from throw- and all the members were so surprised that
ing up her part, and one of the most distiii- no one could think of a word to say to covguished
of living actors is in such a state er his confusion,"
of nervous trepidation and irritability when We have received a piteous appeal from

412 THE CHARLOTTE MEDIOAL JOURNAL
a medical practitioner on behalf of a
ents of his who suffers at such times
pati- courage" by means of alcoholic stimulant.
from — British Med. Jour,
"extreme nervousness and an all 'gone'
feeling accompanied by palpitation"— in
short, from the symptoms of speech fright,
The question is, can medical art give
Complications ot Scarlet Fever.— Gor-
don London Practitioner, says that in the
accompaying nephritis the renal tubules
relief in such a case? In the particul- are nut as a rule disease, but are merely
ar case referred to, the administration of pressed upon by the intestinal infiltration
20 grains of potassium bromide an hour the natural tendency is to complete rebefore
the dreaded moment has not been covery. We. give these organs as little
of much use. Our correspondent asks if work to do as possible; diuretics, or renal
a small hypodermic injection of morphine stimulation of any kind is harmful. We
not sufficient to cause drowsiness, would encourage action of the skin by hot packs
do good. We have no experience of this '>i' hot baths, but when the electric current
treatment, but it is within our knowledge from the main is available, free perspiratithat
the great actress who has been men- on is well induced by placing a cradle covtioned
was enabled to face the trying ordeal ered with hot blankets around the patient;
of the first night by means of 7 drops of to the top rail of this cradle several incandlaudanum.
She learned to rely confident- escent lamps are attached, and the current
ly on this medicine, which never failed of is turned on. Upon diaphoresis being
its effects. As the drug was given only on established, this cradle is withdrawn and
these special occasions she never contracted the hot blankets themselves envelop the
the opium habit. Years after learning patient, by which means the risk of exempirically
this method of preventing stage posure to cold is diminished,
fright, we read that John Hunter, who dis- The bowels are kept open by means of
liked public speaking, never gave the salines; coma, with suppressed urine, refirst
lecture of his course without nerving quires venesection and subsequent intravhimself
for the trial by taking 30 drops of enous saline solution. Dry or wet cupping
laudanum; this gave him courage to face may be employed, but these are likely to
his audience. We think it likely that lau- be useless. Uremic convulsions are rare
danum is used as a preventive of stage in children; they are not often alarming;
fright more frequently than might be sup- they mav conveniently be allayed by chlorposed.
Lord Erskine, the celebrated advo- oform inhalation, followed by chloral hydcare,
who suddenly appeared in the course rate per rectum. Diaphoresis is here again
of the trial of Queen Caroline, disconcerted essential, we avoid pilocarpine especially
the prosecuting counsel, for a great speech in children, by reason of its uncertain actwas
naturally expected; after saying a few ion. Albuminura does not usually require
words, however he fell into the arms of special treatment; it does not require con-
Lord Stanhope, who was sitting next to finement or prolonged milk die; the albumhim.
As Erskine was an old man at the in is likely to diseappear when such patitime,
it was thought that the strain and the ents are fed in an ordinary way and are
excitement had proved too much for him. allowed to get up; the microscope will at
The truth, however, appears to be that he once determine whether the albumin indihad
drugged himself for the effort with cates a lesion or is merely symptomatic,
opium, and had taken an overdose. Our Scarlatinal endocarditis decidedly requirreaders
do not need to be told that this es attention; rest in bed for the milder
method of conjuring away speech fright forms, with little alteration in the puls-rate
must be used with the strictest precautions rhythm or tension; the graver cases are no
against abuse.
We have seen it stated that an American
doubt rheumatic in origin and require the
salicylates with alkalies- The cervical adprofession
was in the habit of giving 10 enitis of convalescence usually presages
drops of fluid extract of gelsemium three nephritis, the urine being frequently found
times a day to students about to offer themselves
as a sacrifice to examiners; the effect
to contain blood and albumin two da3's later
We avoid formentaions, but if the neck is
is said to have been that "all feeling of painful we pack with cotton-wool and
uneasiness was abolished during the or- and bandages firmly. The incision for
deal, and the students were able to tell pus (should this supervenue) should be
just what they knew." This treatment made at the lowest point, and a capillary
would equally well apply to speech fright, dram inserted; it may be necessary to
but we cannot testify to its efficacy from scrape thoughly the abscess cavity, followpersonal
knowledge. As it is, harmless, ing this with a packing of dry antiseptic
however, it might be given a trial. The gauze. In hospital practice we separate
very worst method of preparing oneself to the convalescent from the acute cases by
speak in public is the arousing of "Dutch transference to another ward after the

Bl^tr:i:^i^e:S':::r^^'^:^: ;J;-Patie:ns without success. Recently
the fauces and nose well irrigated durinc^
convalescence. A wartr bath (daily) is ^7^*,^*"""*"* *** ^'**^*'='* **^">» ^^^rafollowed
at least three times a week *'*-~I'Oac'iini's
by
(Deutsche Med.
anointiiiff of the skin. As much time as ^^'^'^^^'^"'f'- ot)servations ' concerned a numpossible
should be spent ^^'^
in '^^^^^
the open treated in the
air °i Fiusen Clinic of
with fairly active exercise. In
^^' -^"^^'eschmidt,
all
in
ordinary Berlin, with a Herseu^
cases the diet should be whatever the
'^"^^ modified by
pati- Nagelschmidt, which is
ent can eat and eujov: we should be care- J?'_^t'^''^'y inexpensive and easily handled,
ful that the milk consumed does
^'^^
not con-
P^''^"'^ suffered for the most part from
tain tul;ercle bacilli, as many cases of
^'°P^*^'* ^'"^^ta- and, as
tua
rule, other methberculo.sis,
both pulmonary °'^^
'and
^^'^ '^^^" ^'"'^'^
glandular unsuccessfully for a
have no doubt deen caused considerable
bv the
length
ino-eslion
of time. Concerningof
tuberculous ^'^e. milk during technique of
convalescence
the procedure, the parts
from scarlet fever or measles
which were not to be treated were first covered
with black paper; the bald portions
Cerebrospinal Fever. ^^'^""^ -LarkiuB, in the ^^^" irradiated for twenty to thirty
London Practitioner, menlious the sera used
minutes, from as near the source of light
in the cerebrospinal fever: The use of anti-
^^ possible, in one or several sessions, acdiphtheriiic
serum was suggested 'hording
by Wolf, to their size. The radiation is
of Hartford. Connecticut, to whom "dually
it ocfollowed
bya swelling of the scalp,
curred that there might be some ^^'^'ch
antagon- promptly becomes associated with
ism between the two organisms, ''edness, because he often a mild exudation, while in
noticed that there was a decrease 'Certain
of diphcases
there is a considerable forma,
theria coincident with the increase of
*'°"
cere- °^ vesicles. The subjective disturbbrospinal
fever. He then iound ^"'^.es
that
are
pure
frequently trifling, but may occultures
of meningococci were killed by
casionally be quite severe, they are best
antidipththeritic serum. The author,
relieved
there- by compresses with a resorcin so-
fore, treated four cases of cerebrospinal lotion ( ,'4 per cent.). The reaction sub-
'^'^^^ '" ^'^°^ *^^° t° three weeks, under
fever by antidiphtheritic serum and all recovered.
The success hoped for by
formation of
this
crusts, followed by desquamamethod
has, however, not been *'°"
realized.
"' ^^^Se shreds. At the end of four
Antipneumococcal serum seems more ^y^eks the
likely
irradiation is repeated, the durato
be of use than antidiphtlieritic,
t'on of
owing the session being lengthened by oneto
the close resemblance of pneumonia ^^^^- This
to
gives rise in most cases only to
cerebrospinal fever, and of the pneumocochyperajmia,
persisting for three weeks. A
cus and meningococcus to one satisfactory
another, cosmetic result is generally ob-
He nas u.sed it once, owing to the
Gained as
presence
soon as after the second, at most
of some C.ram positive diplococci
the third radiation,
in the
but the treament should
cerebrospinal fluid. No good be continued
result
in
followintervals
of a month until
ed its use. Jevers and Elder, however, ^^^ ^'"^^^ remnant of the foci of alopecia has
noted improvement after disappeared.
its injection, say- A relapse is very likely to
ing that the patient became o^cur,
quieter and
unless this is done, and will require
went to sleep; the temperature rapidly
^'^°^ ^^'^ '° seven radiations
fell.
for its control,
followed by a rise some time later but the on Being Tired.-Brunton contributes
patient seemed better and the pulse stron- to the London Practitioner a very interestger.
1 heproduct.on of a rea ly satifactory i„g article "On Being Tired," in which he
anlimeningncoccal serum should not be gives the various attitudes of persons exlong
delayed, and to this we must look as hibiting the characteristics of fatigue as
delayed, and to this we must look as being against those of energy. He says: "One
the most rational, and the best method of constantly hears the complaint from pacoml,atnig
this disease. Jochman produced tiennts that they are 'always tired,' and
a serum for which he claims, distinct thera- i„deed some people avoid working on the
peutic properties; with it he was able to ground that they are 'constitutionally tired.'
confer immunity to mice against six times other people call them lazy, but it is quite
the ordinary lethal dose of the cocci. For possible that in many cases there is some
humans. dose.s of 20 c.c. are required either physical condition in the person which renintraspinallyorsubcutaneously.
Of seven- ders exertion specially distasteful to them
teen patients treated by it only ,S or 29.4 although other people cannot observe it.''
per cent died. Ruppel's serum he tried on Prof, von Poehl ( vide "Rational Orgauo-

414
THE CHARLOTTE MEDICAL JOURNAL.
., ..\ 1 1 .1 *i A-r u^.. Maniacal-Depressive *^ Insanity.— Bolton
therapy ) deals Willi these conditions when
^ doiioh
treated with Spermin Essence as a catalytic '" Brain, London, concludes that the maa?eut
and coeiEcient of vital energy. Sper- "'acal depressive generalization is mitenamin
is the stimulant of the alkalescence of ble as a description of a special kind of
the blood, or rather it brings back to the mental disease. He welcomes it as indinormal
state, as Loewv, Richter, and Poehl dative of^ a tendency to decrease the numhaveshown.
The organic acids which are ber of mental diseases," and thereby to
formed by over-fatigue and over-excitement make a further advance towards the conof
the nervous cells are oxidized, the pro- ception that insanity is one disease. This
ducts of change of substance made non- disease is due on the one hand to various
toxic or rendered soluble, and thus elimi- Shades and forms of cerebral subevolution,
nated from the cells.
^""^ °" 'be other hand to various grades to
If we accept the condition of "being cerebral involution and dissolution.
^^
tired" as within the sphere of therapeutic He does not regard the recurrent or cirtreatment,
and as being brought about by cular" type, as idiopathic m maniac-deauto-intoxication,
Poehl's catalytic agent,
pressive insanity or m anything else.
Spermin, seems indicated as a ferment of While certain types are developmental
the oxidUion of the cells
rather than obscure or accidental in origin,
The Souclion Museum ol Anatomy at he believes we are "circulaires," whether
TuBanc University.- By resoulution of the saue or insane, on account of the functional
Board of Administrators of the Tulane Edactivity
of the cerebrum,
ucational Fund, the Museum of Anatomy ^he writer regards insanity as onedisease
of the Medical Department of Tulane m which there are various clinical forms,"
University was named the Souchon Mu- ^^^ich he divides into two groups: (1)
seum of Anatomy, in honor Dr. Edmund f^ases which may be regarded as sane or
Souchon, professor emeritus of anatomy normal" in the intervals. (2) Cases of
at
the university. This museum occupies
greater cerebral degeneracy. The former
a
large room, eightvfive bv thirty-six
group includes all types of recurrent cases,
feet,
in the new Richardson Memorial Building,
whether capable of recovery or not.
and is well lighted by means of numerous ^^e latterincludes the fo lowmg general
windows and skvbghts. A unique feature ^YPes: (a ) Moral cases, (b) simple emoof
the museum is that the preparation
^'onal
stand
chronic mama, (c) chronic mania
in large glass jars on tables arranged in
^'"^ delusions, (d)
r* '"'^"•^^T'^^
rows, instead of being in cases against the ^""^ asy urn curiosities,
'^J,^"'^^"
wall. All these specimens are real, the ^^e cases in these c iii.cal subclasses
,
dissections having been made after a new
^bow: Alteration of moral sense, alteration
method, elabyrated by Dr. Souchon. There °^ emotional or intellectual control, rapid
are sixtv-seven jars
^"^^
with preparations
uncontrolled association of ideas, ster-
on
osteology, forming a very complete
eotyped, symolical or grotesque association
collec"
tion, unequalled by any medical
ideas.
schhol,
except Harvard. Next come four hundred Tumors of ttie Vermiform Appendix.—
large jars containing dissections showing Losselin de Long ( Mittlg. aus d. Grenzgeb.
the permanet color of muscles, vessels, d. Medico Chir. ) says that there are on renerves,
and organs. Of these, two hun- cord sixty cases of carcinoma of the appendred
aregoodand two hundred have to be dix, a very small number as compared to
made over, as it is believed that they can the frequency of inflammatory affections
be made very much better by the improved of the appendix. This fact alone renders
method. The two hundred good ones the probability of an internal connection
comprise the articulations, muscles, arteries, between the inflammation and the developveins,
lymphatics, nerves, spinal cord, meiit of the carcinoma extremely improbbrain,
and surgical anatomy; all with permaiient
color. The other two hundred reable.
There is more to be said in favor of
Cohnheim's theory; for embryonic separalate
almost entirely to visceral anatomy and tions of epithelium are naturally very apt
will be completed withih two or three years,
The great value of this museum is to prepare
to occur in the genesis of the organ, especially
at the base and at the tip, where the
students for the dissecting room,
assist them in making dissections.
and to tumor is almost exclusively met with. The
It will relatively youthful age of an average of 24
also enable them to review their work in years, in which simple cancer has been noanatomy
rapidly. It has been suggested by ted, points in a similar direction; whereas,
Dr. Souchon that two or three hours a week the much less coiumon cylinder-cell carcishould
be allotted to the study of the pre- noma, which originates from the mucosa,
parations by the students, and that a quiz does not appear until the average age of 52
on these preparations should constitute a years. The prognosis of the operation in
part of the examiuatiou in anatomy. carcimona simplex is rather favorable. Me-

ABSTRACTS. 415
tastases and recurrences have never been the feeling of safetv that has been gained
observed in these cases, whereas cylinder- in so severe a disease. This is a distinct
cell carcinoma presents exactly the same disadvantage, inasmuch as it is found that
behavior, in this respect, as the correspond- the persons surrounding i;.e patient, the
ding neoplasm in the large bowel. He immunized children of the family, and the
contributes observations upon three cases: convalescent himself, are still carriers of the
(1) Carcinoma s,niplex, (2) Lymphocyto- bacillus in a virulent form. The con valesma,
(.3) Pseudo diverticulum, filled with cent carries arouud in his throat for several
mucus, not a new formation in the true weeks germs which are capable of infectsense
of the word. The small lymphocy- ing others. If he is allowed, as is so often
toma, in spite of its clinically becign char- the case, to mingle with the rest of the famacler,
must be designated as malignant, ily and its visitors after a few days of isolaaccording
to its histological behavior. tion, the spread of the disease is much increased.
One of the most frequent routes
Meat-Poisoning.— Lebeam in the Ztschrft.
of spreading is by the school. It is found
fur Aerztl. Portbildung, divided his cases • •
n, » .u .i u- i i- .i i
.... J- . that . the months m which ,
dipthena is east
into three groups, according to the setio- r, » ^, - , i i ii j I
, . , . c , i \ if . frequent are those 111 which children do not
logical point of view. (1) Meat poisonins \ i i t^i ^- c c ^
^.'^ ,\. . .. y
c ^ c
o^ ii"j, go to school. The prevention of infection
through the ingestion of meat from diseased • i- u j u
. ,,-,,. • . ., , ., IS accomplished by various measures, some
animals: (2) meat poisomng through spoil-
^^^^^^^ ^^^^ i^, ^^ individual., which
ed mea improperly treated along hygienic
^^^^ ^e combined intelligently. The measn.es:(.,)mept
poisoning corresponding to
^^^^ suggested by the author are these:
the classical type of botulism 1 he first
i.^i^tiorof the patient from the beginning
group IS produced by the so-called bacteria
„f ^,^^ ^-^^^^^ ^^^^ throughout coiivales
of en ten, s, winch are close yrelaed to the
cence, as long as cultures show the prespara-typhoid
bacillus R. of Kurth Schoit-
^^^^ ^f ^^^ bacilli in the throat or nose,
muller. I he second group is re.erable to
The school must be recognized as of imthe
roteus^bac.l us. or the common colon
tance as a means of spreading the disbacillus.
Both these forms of meat-poison-
^^^^ All pupils and teachers who live in
mg are characterized by gastrointestinal
a family in which there has been diphtheria
symptoms, the clinical picture being domishould
be excluded until a certificate can
nated by manifestations on the part of the
^e shown stating that bacilli are no longer
gastrointestinal tract, abdominal pain, vom-
^^^ ;„ ^j^^ f^^^^t ^f ^^^ tjg„t_ ^^ ^^
iting and severe diarrhoea. Phese cases
^^^^ member of the family. A period of at
constitute meat intoxications of the intestij^^^^
seven weeks having elapsed, rigorous
nal type. In contradistinction to these cases
disinfection of the entire house, the school,
there are others of true botulism, also known
and all places where the patient has been
as allantiasis, or sausage-poisonnig, because
during the course of the disease should be
the first observations conoenied the iiigescarried
out.
tion of spoiled sausage. Botulism is characterized
by severe nervous symptoms, with Intravenous Injections ol Adrenalin in
optic disturbances, paralysis of accommo- Heart Failure —John, according to the
dation and diplopia in the fore- ground of Dublin Medical Journal, has investigated
the clinical picture, combined with ptosis ^le action of intravenous injections of from
'^ and mydriasis. Disturbances of swallow- to 1 cc.m. of adrenalin in cases of caring,
paralyses of the vocal cords and pa- diac failure and of shock, and has come to
ralvses of the extremities follow, and a fatal the conclusion that they will frequently reoutcome
is verv common. These cases of store life to moribund patients, even after
botulism concern poisoning with botulinus all other therapeutic means have failed.
toxin. An increase in the number of botu- lie has frequently given it in the collapsed
linusbacilliin the organism does not occur, condition of pneumonia, in heart failure
Botulism in this respect presents a marked following lysol poisoning, m pleurisy, and
similarity with tetanus. The botulinus >" "lany other conditions. The effect is
bacillus is found in any kind of spoiled instantaneous. 1 he face and the mucous
meat or fish, as well as in other foods, such membranes become blanched, the blood
as vegetables, the articles appearing practi- pressure rises, and the pulse becomes slowcallv
unchanged externally.
ed. This improvement may last from two
.
to three hours. The writer believes that
Prevention ol Diphiheria.-Pecon (Gazjjjg
beneficial effects observed arise partly
zetta Medica di Koma ) says that as a result
f^^^j ^^^ vasoconstrictive action of the
of the introduction of antitoxin in the treatadrenalin
and partly from a direct stimulat-
ment of diphtheria it is found that although •
.ji^^ ^^ tl,e heart muscle or cardiac
the mortality is decreased, the morbidity « , , . .
from the disease is not decreased. This is ganglia. He also suggests that some forms
due to the carelessness which results from of cardiac failure may be due to the want

