TYPHOID FEVER REDUCED IN RURAL COMMUNITIES

Reduction in typhoid fever and improvement in sanitary conditions have followed the intensive investigations of rural communities carried on by the United States Public Health Service in co-operation with local and State health officers, according to the annual report of the Surgeon General of that Service. During the past fiscal year 16,369 rural homes in eight different States were visited and many of them re-visited. In each of these homes information was obtained as to the prevalence of disease and insanitary conditions, and a complete sanitary survey of the premises conducted. This was followed by reinspections to determine if remedial measures had been instituted. In but a relatively small percentage of the cases did the persons concerned, after having their attention drawn to the danger of a particular unhygienic condition, fail to inaugurate corrective measures. Stimulus was given to the work by means of public lectures, the formation of active sanitary organizations, and the enlisting of all publicspirited citizens in the campaigns for reform. Public buildings were also inspected and local authorities given expert advice in solving such sanitary problems as the disposal of excreta, the prevention of soil pollution, and the maintenance of pure water supplies.

The surveys made during the year 1914 had shown that in rural communities less than 1 per cent. of the homes had sanitary toilets, and that more than 50 per cent. of the people were using water from polluted sources. This condition, according to the Public Health Service, made the rural sanitation question loom large among the matters vitally affecting the welfare of the nation. Following these studies and as a result of the interest aroused, the typhoid fever rate, an excellent indicator of the sanitary status of a community, has in some places frequently been cut to onequarter of its previous figure. In Berkeley County, West Virginia, the cases of typhoid fever were reduced from 249 to 40 in one year. In Orange County, North Carolina, the rural sanitation campaign resulted in a reduction of the cases from 59 to 17.

The tangible results of operations in rural sanitation indicate that marked advancement in maintaining hygienic and satisfactory surroundings in country districts is possible by

the application of the common principles of preventive medicine. Insanitary conditions exists largely because they are not known to be such. Actual demonstrations of their harmfulness, together with definite recommendations for their correction, remain one of the most gratifying and successful methods for instituting reforms and has been, in the experience of the Public Health Service, invariably accompanied by definite and measurable results.

NITROUS OXIDE IN OBSTETRICS

In a letter to the Indianapolis Medical Journal for January, Arthur E. Guedel says: "I have written to some twenty men all over the country who have been using this anesthetic method and have received reports of over 1,000 cases of its application. In none is there a serious unfavorable result, the mother and baby always doing extremely well. The only unfavorable reports received are those in which the mother apparently had little benefit from the gas, and these number less than two per cent. of the total." -N. Y. Medical Journal.

RED BONE MARROW IN SECONDARY ANEMIA

Editor Medical Summary:

It is a very remarkable state of affairs when we come to think of it, that red bone marrow is of very little avail in primary anemia. It was considered an ideal remedy in pernicious anemia, and has been tried over and over again, but without permanent results, or indeed, results that would show it had had any benefiting effect. In the anemia following hemorrhage, milk or almost any fluid will have a better effect than red bone marrow, simply because following hemorrhage, what is chiefly wanted is quantity of a circulating fluid, and salt water will do better than anything else except direct transfusion, but here we come to the parting of the ways, the moment we leave the class of diseases called "primary anemias," we find that we hold a pass key, an open sesame, to the cure and correction of the thousand and one ailments that follow on malnutrition in red bone marrow. It is, of course, well known that the blood of the fetus is obtained from the marrow, but it has always appeared that that function of the marrow ceased at birth. If that is so, it has not been clearly demonstrated but whether it is so or not, the red bone marrow of the calf has every claim to our first consideration in the treatment of secondary anemia. Probably the best way to establish the claim I put forth for this remedy is to give cases where the good results have been abundant and lasting. The first case where I saw the astounding, I might almost say the astounding benefit, was in case of hip joint disease, marked by extreme anemia. On examination of the blood, the red blood corpuscles were found to be 3,500,000, white corpuscles 6,000 to the millimeter. I had the child under my care for a year and declined to put him on a splint, or use

extension and counter-extension, because I consider when you prevent a child from exercise, you are doing all the harm that you can but I found the tenderness over the hip joint becoming worse, although I used fresh air, cod liver oil, and every form of nourishment that could be thought of. I then decided to use red bone marrow. In one night the pain in the hip had disappeared, and on a microscopic examination of the blood two days after, the relative quantities of red and white corpuscles had been almost reversed, and were 6,000,000 red blood corpuscles and 3,000 white corpuscles. This case, a boy of eight years, has been under my care ever since and is now straight limbed with no shortening, and only a slight difference in the size of each limb. I have used the red bone marrow off and on ever since, with him, not constantly, but when he had finished a bottle, let him rest for a little while without.

