The Medical Age.

A SEMI-MONTHLY REVIEW OF MEDICINE.

JOHN J. MULHERON, M. D., Editor.

--PUBLISHED BY

GEO. S. DAVIS, Medical Publisher, Box 470

DETROIT, MICH., AUG. 10, 1885.

Editorial.

THE PREVENTION OF CHOLERA.

The North American Review for August contains a series of short articles by well-known writers, under the heading, "Can Cholera be Cured?"

DR. JOHN B. HAMILTON is of the opinion that a vigorous enforcement by the Indian Government of approved sanitary measures, would throttle the disease in its cradle, and deplores the complacency of the nations which permits the periodical excursion of this deathdealing scourge to the countries to the westwards.

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The system of notification devised by the late SURGEON-GENERAL WOODWORTH is potent for much good in the direction of prophylaxis, but in order to its accomplishment of all its possibilities, a skilled medical should be attached to each consulate. sent each consular officer is required to report the existence of any contagious disease in the district to which he may be assigned, and, in the event of the departure of any vessel from an infected port to any other port in this country, to notify the authorities of this country of the fact. In the case of a sailing vessel the notice may be sent by mail, but in the case of steamers the telegraph is used. DR. HAMILTON rejoices in the fact that the old doctrine of detention at quarantine, with its barbarous and cruel exactions has gone to the limbo of exploded dogmas. An infinitely better method is that inaugurated by the President of the Board of Health of the State of Louisiana, which provides for the thorough disinfection of the cargo, passengers, and crew, with their wearing apparel, of all suspected vessels. The vessel must be unloaded at the port of entry and the disinfection systematically conducted. Under this method he thinks cholera could be prevented from gaining a foothold in this country.

DR. JOHN B. RAUCH cites the outbreak of cholera in 1867, in Ohio, Minnesota and Dakotah, and directly traceable to immigrants from Holland, Sweden and Germany, as proof of the

possibility of the transportation of the virus. He, therefore, endorses the suggestion of DR. HAMILTON, of a more vigorous disinfection at the port of entry. He insists also on the necessity of house-to-house inspection by properly qualified persons in every district, who should be vested with power to insist on necessary improvements. His experience, both as a practicing physician and as a sanitary officer, warrants the assertion that cholera in common with the other epidemic diseases, may be preprevented through the active enforcement of a thorough quarantine of observation and sanitation.

DR. JOHN C. PETERS regards the spread of cholera as due to the dissemination of germs, through the excreta, and holds that these germs are readibly destructible by means of acids. In a healthy condition of the stomach the gastric juice is sufficient to effect their destruction, and hence the necessity of maintaining this organ in its normal condition, through proper diet and personal hygiene. Among remedies, aromatic sulphuric acid is the best prophylactic and curative, although the fact that dilute phosphoric acid may be taken for the greatest length of time with the least danger, makes it the preferable beverage as a prophylactic. He insists on the necessity of a prompt checking of a diarrhea during the prevalence of cholera. Impure air while not capable, in itself, of causing cholera, seriously predisposes the system to attack by the specific germ.

DR. H. C. WOOD advocates the removal of all healthy persons from infected communities. While presence of mind plays an important part in prophylaxis, it is not so important as absence of body. With perfect cleanliness of our cities and purity of the water-supply, cholera would be a disease scarcely to be feared; but the DIVES of one block perishes because he has neglected the LAZARUS of the next. During an epidemic those living in the midst of it should drink only water which has previously been boiled for at least two hours. Adding brandy to infected water does absolutely no good. Bottled mineral waters may be used, but all liquors on draught should be avoided.

It is much safer for the traveler to take a bottle of claret or of beer for his dinner than to take water. Attendants on cholera patients should take precautions against self-infection by the carrying of articles to the mouth. The hands should be carefully washed with corrosive sublimate solution or a solution of chloroinated lime, and the mouth should be freely rinsed with similar solutions properly diluted. DR. CHARLES A. LEALE lays down the following rules:

1. Cleanliness in all things-the streets, the home, the person. Keep the cellars, tanks, and sewer connections in good condition. For the

person a daily bath, also a wash of the face, hands, teeth, and mouth after each meal.