41f> THE CHARLOTTE MEDICAL JOURNAL.
of suiBcient suprarenal secretion in the cir- may be involved. It is slow in developculation.
If this is so the good results are ment, itches, and is difficult to eradicate,
even more readilv understandable. Both the gouty diathesis and auto-intoxica-
Treatment ol Facial Paralysis Due to ^'""^ been blamed for this condition.
^^"f
Division of .he Facial Nerve.-March
Sudden deaths n. children with such ecze-
"^as must be refeiTed to status lymphat,-
( British Medical Journal) describes two
cases wherein an anastomosis had been per- '^"^ \^'^^' '°
.
«^Pf' « "'^
^^"".f
treatment
of softening the scabs with oi or
formed to correct the facial palsv.
'=«"^'f feline: this
He contends that where the division of vf must be done gradually.
. ., • 1 . ,1 »• t The writer treats weeping surfaces with dithe
nerve is recognized at the time of ope- , ^ , ,. , , r '^
, . r
ration, a careful adjustment of the nerve ^^'^ solutions of alumnuim acetate for sey-
er^l days, following it by a paste of oxide
mav result in a restoration of the functional
^""^^^es
'
activity of the parts. Where division is not °/ ',
the^Z' hands to prevent "f scratching. "V u X;
so recognized, he recommends an early atadded
in slowly healing cases,
'.« tempt at an adiustmentof the ends, opening ^^^ff
the wound for this purpose. In the case ^^'P^"'' "' '^^ seborrhoic forms. Bismuth,
where an adjustment of the ends has been ^i"c or Lassa s salve is used in dry cases,
I:owIer s solution internally and slight l.xa-
attempted no second attempt should be
^lon are of advan age^ Theamount of food
made within three or four months.
reduced. Barley water
He
may be
favors this adjustment of the nerve "'V^'V/^^
substituted or some of the breast feeding.
ends before any attempt be made to perreasonable
loss m weight need not be
form an anastomosis with either the hypo- f^
„i^^ 1 ^^ ,„-,u ti,„ .^•., 1 „„ = .„,„ feared. Starchy food should be given in
glossal or with the spinal accessory. , , \- . c ^ ^^
reasonable quantities to infants more than
Constitutional Eczema ol Infants.— Peer four months old; after the sixth month vege-
(Munch. med. Woch. ) calls attention to tables are allowed. Eggs and soups should
chronic eczema occurring oflenest during be avoided under all conditions. The diet
the first few years of life and most commonly which has brought the cure should be conduring
the nursing period. In contradis- tinned for months. In underfed children
tinction to chronic eczema the acute form cutting down of diet is not permitted; the
is frequently a true dermatitis; intertrigo is children should be fattened.
a true dermatitis only if co-existing with a
disposition to eczema. The eczemas of
older children rest oftenest upon a tubercu-
/W 1 /Tll3t/t;ilUllt;UU3-
«.r £>llrin£>/Mi ^
lous base, and a positive tuberculin reaction
may be obtained in almost every case. The ^ '^^^^ Variety ol Cutaneous Discomyreai
chronic eczema is undoubtedly
cosis.
a con-
stitutional disease, but secondary dermal
disturbance is quite common in their course,
The two factors of importance in the devel-
Foulerton, in 1890 ( 15rit. Jour. Dermat.),
showed that conditions resembling actinomycosis
might be produced by a slreptoopmeut
of chronic eczema are an inherited Ihrix. Since then attention has been drawn
disposition and the type of nutrition; either to peculiar lesions evoked by different spoof
them may be the more important. There rotrices, and now Ravant and Piiioy (Ann.
are two forms of chronic eczema to be found; de Dermat. et de Syph., July, 1909, Paris)
the weeping, scale-forming eczema of the record a case with special features, apparhead,
and the disseminated dry form. The eutly due to a discomyces. The patient
first form is found oftenest in fat, pasty was a man of 4,t, who had always lived in
children, but even the healthiest may be Paris. Six weeks before his admission to
affected. It begins in the scalp, spreading hospital, he experienced dull pains in his
to cheeks and ears; it may spread to other arms and limbs, unaccompanied by any
parts of the body; there is very little itching, other symptom. Soon there appeared on
Overfeeding and constipation are common the leg and shoulder subcutaneous and iiiwith
these children and a spontaneous cure tramuscular nodules, painful on pressure.
may be noted, when at the end of the first These, at first small and hard, rapidly inyear
a mixed diet is ordered for the child, creased in volume, new ones showed them-
The second form occurs almost exclusively selves in various parts, while in a short
in artificial fed infants; over- feeding is com- time some suppurated and burst, dischargmon
and the patients are usually pale, thin, ing pus containing blood and clots. Finally
and flabby; chronic nutritional or intestinal other deep lesions ensued, periostitis, ostitis
disturbances are frequent. It manifests and synovitis, as well as large inlra-muscuitself
as discrete, dry, red, desquamating, lar and subcutaneous abjcesses. Round
infiltrating islands: also as papular and the fistulse so produced, the skin assumed
pustular foci. Weeping and scale forma- a dark wine hue, fairly well-defined at its
tion are uncommon; part or all of the body margin, accompanied with some thicken-

Clinical
ADEVRTISEMENTS.
FUNCTIONAL
NERVOUS DISEASES
A large proportion of all nenous disorders can be traced to faulty
nutrition. To effect their prompt and permanent relief
Gray's Glycerine Tonic Comp.
is of exceptional therapeutic value. This powerful tonic stimulates
functional activity throughout the body and substantially aids the absorption
and assimilation of nutriment. Nervous affections of
functional origin usually disappear as the normal nutn-
tional index is re-established. Samples on request.
THE PURDUE FREDERICK CO.
208 Broadway, New Yorh
Notes
Officers of the North Carolina Med ical Society.
Isl \ Ice-President. E J. Wood. Wilmington,
2ud VKePreslUenl. Jn». Q, .Myers, Charlotte
»rd Vi.e-Presideiil. L. D. Wharton. Smilhtte
Secretary, D. A. Slant.. o. High Point.
Treasurer. H. D. Walker, Elizabeth City.
Ess.-i.vist."R. V. Brawley, Salisbury.
Leaderof Debate. T>. A Garrison, Gastonia.
Committee on Pnblic Policy and Legislation : R. H. I.ei
RnleiKli : J. A. Burroughs. Asheville (ex-ojticio i : Geo
Thomas, Wilmington : Albert Anderson, Ralei;.'li.
Comm]ltee on Publication: D. A. Stanton. Hijrh Pi
lex-ojicio}; H. A. Royster. Raleigh ; R. L. Gibbon, CI

41
S
THE CHARLOTTE MEDICAL JOURNAL
iiig, while exuberant granulations rose Quinine in Malaria.
round the opeiiings. In the granulations in Folia Therapeutica. Ziemann treats
were embedded little, white, miliary bodies, of the mode of employment of quinine in
vSmears from the pus showed, when treated malaria; of the numerous quinine preparawith
largin, very fine bacilli, having a clear tjons six have gained commendation: the
central space and colored extremities, while pure alkaloid, quinine hydrochloride, quithe
grains were constituted of the same nij,e carbamide dichloride (quinine and
bacilli agglutinated into rosettes. No thread urea hydrochloride), quinine bisulphate,
forms or clubs were observed in the smears, quinine tannate, and the synthetic equinine
but the grains were composed at the peri- (ethylcarbonic ester of quinine). All these
phery of clubs, and in the centre of very ^ust be introduced into the stomach in an
fine threads or minute bacilli. This organ- easily soluble form which guarantees the
ism proved to be a discomyces, related to quickest absorption.
that of actinomycosis, and to it the authors 'fhe best way is to take the dose of quidesire
to attach the name of Discomyces nine in water, to which has been added five
Thibiergi. In the light of these and other or ten drops of hydrochloric acid. Huquiresearches,
one ought, therefore, to speak nine has the least unpleasant tasle, the
now, not of actinomycosis, but of actinomy- others causing repugnance. This may be
coses. The most various parasites appear avoided by swallowing the tablet or encloscapable
of giving rise to actinomycotic ing the salt in gelatin capsules, with chocoforms.
In the case in qi'estion, under full late, or with wafer paper,
doses of iodide internally, supplemented by Quinine is better tolerated if given durincisions
and erasions locally, the existing ing^the nonfebrile period. In dealing with
lesions healed, though somewhat slowly, pernicious malaria, however, we cannot
and the commencing ones aborted without ^ait for this, and in fact there may not be
suppurating.—Edinburgh Medical Journal, any apyrexial period whatsoever.' Nocht
The Presence ol Sudanopliile Leuco- recommends that the dose of one gram
cyics in Diplitlieritic Inlection. should be divided into five parts and ad-
Luigi Benini describes the results of blood ministered at intervals during the day.
examination in diphtheria. There is an in- Ziemann prefers in recent pernicious
creaseofleucocvtosis which intensifies with types, to inject the drug hypodermically,
the severity of the infection. The use of and for this reason selects the most soluble
antitoxin produces hypoleucocvtosis after preparation of quinine, the carbamidated
a half hour from the injection, followed by dihydrochloride (soluble in 50 percent,
hyperleucocytosis lasting for twenty-four water, and containing 70 per cent, quinine),
hours. The leucocytes contain granules When this is employed subcutaneously nethat
are named sudanophile, which indicate crosis of the skin at the seat of injection
an intoxicating agent circulating in the ^^Y follow. He accordingly advises that
blood and having a specific action on the it be injected intramuscularly,
bl.jod. The author has made a study of This method has been tried in thousands
these sudanophile granulations in the blood of instances and has been followed by
of patients at the Pediatric Clinic at Flor- splendid success. A Ricord syringe coneiice.
There were ten cases of severe and taining 4 centimeters and a canula is boiled
twentvnine of less severe diphtheria, and "^ a test-tube, the opening directed downnineteeu
cases of laryngitis. Experiments ward. The water is poured off, the syringe
were also made in animals. The author removed with a pair of sterile forceps and
concludes that in diphtheria there are de- the canula applied. Then a sealed glass
generative changes determined by the tox- tube containing one dram of quinine dihyiiis
of the disease, and these granulations drochloride in l.T minims of water is broken
are found in even the mononucleated leuco- at the apex and the contents sucked up by
cytes. Xo pus corpuscles are found. These the canula. Next 3 cubic centimeters of
sudanophile granules are more frequent in sterile water are ^sucked up at a temperasimple
angina than in the croup cases, ture of about 40 C. The quinine solution
They are greater in number in severer cases is then mixed by raising and depressing the
and are an indication of the severitv of the syringe, the piston is pushed in till the quidisease.
They diminish on the third dav "i"e solution begins to issue from the
of treatment and disappear as convales- canula, and the whole contents of the
ceuce is established. They are not directly syringe introduced vertically into the midinfluenced
by injections of antitoxin. In die of one of the gluteus maximus muscles,
febrile complications they reappear, but are the area of injection having been previously
not found in post-diphtheritic paralysis, disinfected. The mid- area between the tro-
They are determined by the toxic action of chanter major and the tuber ischii should
the diphtheria toxin on the leucocytes of be carefully avoided so as not to strike ihe
the blood.— Rivista di Clinica Pediatrica. sciatic nerve. Only very rarely does this

ADVERTISEMENTS. 419
ra For Upwards of Forty Sfl
|M| fs Y^f-e Years fK« i the le^ ^1:
1 ears ine 111
Use use of or Sj
I
Tenon's syrup of i
I l)ypopho$pbiu$
|
HH has been recommended by the bS
M Leading Medical Specialists Sfl
ffi in all Countries ]
I " i
m /?^/V»i-/^

420
give rise to a slight burning at the seat of
injection, and this speedily disappears.
(Juinine thus introduced acts promptly
and powerfully. Zieuiann has used this
method even in little children. Altogether,
the results have been brilliant. Relapses
have been very rare, even when the drug
has been given by mouth. When the latter
mode of administration must be applied, he
gives the quinine in a mixture containing
chloroform, gum and sugar: and this would
be retained when otherwise the drug would
be rejected.
The administration of quinine by the rectum
is liable to produce vomiting. By the
skin it is too uncertain in action.
Gunshot Wound—Peculiarities.
On 9ih March at the meeting of the Leipzig
Medical Society Rimann showed projection-pictures
of the case of a young woman
wlio had been shot with a revolver.
The fatal wound was in the right temple;
but the interesting point about thecase was
the fact that there was a beautifully stellate
wound of the skin in the centre of the forehead.
On examination of this wound it
was found that the edges of the radiations
were undermined, and that the subcutaneous
tissues under them were blackened by
the powder, although no blacking of the
external surface had occurred. The projectile—a
7 mm. calibre bullet—was found
lying on the bone mushroomed, so that its
hollowed base was like the head of a stud,
lying in a button -hole slit in the integuments.
The peculiarities of this wound
were due to the revolver having been held
in contact with the skin, the explosion-gases
having thus followed the bullet, been obstructed
by it when it became mushroomed,
and then taken the direction of least resistance—laterally.
In the outer table of the
skull three fissures were found, the inner
table being intact.—Muenchener Med.
Woch.
Early Diagnosis oi Gastric Carcinoma.
Marini discusses the cytological examination
of vomited material and of fluid obtained
by washing out the stomach, and
maintains that an aid may be obtained by
this means in the diagnosis of suspected
carcinoma ventriculi. He has himself examined
the contents of the stomach in
thirty-seven cases of carcinoma, and while
he has only found fragments of tumor in
three cases, he has been able to detect isolated
tumor cells in thirty-two cases. He
describes the tumor cells as consisting of
flattened or cylindrical epithelium, and
readily distinguishable from the normal
cells of ihe oesophageal and gastric mucous
THE CHARLOTTE MEDICAL JOURNAL.
membrane. The exact type of cell of course
varies with the type of carcinoma present.
He regards the detection of these cells as
the most reliable means of making a diagnosis
independent of performing an exploratory
laparotomy.— Archiv. fur Verdauungskrankheit.
A Sclenlilic Priest on tlie Danger of
Holy Water.
The sanitary dangers lurking in "holy
water" have often been referred to by medical
men. They have recently been scientifically
studied by a monk, Fr. Augustin
Gemelli, who is himself a highly qualified
medical man. He publishes his results in
the Scuola Cattolica. Each cubic centimeter
of holy water in the basins in the
church of Santa Croce, Turin, taken from
the surface contained 150,001) microbes,
while a cubic centimeter taken from the
bottom contained no less than 6.000,000
microbes. He injected this water into animals
and found that it always killed them,
the causes of death being tuberculosis,
colitis, or diphtheria. He does not think a
daily cleansing with corrosive sublimate
sufficient, but recommends a new form of
holy water receptacle so constructed that
persons instead of dipping their fingers into
it can obtain three drops of holy water by
pressing a button. A vessel of this nature
has been placed in the church of Vergiate,
Milan. Fr. Gemelli turned his attention
also to the grilles in the confessional boxes.
Water which had been used for washing
these only contained 2.5 microbes per cubic
centimeter and when injected into animals
only proved fatal to ten per cent, of them.
— London Lancet.
Cold Affusion in Delirium Tremens.
The author describes the treatment that
he uses in cases of delirium tremens. The
patient is stripped naked and lies on a
blanket over a waterproof sheet. A copious
supply of ice-cold water is provided,
and a large bath sponge dripping with the
iced water is dashed violently on the face,
neck, chest and body as rapidly as possible.
He is then rubbed dry with a rough towel,
and the process is repeated a second and a
third time. The patient is now turned over,
and the wet sponge is dashed on the back
of the head and down the whole length of
the spine two or three times, vigorous fric-
tion with a bath toivel being employed between
cold water applications. By the time
the patient is dried and made comfortable,
he will be fast asleep.—Broadbent, British
Medical Journal.