Since I found such remarkable results in the foregoing case, I have used the same remedy in the profound anemia that follows syphilis in its first stage, and recommend it, just as confidently. Any one who uses it in syphilis, after reading this atricle, will thank me many times when they see the pale, cadaverous, weak, trembly anemic patient turned in a few days, into a buoyant, hopeful, thankful individual. Of course, the red bone marrow in syphilis does not supercede salvarsan and mercury, but must be used as an adjuvant.

I have also used it in the anemia following leucocythema and malaria. In these two cases, combined with arsenic, it will work wonders. I can confidently recommend its use as I said before in any case of secondary anemia, but as I also said, it avails us little in the acute anemias that are so distressing and disastrous.

ROBERT ORMSBY, M.D. 368 Lexington Ave, N. Y.

FRANKLIN'S LAST HOURS

Editor Medical Summary:

The following is from a friend, who gives the narrative:

Said he: "I rapped at the door, and Mary Humphries greeted me."

"Weel, David, how dost thou?"

“O, much after the old sort, Sarah; but that's neither here nor there I came to see Dr. Franklin."

"Weel, then, thou art too late, for he is just dead!"

"Alack a day," said I, "then a great man is gone!"

"Yes indeed," said Sarah, "and a good one too! It seemed as though he never thought the day went away as it ought, if he had not done some one a service. However, David, he's none the worse off for that now, where he is gone to; but as thee came to see Benjamin Franklin, thee shalt see him yet." And she took me into his room, and as we entered, she pointed as he lay there, saying: "There! Did thee ever see anything look so natural?"

And he did look natural indeed; his eyes were closed, and except that you saw that he did not breathe, you would have thought he was in a sweet sleep, he looked so calm and happy. Observing that his face was fixed toward the chimney, I cast my eyes that way, and, behold! Just above the mantel-piece was a noble picture. I could not help calling out: "Bless us all, Sarah, what is all this?" "What dost thou mean, David?"

"Why, how came this picture here, Sarah?" You know that many people think he was not after this sort?"

"Yes," said she, "I know that too! But thee knows that many who make a great fuss about religion, have very little; while some who say very little about it, have a great deal."

"That's sometimes the case, I fear, Sarah," said I.

“Well, and that was the case with Benjamin Franklin! But be that as it may, David, since thee asked how the picture came there, I will tell thee! Many weeks ago, as he lay, he beckoned me to him, and told me of this picture upstairs, and begged I would bring it to him. His eyes brightened up as he looked at it, and he said: 'Ah, Sarah, that is a picture worth looking at; that is the picture of Him who, came to teach us to love one another!' Then after looking at it wistfully

for some time, he said: 'Sarah, set this picture up over the mantel-piece, right before me, as I lie; for I like to look at it.' And, as thee sees, he died with his eyes fixed upon it." D. L. FIELD, M.D.

Jeffersonville, Ind.

"HAVE THE TONSILS ANY KNOWN FUNCTION?"

Editor Medical Summary:

The above query in the January Number of The Summary brings up an old topic, in which an almost routine practice of modern surgeons cling to the idea that the tonsils are merely a nidus for the hatching of germs, and should in all cases be removed. While surgical operation is necessary for the relief of a multitude of conditions, it is obvious that many of our surgeons are weaklings in the matter of taking note, and of properly interpreting the varied and multifarious phenomenon known as symptoms in disease. "We are all cognizant of the danger of over-sized or infected tonsils."