2. Proper clothing, easily fitting and comfortable. It is better to have too much than too little. A broad flannel band around the abdomen, worn day and night, will be useful.

3. Temperance in all things, with a generous diet of all wholesome articles-fish, meats, vegetables, and clean, ripe, seasonable, native fruits, with extras to a proper degree. If any article is known to disagree with you, avoid it. Do not eat or drink indiscriminately between meals, and if any distress is caused by improper substances in the stomach, quickly reject them.

There should be inspection, under consular direction, at exit ports where cholera may be present, of all persons or articles that may convey disease; enforcement of rigid quarantine at all entry ports; establishment of quarantine hospitals; thorough disinfection of all suspicious articles; compliance with the law that requires cases to be reported. As soon as cholera appears, all infected places should be divided into districts, to be presided over by Small temporary hospitals proper officials. should be established, fully equipped with physicians, nurses, telephone communication, and an ambulance. All that cannot be properly cared for at home should be immediately removed to a hospital.

Those who have battled with epidemic Asiatic cholera in its most malignant form at the homes o. those affected, can testify that absolute quarantine prevents its entrance, thorough disinfection exterminates it, and proper treatment carries a very large proportion of even the severest cases to recovery.

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A. G. KIMBALL,

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S. S FRENCH,

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A. F. KINNE,

Battle Creek. Ypsilanti.

W. P. MANTON,

Detroit.

SURGERY.

DR. W. H. DELAMB, Chrman, Grand Rapids.

If circumstances compel any of these committeemen to decline the appointment, it is requested that early notice be given the president, that the vacancy may be at once filled.

It is also requested that members intending to present papers at the meeting in June next, will, if practicable, give early notice to the chairman of the proper committee, not later than May 1st, for convenience of arranging the programme of arrangements.

DR. E. P. CHRISTIAN, President.

THE FERRAN BUBBLE BURST.

Almost any theory, however preposterous it may seem a priori, will attract attention if urged boldly and persistently, and the boldness and the persistency of FERRAN won for his claims a consideration which it could not otherwise have received. A priori it is phenomenally absurd. Were cholera a disease one attack of which exhausts the liability to subsequent attack, as in the case of smallpox, scarlatina, etc., FERRAN'S so-called inoculation with the modified cholera virus would have commended itself to reason, but reasoning from our knowledge of the disease, it is preposterous on its face. The methods of the Spanish charlatan won for it, however, a great deal of notoriety.

But the bubble has now completely collapsed, and FERRAN stands forth in his true colors, as an unprincipled quack. His claim that his inoculations, which were performed by the thousand and even tens of thousands, granted immunity from the scourge, has been shown by the inflexible logic of events to be baseless and wicked in the extreme. He preyed with the rapacity of the most characteristic American quack (who is usually held to be the most pronounced of his species). Through his boldness, effrontery and plausibility, he won the ear of learned societies abroad, and with the acuteness of his kind, turned the advantage thus gained to his profit.

In a communication to the Chicago Tribune, an American student of KOCH gives an account of a visit to this Spanish sharper. After introducing himself to FERRAN, our compatriot requested some information as to his method. He was promptly informed that it was his (FERRAN'S) private property and would not be divulged except to his own government and then for a sufficient pecuniary consideration. With this information he was somewhat unceremoniously shown to the door. Disguising himself as an artisan he called on the quack a few hours later, and submitted to an inoculation.

An incision was made in the arm above the elbow, and a waxy piece of matter was introduced and secured in place by means of an adhesive plaster and bandage. Three pills were also given, with instructions to take one after 36, 72, and 108 hours, respectively. Our friend hurried out of the hospital as fast as the crowd in the place would permit, and in about 20 minutes found himself in his room at the hotel. Here he tore off the bandage and plaster and removed as much of the "virus" as was possible after that lapse of time. An analysis showed it to contain elaterium, croton oil, vaseline and perhaps other ingredients. The pills were made up of the same constitu

ents.