Tblosinamlne In Deafness.— Mollison
(Guv's Hosp. Gazette) mentions five cases
of deafness which were treated by means of
injections of fibrolysin. (Jf these, two distinctly
benefited: one. a girl of fifteen, improved
for a while, but ceased attending,
because the injections gave some pain; one
was apparently unaffected, though the patient
said she heard better; and the fifth
case, though quite recent, seemed to be improving
slightly and was still under treatment.
One ampulla (2.? c cm.) was injected
into the gluteal region three times a
week, the skin being first frozen with a
spray of ethyl chloride, and the treatment
fn each case continued for some consider
able time.
Rapid Method ol Examination of the
Stools of Nurslings and Infants; Appreciation
of the Biliary. Intestinal, and
Pancreatic Functions.— Triboulet (Jour.
de .\Ied. de Paris' recommends a rapid and
correct method of examination of the fresh
stools of infants and children, which tells
us ihe condition of the biliary, pancreatic,
and intestinal functions. The test is made
by mixing a portion of the stool with (lis
tilled water and agitating it in a test tube.
There are then a

422
THE CPIARLOTTE MEDICAL JOURNAL.
The patient made an excellent recovery, these, the cases of typhoid fever, septi-
The hyperpyrexia in this case was ascribed cemia, and the group comprising endocardto
the development of pericarditis, though itis, chorea and infectious arthritis were of
Dr. Burnet thought that the salicylates particular interest. Of thirteen cases of
might have something to do with it, espec- typhoid ten gave positive cultures. Of the
ially as the high temperature was accom- other three, two were in a late stage, where
panied by a maniacal state. He was doubt- positive results were not to be expected,
ful as to the safety of applying an ice-bag and one gave no Widal reaction, and the
to the chest in such cases, for this might diagnosis was uncertain. Several gave
produce a great deal of shock and perhaps positive cultures some days before the Widal
collapse. He recommended tepid sponging reaction appeared. One case giving typiin
the first instance, followed by the appli- cal clinical appearances of typhoid was
cation of cold to the head by sponging or recognized as pneumonia by the finding of
ice bag. Should these measures fail, the the pneumococcus in the cultures; 80% of
cold douche over the head and neck should the cases of septicemia gave positive culbe
used, the head being held over a basin tures of the pus organisms or Fraenkel's
or bath. pneumococcus, and these cultures were of
some value in differentiating from typhoid.
Government Appoints a Commission to Qf special interest in the endocarditis and
Study Pellagra. arthritis group was the occurrence in sev-
A special commission of scientists was eral cases of the pseudo-diphtheria bacillus,
appointed on November 4th by the Secre- Aside from the values of the blood cultary
of the Treasury to make an examina- tures m differential diagnosis, kiralyfi
tion into the causes of pellagra and report thinks that the frequency of positive results
on official action necessarv to arrest the '« comparatively mild cases shows bactenprogress
of the disease. The members of emia to be much less ominous than was
the board will visit those States where the formerly supposed.—Ze.tschr. fur. khn.
•
disease is prevalent, and co-operate with
boards of health and other medical organ- "Doctors Must Be Good."
izations in devising ways and means for
^^^^^^ ^^.^ ^^^^.^^^ ^^^ gj ^^^^^^ ( ^j^.)
preventing the further spread of pellagra,
^^^g^^g comments editorially upon the rec-
The commission is composed of the follow-
^^^ ^^^.^^^ ^f ^^^ g^^j^ ^^^^^ ^^ Health in
ing members: Passed Assistant Surgeon
^^ ^^^j^^ ^^^ license of a physician who
John S. Anderson, director of the Hygienic
^^^ prostituted his profession privileges by
Laboratory, chairman: M. J. Rosen an,, of
^^^^i;, vvhiskev prescriptions indiscrimithe
Public Health and Marine Hospital
^^^^^,^, 'phe offense was a flagrant one, in
Service, Dr. Reid Hunt, Chief of the D.vis-
^^ ^^^ ^^ the physician had repeatedly reion
of Pharmacology,^ Hygienic I.abora-
^^.^.^^ warning of his misdemeanors by
tory: Passed Assistant Surgeon Lharles H.
^^^^^^^ ^^^ ^^^^^ ^^ ^^^ p^^ of the local
Laviiider, Secretary of the Commission; Dr.
^^tij^nties; but despite the punishments,
William A. White, Superintendent of the
i^j^ record shows no diminution in the num-
Government Hospital for the Insane; Dr.
ber of prescriptions for whiskey which he
Nicholas Achuccaro, Specialist m Nervous
^„„jj,j^,ed to write, as no doubt the busi-
Pathology, Gove;nment Hospital for the „ess was profitable and the fines insignifi-
Insane, and Passed Assistant Surgeon J.
cant, since he issued as many as 2,000 wl
D. Long. . I^gy prescriptions in one month. The writer i|
•
of the editorial referred to, exhibits an i
Blood Cultures in Febrile Diseases. illuminating perception of the responsibility I
Kiralyfi reports an interesting series of of physicians and the limitation of the j
observations on SO cases in which blood privileges conferred by license to practice ,
cultures were made. Sixty of these cases medicine. The clarity of his utterances i
were acute infectious diseases, while the
comes as an encouraging variation from the,,
other twenty were cases of various kinds fuliginous dissertations usually offered m ;
during the course of which fever of obscure newspaper comments anent medical prac-
origin occurred. In these twenty, cultures tice and its relation to the public the I
were negative in all but two, the fever be- Board suspended the physician s license .
ing due to other causes than bacterial tox- for a period of fifteen years, which prompts,,
ins. Inasmuch as the occurrence of bac- the Gazette to say:
teriemia in the course of chronic diseases "During that time it is hoped the doctorj;
makes the prognosis graver, Kiralyfi thinks will have ample time to reflect upon the j
such negative findings may often be of value of a physician's license. The action:!
value. Of the cases of acute infectious of the State board in this case may seem a I
disease, .S4% gave positive cultures. Of little drastic, but it is not. The offenderi!
; ^

p
was a notorious one. He not only violated
the law but did it openly and persistently,
in the very face of frequent warnings. Indeed,
he had been arrested, convicted and
fined by the criminal authorities of the
county in which he resided, but without
permanent results to his betterment. The
board was fo ced to do something and it
acted wisely in letting it be understood that
it stands for the rigid enforcement of the
laws."
It now remains for the local authorities
of Boone county, in which cjunty the offense
was committed, and for the Boone
County Medical Society, to see to it that
this oflfender against the laws of the State
and the tenets of the medical profession,
shall not violate the restrictions placed upon
him, during the period of suspension of
his license to practice, by any condonation
on their part should an attempt be made by
him to engage in the practice of his profession.—
Missouri State Medical Journal.
"Kelene" ^ Fries Bros. ) is a pure Chloride
of Ethyl, and is furnished only in new glass
automatic spraying tubes; no empty returned
tubes are ever accepted.
A large saving in cost might be made by
buying up tubes already used. But the risk
of spreading infection is too great to take
any chances.
This is specially applicable to Metallic
tubes, which offer a peculiar temptation to
collect and refill.
Metal Containers have been entirely discarded
by Fries Bros., as unsanitary. The
purity of the product can only be relied upon
when stored in glass. The collection and
refilling of empty tubes from dispensaries
and hospitals throughout the country where
"Kelene" or Chloride of Ethyl is extensively
used in Clinics, is a dangerous economy
and should be discouraged by operating
physicians.
The absolute purity of the product of
Fries Bros, is guaranteed by their glass
automatic spraying tubes, and can be used
with implicit confidence.
As preliminary to Ivther and Chloroform
in Cieneral Anesthesia it gives the utmost
satisfaction. Complete relaxation iselTected
in M) seconds with entire freedom from disagreeable
or dangerous aftereffects. When
chemically pure Chloride of I'Uhyl is a stable
solution. "Kelene" is jjure Chloride of
Ethyl.
"Kelene" requires no steam valve fo
discharge. Simply press the lever, and th
automatic sprayer will do the rest,
I^ucrapen, astringent and anesthetic, is
one per cent beta eucain lactate in 1:5000-
Sui)rarenalin solution. It is prepared
I Toilet-^ Hygienic I
I ANTISEPTICS 1
After trying various agents
recommended for the hygitne ot
the toilet without saiistactory
re-ults, give Tyree's Powder a
chance. T.y a twenty five cent
box. It has the highest indorsements
£rom fc "nti.sis acd practitioners,
who have usid
great many yf
wilti unfailing results in Leucorrhea.'Gon.
orrhea. Vaginitis Piuiitus, etc. as well as
Prickly Heat, Ulcers, Poison Oak, Tender
Feet, OflFensive Perspiration. Hives, Eczema,
Old Sores, ; nd Catarrhal Conditiciis
of the Nose and Throat.
It neither pains or stains. Is odorleFs
and economical, without the all pervading
tell tale odor of Carbolic. Iodoform, etc.
Be sure you get Tyree's Powder. A
sample and booklet containing its composnion.
bacteriological and clinical potencies
furnished the profession free upon
a:)plicati
I J. S. TYREE, Chemist WashiDgton, D. C. |
especially for eye, nose and throat work,
and for the convenience of dental surgeons.
By ajiplying Eucrapen locally or by injecting
it, pain and hemorrhage are avoided
and anesthesia is prolonged. Eucrapen is
supplied in stable solution and in triturates
by Armour & Company.
Dr. U. V. Williams,
Sec'y., Franklin County Medical
Society, Bank Place.
I'rankfort, Ky. Sept. 21 '0')
Laine Chemical Co.
New York.
Gentlemen;
—
Some weeks since I wrote you for
literature and sample of Sulpho-Lythin
with Hexamethylenamine ("Tablet
No. 6.") to which you promptly replied.
The sample I immediately administered to
a patient with infected gall-bladder and
ducts or gall stones—patient had beed suffering
for months and nothing seemed to
avail, until I was well nigh in despair
The sample seemed to so benefit her that I
made order direct to you. The order has
been duplicated through a local drug house
here twice. I am simply delighted. I
also had equally gratifying results in case
of Rheumatoid arthritis, lumbago and
sciatica of possible gonorrheal origin. Both
patients fast convalescing and will recover.
Yours verv truly;
(Signed) U. V. Williams, M. D.

The symptoms of all
•HE CHARLOTTE MEDICAL JOURNAL.
Catarrhal Conditions
are favorabh' influenceil hv the combined
mild, soothing, sedative, antiseptic and astrin
gent action of
Send for Catalogue
and
Descriptive Circular
Matter. 1
Solution Bismuth
^ Hydrostia
Competent authorities agree that very
LITTLE MEDICATION is required or is
DESIRABLE in the treatment of this'disease.
It is necessary to CONTROL the TEM-
PERATURE of tile patient, and the best way
of reducing dangerously high temperature is
by repeated sponging of the body with tepid
water, the use of the wet pack, or when the
surroundings will permit, the emj)loyment of
the full bath.
The ALIMENTARY CANAL should be
kept in as nearly an aseptic condition as possible,
and this may be accomplished by the
JUDICIOl'S administration of Zinc .Sul'pho-
Carbolate (the Merrell Company supply this
remedy in the convenient form of 2, 3 and 5
grain tablets).
The GREATEST DANGER which
THREATENS the patient is that of INTES-
TINAL PERFORATION, and the remedy
which will do more toward lessening this
DANGER than any other is .SOLUTION
BISMUTH and HYDRASTIA— Merrell.
It acts as a sedative and mild astringent
to the entire intestinal tract and favorably
modi5es the entire course of the disease.
Many years of SUCCESSFUL employment
of this remedy JUSTIFIES the CONFI-
DENCE placed in it by the Medical Profession.
1 TYPHOID
FEVER
^VTn. S. Merrell
CHemical Co.

TABLE OF CONTENTS FOR VOLUMI
Table of Contents for Volume 60,
Original Comtnanicaonati.
A plea for the Early and
Thorough Removal of
Tonsils anil Adenoids in
Children.by Dunbar Roy,
M. D., Atlanta, Geopffia, 213
A Cursory Review of Pulmonary
Tuberculosis, by
Bittle C. Keister. A. M..
J[. D., Roanoke. Va 21),J
A Case of Abdomiirti Gunshot
Wound with IntHslinal
Perforations, with
Special Reference to thw
After-Treatraent with
"Saline Drip," by Theodore
Madoox. M. D.,
Union, S. C 12
A Case of Osteomalacia, by
.1. Steven Brown, M. D.,
Hendeisijtiviue. \. C 143
Accuracy in the Diagaosis
of Diseases ef the Chest,
by Lewis M.Gaine.-,,M.U.,
Atlanta. Ga 218
Acidosis B'oliowing Chloroform
Narco.'jis: Report of
a Fatal Case, by J. F.
Patterson. M. U., New
Bern, N. C, 237
Alcohol, by Wm. deB. Mac-
Nider, M. D., 86
Amoebic Dysentery with
Abscess of Liver—Confirmed
at Autopsy, by
Wm. Allan, M. D., Charlotte,
N. C, 144
An Antiseptic Leech, by
W. D. Witherbee. M. D ,
Charlotte, N. C 68
Anai)hyla.\i3 and its Rela-
tion to Practical Medicine,
by Dr. R. N. Duffy,
New Btirn, N. C, 90
Antitoxin or Serum Therapy
in the Ti-eat-neut of
Whooping- Cough, Measles
and Scarlet Fever, by
Stephen Harusberger, M.
D., Cutlett. Va., 138
Carbuncles, bv J. G. Johnston,
.M.D., Chest'-r.S. C, 224
Chronic Alcoholism, by Gno.
H. Simpson. M. D., Park-
ersbuiir. VV. Va ,
Clinical isotes on Sanatorium
Wotk, by .1. C. Wal-
308
ton, M. D., "Richmond,
^Virginia, 6i
Constructive and Jraperalive
Operative Surgery,
Exiraoidmarily Uuiquo
Cases, with Successful
Results, by Dr. Russell
Bellamy, Wilmington, N.
289
Examination and J)iagno3is
of Diseasu's of the Anus
and Rectum, by E. H.
Terrell, M. D., Richmond,
Va 303
Eczema, by Albert D. Parrott.
M.D., Kinaton, N. C. 162
Ectopic Gestation—With Criminals, by Chas. V
Keport of a Case of the Carrington, M. D., Rich-
Abdominal Type, by John mond, Va., 309
Egerton Cannaday, M D. 373 Surgery and Su'-frical Liter-
Gall illadder Disease, with ature of the I'.ighteenth
Kaport of Two Cases, by Century, by T. E. W.
Dr. L. A. Crowell, Lin- Brown, M. D., Asheville,
colnton. Ps. C 366 N. C, I5(j
Gisiric aicer.by MaitOtey Squint and the Importance
Burke, M. D., Richmond, of Its Earlv Correction,
\ • 1-^
V'*^'"",^', ;,
by Dr. Hugh M. Lokey,
Healthful Children, by J. Atlanta, Ga. .232
.^leven Brown, M. D., The Russianizing of the
Hendersonville, N.O.,... 65 American Medical Pro-
Iniant Mortality, by St. fesaion-My Contentions
Geo. T. Grinnan, M. D,. Proven, by G. Frank
Kichmond, Va., 3S0 Lvdston, M. D., Chicago, 377
Mei-curic Calaphoresis vs. The Surgical Treatment of
Radiotherapy and Excis Hepatic Ascites, by W.
ion in the Treatment of Lowndes Peple. M. D..
Cancer, by Amedee Grnn- Richmond, Virginia, .... 382
ger, M. D New , Orleacs, The Duty of The Doctor to
^a-. 305 His Municipality, by Roy
Prfriphoral Operation for K. P.annagan, M. D.,
Tic-Uoulourex; Report of Charlottesville, Va., 292
Case, by Dr. A. E. Baker, The Influence of Modern
Charleston, S. (;., 225 Education on the Physil^rsonal
Experience in cal Development of VVo-
I'rostatic -Surgery, by E. man, by D. L. Wilkinson,
C. Bryan, M. D., Rich- M. D., Moutevallo. Ala,, 221
mond, Va ; 7 The Potency of Medication
Perinephric Abscess—Re- in Serious Cardiac Disport
of Two Cases, by T. ease, by Alexander G.
E.W. Brown, M.D., Ashe- Brown, jr., M. D., Richville
N. C, 150 mond, Va , 226
Present Status of the Pella- The Violot and X Ray
gra Problem, by Edward Cha'-ms, by Robert Gray,
JennerWood, S.B., M.D., M D.. Piohucaico, Chia-
Wilmington. N. C 69 gas, Mexico, 229
President's Address, by J. The Hypodermic Treatl'\
Highsmith. M. D., meut of .Malaria, by Geo.
Fayettevi.le, N. C, 21 E. Kornogay, M.D .Ci eve-
Prophylaxis in Typho i d land. Miss., 235
Fever, by W. P. llorton. The Value of Employment
M.D., North Wilkesboro, in Cases of Dementia Prae-
N. C 142 cox,by Paul V. Anderson,
Ilaport of Two Cases of M. D., Morganton, N. C, 19
Haemophilia, by Parks M. The Essentially Different
King, M. D., Charlotte. Treatment Required for
N. C, 1 .Some Conditions often
Report of a Case of Pulmo- Mistaken for Neurasnary
Edema Complicating thenic, By Tom A. Wil-
Pregnancy, by Dr. Wil- Hams, M.B., M.C., (Edin.)
liara L. Kirkpatrick,
Pacolet. S. C
Repair of Recent Lacerations
of the Perineum, by
5
Washington, D. C,
The Surgeon and Gynecologist—
Not an Entity, by
C. M. Strong, M. D., Char-
26
Charles R. Robins, M.D.,
Richmond, Virginia, 385
Results of Stomach Analyses
in Pellagra.by Dr. W.
lotte, N. L'
The Growth and Developmunt
of Preventive Medi-
cine, by Arthur R. Guer-
67
O. Nisbet,Charlotte,N.C. 365 ard, M. D., Fiat Rock,
Some Clinical Studies on N. i 73
l^ellagra. by C. S. l-'ixley. The Business Methods of
M. D., Winnsboro. S. C, 338 the Profession, by Dr. Ed-
Sexual Hygieue, by H. C. win G. Moore, Elm City,
Buck, M.D., Friars Point, N. C, 139
Mississippi, .'101 Tiie Apparent Divorce of
Some Recent Views Con- .\i< dcru Medicine and
cerning the Nature of Surgery, and Some of its
Typhoid Fever, by L. B. Consequences, by J. Alli-
Newell, A. B., M. D., son Hodges. M. D., R ch-
Charlolte, N. - 61 mond, Va 145
Sterilization of Habitual The Care of Post Operative