1. "Are the tonsils an ever-present menace to health?" No. In the annual reports of nearly all the special hospitals for diseases of the throat and nose, the number of tonsils removed, as compared with other operations on the upper air tract and its appendages, is simply appalling. Also, the almost universal report from the inspection of school children reveals the fact that, at this particular age, nearly all children have more or less enlarged tonsils. That most of these are harmless, if not actually physiological, and that their removal in these cases is not only unnecessary, but injurious to the proper development of the child, is our conviction. The rarity of rheumatism or heart disease in children, as well as a horde of other so claimed diseases, while nearly every child has enlarged tonsils at some time in life, would indicate that their removal is only exceptionally advisable unless they mechanically interfere with respiration, deglutition or speech. Much wild and incontinent talk, for which the present generation of doctors are to blame, having thrown our teachers and the public into hysteria, is resulting in much confusion.

2. "Is there such a thing as normal tonsils with a possible function?" Yes. What are the tonsils? Isn't it a fact that they are two oval glandular bodies, composed of follicles,

between which small mucous glands open, and are covered on the external surface by a fibrous sheath and an expansion of the submucous lining of the pharynx? And more, their inner surfaces are marked with minute depressions which are the orifices leading to the glandular crypts or follicles. The secretion of the tonsils in a healthy state, is vicid and transparent; but is apt to become white and thick from inflammation, as in chronic tonsillitis. The tonsils are variably enlarged in different individuals, the enlargement between, is generally towards the middle of the throat; and it is for this reason that it is not easy to feel an enlarged tonsil through the external surface of the neck. There are several lymphatic glands between the tonsils and the greater cornua of the hyoid bone, which receive the lymphatic vessels from the tonsils; these are usually enlarged when the tonsils are indurated, and their enlargement may be easily mistaken for the tonsils themselves. There is a continuous chain of lymph-follicles extending from one tonsil to the other across the upper part of the pharynx, the lymphatics arise around the numerous follicles and the glandular substance and pass into the submaxillary lymphatic glands. Whatever its function may be, and the production of leucocytes is undoubtedly one of them, the result is not, as is generally believed and taught, a lymphatic gland.

Many theories have been put forward as to the cause of enlarged tonsils and adenoids, but it is impossible to conclusively rule as pathological most of these opinions. It is a peculiar fact that most children between the ages of two and ten years have enlarged tonsils and adenoids, although they may or may not be visible at birth. For this reason it looks as though the enlargement were an attempt on the part of nature to supply some deficiency of embryonic tissue at this early stage in life, and therefore a purely physiological function, as they normally begin to decrease soon thereafter, and continue to disappear as one reaches maturity.

There are too many needless operations, and the general ignorance of embryology combined with the modern surgical mania has led to the sacrifice of thousands of tonsils, as well as to the too frequent opening of the abdomen for the removal of healthy and beneficial W. H. SMITH, M.D.

organs.

Shell Rock, Iowa.

INNOCUOUS DESUETUDE

Editor Medical Summary:

In the 80's, great claims were made for "berberis aquifolium"; Jamaica dogwood; viburnum prunifolium; chian turpentine; quebracho; kava kava; kokium; yerba santa; grindelia robusta; goa powder; asclepias; curare; coto bark; bayberry bark; guarana, etc., etc. They may all be found now in the medical scrap pile!

New medicines rapidly supplant the old. There is a rapid advancement and the medical world is crowded with new discoveries, pharmaceutical wonders, marvelous inventions, new theories of disease, and the treatment; until we hardly know "where we are at," or whether we are "cock-sure" of anything. What is the rage today, may be junk in ten or twenty years hence! I believe it is the rule that the mass of medical men have more faith than knowledge. We are prone to try anything, however extravagant the claims, and in a majority of instances, we are disappointed. The profession is going daffy on antis, sera, vaccines, bacterins, etc. This craze may, ere long, be followed by a treatment based on entirely different views of diseased conditions; and a different line of remedies. Who knows?

Change and progress are written on every thing; science, art, theory, invention and discovery. As these advances go on, our conceptions, ideas, acquiescence in new things, tend to an adoption of such changes; and old things are "passed up." Will not the time come when medical men will be condemned for using excessive amounts of antitoxin, in a great many cases, far more than may be necessary to destroy toxins? If 5000 units will do, panic, anxiety, recklessness, may pump into a patient 40,000 units, or perhaps 30,000 units more than is needed. The sequel in many cases must be, eventually, grave organic kidney disease. A patient, conservative course is the only safe one.