The communication concludes with an expression of surprise at such a stroke of smart

ness in a Spaniard, and with an humble hope that FERRAN is not a Yankee in disguise. The thing has the flavor of wooden nutmegs decidedly. At any rate, the man is a genius, who can gull thousands and attract universal attention by taking in vain the name of the cholera microbe, and physicking people so deftly that they have the redeeming symptoms of a disease that will not be trifled with in any such way. It is barely possible that if such a monstrous and wicked humbug were detected in some sections of this country during an epidemic of cholera, he would take his departure to the happy hunting grounds with his boots on.

STATISTICS.

The saying "figures don't lie," has developed almost into an axiom. But figures are forced to lie, very frequently, nevertheless, and in no direction are illustrations more plentiful than in that of statistics. The thousand-and-one religious sects, many of which are almost diametrically opposed to each other in their beliefs, all go back to the Bible, the infallible book, for their foundation and justification. While the sacred book may be a consistent and truthful record of events and an infallible guide to conduct, when read by one whose mind is of the proper depth and breadth, the narrow and shallow mind has made it to lie often and contumaciously. And it is precisely so with the figures of statistics. With a mind keyed to truth they are valuable aids and guides, but when handled by a mind with a preconceived theory to sustain, they are truthful or mendacious according to the truth or falsehood of the theory. It is a question whether they have been helpful or otherwise in medicine. The facility with which they may be twisted to suit any purpose has made them mischievous as well as beneficial at times.

In the course of a recent editorial which touched on the question of collecting statistics, the Medical News inquired, how often does the series of questions which the seeker presents you, show that he is endeavoring to sustain a particular plan of treatment, instead of being, for the time, an intelligent, just and unbiased judge; or else it contains interrogatories, some pertinent, some impertinent, hypotheses probable and improbable, consistent and inconsistent. It then gets off the following burlesque: Dr. A., for example, is preparing to read a paper upon diarrhoea before a local, state or national organization, and his questions run possibly somewhat like this: How many cases of diarrhoea have you seen in your ten, twenty or forty years of professional life? heredity a factor in the production of the disease? If your answer is negative, do you not believe it might be in some cases? Do

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you believe microbes are the essential cause of the disease? If green apples were the exciting cause, specify the number, kind, and size of the apples; if the disease was attributed to "teething," please state the particular teeth concerned. What were the thermometric, barometric, and ozonic observations made when the disease was most prevalent? Do you believe that the induction of premature labor is advisable in some cases of obstinate diarrhoea? If premature labor be induced, would you use two ligatures or one for the cord? Please give the hygienic and therapeutic means which you have found most successful in the treatment of diarrhoea. Have you ever used germicides in the treatment?

This is, however, scarcely a burlesque after all, for we have seen it almost duplicated in sober, downright earnest. Some of the inquiries sent out by some Boards of Health, for instance, are quite as amusing, and scarcely more relevant. But the published replies answer an admirable purpose in swelling the volume of the transactions.

THE PNEUMONIA-COCCUS OF FRIED-
LANDER.

DR. GEORGE M. STEREBERG, U. S. A, in a paper which appears in the July number of the American Journal of the Medical Sciences, calls attention to the so-called pneumonia-coccus of FRIEDLANDER, which he claims is, in fact, indentical, specifically, with a micrococcus which he previously described, and which is found in normal human saliva, and with that found by PASTEUR in the blood of rabbits which had been injected with the saliva of a child which died of hydrophobia in one of the Paris hospitals. The micrococcus he names Micrococcus-Pasteuri. The capsule, or mucous envelope, which sometimes surrounds this micrococcus, described by FRIEDLANDER in 1883, and photographed by STERNBERG two years previously, cannot be accepted as a distinguishing character of this species, inasmuch as it is not constantly present, and the circumstances upon which its development depends have not been accurately determined. It is established that this is a pathogenic organism, as far as certain lower animals are concerned, and that its pathogenic power varies under different circumstances. It seems extremely probable that the micrococcus is concerned in the etiology of croupous pneumonia, and that the infectious nature of this disease is due to its presence in the fibrinous exudate into the pulmonary alveoli.