426 THE CHARLOTTE MEDICAL JOURNAL.
Cases, by Henry Norris.
M.D..Rutherfordton,N.C. 149
Treatment of Consumption,
by W. H Coffman, M.D.,
Richmond, Va., 239
Tuberculin Administration:
A Perfect System of Dose
Graduation, by Lucius B.
Morse, M. D., Chimney
Rock, N. C, 230
Tjphoid Fever. Importance
of Early Diagnosis
— Fasting-—Special Diet
—Surgical Rest of Bowel
—and Simplicity of Treatment,
by A. J. Burkhotder,
M. D., Richmond, Va.,.. 17
Urethral Stricture, by W.
L. Champion, M. D., Atlanta,
Ga., 4
Editorial.
A Pathognomonic Sign of
Appendicitis, 165
A New Theory Concerning
the Etiology of Adenoids, 162
Alabama Medical Examiners,
I(i3
American i'ublie Health
Association
S19
Anaphylaxis Itil
Anti-Typhoid Inoculation, 36
Abiotrophy,
391
Benzoate of Soda, 163
Blood Pressure and Life
Insurance,
Calcium Salts and Body
99
Metabolism, 97
Concerning the House Ply, 97
Catawba Sanatorium, 101
Carbohydrate Metabolism
and Diabetes 245
Conference on Pellagra, .. . 317
Dr. W. H. H. Uobb, 102
Dr. Chas. Duflfy, 160
Dr. Russell Moves to Asheville,
395
Deaths, ]67
Deaths, Ill
Deaths, 253
Deaths 325
Deaths, 46
Deaths 401
Editorial News"Items, 38
Editorial News Iteias, 166
Editorial News Items 103
Editorial Ntws Items 2.'i0
Editorial Nhws Items, 321
Etiolo>:y of (iall Stones, 247
Editorial News Items, 396
Geriati'ics, 164
Guilford County Physicians
and Prohibition, 31«
Highlands, N. C 101
Human and Bovine Tuberculosis
35
Immorality, 249
Leprosy, 313
Indicanuria— Its Significance
392
Local Factors in Etiology
of Tumors, 394
Mechanical Vibration 161
Meeting of the Medical Society
of the State of North
Carolina, 33
Marriages, 401
Marriages, 44
Marriages, 324
Marriages, 253
Marriages, 167
Marriages, 110
Osteopaths Succeed in
Georgia 163
Opportunities lor Sanitarians
.S93
Peristalsis Hormone, 248
Pellagra and Pellagraphobia,
243
Rex Hospital... 249
Rex Hospital 163
Rabies 102
Standard Oil vs. Hookworm 315
Review of Southern Medical Literature,
47, 111, 1611, 254,
350, 402
Book Notices.
A Magazine of Merit, 175
A Candid Judge, 176
Atlas and Epitome of External
Diseases of the
Eye. by Professor Dr. O.
Haab, of Zurich 334
Atlas and Epitome of Ophthalmoscopy
and Ophthalmoscopic
Diagnosis,
by Professor Dr. O. Haab,
of Zurich 175
A Treat for the Doctor, ... 407
A Text-Book of Obstetrics,
by Barton Cooke Hirst,
M. D.,
Bier's Hiperemic Treatment
in Surgery, Medicine
and all the Special,
405
ties, by Willy Myer, M.
D.,
Clinical Examination of the
Urine and Urinary Diag-
118
nosis, bv J. Bergen Ogden,
M.'D., 405
Dietetics for Nurses, bv
Julius Friedenwald, M.D". 117
l)iet in Health and Disease,
by Julius Friedenwald,
M. D., and John Ruhrah,
Medicine, by R. Tait Mc- 4
Kenzie. B.A., M.D 404 I
Good Thing.-b in theNovem- ^
ber Lippincott's 406 ^
Modern Materia Medica and ji
Therapeutics, by A. A. 3
Stevens, A.M. M.D 404 J
Medical Gynecology, by 1
Samuel Wyllis Bandler, i
M. D 405 J
M. D., 118 1
Essentials of Bacteriologv, {
By M. V. Ball, M. D.,.'. 119 3
Exercise in Education and -l
Hand-Book of Diseases of a
the Rectum, by Louis J. »
Hirschraan, M. C, De- Jtroit
Michigan, U. S. A., 117
International Clinics 117
Manual of Therapeutics.
Parke, Davis & Company,
S. A. L. Railway Surgeons, 316
Structure of Opsonins,
:il2
Surgical Sheck, 311
Sohafer's Mfathrr^ rf Artificial
Respiration 247
St. Joseph's Infiri. a v 249
Southern Medical .v.s.^ociation
396
"The Russianizing of the
American Medic;il Profession,'"—A
Few Plain
Detroit Mich 174
Words, 389
The Duty of the Physo-ian, 395
The Physicians National
Board of Regents, 159
The President's Annual
Address, 37
The Record of the Fourth
of July, 244
The President of the Medical
Society of the Stale
of North Carolina, 35
The Nerve Theory of An-
Henrv V. Arny, Ph. G.,
Ph. D.,
175
Philadelphia General Hospital
Reports, Vol. VII,
1U08,
332
gina Pectoris, 98
The Causation of Sex, 100
The Trained Nurse, 325
Typhoid Fever, 311
Typhoid Problems, 164
Uric Acid and Gout, 314
Virginia Medical Examining
Board,
163
X-Ray Burns, 160
Medical and Minor Surgi- :
cal Diseases of Winneu, 4
by Samuel Lile, M D., . . 119 |
Manual of the Diseases of
the Eye for Students and
General Practitioners, by
Charles H. Hay, M. D.,.. :
Principles of Pharmacy, by
PhysioloHry for Beginners,
by Walter Moore Coleman,
A. B
Studies in Rabies. Collei:ted
writings of Nathaniel
Garland Keirle, A. M.,
M.D.,D. Sc, 332
Studies of the Human Form,
by Robert W. Shufeidt,
M. D., 11^
Surgical Diagnosis, by Daniel
N. Eisendrath, A. B.,
M. D. 40.3
The Principles of Hygiene,
by D II. Bergey, M. D.,
The American Pocket Medical
Dictionary, edited by
W. A. Newman Dorland,
M. D 174
The Popes and Sciences, by
James J, Walsh, M. D., 53
The Diseases of Children, ;
Tuley, M. |
by Henry Enos
D.,
332 ]
The Psychic Treatment of
Nervous Disorders, by /
Paul Dubois,
119
;
I
The Practice of Medicine, S
by James Tyson, M. D.,. . 334 ;
Tetany and Exophthalmic i
Goiter, by Drs.JohxiRog- (1
,:
ers and Silas P. Beebe, . . 334
Text-Book of Hygiene, by
George H, Robe, M. D., 333
Tuberculosis: A Prevent- ,1
able and Curable i^isease,
by Adolphus S. Knopf,
M. D., 174 •!
,
Treatment of the Diseases
of Childi-en, by Charles i;
Gilmore Kerley, M. D., 117 ;|
Thornton's Pocket Medioiil 'i
Formulary 117 (
Vaccins and Serum Thera-
.

py, bv Edwin Henry
8cborer, M. !) US
\v>Mf no- tJiS Shoit-Story,
! Pfcig-
Esenwein... '. 53
Abstracta.
e of Kheumaiized A v-
1 .tis in a Child aged
;
I ,iud a half years, 407
.\rni- Leucucythffimia in a
CuUd Af;ed Eight Years, 410
ACaseof Tubercular Uheumatism
in a Child 311
A Case of Baoillary lulecf
the Uriiiaiy Tract
led by tlirt Corres-
.lig Serum and Vac-
267
A \",tn f.ir a Rational Pu.rperium,
262
Acute PuruleutOphlljaluiia 26£
A Case of Tuberculous Nephritis
as a Sequel to Angina,
2t)7
A New Method of Sphinuteric
Control after Colostomy,
124
A Case of oevere Facial
Carouncle, with Luuwig's
.\ngina and Pai otitis, 186
A Case of Acute Lupus Erythematosus,
186
A Caseof TuLierculous Meningitis
without Tubercles 192
Acute Necrosis of Skin, 176
Bees' Stings and llheumatism,
256
Bacleriologicand Serologic
luvestigaiioDs in Scarlatina,
260
Constitutional Eczema of
Infants, 416
Cerebrospinal Fever, 413
Complications of Scarlet
Fever 412
Certain Bacilli Coli Infections,
409
Case of Missed Labor Treated
by Abdominal Section 262
Cancer of the Penis, 267
Congenitiil Heart Disease
aud Polycythemia 262
Congenital, llerodilary,and
Family Hematuria 257
Carbon Dioxide Snow in
Dermatology, 259
Chronic "Rheumatic"' Myositis
266
Cholin and its Connection
wiih Epileptic Fits 336
Cornplications of Suppuration
in Air Sinuses, 189
Chronic (iaslric and Duodenal
Ulcer, 190
Cardiac Pain, 181
Chronic Eczema of Infants, 121
Cerebrospinal Pevor It2
Double Cervical Ptib 340
Diplithurias with invisible
Location (Crypto-Diphil'"-ias),
178
itialmic. Goitre, as a
• I to Tubercular Af-
..MS, 260
ru.r.iirjg in Measles and
Scarlatina, 132
Fatal Case of Pernicious
Vomiting of Pregnancy, 191
Functional Albuminuria in
the Infant, 194
INDEX TO VOLUME SIXTY.
Heart Disease, 267
Hypertrophy of the Female
Mamma, 3jo
Interpretation of the Poro
Uterus in Relation to the
Third Stage of Labor,.. . . 268
loUipin in Syphilis, 189
Inguinal Hernia 178
Intravenous Injections of
Adrenalin in Heart Fail-
""•e 415
Kyphosis with Spinal Crest, 187
Lysol Poisoning from Intrauterine
Irrigation 262
Meat- Poisoning 415
Maniacal-Depressive Insanity
414
M-'at Broths for Infants,. 335
Marriage of Women Having
Cardiac Diseases, 120
Methods ofCataract Extraction,
190
Malformations of the Heart 26^
New Methods of Treatment
of Gastroenteritis 177
On Perforation of the Stomach
and Small Intestine
as a Stqui^l to Ovariotomy
and Hysterectomy, 341
On the Treatmfenc of Severe
Urethral Strictures, 121
On the Treatment of Bronchial
Asthma 122
Opium in the Therapeutics
of Infancy, 181
On Being Tired, 413
Puerperal Fever 337
Prevention of Diphtheria, 415
Polyserositis, 122
Pneumococcus Vaccines in
Pyopericardium in Children
182
Prostatic Enlargement, 184
Phthisis, 185
Prognosis in Tetanus, 177
Had inactivity and Carcinoma
185
427
Facial Nerve, 110
Surgical Treatment of Benign
Gastric Affections, 408
Three Cases of Henoch's
Purpura, 407
The Efficacy of the Anti-
Gonorrhe.c Arhovin 408
The Treatment of Irreduci-
ble Intussusception by
Lateral Aniisti mosis, . . , . 409
The Exudative Diathesis, 118
The Diagnosis uf Beginning
Tabes, 410
The Souchon Museum of
Anatomy at Tulane University,
414
Tumors of the Vermiform
Appendix, 414
The Treaem ut of Alopecia
with Ultra-Violet Kays, 413
The Need tor More Prompt
and Thorough Treatment
of Children Suffering from
Rheumatism or Chorea, 180
The Hot Air Treatmeat of
Acute Suppurations of the
Hand, 124
The Effect of Hypophysis-
Extract upon the Blood-
Urinary Bacterial Infections
in Childhood, 125
Tuberculosis of the Hip-
Joint,
Ti-eatment of Labor in Con-
128
tracted Pelvis 128
Typhoid Fever in Children, 130
the Treatment of Pneumonia
and of Some of its
Complications,
The Surgery of
130
Lingual
Thyroids 182
The Operation of Cardiolysis,
183
The Causes of Obstruction
Pioducing Cyanosis During
the Nasal Adminis-
Red Degeneration of Utertration of Nit'-oiis O.Kide, 184
ine Fibroids Complicat- The Principal Ways of Tuing
Pregnancy i88 berculization in theYoung
Radioaciivitv and Carci-
Infant, 187
noma : 120 The Surgical Treatment of
Remarks on Common Types
Colitis, 188
of Sore Throat 264 Typhoid Bacilli in the
Retroversion of the Uterus, 258 Blood of Patients not Sick
Rupture of an Incarcerated with Typhoid 189
Retroverted Gravid Ute- The Fate of Damaged .loints 193
rus— Recovery, 338 The Condition of the Heart
Speech Fright, 411 and Lungs after Abdomin-
Some Oriental Suggestions
al Operations 193
in Matters of the Healing The Antisepsis of Abortion 193
Art,
260 Treatment of Tuberculous
Suprapubic Prostatectomy Peritonitis by Means of
without Opening the X-rays,
177
Bladder,
340 The Remedies for Depopu-
Serum Treatment of Cerelation,
179
brospinal Fever, 311 Tubercular Peritonitis in
Schlatter's Disease; or, the Nursling, 171
"Rugby Knee," 125 The Differentiation of Aor-
Spontaneous Infantile Myxtic
Aneurysm and Mediedema,
128 astinal Tumors 257
Statistics of General Anes- The Infection of Consumpthesia
122 tion 258
Scorbutic Etiology,
181 Treann. ut of Severe Ar-
Serum Treatment of Diphthritis
259
theria Intoxication, 179 The Zittman Treatment of
Spinal Analgesia, 180
Treatment of Facial Paralysis
Due to Division of the
Syphilis, 262
The Operative Treatment of
Trigeminal Neuralgia,... 266

428 THE CHARLOTTE MKIUCAL JOUKNA.
The Etiology of So-Called
Congenital Dislocation of
the Hip 267
Treatment of Postpartum
Hemorrhage, 268
Treatment of Lobar Phru- ing,
monia, 338 Vaccinal
Treatment of Incoei .-,ihle Childhood
Jmmiinitv
Vomiting of Pi-egnHi, '.v. 120 Vegetarian Dietia HeaUb, 33»
Tumorir of the Cerehellum ir j t tj- i
inChildren 121 Value of Kinesolherapy in jj
Erythematosus 334 Uterine Cnncer m Uterine Hemorrhage,.. The Treatment of Lupus
, 178 i
.
Tubercle Bacilli in Caseated Use and Abuse o? r.r.prie- X-Ray 1 reatraent of limg- f
Lymph Glands, 33fl tary Foods in lufant-kod- worm of the Scalp 191 !
Hypcrncpbroma.—W. Trotter, in the
London Lancet, finds 75 cent, of cases of
tumors of the kidney to be hypernephromata;
the remainder are made up mostly
of sarcomata, to a much less extent of equamous
epitheliomata of the pelvis, while a
true carcinoma of the kidney apart from
hypernephroma is a very great rarity, or
possibly does not exist. The kidney tumors
of children are practically all sarcomatar
there is but one case of hypernephroma
in an infant. Malignant disease of the
kidney affects earliest childhood and middle
age, but rarely young adults and the
aged. Hence hypernephroma is the common
kidney tumor of adults; conversely,
any given tumor in an adiilt is much more
likely to be one of this type than anything
else. This is probably the only absolutely
etiological factor bearing on the disease.
There is the history of injury, but the conditions
here render this history suspicious.
The tumor may be present for a long time
before it is discovered, so that injury may
come to have its apparent importance merely
by calling attention to the part; moreover,
an injury may induce a hemorrhage
from a kidney the seat of a tumor when it
would not do so from a sound one. Once
the diagnosis is established the treatment
is clear; such a kidney must be removed.
A local resection when the tumor is small
will not do; nothing less than total nephrectomy
is justifiable. In the absence of
secondary growths mere size of the tumor
is no contraindication unless there is obvious
iuvolment of other abdominal organs.
Although tumors of the colon suitably
placed frequently involve the kidney, tumors
of the latter rarely involve the colon.
In favorable cases there is always an excellent
probability of very prolonged immunity—
a period of ten years' freedom
from recurrence is not unknown; it is probable,
however, that unless operation can
be done a good deal earlier than at present
permanent cures are likely to be rare.
Transplantation of Organs by Vessel
SaiuFc.— ( Archiv. f. Kliit. Chic.) has successfully
transplanted the kidneys and thyroid
glands of animals by means of vessel
suture.
The extirpated kidneys were transplanted
with their vessels, the vessels being
lf*7
338 •
sutured to the vessels in the same animal |
o'- another animal (dogs being used), the 5
ureter led to the surface through the skin. •
The < rgan
secreted urine abundantly for '
several days. The animals died, however, ,
in a s^iort time (at the latest ten tUiys) of j
ascending pyelonephritis. The writer, i
therefore, planted the kidnev vessels in the y
iliac vessels, and planted the ureter in the ^
blarkler. The animal died three weeks "j
'
after the operation, of chronic, localized, J
suppurative peritonitis. The transplanted
kidney was found macroscopically and microscopically
unchanged.
Further research dealt with transijlantatiou
of the thyroid gland. Both lobes of
the thyroid gland of a dog were extirpated;
the left lobe was then implanted on the
right side of the neck by vessel suture.
After fifty days examination showed that
the reimplanted thyroid obtained circulation
from surrounding tissue, and was macrascopicall
and microscopically normal.
He has also successfully transplanted
thyroid gland from other animals, always
from the same species, however.
Election of Officers.
At a recent meeting of the Medical Association
of the Southwest held in San Anto-
nio, Texas, the following officers were elected:
President, Dr. H. G. Moody, San Antonio;
vice-presidents: Missouri, Dr. Howard
Hill, Kansas City; Kansas, Dr. C. E.
Bowers, Wichita; Oklahoma, Dr. D. A.
Meyers, Lawton; Arkansas, Dr. A.J. Vance,
Harrison; secretary -treasurer. Dr. F. H.
Clark, El Reno; executive committee: Missouri,
Dr. S. G. Burnett, Kansas City;
Kansas, Dr. J. F. Gsell, Wichita; Oklahoma,
Dr. E. S. Laine, Oklahoma City;
Arkansas, Dr. J. A. Foltz, Fort Smith;
Texas, Dr. K. H. Carv, Dallas.
The Southern Surgical and Gynecologi- j
cal Association will hold its twenty-second 1
annual meeting at the Hot Springs Hotel, S
Hot Springs, Va., December 14, 15, and i
16, 1909. The president of the association '<
is Dr. Stuart McGuire, of Richmond, Va.; i
the secretary is Dr. W. D. Haggard of >
Nashville, Tenn., and the chairman of the ;fl
committee of arrangements is Dr. Lewis C. |
Roscher of Richmond, Va. f

tZ^
ADVEKTISEMKNTS.
A Post Graduate Course in Surgery for Medical Graduates Only.
^>;D£. W-A-Sliepherd, D.,
St. Clmical Surger.v : 2,,!
amiaationswill be made o
al lesions present, will bf .1
str.iction in the details .-.f