Jeffersonville, Ind.

D. L. FIELD, M.D.

If a child vomits incessantly, remember that a minute dose of morphine (1-100 grain), alone or with atropine, will generally produce sedation. Meanwhile, clean out the bowels with small doses of calomel and with

enemas.

SOME THOUGHTS AND OBSERVATIONS

Editor Medical Summary:

It is worthy of notice that in each succeeding issue of The Medical Summary our family of contributors are more confidential in relating personal experience in practice-getting.

Success in an occupation should be conclusive evidence of qualification, but this is not the case with numbers of doctors in the eyes of the laity, as long as manufacturers can palm off on the doctor their new and just-asgood, but cheaper products. Many a doctor will never know the value or action of some dependable drugs.

Proper dosage of a drug to obtain a desired result is as important in my practice as are indications for its administration. Administration of heart stimulants is frequently superfluous practice, and dangerous when the blood stream is coagulating.

Intelligent observation sustains the fact that like begets like under some conditions, but theories of heredity have gone to seed. Who would have thought that the study of medical science by a doctor would have originated the idea that no disease is contagious or infectious and that the germ theory of disease is a mistake; but in this progressive age, we are not surprised by such volcaniclike outbursts of wisdom. We ourselves are a long gunshot behind such wonderful discoveries. No reforms worthy of note were ever accomplished by a slipshod reformer. T. C. ESTES, M.D.

Bennett, Mo.

TREATMENT FOR PELLAGRA

Editor Medical Summary:

Some time ago I promised you a treatment for pellagra, but have up to this failed to send it, but will do so now.

I will not go into details as to etiology of the disease, nor the course it runs, but will simply give treatment for the pellagra.

I notice, however, the same thing has been written up thoroughly in the Journal of American Medical Association, I think, in June, 1915. I have tried this out and it seems to work miracles. The treatment consists of a piece of fly-blister about the size of a half dollar, placed upon the breast, or some part of the anatomy least exposed to friction. Leave it remain for sufficient length of time

to draw a good blister. After the blister has been formed, draw out with a sterile hypodermic syringe, one or two cc. of the fluid, and inject intra-muscular, and allow the remaining fluid, if there be any, to absorb, dry up or go away, as it will.

This treatment should be repeated every seven days, until six or seven treatments have been taken, at which time the patient will be greatly improved in health, and the symptoms entirely disappeared.

I would be glad to hear from anyone that tries this, or answer any inquiries from people that are interested.

W. W. SWARTS, M.D.

Wichita Falls, Texas

USEFUL IN TUBERCULOSIS

Editor Medical Summary:

The following outline for certain indications in tuberculosis may prove of value to some of the Summary family:

Appetite: Creosote, macrotin, lycopin. Absorption stimulates: Iodine. Bronchorrhea: Calcium, lactophosphate, benzoic acid. Cough: Iodoform, codeine, macrotin, emetin, canabin, lycopin. Digestion: Arsenic, enonymin, juglandin. Dyspnea: Aspidospermin, adrenalin. Diarrhea: Calcium, lactophosphate, corrosive sublimate, atropine, copper sulphocarbolate, calcin, silver oxide, zinc sulphocarbolate, lycopin. Fever: Aconitin, digitalin, creosote, emetin. Germacides: Creosote, calomel, (disinfect the bowels) calcium sulphide. Hemorrhage: Glonoin, calcium lactophosphate, atropine, cactin, lycopin, hydrastin. Irritability, allays: Iodoform. Secretion, checks: Helenin, eucalyptol, menthol. Secretion, stimulates: Iodine, emetin, apomorphine. Sweating: Creosote, calcium, lactophosphate, lycopin, atropine, picrotoxin, agaracin. Sensibilities, arouses: sanguinarin nitrate. Tension vascular, relaxes: Glonoin, apocynin, cactin. Sputa, fetid: Eucalyptol, menthol, creosote, benzoic acid. Tonic: Quinine, iron, or tabular tinctures should be remembered. If it was not for the iron in the blood we could not breathe, etc. Prompt improvement may be expected from its use, because it revivifies the muscular walls of its tubes with an increased supply of oxygen.

Mosheim, Tenn.

M. G. PRICE, M.D.