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to withstand the germ and finally throw it off. Do I not see this state of affairs all around me? Hundreds and thousands of consumptives are constantly with us, each of them a menace to himself and a danger to the public. Many of these are ignorant of their condition—all of them are ignorant of their danger unless otherwise instructed. The lay mind fears the word consumption and shuns to hear it, and the physician is often too delicate to tell the truth. If the picture as I have painted it is not overdrawn, then in all fairness and justice is it not right and proper to tell the truth? The question is one of profound proportions, and I for one believe in meeting it fairly and dealing fairly with it. The feeling, “greatest good to the largest number,” should guide us and actuate us toward doing our full duty to the public, as well as to our patient—to the healthy masses, whose number should be legion. Make known, then, to the tuberculous patient his real state, and warn him about others. This course I have adopted and continue to pursue. Let it bring calumny upon me from ignorant friends and relatives, which I can not believe I deserve; I care not. I have some time since ceased to cater to the whims, fancies, and follies of my clientele. Man's highest aim in life should be directed toward the creation of a posterity of which he and the world at large may be justly proud. To endow an offspring with a disease which he and his offspring continue to transmit, either in its entirety or as an idiosyncrasy to future generations, is certainly opposed to man's “Ideal Aim.” Let us then, I reiterate, tell our patients the true nature of their complaints. This is already a step toward effecting a primary, or at least an ultimate cure. To say to a man " you have merely a bronchitis," when that bronchitis is of tubercular origin, is making him believe the limbs of a tree can have some organic disease and the leaves thereof not suffer. These leaves contain the green coloring matter, the chlorophyl, and are all important-like the air cells, the ultimate ends of the bronchial tubesin the proper interchange of oxygen and carbonic acid gas, and they do suffer where pulmonary tuberculosis exists. Is it natural to suppose that the individual under these circumstances, where he knows not the real nature of his malady and believes' it is “merely a bronchitis”—I say, is it natural for this individual to take the same care of himself that he would did he know he was the subject of a very serious ailment? Most certainly not. And it is not necessary to portray a death-bed scene to these people when we make known to them their condition. People do get well of pulmonary tuberculosis. Of this I am no longer
in doubt. I am absolutely certain of it since I see, at the autopsy table, examples of cured tuberculosis, and occasionally where considerable destruction of pulmonary structure has already been brought about by the tubercular process. I often say words of very good cheer to these people; tell them they can get well. That much depends upon them, and I go into many particulars about the life they must lead in order that a cure be effected.
If we tell our patients what is actually ailing them, and dwell on the dangers to others, and how best to overcome these dangers, we will have made a decided advance toward lessening the number of cases of so-called “ acquired tuberculosis.” In undertaking this great and noble work-and it is surely noble—there are many measures which need our attention. They are too numerous to mention in this short paper, which I had intended should emphasize only one important point, viz., with reference to what I am accustomed to term “house infection" and "room infection." By this term I would refer to the house, and more especially to the one room, where the consumptive has spent his last days—where he has lived and died. I could point out to you such houses by the score and direct you to the rooms where men and women are living and dying of this dread disease, often ignorant of their own condition, surely ignorant of the danger they are to others, and unmindful of the consequences.
These rooms and houses become the very hotbeds of disease, seething and reeking with the number and virility of the tiny micro-organisms which are the causal factor. One member of the family after another has passed away, until all have gone, and the faithful doctor has said “Amen, and God's will be done," for the last time he thinks and hopes. But no, this demon, disease, wills otherwise. The tubercle bacillus has not yet died. He is alive and has found other soil for his developinent, growth, and multiplication. He has possibly withstood heat and cold, hunger and thirst, to a certain extent, then, finding his surroundings and environments uncomfortable and not suited to his best interests, he has gone into what we term the “spore state.” Here he is practically safe. Season may come and season go, all things else being equal, he still exists, is still a tubercle bacillus in the spore state, and with proper soil and temperature he can again bud forth into an active, living, and virile germ. I appeal to the health officer for the destruction of this germ wherever and whenever found. I appeal to this health officer to remedy the condition and state of affairs which permits a man to die of consumption and
be buried, while the landlord smears on some new paint on the outside of the house (or possibly fails to do this), and puts up his sign advertising for a new tenant, who may come to be a new martyr. I appeal for some sort of a system which will permit of and demand the proper sterilization of the sputum and of the quarters of the patient during his life and after his death. If this be done, I vouchsafe the opinion, tuberculosis will become a thing of the past. We placard the house containing the measles patient, we placard the house containing the scarlet fever and the diphtheria patient, while tuberculosis, carrying off many times as many patients as all of these diseases together, is wholly neglected by us. Louisville ranks high as a medical center. Many eminent men, reared and trained here, have accomplished much for the profession and for the public. Let us now be the first to institute measures (such as New York has partially undertaken) toward the limitation and control of tuberculosis. That others will follow is an assured fact, and sooner or later we can be reasonably certain that there will be no need for the erection of such institutions as the following newspaper article, which by chance lies on my table at the present moment, describes. It reads:
A Modest BeneFACTOR.-A benevolent Hamburger, who withholds his name, has bequeathed two hundred and fifty thousand marks for the erection of a hospital with rooms for one hundred tuberculous patients, who are to get bedding, board, and treatment for twenty-five cents per day.