4,^0
THE CHARLOTTE MEDICAL JOURNAL.
Pernicious Anaemia.—Taylor, in The In the second or anaemic stage, the pains
London Practitioner, reports 10 cases of reached a high degree of severity, so as to
this disease and makes the following ob- prevent the patient altogether from moving
servations: the extremity; the gentlest contact of the
It is clear that the symptoms of pernic- soft parts gave rise to intolerable pain. In
ious angemia may be many and varied; in the third stage, when the gangrenous proone
case a gastro-intestinal disorder may be cess was already well under way, complete
simulated; in another the patient may ap- ansesthesia appeared in the gangrenous
parently have a nervous disorder, or again portions, together with a small hypersesthere
may be complaints of nothing except thetic area at the boundary of the healthy
weakness, loss of breath and oedema, which tissues. This was the point of origin of the
might be due merely to chlorosis.
pains, which appeared from time to time in
By the examination of the blood alone periodical attacks. Finally, in the fourth
can'the diagnosis be at once settled, and, stage, when the gangrenous tissues were
for the sake of cases of pernicious ansemia, already completely mummified, it again
the author would urge that more frequent became possible to determine pain by means
routine blood examinations should be un- of pressure. This state of afTairs caused
dertaken; many, of course, would show the patient herself and her friends to hope
nothing abnormal, but, at any rate, as a that the gangrenous portions of the exresult,
many more patients with pernicious tremity would recover. The color of the
anaemia would have their disease recogiiiz- skin coverings of the extremity likewis
ed earlier, and appropriate treatment start- varied considerably; it was deathly white
ed, and possibly harmful treatment avoid- during the first few days, then took a mared,
for if the case were thought to be chlo- ble tint, changing to a dark purple, and
rosis, and iron administered, it would be finally to a bright red, in the stage of mumone
of the worst possible things for pernic- mification (changes of the haemoglobin?),
ious antemia.
Unfortunately, the patient could not be kept
The recognition of idiopathic pernicious under observation until the end of the disancemia,
in any case with obscure symp- ease. The conservative treatment (rest,
toms, rests on the following blood changes warmth, analgesic remedies) adopted in
—reduction in the number of red corpuscles, the hospital did not satisfy the friends of
with a high color index, and leukopenia, the patient, who desired more energetic
The presence of megalocytes in large num- measures, such us massage, and the patient
hers, and of normo and megaloblasts. was removed from the hospital against the
Among the white corpuscles a lymphocy- advice of the physicians The outcome of
tosis, usually of over 40 per cent., and a the case is unknown.
not greater percentage than four of eosino- Upon the basis of his personal observa-
pliils. tion as well as the statements in the litera-.,
„^ „ ... . „ . . ture, the author believes himself justified im
The CompSicat.on ol Typho.d Fever
^j^^ following conclusions;
with Gangrene of the Extremities.-
^ The immediate cause of gangrene o?
Biron (Wiener Khu. Wchschrft). Thecase the extremities in tvphoid fever is the obreported
by the author concerned a young struction of the afferent vessels (arteries),f
woman, 21 years of age, who was admitted sometimes of the efferent vessels (veins).^
to the Obuchow Hospital for Women, in in certain cases the interruption of the cir-
St. Petersburg, suffering from an attack of culation mav be due to causes of a functyphoid
fever. In the beginning of the tional character ( spasm of the vessels
third week of an illness of moderate sever-
ity, when the temperature was already re- Treatment lor Intestinal Worms.—SavillTj
turning to normal, there appeared an un- in The London Practitioner, points out that
favorable complication in the shape ofgan- intestinal worms mav give rise to no sympgrene
of the right foot and leg. This gan- toms at all. These worms are most fregrene
was preceded by a stage of severe quentlv met with in children, and mav re- !
pain in the extremity, the cause of which main undiscovered until they are found in i
was not very clear. One and a half days the stools. The symptoms are verv indefilater
appeared manifestations of well- nite, and consist of vague and persistent, ^
marked local aneemia, followed by a pur- though often paroxysmal, pains in the abdo- ;
plish discoloration and loss of sensation, men; capricious and sometimes ravenous
etc., in the tissues, pointing to the true appetite, in spite of which the child be- \
character of the disease. In the first or comes thin and sallow, grinding of the teeth 3
prodromal stage, which lasted about one at night, picking of the nose, and other re- ||
and a half days, the pains in the extremity flax phenomena; irregularity of the bowels, |
were entirely spontaneous, without depend- or diarrhoea; threadworms produce intense i
in g upon movements, pressure and so forth, itching of the anus, and consequently i'
)
I

fidgetiness, especially at night. They mav
wander forwards and cause vulvitis.
The treatment differs for the diffeient
worms. For threadworms the best treat
meiit consists of quassia injections. After
an aperient, one ounce of powdered quassia
to a pint of Ijoiling water is, when cold, in
jected into the bowel, and retained as long
as possible. Common salt injections of the
same strength may be used. The worms
are destroyed with two or three such in lections.
Santonin (one grain") in a powder with
calomel is very efficacious; it should be
given on alternate days for three doses, fol
lowed by castor oil. Where the worm has
its habitat high up in the intestine (as the
tapeworm) treatment is conducted in three
stages.
< 1 ) In order to starve the parasite by
keeping the alimentary canal as empty as
possible, the patient should have no food
after midday, and at night or next morning
a purgative must be taken. This leaves
Hernia ol Ibe Diaphragm, Traumatic
and Acquired.— Little-Jones (.Liverpool
.Medico Chirurgical Journal) reports two
interesting cases. The first was that of a
young man who fell down a flight of stairs
and shattered a picture glass. He sustained
a wound about Z'i inches long in his
nth left intercostal space, through which
null piece of omentum was protruding,
.luthor removed the eighth rib, cleaned
out the pleural cavity of a large amount of
blood and glass and found a rent I'/i inches
in length in the diaphragm about half an
inch from the pericardium, through which
omentum was protruding. The omentum
was ligated and removed and the rent in
the diaphragm was sutured. Despite a
rather severe attack of pneumonia, the
patient recovered and is today perfectly
well. The second case occurred in a child
of eight, who gave a history of repeated
ADVERTISEMENTS.
the worm uncovered, and thus readily acted
upon by (2 1 the anthelmintic, which is
given about an hour after purgation. The
chief anthelmintic is extract of male fern.
Some recommend thirty minims of spirit of
turpentine to l)e given with this; others give
kousso (four drachms) or pelletierine (two
grains of the alkaloid ); (3) two hours later
give calomel with saline aperient to eject
the worm from the body. The stools must
be examined to see that the head is passed, attacks of colic consequent to a fall which
If only segments are passed, the worm will occurred eight months before. An attack
grow again, and the same treatment will of obstruction supervening, the patient was
have to be repeated within three months. operated upon and it was found that the
For the round worm the specific remedy is omentum and parts of the transverse and
santonin, given in two grain doses to a child descending colon had passed into the left
of three and upwards; for an adult five pleural cavity through a hole the size of a
grains are given.
shilling. Great difficulty was met with in
attempting to reduce the contents, but this
was finally accomplished when the negative
pressure in the pleural cavity was released
by puncturing the diaphragm with a probe
director. Nevertheless a po.'tion of the
omentum was found densely adherent and
the author contented himself with closing
the opening in the diaphragm with the prolapsed
omentum. The patient seemed to
do well for two days and then died from
causes not discoverable at the autopsy.
A New Finished Stock Building for the
Lilly Laboratories.
Eli Lilly & Company have under way a
new stock building. Tlie excavations are
complete and much of the foundation is in.
The location of the building is immediately
east of the front section of the original
plant, with which it will be connected by
subway and enclosed passages. The building
will be 70x180 feet, consisting of a sub-

4.i2 THE CHARLOTTE MEDIOAL JOUKNAL
basement, basement and two stories, giving- ent neurons combine with spinal associa-
floor space of about ^1400 square feet or a tion neurons, through the intercalary v.eulittle
more than one acre. The sub-base- roiis, in augmenting: and inhibiting the
ment and basement will be of re-enforced outflow of energy of the spinal motor neucoTicrete.
The superstructure will be of roiis whereby the most varied, refined, and
brick with stone trimmings. The building complex u-uscular reactions in adaptation
above the ground will be massive, of slow to environment are effected. The nervous
burning construction with complete sprink- energy is expended in the gray matter of
ling system. The sub-basement is designed the brain and spinal cord. Other points
for a storage for drugs which are ground referred to by the author are the significance
green and packed in alcohol. The other of the nodes of Kanvier, theories in referfloors
will be occupied with finished stock, ence to the functions of the interfibrillary
The new building will provide the Lilly cb.romophilous substance of the ganglion
Laboratories with one of the finest stock cell and the dendrons. Is this chromophilbuildings
to be found anywhere, and it is ous substance the source of the energy,
imperatively needed to take care of the in- and if so, is it used at the site of its formacreased
demand for Red Lilly Pharmaceu- tion or is this substance, which in the dead
ticals. cell corresponds to the Nissl granules, a
Present Position ol the Neuron Theory store of energy- producing substance in the
Doctrine in ReSalion to Neuropathology, latent state analagous to the preferment of
— Mott, in the British Medical Journal, says the sweat glands, a substance which is
that a neur>n is a nerve cell, and all its pro- transformed into t';e active energy-processe.s,
including protoplasmic processes or ducing substance at the terminal aborizadendrons
and the axis cylinder process with tion of the neurons? In general the author
its cone of origin, its collaterals or side- regards the neuron theory as resting on a
branches, and its terminal arborization, surer basis than ever before.
The neuron thory is that the nervous sys ParaShyroId Findings In Galvanic Hy-
tern consists of in numerable such anatomi-
,, perirriialjl5iSyol . , , . . CiiiSdrcn.— Yanase(Wiecally
independent nervous units in cont.g-
„er Klin. Wchschrft ) savs that anatomical
uity out not contn.uny. 1 he author beexaminations
of the parathvroids were perheves
that he trophic and genetic indeformed
in 89 cases, the most common pathpendence
of the neurons has been estabological
change bein- found to consist in
lished. The question arises how are they
hEemorrhages into the glands. These hsmorcoimected
with one another? The method phages are acquired at the beginning of
of Golgi appeared to showthat the neurons
post-foetal life, perhaps during birth, and
are arranged m systems, and numerous ex-
^^,,,,0^ as a rule be demonstrated after the
penments were made te show that the deng^^j
Healing takes place in such a
dnlesexer

I actually
I
! tion
i dition
j
I be
ADVERTISEMENTS.
Malignant Syphilis. - Rost (Dermatolofr.
Zeitschr I describes six cases of malignant
syphilis and then discusses the clinical features
and treatment ^^Sulpho-
of the disease. In one
of the cases an ulcer of the throat produced
a fatal haemorrhage through arrosioii of the
superior thyroid artery. In three cases it Lythin
L-V IBBIII f "Tables No.6'
was impossible to demonstrate the spiro- ,vr-pt^r
chEeta in the lesions of the skin and mucous UCVI-ME-UVi cm ,R,u,r I
membranes. This agrees with Hoffmann's ntXAiViU HllENAiVliNE
'
experience that in typical ulcerations of ^- S. P.
malignant syphilis the spirochjeta either rh„i«„ „-.cannot
be found or ^^^'^^^^"fl"^- ^'''^^y «nd
at least is present m
ver>' small numbers. In one case the glands Urinary Antiseptic.
were scarcely able to be felt, agreeing with Effective in all conditions produced by
claims of some authors that in malignant Hepatic Insufficiency,
syphilis glandular swelling is markedly
slight.
Effective in
In three
arresting,
cases there
preventing
were
and coun-
joint
manifestations,
teracting
involving
bacterial invasion
in one
of the gall-
case nearly
bladder.
all the joints and Hence it is
lasting indicated in
for years. The
changes appeared to affect the
Cholangitis,
capsule of
Cholecystitis and
the joints, and no great disturbance of func-
Cholelithiasis.
tion was noted.
Effective in Typhoid Fever, as a preventive
Brain symptoms, such as headache, de- and curative agent, being an Intestinal
pression, sleeplessness, deafness, numbness, Antiseptic.
etc., were present in two cases. These mani-
Effective also in
festations the writer
Toxemia of Pregnancy.
considers to be due not Sample, literature
to
aud clinical
destructive reports
processes in the
upon request
brain, but to
the result of action of toxines.
LAINE CHEMICAL CO.
Lumbar puncture, made during severe
cerebral symptoms
Manufacturing
in one
Chemists.
case, showed that
the pressure in the brain was not increased,
NEW YORK.
and that the cerebrospinal fluid contained
neither leucocytes, spirochretce nor bacteria Continuous Catheterism of Ureters In
If the brain symptoms had been due to les Bladder Lesions.— Cardeiial of M a d r i d
ions instead of toxaimi the cerebrospinal . (Zentralb. fur Chir.J advocates the pr;icfluid,
the writer thinks, would have shown tice of continuous catheterism of both uresome
pathological change. ters as a means of keeping the bladder dry
For the local treatment of ulcerating in certain cases of suprapubic cystotomy.
syphilis the writer advises warm compres.ses Such practice, the author slates, has been
of a 1 per cent, solution of bichloride of found very useful in his own surgical work,
mercury. Bier's hyperamic treatment also and he believes that it can be applied withis
to be recommended, excellent results be- out any risk of setting up ascending septic
ing had in one case from this method. The infection. Ureteral catheterism has been
opinion that mercury fails to cure or even carried out by Albarran in both the preaggravates
malignant syphilis is ventive and the curative treatment of renal
not subscribed to by the writer. He con- fistulae following nephrostomy, but ihe value
siders the choice of the mercurial prepara- of this procedure has not hitherto, it is held,
and the length of time for its employ- been tested in the operative surgery of the
rnent to be a matter of great importance, bladder. The author, after he has opened
The soluble preparations are not very the bladder above the pubes for the extracpowerful.
The "Ilir.sch injection" and tion of a calculus or for the excision of a
"Hydrargyrum colloidale" failed to give tumor or an enlarged prostate, introduces a
good results. Large doses of unguentum No. 9 or 10 Charriere into each ureter and
ciiiereum are very efficacious wlien the con- then passes the other ends of both catlieters
of the skin admits of their employ- along the urethra. The retention of the
meiit. The insoluble preparations are to catheters for several days after the operarecommended
above all others. The tion serves, by keeping the vesical cnvity
salicylate of mercury is especially useful in free from urine, to improve the results of.
the beginning of ihe treatment to ascertain suprapubic cystotomy. Troublesome post-
Ihe i)atienl's reaction to the drug and later operative hceraorrhage may be more effectfor
after-ireatment. Calomel injections are, ually controlled by packing the vesical
f however, the be-^t, and are pr(>ductive of cnvity with compresses that remain dry and
I
excellent results in the severest cases. firm, and if the flow of urine through the

4,U THE CHARLOTTE MEDICAI, JOURNAL
iprapubic wound be suppressed the dura- formitj' by osteotomj', than to subject the
if the after-treatment will very prob- patient for years to extension apy^aratus.
ably be shortened. The abdominal wound Tuberculosis of the knee-joint ( 1 10 cases)
is closed or kept open, according to the
nature of the case, and the patient when
was generally treated by conservative meth-
ods: Extension, fixation, iodoform injecable
to take fluids should be treated by re- tions. In cases of obstinate recurring conpealed
doses of some urinary antiseptic tractures resection is to be recommended,
such as urotropin, helmitol or vesipyrin.
The permeability of the catheters must be
with ankylosis in the extended position.
This operation was particularly done in
carefully tested from time to time by the adults. Thirty-seven cases were treated
injection of small quantities of a 4 per cent,
solution of boric acid or a 1 per cent, solution
of nitrate of silver. If, as will be indicated
by the arrest of the flow of urine, and
solely by hyperemia. In tuberculosis of
the ankle joint extensive use was made of
hyperemia (17 cases with 13 cures). Of 11
cases treated with iodoform-glycerin injecby
feelings of discomfort and pain in the tion, all were cured, and of 15 subjected to
region of the corresponding kidney, either resection, 14 were cured. The functional
catheter becomes blocked, this, it is stated, results after hyperemia treatment were parcan
be readily replaced by a fresh one ticularly good. Of tuberculosis of the
guided by a long mandrel, in accordance
with the instruction of Albarran. On the
fourth or fifth day, if no complications
elbow-joint, there were 28 cases, of which 5
were treated with iodoform with 4 cures,
and 9 by resection with 2 recurrences and 2
have occurred, the compresses are removed deaths; in 4 bony ankylosis ensued; in 2
from the bladder and the operation wounds only slight mobility was obtained, while in
closed by sutures. After another interval 2 the joint was freely movable. In 6 cases
of on.e or two days the ureteral catheters in which hyperemia was resorted to 3 had
are removed and the bladder is drained by moderate and 3 excellent mobility. Of
a retained urethral catheter. The author tuberculosis of the wrist, 34 cases were
has had occasion to prolong ureteral cathe- treated— 14 with iodoform injections, with
terism over nine days, but neither in this good results in 8 and subsequent resection
clinical experience nor in experiments on in 6. Of 12 cases of resection 9 were cured,
animals, in which the catheters were re- He is especially predisposed in favor of
tained for 16 days, were any complications Bier's method of hyperemia in the treatobserved.
The practice of continuous ure
teral catheterism may be capable, the
ment of tubercular arthritis, and from his
results concludes that in the knee joint the
author suggests, of giving excellent results percentage of cures of hyperemia is about
in the surgical treatment of vesical and of
fresh vesico-vaginal fistulse.— British Mediequal
to that of the iodoform treatment,
while the functional result is decidedly betcal
Journal. ter. As regards the elbow, ankle and wrist,
Tuberculosis of the Joints.—V o g
all the cases treated by this method were
e 1 cured, and here also the functional results
( Deutsche Zeitschrift fur Chirurgie) upon ^^gre more favorable than from any other
observations in 349 cases of tuberculosis of
the joints, presents some interesting statismethod.
tical data. In the first two decades of life Scopolamin-Morphin in Labor.-Croom i
<
the disease involved the hip or knee joint (Journal of Obstetrics and Gynecology of
in the vast majority of instances. Later the British Empire ) reports his experience
this predominance is much less marked, with scopolamin-morphin narcosis in sixty- {
Hereditary predisposition is present in 55 two cases of labor. Various do.ses were \
per cent, of the cases. Regarding treat- used. With onefour-hundredth grain of
ment, tuberculin proved of no value. Good scopolamin and one-sixth morphin, the re-
|
results were obtained with iodoform. Great suits were uneven and unsatisfactory, al- a
caution is demanded in the prognosis, since though the pain was diminished. With
even after years of apparent cure a late re- one-two hundredth grain scopolamin and i|
currence may ensue, particularly after a one-sixth morphin he had better results, but J
trauma. The special treatment of the dif- his best results were obtained by using one- :
ferent joints may be summarized as follows: one-hundredth grain scopolamin and one-
In coxitis: Modified extension, followed sixth grain morphin. With this latter the 'j
by fixation, in connection with intra artic- painfulness of the contractions was mark- ;|
uiar injections of iodoform glycerin; in case edly lessened, and in some cases entirely :!
of failure of conservative methods, arthrec- abolished. The patients slept soundly in ,i
tomy or resection is indicated, with preser- the intervals between the pains and in many ''•
vation of the femoral head if possible. It cases for an hour or two after the comple- I"
is preferable to let the joint heal in a patho- tion of labor. In only two cases was a J
logical position, and later remove the de- thorough resuscitation of the child neces- ;
^
]
,j
i
i

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IS a Prescription that does not disappoint in the treatment of
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Its action IS primarily on the mucous and serous structures of the nose, throat
and lungs, which are the tissues involved in Spasmodic Asthma, Ilav Fever and
Croup. RESPIRAZONE Relieves Asthma promptly and effectively bv allaying
Hyperesthesia, relaxing muscular tension and subduing inflammation by reso
lution, rationallv meeting the pathological requirements of these cases.
-Another superior prescription is our
FEBRISOL LIQUID
FORMULA: I'.ach Fluid Dram Contains chemically pure:
I'henacetine 2 grs. Acetanilide li gr.
!^alol i " Tartaric Acid ;
Cit. Caffeine i " ^- Soda
^
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Fever and pain are the ever present conditions at the sick bed, and to
promptly subdue the one and relieve the other is the desideratum of every clinician
Febrisol has solved the problem how best to do this.
I'ree samples to the profession upon application.
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Manulacturing Pharmacists.
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sary, and none were lost. In fully one- siderable in their susceptibility to the drug,
half of the cases only one injection was The cases most suited for this form of
necessary. If repetition was necessary his treatment are primiparae of highly nervous
experience shows that only the scupolamin temperament. The drug can be given
should be injected the second time. The earlier in these cases than chloroform,
drug was given mainly in the second stage Whenever anything in the nature of operaand
the elTects were, (I ) soporific, (2) nar- live interference or manipulation is necescosis
and anesthesia, and (3) amnesia, the sary, it is distinctly desirable to give chlororemembrance
of suffering being abolished, form in the ordinary way. The drug does
In two cases forceps were apitlied after two not seem to hasten or retard labor. It should
injections, and the patient delivered with- not be given to patients with irregular and
out suffering. In a few cases where the feeble pains, and in patients physically
drug was given during the first stage the weak and unfit it should be given with
OS dilated very rapidly, although the pati- caution.
ent was very sleepy and just conscious. On the whole the writer is of the opinion
Chloroform was given in ten cases. Of that in scopolamin-morphin narcosis we
these, four were forceps cases, in two it was have an efficient means of controlling, the
given to pass i)erineal stitches, on one ver- pain of labor, and that it is practically safe
sion was performed, one was a breech case when ordinary precautions are taken.
in a flat jielvis, in one there was extreme Treatment ol Inoperable Carcinoma of
pain at the end of the second stage, and in the Uterus with Acetone. — G e 1 1 h o rn
one it was necessary because the patient (Munchener medicinsche Wochenschrift)
became extremely noisy underthe influence states that after experimenting for a year
of the drugs. and a half he has found in acetone a sub-
There were no bad effects in heart, respir- stance which meets the demand for someation,
or pulse. The only untoward result thing to control the discharge, the odor,
is that the child is born sleepy and does not and the hemorrhage in inoperable carcinobreathe
well or cry. but in all cases the ma of the uterus. The fuct that acetone
ordinary methods of reviving are sufficient, quickly hardens tissues for microscopic
There is jierhaps a slight tendency to post- sections led the author to use in cases of
partum hemorrhage. Patients vaiy con- carcinoma of the uterus. The technique is
.

436 THE CHARLOTTK MEDICAL JOURNAL.
as follows: In the first place the ulcerated operative cases hardl}' reach a similar persurface
is thoroughly curetted. The re- centage. The mortality was found to be
suiting wound cavity is then carefully dried, lowest in those hospitals where no surgical
and one to two tablespoon fuls of pure ace- interventions were performed,
tone is poured into the wound through a There is one exception, consisting in the
cylindrical speculum, with the pelvis ele- hydrocephalus of certain chronic cases,
vated and kept in this position for fifteen to The removal of this hydrocephalic complithirty
minutes. Then a narrow strip of cation would appear to be advisable, and
gauze is packed into the wound cavity, the author for this purpose performed drain-
The patient is then put into the horizontal age of the two lateral ventricles in two
position, the speculum withdrawn, the cases, and further recommends simultalower
part of the vagina and the vulva neous drainage of the fourth ventricle by
washed out with sterile water and dried, opening the atlanta-occipital ligament.
In twenty-four hours the gauze is drawn The danger of this drainage consisiS in scout,
and in two or three days the patient condary infection during the after-treatleaves
her bed. In five days another treat- meut. In order to guard against this risk,
ment is carried out. The pelvis is raised, the author employed for drainage purposes
a cylindrical speculum put in and filled small silver-wire frameworks, 4 cm. in
with acetone, and the patient kept in posi- length, which held parallel threads of cottion
for half an hour. ton wick. By means of the successive
The treatment is painless, hence anes- pulling out of these threads it was possible
thesia is unnecessary, but the vulva and tore-establish the drainage, after an obperineum
must be protected from the fluid, struction had resulted, with a favorable
At the beginning this treatment is repeated influence upon the outcome,
three times a week. Gradually the interval
^toe Therapeutic Use ol SuSphur.between
treatments can be lengthened ac- „. ,
, ,,, , ,, , ,,, , , r. ^ .u ^
* cording to the results. If the patient agrees ^'^''Y ^^''^''- ^^"^ Wchschrft.) says that
^he observation to the effect that the sul-
to it, the currettement mav be repeated
preparations are often of very
everv one or two
unequal
months, o'n this point it Pjl^';
effic-ency ,s referable to the more or less
has been observed that the subsequent curfi"«'>'
d'^^tnbuted
rettements are much less bloody and
form of the sulphur in the
only a
Preparation employed. In the author s ex-
small amount of necrotic tissue comes awav;
thev can often be carried out without an
penence a constant and uniform effect was
anesthetic. After a few days a diminution
obtained by means of a oO per cent, sulof
the bad odor is clearly
Pl^ur omtment prepared by rubbing up a
distinguishable:
quantity of still moist,
the discharge gradually and
newly precipitated
completely
disappears, and at the same time the
^^ Pl^"'''
fetor. ^'^1. an ointment vehicle (pasta
^^^f""^,
Hemorrhage
P^ltiformis)
becomes
The employment of
. less or entirelv disap-
'•?'«
pears. After two or three weeks the crater ^^^P^^', P^ste was followed by favor-
able results in cases of scabies, acne vulalmost
without exception becomes smaller
and its walls become smooth and firm. On S^^^, seborrhcea of the scalp pityriasis
versicolor, herpes tonsurans, and all
account
forms
of the absence of bleeding anddisof
^fl?l?!;.!!?:P!!l°!ll"''*'^f:_f ":^ ^!'.i°'''^'
seborrhoeic eczema. Certain cases of
charge the general condition of the patient
hronic eczema as well as fresh efllores-
becomes improved. . . . ,., . ^
One apparent cure of a well-marked case
^^"^^^ of psoriasis were likewise favorably
influenced.
of cervical cancer
The preparation was painted
is reported in detail.
About a dozen cases have
o" the parts
been
two or three times daily, or it
treated in
^>'^^ ''"'^^^'^ into the affected skin
this way, but with the exception
segments,
noted there
was no permanent improvement, although
the lives of the patients were prolonged.
Salisbury N C
Aoril 9th 1909
The Surgical Trealmenl ol Epidemic Laine Chemical Co.
Meningitis.— Radmann (Mittlg. aus d. Gents. For years past, I
Greiizgeb. d. Med. u Chir. ) says that sur- have used Sulpho-Lythin with good results
gical measures, in a general way, are not in chronic rheumatism and in furuiiculosis
promising in the management of epidemic or the tendency to boils. More recently, I
meningitis, even for theoretical reasons, have been using your No. 6 tablets with
since the condition is not a local suppura- success in cystitis and prostatitis. Still
tion, the clinical picture being governed more recently, I tried your No. 4 tablets in
by the general infection. Against the lat- a case of acute articular rheumatism, and
ter the local interference with the inflam- the pain and tenderness abated in forty
matory products in the meninges is power- eight hours. Your preparations are valuable
less. This view is supported by statistics, and I shall continure to use them in my
One-third of the patient"! recover without practic_. Yours Very Respectfully,
surgical surgical treatment, whereaa the j. H. Faust, M. D.

ADVERTISEMKKTS, 4,37
A S-Pheu, formerly kuowu as Ther- "Proitssor Hks^x (
Berichle der Deutschen
mol, has been proven by extensive chemi- GeselL, Vol. 37, p. 3076), states: "in the
cal and clinical tests, to be of potent and matter of reducing temperature the anilides
reliable therapeutic value. work better than the phenetides; but even in
The abbreviation—a-s-pheu—explains small doses they develop quite early the un-
the nature of its composition—acetyl-^ali- desirable change of oxyhemoglobin into
cy\phenti\dLm. It is free from suggesting methahemoglobin, which appear as cyano-
its therapeutic application and any tend- sis. The phenetidin product, substituted
eucy to commercialize. with acetyl-salicylic acid (a s-pheu or
"This compound, which is not a thermol), proved inactive even in large
pharmaceutical, is so intimately encapsul- doses (0.4 grams*"—where there was no
ated by chemical condensation that it un- temperature.
dergoes gradual cleavage in the living body Professors Anschutz and Bertram, in the
and by the even supply, as it were, of its same publication, state; "The firmness
active component parts, doubtless exerts its with which the acetyl group is confined
full therapeutic value within the body, into this substance is to be noted."
without unduly disturbing the stomach, Br. W. D. Hamaker, secretary of the
depressing the heart's action or impairing Pennsylvania Medical Examining Board,
the pliysif logical integrity of the blood states: "With a-s phen I have been able
which so commonly follows the use of t'' reduce the time of treaMnent of typhoid
other salicylic and phenetidin compounds
• •
,
J .J ,.
when given in adequate doses.
fever one-half—except in very rate cases—
with entire safety to the circulation and res-
. . , ^
piration. In the future I shall treat pneu
A-S-Phen relieves headache, neuralsia, ^j^,,;^ with it."
catarrh, is useful in the disorders of men- Dr. Eugene B. Glenn (Surgeon with rank
struation, as a nerve calmative,
grippe, whooping cough, etc.
and in la of Major, National Guard of North Caro-
''"a): "Am using a-s-phen for the removal
AS Phen possesses antiseptic effect
''^ ^^''^' '" "^^ tuberculosis cases: and with-
. , ., . , out any signs of sweating as th; result of
on the urine. It serves to inhibit the . ^ ^, ...
the use of the medicine,
formation of fever: (1) By retarding through
^r. Henry Beates, Jr., president of the
its antisef>tic jjroperties the rapid growth of Pennsylvania Medical Examination Board,
the specific bacteria: (2) By its diaphoretic states: "I use a-s-phen (thermol) in those
and diuretic action and the consequent types of infectious disease like typhoid fev-
elimiiiation of the toxins; (3) By its ver, in those cases where the purin bases are
nerve sedative influence on the heat-regu- evolved in excess like rheumatic and kin-
latiiig powers of the nervous system and dred disorders, and in that other class of
the retarding of tissue waste. disease for which the salicyl group is indi-
Prof. Samuel P. Sadtler, Ph. D., LLD., cated, and where I have found it as reliable
and his son, Samuel S. Sadtler, S. B., state: as is quinine in malaria. I also use it in
We verified the composition of a-s-phen neuralgia as a nerve sedative and in those
qualitatively and quantitatively, which catarrhal conditions so symptomatic of the
clearly identified it and established its so-called uric acid or gouty diathesis. I
proximate composition, and found it tobea believe this product to be one of the most
definite synthetic compound—acetyl-salicyl valuable compounds ever created by man."
phenetidin, whose formula is C8H4 (OC-2- Send SI for fifty .5-grain capsules and a
HaO) CO.NiI.C,,H4 (OC.H.-,) or CirH; one-minute high grade clinical thermoine-
NOj This composition was established by ter to the Organic Chemical Manufacturing
f A.nsch\i\.z a.\\A}iQXUdiva. Berichie der Chem. Company. 2559 North Sydenham street,
Gesell. 37, p. 3975)." Philadelphia, Pa.

4.i8 THE CHARLOTTE MKDICAI, JOURNAL.
Locomotor Ataxia and Paralysfs Jn the nev may be assumed if catheterization of
Light of the Newer Syphilis Rcscarcl^.-
^j^^ ^^^^^^ ^^-^^ ^^ ^^^^^ ^^^^, retention of se-
LessertBerl.klniWochenschr) states that
^.^gjiQ^y i„ ^^^ ^^^^^^ p-gj^.j^ Repeated
Wassermann's syphihs reaction is positive
ngors in the course of a febrile pvelonein
paralysis m lOU per cent, of the cases and
pj^^j^jg p^j^j ^^ ^1^^ presence of abscesses in
in ataxia locomotor m .0 per cent, of the
the cortical portion. .-Vcute and subacute
cases examined Both diseases must be
pyelonephritis demand nephrotomy, if perlookedupon
astheresultof syphilis, but in
^fstent and general septic symptoms point
none of them IS the real process a syphihtic
^^ abscess formation in the parenchyma,
one. It is Ihe result ot nerve degeneration
^,^ bilateral disease nephrotomy may be recaused
by meningitis syphi it.ca, which -^^^^ ^^ ^^^.^ ^j^j^^ .pi^^ u,iiiateral hemmay
still be present or not. flie meningitis
atogenous form of cortical al)scess, such as
luetica may be compared with the media
occurs after furunculosis or angina, as w?ll
infiltration in aneurysm of the aorta This^^jjg
sequels (paranephritis), must be
explains why auiiluetic treatmem does not
^^^^^^^ j^,, ^^,i^. ^g^^^t to nephrotomy and
benefit the disease. Healthy persons, who
j^cision of the abscess. Nephrectomy is
have suffered from syphilis before, show the
indicated in chronic supuralive processes
reaction in 50 per cent of paralysis. It is
j,, the kidnev accompanied by sclerosis of
possible, according to Lesser's experience,
the ureter (empyema of the renal pelvis,
to make the reaction disappear by specific
p^^^jg,,^ nephrolithiasis), provided the
treatment Healthy persons showing the
functional capacity of the other kidney is
reaction should therefore undergo antisyphsatisfactory
ilitic treatment for a considerable time.
This is the prophylaxis for paralysis and Incomplete Ligature o! Arteries in the
ataxia locnmotica. Treatnient of Aneurism.—Doyen ' Munch.
The Treatment ol Purulent Non Tuber- Med. Wochensch. ) says the operation sagculous
Disease of the Renal Pelvis.— gested consists in encircling the artery
(Munch, med. Wochensch) says that while above the aneurismal sac with a silken
certain forms of acute and chronic pyelitis ligature, which is tightened only sufficientcan
occasionally be cured by medical and ly that the pulsations below are barely perdietetic
treatment, local and surgical meas- ceptible. In cases of aneurism of the abures
are of chief importance. In acute domiiial arteries, subclavian or carotid,
febrile pyelitis catheterization of the ureter nothing further is done, but in aneurisms of
is indicated both for the removal of retain- the main artery of a limb incomplete ligaed
inflammatory products as well as for ture is followed by longitudinal resection
irrigation of the renal pelvis. Chronic of the sac and restoration of the normal
pyelitis should be treated by irrigation of lumen by a doucle longitudinal suture. He
the renal pelvis or instillations. The best reported a case of aneurism of the popliteal
results are obtained in infections due to the artery in which normal conditions were
bacterium coli and gonococcus, while the thus restored over a section of 11 cm,
local treatment is of less value in staphy- Owing to subsequent obliteration of the
lococcus, streptococcus or proteus in fee- popliteal vein with considerable edema of
tions. In cases in which tuberculosis is the limb, he resorted to the following prosuspected
and in pyelonephritis irrigation cedure: The entire external jugular vein
of the renal pelvis is contraindicated, and WdS removed from a sheep and placed in an
this also applies to infective hydronephro- isotonic saline solution. The tibioperoneal
sis. If repealed evacuation of accumn- veins of the patient were then exposed and
lated secretions in the renal pelvis with the one of them found permeable. An incision
uretral catheter and the use of local medi- was next made in the popliteal region and
cation has proved ineffective, and the the proximal end of the politeal vein found
febrile condition or other severe general in Hunter's canal. At each end of the exphenomena
persist, nephrotomy should be tirpated vein of the sheep three sutures were
undertaken. This operation should also inserted; the exposed tibiopereneal vein
be considered as a primary procedure in was then transversely divided, invaginated
cases of acute and chronic pyelitis in which into the sheep's vein, and the latter sutured
uretral catheterization cannot be carried to the external coat of the tibioperoneal. .A
out, as well as in infective hydronephrosis long curved forceps was inserted into the
and pyonephrosis, or it may be replaced by femoral wound and made to perforate the
nephrectomy in the latter two conditions, tissues of the politeal space down to the tib-
Fistula of the renal pelvis, or severe inju- ial wound, the sheep's vein drawn through,
ries of the renal substance after nephroto- and its proximal end sutured i;ito a longimy,
revnires secondary nephrectomy. He tudinal incision in the popliteal vein. The
further stated that in acute febrile cases of implanted segment had a length of 25 cm.
infection of the upper urinary passages an The wound was drained and complete resinvolvement
of the parenchyma of the kid- toration of the circulation took place.

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the prize ofTer(

440 THE CHARLOTTB MEDICAL JOURNAL. ]
Chronic Appendicitis m Children. children. He doubts any such connection |
Comby thinks that this condition is much with angina as iri often assumed, but does '
more common than is generally supposed, note an apparent relation to influenza. He
and that while usually the diagnosis"is not 's also doubtful regarding any special relamade
unless an acute exacerbation calls
|
tion between diet and appendicitis. He special attention to the appendix, careful emphasizes, however, the importance of in-
i
observation on the part of the physician fectious enteritis, especially folicular colitis,
may lead to earlier recognition of the trou- i" tbe etiology.
ble^ and consequently an earlier cure. He He thinks that too little attention is giv'en |
reports having observed over 120 cases of to possible appendicitis in childhood; that
chronic appendicitis, which form the basis vomiting and abdominal pain are too often 1
of this article. slighted, and that laxatives are given too I
The etiology is often vague. The dis- o^^en and too carelessly in such conditions, ease mav occur in well nourished children, "e calls attention to the difficulty in diagwithout
'previous intestinal disease, and in "Of^ m young children nientionmg especthese
some general cause—heredity, family
j
,
'^lly- besides other conditions discussed by predisposition, etc., may plav apart. More

ADVERTISEMENTS.
St. Luke's Hospital
1000 WEST (iRACE STKEET,
== RICHMOND, VA.
Owned and personallvconducted
by Dr. Stuart McGuire 'for the exclusive
ii-';e of his private patients.
Building erected for the purpose
to which it isdevoted, and combines
the comforts of a home with tlie
conveniences of a modern sanatori-
residential section
convenient to all parts of the city
by means of the street car service.
Desij;ned especially for surgical
and gynecological ca.ses. No contagious
diseases, insane or colored
patients received.
Cost of bed, board and general
nursing from f 14 to f 18 per week
For further information, address
the Secretary.
>^^^^^^%^^^^^^^^^^^^^^^^^^^^^j^=?^^=^^=^^^^^^j^^^^^^^^^^^^^^^^^^^^^
isA^vo Ai. TAYi^oie, jvj. r>.
Both
BROADOAKS
SANATORIUM
Morganton,
North Carolina.
A Private Hospital for the
Treatment of Nervous and Mental
Diseases, Inebriety and Drug
Habits
A home for the Permanent Care
of SELECTED CASES OF
CHRONIC NERVOUS AND
MENTAL DISEASE.
JS O. BEJALI^, JVI. r>.
Medical Officers reside in the SANATORIUM and devote their
whole time to its service. New addition just completed admits
of thorough classification of patients, and gives better faci-
lities for the care of all. Billiards, Tennis and other diverting
amusements.
Complete equipment for Hydrotherapy now being installed.
Correspondence with physicians solicited.
g#«€€e€€€«#€€€€€«