WANTED! A SANITARY CLEARING-HOUSE.- At a recent vestry meeting Dr. Edmund Gwynn attributed "the usual crop of typhoid cases" in Happy Hampstead to the holidays. It is almost a pity that we have not some sort of sanitary clearing-house to deal with accidents of this kind. Surely the origin of typhoid contracted at a watering-place ought to be investigated. There is a sort of conspiracy of silence on the part of the sanitary authorities of many watering-place which augurs an evil conscience on their part. Not a few of these towns refrain from sending to the Local Government Board their weekly returns of infectious cases. While we are far from saying that the city health officer is always right in looking abroad rather than at home for the origin of his typhoid cases, we think it might not be amiss if medical men when asked to recommend a health resort would give the preference to such as are least guilty of this policy of concealment.-British Medical Journal.
Reports of Societies.
TRI-STATE MEDICAL SOCIETY OF ALABAMA, GEORGIA, AND
Ninth Annual Meeting.
[CONTINUED FROM PAGE 27.]
R. M. Cunningham said that the experiments related wiped out the functional diseases. The pathology of the writer explains the symptoms and indicates the treatment.
L. S. McMurtry said that nervous symptoms were often thought to be due to gross lesions; when these were removed the symptoms were not relieved. By elimination, rest, and feeding, by improving the nervous system, many improve.
G. C. Savage related cases with pigeons, which were killed in different stages of exhaustion, which showed that exhaustion reduced the size of the cell. We need not dispense with functional diseases. The changes are physiological rather than pathological.
In closing Dr. Dercum said that the essential in simple neurasthenia, fatigue, may complicate symptomatic neurasthenia. To Hodge is due the credit of first making observations of cell changes.
F. B. Sloan, Cowan, Tenn., illustrated “ The Application of the Plaster Jacket and Dressings" on a subject on a frame by which the patient is to be suspended in a hammock while the jacket is applied. The patient was placed in hammock, which was supported by roller around body and around top of frame, and plaster jacket over hammock.
Duncan Eve had known of this apparatus, but had no satisfactory idea of its merits until this demonstration. The method promises much.
R. M. Cunningham had a case to die just after suspension in the Sayre apparatus, in which there is severe shock after extension in Potts' disease. Would use this appliance in future.
Dr. Sloan closed the discussion by relating three cases treated with the apparatus, which is the invention of Dr. T. W. Sloan, of Seattle, Washington.
John A. Larrabee, Louisville, Ky., read a paper on “Some Points in the Treatment of Typhoid Fever," in which he claimed that, as we are aborting other microbic diseases, it is not unreasonable to attempt to abort typhoid. He thought that the products of the typhoid fever bacillus were far less injurious than the heterogenous microbes and ptomaines formed in the intestinal tract by reason of improper diet and from poisonous gases the product of putrefactive changes, all of which are in our power to prevent. Intestinal antisepsis is the sine qua non of treatment.
Avoid narcotics, lest the already cloudy typhoid cerebrum should forget to preside over the function of life. May occasionally be used with restlessness, factition, and a dilated pupil, especially accompanying hemorrhages. Physical examination should be made every visit. Tympany should not be allowed to elevate above the spinous process.
For this use
R 01. terebinth.,'.
dr. j ; Rochelle salts,
oz. j; Glycerine, M. Inject one half in pint water, and remainder, if not relieved, in two hours.
He indorsed the principle on which Dr. Woodbridge bases his treatment, intestinal antisepsis. The essence of cinnamon more potent to destroy micro-organisms than carbolic acid. For thirty years has never been without a pill made after the formula of Dr. Fisher, an army surgeon, consisting of crude inercury with aromatic oils and terebinthinates, cubebs, copiaba, peppermint, aloes, and colocynth (now made by Eli Lilly & Co.). When purgation ensued alternated with 5 or 10 grains “ Tully's Powder.” The annoyance of the fifteen minutes dosage advocated by Woodbridge he thought deleterious. He advocated specific treatment, that is, all intestinal antiseptics which are innocuous. Had used guaiacol, guaiaquin, especially where there is any probability of malarial complication, etc.
Hyperpyrexia important, but must be overcome by means not prejudicial to patient. When temperature persists at 104°, 30 drops externally to small area of abdomen. Never use antipyrine or acetanilid. If pulse and temperature rate greatly disturbed, use small doses of strychnia.
It is a question whether the enforced feeding of the present day is not as deleterious as the venesection almost to exsanguination of former days. Complete anorexia helps to make early diagnosis. Bouillon,