XXII THE CHARLOTTE MEDICAL JOURNAL.
Intravenous Use Of Dlpbtlieria Antitoxin, demonstrated. Each case must be dealt
In severe ca&esof diphtheria E. Schreiber with according to its peculiarities,
uses the antitoxin intravenously. Even The treatment should be constitutional
very young children could tolerate as much and local. Under the former head must be
as 2,000 units without any after-effects. In included careful regulation of the diet, so
two almost desperate cases 6,000 and 10,- that the intestine may not be loaded with
000 units were injected with absolute sue- materials that may form a favorable soil for
cess. infection. Anything, like coffee and tea,
OAmong 20 cases treated in this wav, only which causes flushing of the face, is conene
died on the thirteenth day of heart fail- traindicated. Quinine is often useful,
ure. The temperature always falls more Locally, in the hyperemic stage, he prerapidly
and the general condition improves scribed cooling lotions and ointments of
more quickly than after the usual subcuta- subacetate of lead. Ichthyol in the form of
neous administration. The small percent- a lotion or an ointment he also found to be
age of carbolic acid present need not cause amousj the most useful of local remedies,
alarm. The local process does not, how- In chronic cases the constant application of
ever, clear up more rapidly. Where a vein a strong solution of ichthyol is the best
cannot be exposed, the injection should be remedv, but iodine liniment is also valuamade
into the gluteal region, as absorption ble. In severe conditions linear scarificais
here more rapid than from the subcuta- tion or light touch's of the thermo-cautery
neous tissue.— ;\Iuench. med. Woch. he found often to give good results. In
subacute cases he has sometimes used high
New Treatment of Syphilis.
frequency currents and in chronic cases the
Finsen light and the X rays with success. '
As soon as the primary sore has appeared These agents are particularly useful in the i
it is impossible to abort syphilis, but, ac- later stages when there is thickening of the i
cording to the observation of H. Hallopeau, integument. Radium may be applied to ;
the course of the disease may be much limited areas for ihe seme purpose.—The i
shortened by the following treatment: o.t London Medical Lancet,
Gm. atoxyl, dissolved in 2 Cc. of boiling .
water, are injected daily into the immediate
vicinity of the primary sore during the entire
period of incubation; that is, about six
itchina and its Treatment.
Itching, or pruritus, is a prominent symp- ;
weeks." In oersons over fiftv, with disturb- torn of many skin affections. It may also i
ance of vision, the atoxvl derivative, hektin, occur without any skin eruption, or such ;
is to be preferred, though it causes more skin lesions as are present may be the result |
severe local reaction. The sore will rapidlv o^ scratching. Very often it is on account \
heal, the swelling of the inguinal glands °^ the pruritus that a patient seeks advice, \
will be slight or absent, and a roseola or rather than because of the inconvenience
other eruption will not appear. At the
.'
of any eruption, or for other symptoms. ]
same time, the patient receives daily for ^^^^t it is the duiy of the medical man, not |
two weeks 0.02 Gm. of mereurv benzoate merely to attempt to treat this symptom, but by injection, with fivst 1 Gm., then 2 Gm.
^
to find out the cause of it, and, if possible, :
of potassium iodide internally per dav. An to lemove it.
ointment containing ,30 per cent, of atoxyl Having made the diagnosis of scabies or
j
is applied locallv to' the sore. The pain of of pediculosis, the treatment is aimed at the
the injections of the benzoate can be dimin- cause of the disease, and the well-known |
ished bv dissolving 0.02 Gm. of the salt in application for these complaints generally ;
4Cc.ofa 10-percent, sugar solution. In quickly remove this troublesome symptom,
some cases that were treated in this manner I" scabies, however, a good deal of itching i
the Wasserman reaction never became posi- may be complained of even after disease is
j
tive.—Gaz. de Hopit. cured. This is generally speedily removed
j
^___^^ by a mild tar lotion. The treatment of
^
"^^'^ Treatment of Lupus Erythematosus. ''°\^^ entered into here. In ^
f.",^'"^
lichen planus and urticaria the same appli- :
Lupus erythematosus appears to Sir Mai- cations are useful as in pruritus from other '.
colm A. Morris, of London, Eng., to be causes. In pruritus dependent upon the 1
essentially a chronic inflammation of the disturbance of the digestive functions the i
skin, local in origin, and depending on a bowels must be regulated and careful atten- "J
condition of the circulation which makes tion given to the diet. Alcohol, coffee, and ';
the integument prone to vasomotor disturb- any paiticular kind of food which has been i
ance. This may cause a predisposition to found to disagree must be avoided. Appro- j
toxic infection, but neither the fact of such priare treatment for diabetes and albumi- *
infection nor its nature has been positively iiuria will generally relieve the itching i.
\
•

:«^
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XXIV
THE CHARLOTTE MEDICAL JOURNAL.
which occurs in these conditions. Cardiac that exists between creosote and calcium
cases will relief from small doses of digi- hydroxide, which yield on trituration a
purplish red substance, ^aiis. with a slight odor
There are certain empirical remedies of creosote and a sharp taste. It is soluble
which have been found useful in obstinate in water, giving a permanent solution when i|
cases, or as temporary measures in all cases, preserved out of contact with air. It is
;
These are quinine in large doses; antipy- conveniently prepared by mixing about five ^'
rine in doses of grn. V, gradually increased; pounds of calcium hydroxide with one
pilocarpine, grn. 1-16 to 1-10, by the mouth, pound of creosote and slowly percolating
when the itching is most troublesome—the with water so as to produce a solution havgood
effect of this remedy is often very iug a specific gravity of about 1 .011 . When
striking. Cannabis indica is recommended prep ired in this way one pound of creosote
in the pruritus of old people, in doses of 5 yields about twenty pints of calcium creo-
to 20 min., well diluted, three times a day, sote solution, each fluid drachm of which i
after food.' contains about three drops of creosote. I
In all cases local applications are useful, The s >lution has a smart peppery taste, but \
and the list of such applications is a long it does not exert an irritating or caustic ij;
one. Among the most useful are lotions action on the tegumentary membranes. A ;'
containing liquor picis carbonis, 3j ad 5x; suitable dose for an infant of one year is -•,
acidum carbolicum, ifExl ad 3x; sanitas, from three to five drops in water every two j
3ss ad 3x, Alkaline lotions are: bicarbon- or three hours. For a child of six to eight |
ate of soda or borax, 3ij to 3x, with or years doses of one teaspoonful may be given, I
without a few drops of dilute hydrocyanic and for an adult from one to two dessert I
acid; lotions containing a powder in sus- spoonfuls in a glass of water. As much as |
pension, oxide of zinc, calamine, talc. Or six fluid ounces of the solution had been ad- !
a powder mav be suspended in the tar or ministered during the day without protest |
alkaline lotion. Someiimes cold sponging or any unpleasant symptoms. It is not
with vinegar and water, or with alcohol necessary, however, to give more than a
j
and ether, followed by powdering with dessert spoonful in cases of acute disease. :
starch powder, gives relief. Lotions may I" rare instances Dr. Kolipinski has observ- :
be conveniently applied by means of a ed as intolerance of too large a dose, par- i
spray. A lotion of perchloride of mercury,
ticularlv in frail children, but a reduction
grn. v ad x ad 3x, is cleanly and odorless, o^ the dose to from fifteen to thirty minims ]
It is useful to bear in mind several pre- stopped the vomiting. In a few cases an ,
scriptions, for often one relieves where an- eruption of the skin occurred on the ex- ;
other fails.—The Hopital, London. tremities, trunk, and face, accompanied by '
- some irritation, but the .ash disappears !
The Therapeutic Value ol Calcium Creo- within a few days, without suspending the j
sote. treatment. Dr. Kolipinski recommends the i
The Lancet remarks that although the use of solution of calcium creosote in a va- ;
therapeutic value of creosote is generally '^^fty of conditions, such as pneumonia, in i
recognized, its extremely acrid taste has ^^'^h he declares it slows the respiration
militated against its wide employment. ^"^^ P''^^^' facilitates and increases the ,
Various attempts have been made to elimin- cough, and renders unnecessary the use of (
sedatives,
ate this objectionable feature. Thus it has
or hypnotics, and in enteric fever,
been incorporated with oil and enclosed in
»' '^^'''^ '^ ^''^^ ^^ a" efficient non-poisonj
antiseptic to the mouth cavity, stomach, I
gelatin capsules, aqueous and alcoholic
""^l
^''^
mixtures have been made, and various commtestine.
Dr. kolipinski suggests that 1
pounds of creosote-e.g., creosote carbon- it may be foun 1 useful in various systemic i
affections
ate-have been introduced, but with the
and local patuological conditions, •
exception of the carbonate no preparation ^^.^ ^hat it deserves a trial as a topical apof
creosote appears to have satisfactorily pbcat.on in dermatological practice.-The j
solved the problem of administering the
Lancet, London.
^:
drug in adequate doses without causing i
nausea, vomiting, and digestive disturb- Why Use Morphia?
ances. It is of interest, therefore, to refer The practice of using morphia for simple ^
to a paper by Dr. Louis Kolipinski in a re"
cent number of the Monthly Cyclopaedia
pains and neuralgins of different varieties
cannot be too strongly condemned. As
and Medical Bulletin (June 1909), wherein
he recommends a solution of calcium creothese
preparations afford speedy relief, it is,
taken for granted without any further console
as possessing in a perfect degree all of sideration, that they are precisely what thej
the medicinal virtues of creosote without condition requires, and patients fly to their;
anyof its objectionable properties. Advant- use on the slightest provocation without
age is taken of the marked chemical aflBnity consulting their physicians at all. Such
'
j
|
^

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The First Application of
RCvSINQL OINTMENT
In itching and irritable conditions produces a feeling of comfort to the
sufferer never before experienced.
It is the standard remedy for Eczema and acute inflammation of
the skin and muco-cutaneous margins, and is a superior dressing for
Burns, Boils, Skin Abrasions and superficial wounds and sores.
Il is the recognized specific for Puritus Ani, Itching Piles, etc.
As a nutrient Soap for the Skin
RE5INOL SOAP
is without a parallel
It nourishes the underlying tissues, prevents congestions and eruptions,
obviates waste and atrophy, thus preventing wrinkling and
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The Eclectic Practice of Medicine. By Rolla L,
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Essentials of Medical Gynecology. By A. F. Ste^
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XXVI
THE CHARLOTTE MEDICAL JODRNAL.
persons, lonj; before they recognize the fact, plants and observations on humun beings
learn to rely unconsciously upon morphia not founded on the individual experimenfor
relief, without realizing that they thus tee's own statements show that there are
slowly drift under its pernicious influence, four marked effects of electric energy proand
in a short time absolutely require the
drug independently of the original condiduced,
uncomplicated by chemical effects,
by high-frequency currents; U' Increased
tion which induced its use. cell activity, increased metabolism; (2) rein
almost all the cases of pain except, turn of a locally inflammed tissue to its
perhaps, those of the gravest surgicil char- normal; ( ,1) either general vascular dilata*
acter, the exhibition of one of the approved tion or contrt.ction, according to the particderivatives
of the coal tar series will be ular method used, and (4) "inhibition,"
found amply sufficient in its anodyne and diminished sensory or motor excitability,
analgestic character to obtund all of the So that where one or more of these effects
pain symptoms. Indeed, it is a matter of is or are desired and where the remaining
record that in the celebrated case of Barry, effects are not prejudicial, or can be very
treated by Dr. A. V. L. Brokaw, Professor much diminished or abolished, there highof
Anatomy and Surgery, Missouri Medical frequency treatment may be of real value.
College, and Surgeon to St John's Hospital and for these reasons has a fjrospect oj conwhere
a thorcic wound, thirteen and a half siderable therapeutic use in the future.—The
inches in length, penetrating the lung cav- London Medical Lancet.
ity was the feature, anlikamnia tablets were
used for the relief of pain, and it is now Tobacco Poisoning In an Infant.
becoming quite a proposition with the propo- .
^ ^
I^ema.re reported ,j,.t. -.jtij
to
sition with the profession as to whether . /'
the socetyde Pedmorphia
is not to be driven almost entirely '^^'^ "^^^l^^o^ °"^ °f age who ate a
^,
l^^'
from the field, in the broad general sense '''^^''^^!^
k? K"'".^n n'^o ^"^ °/ .'^''°'
probably about
which has so long marked 002 gm. of n.cotme.
its use. °/,
After sleeping for an hour he awoke, cried,
An Ideal Form ol Administering Bromides.
and vomited. There was diarrhoea, pallor,
^nd cold sweating. Two hours later he was
prostrate and drowsy, very pale, with cold
In many diseases in which the Bromides
extremities, with cardiac or respiratory disfind
their chief field of utility, it is necesturbances.
Tobacco was vomited and
sarv to administer them over prolonged pe- P^^^ed in the stools. Tea, brandy, and
riods, particularlv epilepsy and the various warmth were administered, and at midnight
neuroses
the patient went to sleep. In the morninghe
Owing to the special care and accuracy awoke quite well.— British Journal of Chilemployed
in its mfinufacture,
"'"^h's and the
Diseases,
special
purity of the salts entering in its composition,
Peacock Bromides constitutes an
ideal of bromide medication.
'
. TTt 7,
A Fosltlve Aid.
^_
"Cactina Pillets presents a valuable drug.
In gynecological practice. Peacock's Bro- the true Mexican Cereus Grandiflorus, in its
mides has a large field of utility, particu- best light.
larly in cases of uterine congestion and It will strengthen the heart's action; it
nervous dysmenorrhea, and for the relief of does support the heart; its prolonged use
the nervous excitement and irritability so will unquestionably encourage the physiofrequently
met during the menopause. In logical action of the human pump; and this
these conditions it controls the abnormal welcome assistance to the heart and circureflexes
without depression of
turbances.
gastric dis- lation is absolutely without danger or an-
noyance to the patient. One can not find a
Commercial bromides or its substitutes more helpful and kindly drug in functional
cannot possibly give the excellent results heart troubles.
ogtain.Sble from Peacock's Bromides. Cactina Pillets is a positive aid in cardiac
COMPOSITION.
therapy."
Each fluid drachm contains fifteen
grains of the neutral and pure
bromides of Potassium, Sodium
Ammonium, Calcium and Lithium.
Scopolamine-Morpltine Narcosis During
Labor.
Croom read a paper on his experience
with scopolamiiie-morphine narcosis during
Hlgb Frequency Currents and their Med
leal Application.
C. F. Bailey's conclusions are thus sumlabor,
at a recent meeting of the Edinburgh
Obstetrical Society. He gave the results of
ts action on 63 cases in private and in hospital.
He had begun with doses of 1-400
marized: Experiments on animals and grn. of scopolamine, and 1-6 gin. of mor-
.

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XXVIII THE CHARLOTTE MEDICAL JOURNAL.
phine, but these had little eifect and were to idiosyncrasy of the patient. He used
unsatisfactory, So also with double the 1-100 grn. of scopolamine and 16 grn. of
dose of scopolamine. He believed the best morphine, repeating the same dose of scodose
was 1-100 grn. of scopalamine and 1 6 pohimine if necessary without the morgrn.
of morphine. He usually administered phine. As the patient was not so conscious
it toward the end of the first stage of labor, of the pains then, these cases required more
when the pains were coming regularly every careful attendance of the medical man. One
few minutes. Occasionally a second dose patient had expressed herself to the effect
of Scopolamine of 1-200 grn. was necessary, that she had some feeling of pain, but in a
but he found it advisable not to repeat the
morphine. With these doses the pain of
the uterine contractions was markedly difar-away
manner, as if the pains were in
the other side of the room. He had found
as much thirst from large as from smaller
minished and in some cases abolished altogether,
and the patient slept soundly in the
doses. It was useful in cardiac cases and
where one had to hasten labor.—The Lonintervals
between the pains and after the don Lancet,
completion of labor. Further, the memory
Treatment of Malaria.
of the pains was in most cases strikingly
blurred, and many of the patients awoke Ter-Grigoriantz treats malaria as follows:
with no recollection whatever of their During the acute stage the temperature is
labors. He had found no ill effects from taken every two hours; if it has dropped
the drugs upon the mother except a little one degree from its highest point, two doses
tendency to postpartum hemorrhage, but
occasionally the children were born sleepy
of 0.3 Gm. of quinine hydrochloride are
given within two hours. On the following
and required to be revived. In no case was day another dose is given four and two
the child's condition serious and none were hours before the attack, and a third one at
stillborn. He believed that the treatment night before retiring. This applies to the
was most suited for nervous primiparae, and quotidian form; in the tertian tj'pe the
particularly in private practice. He em- morning doses of the second day are omitphasized
the necessity of using the drug in ted. If the attacks cannot be checked in
a freshly prepared form. this way, the patient receives an injection
Dr. Haultain had used 1-200 grn. of sco- of Laverau's solution (quinine hydrochlorpolamine
with 1-6 grn. of morphine during ide, 3 Gm.; antipyrine, 2 Gm.; distilled
the first stage, when patients were often too water, 6 Cc.) daily at 9 and 1 o'clock. No
ready to cry out for relief. Its effect lasted more attacks will occur, yet the disease may
about from five to seven hours, and it had remain dormant for years. In such cases
the advantage that during the second stage, injections of arsenic are indicated. The
if the pains were very severe, then a very prominent symptoms of malaria larvata are
small quantity of chloroform was required
to relieve them. On several occasions he
a large, hard spleen, atony of the stomach
with hyperacidity and constipation, headfound
the effects pass off, and that when aches with various other nervous symptoms,
the second stage came on the patient exag- and anemia. The best drug to remove these
gerated the suffering. In several cases the symptoms, according to the author, is
condition of the child gave very great anxi- atoxyl. It is used as .5 per cent, solution
ely when the dose mentioned above had been in 0.5 per cent, carbolic acid ( /

ADVIiRTIESMENTS,
HUMAN HANDS
HAVE NO PART IN MANUFACTURING
{Inflammation's Antidote.)
From the moment the ingredients are placed in the spe-
cially designed compounding machine until the nurse removes
the finished product from the sterili/.ed container at
the bedside, every move in the making is done b}' machinery
and under the most rigid antiseptic precautions. By pre-
venting exposure it is possible to conserve to the highest pos-
sible degree Antiphlogistine's hygroscopic properties.
No plastic dressing can be mixed in a mortar box with
a hoe or in an ice cream freezer or even with a druggist's
mortar and pestle and possess any scientific value. Its hygro-
scopic and osmotic qualities are necessarily ruined, owing to
absorption of atmospheric moisture.
In using .\ntiphlogistine, the ORIGINAL and ONLY
antiseptic and hygroscopic plastic dressing on the market,
the physician knows that he is getting the BEST. Years of
experience, specially designed machiner}', a perfect container
and the knowledge how, when and why, enable the originators
of Antiphlogistine to turn out a remedial agent which
in kind has never been equalled in the historj' of pharma-
ceutical manufacturing.
The wise medical man who believes in ORIGINAL pro-
ducts, which are always the BEST products, prescribes,
ANTIPHLOGIS TINE
(Inflammation's Antidote.)
THE DENVER CHEMICAL MFG. CO.,
NEW YORK,

XXX THE CHARLOTTE MEDICAL JOURNAL
tor of the degree of toxemia from which dy. During the period of time I have a
the patien t suffers. ludicaiiuria is the large number of cases on record which 1
term used to denote the presence, in the could detail would space permit, but I must
urine, of indoxylpotassium sulphate, a desist and limit myself to a few which 1
decomposition product of indol, a substance will offer to show why I confiiie mself to
generated in the intestine as a result of the this single remedy and leave it lo the reader
action of putrefactive bacteria upon proteid to determine the value of my judgment,
or albuminous material. It is of distinct Mr. G. C. A., age 37, traveling salesdiagnostic
value as an index of the extent man, consulted me in reference to his "caof
intestinal putrefaction and of the degree tarrh," which hadgivenhim much discomof
the constitutional absorption of toxic fort for some time. Complained of frequent
material thus generated. When any ap- attacks of headache, occasional sore throat
preciable percentage of indican is detected and incidentally mentioned the fact that his
in the urine it is always wise to cut down sense of smell was failing him. 1 examthe
proteid elements of the diet, (meat, ined his nose carefully and found him in
eggs, etc.). In addition to dietetic restric- the first stage of beginning atrophic rhintions,
a liquid combination exercising itis. The tissues looked dry and drawn,
cholagogue, antiseptic and digestive pro- there were some crusts which were very adpertiee,
such as Chologestin, ib extremely herent and had some odor. When deuseful.
This preparation, by virtue of its tached, which was with difficultv, the mucontained
sodium salt of the natural bile cous membrane showed a tendency to
acid, (sodium glycocholate J is a true bleed. I spent some time in rendering the
physiologic cholagogue, which materially affected parts perfectly clean, using a soluincreases
the formation and secretion of tion of Glyco-Thymoline and water equal
the biliary fluid. The natural sodium parts, warmed to proper temperature. He
salicylate (from oil of wintergreen) sup- was further instructed in the use of the K.
plements the cholagogic activity of the bile & O. Nasal Douche which he continued to
salt and also serves to liquefy the bile, use daily. 1 gave him general instructions
At the same time, it acts as an intestinal as to his habits, diet, way of living, and he
antiseptic. The pancreatin (which, in left me. Saw him several months later
Chologestin, is deprived of its inert, while passing through the city and he came
mucinous material) aids in the digestion of up to the office and I looked him over
the albuminous foods and the sodium again. Tc my great surprise the atrophy
bicarbonate adds the necessary alkalinity had been unmistakably arrested in its proto
the combination, with the physiologic gress, his throat was normal, he not being
stimulation of the heptic cells and the con- obliged to hawk so incessantly any more
sequent increased activity of the liver, the and his sense of smell had returned comexisting
intestinal putref acting is overcome pletely. Here is a case which was entirely
and the absorption of toxic products pre- restored by the conscientious and diligent
vented. The manufacturers of Chologestin use of Glyco-Thymoline,
( F. II. Strong Company, 58 Warren St., Fred. H. K., aged 26, vocalist, came to
New York) will be pleased to send formula mecomplainingof his throat which troubled
samples and literature to any physicians him considerably in his work. Stated that
requesting same, together with a handsome he had received treatment from three or
Indian Color Scale, with approved tests and four physicians without receiving any beneinterpretation.
The test for Indican is fit. Said previous treatment consisted in
simple and readily applied. cauterizing the tonsils: throat no better for
all this. Upon examination found nose
The Test ol Time.
normal and pharynx in fair condition, and
In Glyco-Thymoline I have found a pre in the face of all I had learned from preparation
upon which the body medical has vious treatment was puzzled for a few moplaced
the seal of approval and one calcu- ments. Completing my examination with
lated to meet the requirements of the medi- the small mirror passed up behind the soft
cal practician's varied needs. The pre- palate, I noticed a deep ulcer high up in
paration is too well known by reason of its the naso-pharnyx. completely hidden from
world wide (T use this term advisedly) use, view by the velum palati. Everything at
to necessitate or warrant a description or once became clear to me. Time and again
analysis here, nor do I propose to speak for I succeeded in getting results when others
others beside m\'self. It is, however, a failed because I took the trouble to inspect
pleasure to state that for the past eight years the naso-pharynx. a cavity very much neg-
I have used this preparation to the exclu- lected. There was only one thing to do
sion of all others in my work at Ihe clinic and one way to do it. Glyco-Thymoline
and in private practice whenever 1 wanted was ordered to be used with equal parts of
a mild cleansing antiseptic detergent reme- warm water as a douche for the nose. Pa-

I
'A
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the proportions can be
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Try fresh milk modified by
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and quiet. The new sanitarium has- 30
rooms. Most modern appliances, electrical, vibratory,
and hydro-therapeutic
Our'treatment meets individual requirements,
with avoidances of suffering or inconvenience.
The Telfair Sanitarium furni.shes an ideal home
for nervous patients who may be in need of a
change of environment and the advantages of the
most improved electrical and hydro-therapeutic
appliances.
For detailed information write for circular and
reprints in Journals.
Clinical Results Prove Therapeutics B
Anasarcin
Gives Relief in
iccessful practitioners, demonstrate that
VALVULAR HEART TROUBLE
ASCITES AND ANASARCA
EXOPHTHALMIC GOIT
BRIGHT'S DISEASE
CIRRHOSIS OF THE LIVER
Use Anasarcin in any obstinate case tid note results.
Triol (lunntity and lilcralure on THE
requcsl. lo physicians only.
Messrs. Thos. Chri:
X: Co., ondon Agents.

tient readily learned the trick of closing up
the cavit}' and allowing the medicament to
remain in contact with the diseased parts
for qnite a while. In two weeks this patient
was well of a trouble which threatened
to cause him to abandon his vocal work,
and which had caused him considerable
expense, pain, and loss of time. I number
him among mv most grateful patients.
Oscar F. Baerens, M. D., Ph.G., Prof, of
Diseases of the Ear, Nose and Throat, St.
Lonis College of Physicians and Surgeons,
St. Louis, Mo.
Philadelphia Number.
The American Journal of Surgery will
produce in December a Philadelphia issue
of their journal, the subject matter of which
will be composed entirely of contributions
from among the leading men of that city.
Among the subjects to appear and their
contributors are as follows:
"A Consideration of the Diagnosis and
Treatment of Retro-Displacement of the
Uterus," by E. E. Montgomery, M. D.,
Professor of Gynecology, Jefferson Medical
College.
"Polypoid Growth of the Rectum and
Report of a Recent Case," by Lewis Adler,
Jr., M. D., Prof, of Diseases of the Rectum,
Philadelphia Polyclinic.
"Tumors of the L'rethra in Women," by
Barton Cooke Hirst, M. D.. Prof, of Obstetrics,
University of Pennsylvania.
"The Control of Hemorrhage During
Pregnancy," by Edward P. Davis, >L D.,
Prof, of Obstetrics, Jefferson Medical College.
"Cyclodialysis, " by Walter L. Pyle, A.
M., M. D., Ophthalmologist to the Mount
Sinai Hospital, Ass't Surgeon of Willis Eye
Hospital, etc.
"Roentgen Treatment of Malignant Diseases,"
by Charles Lester Leonard, A. M.,
M. D., ex-President of the American Roentgen
Ray Society.
"The Conservation of the Middle Turbinated
Body," by William A. Hitschler,
M. D.
"The Diagnosis and Treatment of Ectopic
Pregnancy," by F. Brooke Bland,
M. D.
The following well known surgeons will
also contribute, and their titles will be announced
at a later date.
Ernest La Place, A. B., A. M., M. D.,
Prof, of Surgery, Medical Chirurgical College.
Prof. William Campbell Posey, Prof, of
—
THE CHARLOTTE MEDICAL JOURNAL
sor of Genito-Urinary Diseases, Medical
Chirurgical College.
John A. McGlinn, A. M,, M. D., and
others.
Something You Should Keep In Mind.
Here it is! In fully nine-tenths of the
cases you are called upon to treat (and
especially is this true in acute diseases)
there, s something wrong with the alimentary
tract which demands correction. The
first indication is for a quickly-acting, nongriping
and effective "clean out". Once
the irritating and poisonous fecal waste is
removed and the alimentary canal maintained
in healthy condition (the patient
gegins to improve and in the absence of
crippling diseases or severe specific infect
ion, goes rapidly on to recovery. For this
"clean out" there is no remedy more effective
than Abbott's Saline Laxative—or
Salithia when there is rheumatism or the
uric-acid diathesis. If the bowel is bsdly
clogged commence with a few doses of
Calomel, Podphyllin and Bilein Comp.,
Abbott. Doctor, try this plan. It "works"
and will please you.
The H. K. Mulford Company Obtains the
Grand Prizes and Gold Medal at the
Alaska-Yukon-Pacific Exposition.
The Director of Exhibits of the Alaska-
Yukon-Pacific Exposition announces that
the Jury of Awards has awarded the H. K.
Mulford Company, of Philadelphia, the
Grand Prize for Antitoxin and Special
Syringe Container, the Grand Prizes on
Tuberculins and Serial Dilutions of same,
and the Gold Medal for Biological Products
—the highest award granted.
The H. K. Mulford Company are to be
congratulated upon their triumph. The
Grand Prize on Antitoxin and Special Container
is a special honor, not only in recognizing
the excellence of the Mulford antitoxin,
but their constant efforts to improve
and perfect the production of antitoxin.
Metal Plnnger^....^
Fineer-rests^...^
The Mulford Perfected Syringe j
especially in increasing the potency of the
Ophthalmology, Philadelphia Polvclinic.
sera,
John G. Clarke, M. D., Prof
reducing the bulk for administration,
. of Gynecology,
University of Pennsylvania. and their perfection of the syringe package.
I
\
H. M. Christian, M. D., Clinical Profes- The latest Mulford syringe undoubtedly

m
I
Sy
R E P R E S E NTS THE M O ST ^^y^-*'^^-
VALUABLE COMBINATION 1
KNOWN TO MEDICINE
EAC/i WINEGL/\S5FiJL CONTAINS Ot^E CRAl^r-
OF THE PEPTONATES OF MANG/' : ECE AND IRC
EISNER MENDEILSON CO., New
^ir'^T
Dr, F T, Meriwether^s Private Hospital
24 Grove Street
AsKeville, N. C.
For Surgical and Gynecological Cases
Modem in all respects, Trained Nurses.
In Asheville's superb climate; centrally located, but on a quiet and retired street.

XXXIV THE CHARLOTTE MEDICAL JOURNAL.
represents the greatest improvement of this powers, and in many cases it is by no
approved style of container. means easy lo give a definite opinion.
The jury, in awarding the grand prizes Briefly, he defines mental deficiency as
on the tulDerculins of graduated potency, meaning a permanent want of sense. There
bacterins (bacterial vaccines) and vac- are three degrees: (a) Idiocy, or very great
cines, recognized the H. C. Mul ford Com- mental deficiency; (b) Imbecility, or conpany
as the leading house engaged in the siderable and marked mental deficiency;
manufacture of these products. (c) Feeble-mindedness, or lesser, but nev-
The jury also recognized the importance ertheless definite and permanent mental deof
bacterins and of tuberculins of graduated ficiency.
potency as therapeutic agents by grouping The well defined types most frequently
them with vaccines employed for the pre- met are: (1) Microcephalic, (2) Mongovention
of smallpox. Antitoxins, bacte- lian (3) Cretinoid, (-1) Epileptic, (".SJHyrins
and vaccines are three epoch-making drocephalic, (6) Cerebral Diplegic.
products, representing the highest scientific Besides, there are many cases which do
advancement for the prevention and treat- not conform to any well defined type,
ment of disease. though there is no doubt about their men-
The method for graduating the dosage of tal deficiency. Such cases form a large
tuberculin by serial dilutions has made tu- proportion of the mental defectives seen at
berculin therapy comparatively safe in the a large children's hospital and at schools
hands of the general practitioner. When for such children.
it is considered that the initial dose of this Lapage says the following points should
potent agent is 1-10,000 of a milligram—a be noted when examining a child for menportion
almost inconceivably small— and tal deficiency: U) The family history, (2)
that the increase in doses must be graded the health of the mother during pregnancy,
so carefully that it requires from six months (3) the personal history of the child, into
a year before the dose of one milligram eluding troubles at birth, ( 4) the presence
can be given, the advantage is apparent of or absence of physical stigmata, (,5) the
having a graded system of dosage so ar- height and width, (6) the speech, (7) the
ranged that each dose can be accurately sight, (S) the hearing, ( 9) the ability to
determined by increasing by two drops the sit up, to walk and to control the spincters,
dose of the serial dilution. and the age at which these powers develop-
Every dose of Mulford's Antitoxin and ed, (10 ) tlie age at which the child began
Curative Sera is furnished in the Mulford to walk, ( 1 1 ) the memory, attention, will.
Perfected Syringe, which possesses the fol- and temperament, (12) the standard in
lowing advantages: which the child is, the power of reading.
It is thoroughly aseptic, rendering con- writing, ciphering, and of performing mantamination
impossible. ual tasks.
The metal plunger screws into the rubber In conclusion the writer says that the
plug, adjusting pressure and making action diagnosis of the slighter forms of mental
positive. deficiency, i. e., of less degree than imbe-
The metal finger-rest with rubber guard cility, or idiocy, is not as a rule made dual
top of syringe prevents any possibility ring the earlier years of life, i-nless the
of the syringe breaking or injuring the op- child conforms to one or the other of the
erator's hand. well recognized types. Inability to sit up,
The needle is attached with flexible rub- lateness in learning to walk and talk may
ber, permitting motion of patient without excite the alarm of the parents. As the
danger of tearing the skin. child gets older, the diagnosis becomes in-
The special adjustable rubber has great creasingly easy. Still, up to the age of r,.
advantage over other packing, as it does 6 and 7 years, there are quite a number of
not shred, absorb serum, or become pulpy, cases in which the diagnosis is difficult.
This syringe is simple and accurate, hav- The points that help are the development
ing no parts to get out of order. of the power of walking and of talking,
.JY- "o^'r,- Mulford Company publish Working Bulletnis on Biological Products.
Copies will be mailed upon repuest to the
Philadelphia office.
the amount of control wer the sphincter,
, ^, , ^ , ., . , ,
and the general mental capacity, as judged
from the actions, the speech and language,
_. „, . "r~i7 *
... . . «. the expression, the power of memorv, at-
The Diagnosis of Permanent Mental Dellciency
In Infancy and tention,
Childhood.
imitation, and will, the presence
y nil J of perverted instincts and habits, such as
Lapage says the medical man and nowadays
especially the school medical
""usual wautonnesn and violence, or an in-
officer,
has frequently to decide whether an infant
or a child has possession of its full mental
satiable appetite, as the eating of clay or
dirt.—The London Practitioner.

ADVERTISEMENTS
The Success of Listerine is based upon Merit
The manufacturers of Listerine are proud of Listerine—because
it has proved one of the most successful formulae of modern
pharmacy.
This measure of success has been largely due to the happy
thought of securing a two-fold antiseptic effect in the one preparation,
I. e., the antiseptic effect of the ozoniferous oils and ethers,
and that of the mild, non-irritating boric acid radical of Listerine.
Pharmacal elegance, strict uniformity in constituents and
methods of manufacture, together with a certain superiority in the
production of the most important volatile components, enable
Listerine to easily excel all that legion of preparations said to be
"something like Listerine."
"The Inhibitory Action of Listerine," a 208-page book, descriptive of the
antiseptic and indicating its utility in medical, surgical and dental
practice, may be had upon application to the manufacturers,
Lambert Pharmacal Company, Saint Louis, Missouri,
but the best advertisement of Listerine is
mSTERM
THE PINES, Black Mountain, NortK Carolina.
A private Sanatorium specially equipped for the treatment of early
Tubeniclosis.
Besides the main building also have tents and cottages specially construct-
ed to insure thorough and constant ventilation. Altitude 2,800 feet. Situ-
ated in pine grove of twenty acres.
Kates on application.
CLYDE E. COTTON, M. D.
The Hygeia
—
Private Hospital and Sanatorium
101 West Grace Street, Richmond, Va.
DEVOTED EXCLUSIVELY TO MEDICAL AND NERVOUS DISEASES
EXTENSIVE improvements and additions have just been completed, which make
The Hvgcia now the largest strictly private Medical institution in this country. All
approved Hosi'ital facilities for aru/f cases, and full Sanatorium facilities lox chronic
cases. Equipment: Baruch Therapeutic Baths, Electricity, Vibration, Electric Light,
X-Rav, Nauheim Baths, Massage, etc., together with laboratory methods of diagnosis.
Usual Rates. Descriptive booklet. J. ALLISON HODGES, M. D.

THE CHARLOTTE MEDICAL JOURNAL.
THE CHARLOTTE. SANATORIUM
Corner West 7th & Church Sts. Charlotte, N. C,
D. A. Tompkins, President. E. C. Register, M. D.. Vice-President,
W. D, Witherbee, M. D., Secretary.
every detail, all the latest and most modern appliances are found m each department
SPECIAL EQUIPMENT
The most Improved hydrotherapeutic apparatus, Complete Electrical Equipment,
Sun parlors, two Surgical Operating Rooms, Electric Elevators, Vacuum Cleaning
System and Rooms with Private Phones.
The Training School for Nurses consists of a Superintendant and Corps of forty
nurses.
CHIEFS OF THE DIFFERENT
Medicine Surgery
EDWD. C. REGISTER, M. D- G. W. PRESSLY, M. D.
Nervous Diseases
J. R MUNROE, M. D.
Diseases of Digestion
C. M. STRONG, M. D.
Eye, Ear, Nose und Throat
E. R. RUSSELL, M. D.
Hardly another of all the preparations in existence
offers a wider scope to imposition under the
plea of "jnst as good" than the scientifically standardiLed
Eucalyptol.
The most recent fraud practiced in regard to this
product is an attempt to profit 1)3' the renown of the
firm of Sander & Sons. In order to foist upon the
unwary a crude oil, that had proved injurious upon
applicatioi:, the firm name of Sander & Sons is
illicitly appropriated, the make-up of their goods
imitated and finally the medical reports commending
on the merits of their excellent preparation are
made use of to give the desired lustre to the intended
deceit.
This fraud, which w^as exposed at an action tried
before the Supreme Court of Victoria at 1 elbourne,
and others reported before in the medica literaturei
show that every physician should see that his pat-
ent gets exactly what he prescribed. No "just as
good" allowed.
DEPARTMENTS
Cancer and Skin Diseases
W. D. WITHERBEE, M. D.
Genito-Urinary and Rectal Diseases
A. J. CROWELL, M. D.
Anaesthetics
W. 0. NISBET M. D.
A. M. WHISNANT, M. D.
J. C. MONTGOMERY, M. D.
F~oi- F'utI Information Address E. C Register, JW.
CHMRLOTTE, IV. C:.
D.
Danger Due to Substitution.
Of all the many hypnotics at the command
of the medical profession there is
none that gives as uniforn satisfaction under
all conditions as Bromidia, As has
been previously stated, the sleep produced
is of a true physiological character. It is
dreamless; and the patient awakes refreshed
and vigorous. In proper dosage, Bromidia
is perfectly safe and does not depress the
heart. A teaspoon ful should be given in
water and, if necessary, repeated hourly
until four doses have been administered.
It is needless to state that, in order that, in
order that maxium affect may be obtained
from the initial dose; the patient should be
placed under conditions favorable to the
induction of sleel.
J