But this cannot be considered as definitely established by the experiments which have thus far been made upon lower animals. The constant presence of this micrococcus in the

buccal secretions of healthy persons indicates that some other factor is required for the development of an attack of pneumonia; and it seems probable that this other factor acts by reducing the vital resisting power of the pulmonary tissues, and thus making them vulnerable to the attack of the microbe. The supposition enables us to account for the development of the numerous cases of pneumonia which cannot be traced to infection from with

out. The germ being always present, autoinfection is liable to occur whenever from alcoholism, sewer-gas poisoning, crowd-poisoning, or any other depressing agency, the vitality of the tissues is reduced below the resisting point. We may suppose also that a reflex vaso-motor paralysis, affecting a single lobe of the lung, for example, and induced by exposure to cold, may so reduce the resisting power of the pulmonary tissue as to permit this micrococcus to produce its characteristic effects.

Again, we may suppose that a person, whose vital resisting power is reduced by the causes mentioned, may be attacked by pneumonia from external infection with material containing a pathogenic variety of this micrococcus having a potency, permanent or acquired, greater than that possessed by the same organism in normal buccal secretions.

THE INFLUENCE OF COCAINE, ATROPINE, AND CAFFEINE ON THE HEART AND BLOODVESSELS.

There are few known drugs that have, within such a short space of time, risen from comparative obscurity to such practical as well as theoretical importance as cocaine. Its great value as a local anesthetic, and its wide application in all the branches of medicine and surgery, together with our comparative ignorance in regard to many points of its action on the animal organism, are sufficient to attract attention to a valuable experimental paper on the influence cocaine, atropine, and caffeine on the heart and blood vessels, by DR. H. G. BEYER, U. S. N., which appears in the July number of the American Journal of the Medical Sciences.

DR. BEYER finds : 1. That cocaine is exceedingly prompt and uniform in its effects upon the heart. 2. In small doses it is a powerful stimulant to the heart's action. 3. In medium doses it has an inhibitory influence over the ventricular contractions. 4. In large doses it produces diastolic arrest, from which, however, the heart may be recovered under suitable conditions. 5. In small or large doses it produces contraction of the blood vessels, independent of the central nervous system. 6. A rise in the blood-pressure, consequent upon the administration of cocaine, is due to a direct action of

the drug on the heart and blood vessels, stimulating the former and constricting the latter; a fall in blood-pressure coming on after the rise, must be accounted for by the action of cocaine on the heart alone, since its constricting influence on the blood vessels outlasts the stimulating influence it exerts over the ventricle of the heart.

1. That atropine, in certain doses, increases the rate of beat of the heart, and also the amount of work done. 2. That it exercises an inhibitory influence over the contractions of the ventricle. 3. That it first causes a contraction and afterwards a dilatation of the bloodvessels. 4. That cocaine acts on atropized vessels in the same way that it does on normal ones, e. g., it causes their contraction.

That caffeine in small as well as large doses produces dilatation of the blood vessels in the terrapin; any rise in arterial pressure due to caffeine is, consequently, to be explained only by the stimulating effect caffeine exerts on the heart itself.

KOLA.

The Bulletin General Therapeutique, of January 15, 1885, contains an exhaustive article covering a physiological and therapeutical study of this drug, by DR. MONNET, Chief of Clinic at the Faculty of Medicine, at Lille, and undertaken at the instigation of M. DUJARDINBEAUMETZ. It divides the subject as follows:

1. With reference to botany and history; 2. With reference to the physiology of kola; 3. With reference to the general therapeutics of kola; 4. Therapeutic application.

The following is an epitome of the conclusions reached: 1. Kola, through the caffeine and theo-bromine which it contains, is a tonic to the heart, the beats of which it accelerates; it increases its dynamic force and regulates its contractions. 2. A second phase of its action, similar to that of digitaline, proves it to be a regulator of the pulse, which revives under its influence, the pulsations becoming fuller and less numerous. 3. In consequence of its action upon arterial tension, diuresis is increased, and, consequently, kola can be employed to good advantage in cases of dropsy, with cardiac lesion. 4. It might be deduced from observation that kola, which acts energetically upon cardiac contractions and upon the contractility of muscles of organic life, would, on the other hand, have a paralyzing influence upon the striated muscles, when it is used in toxic doses. 5. It retards tissue metamorphosis and diminishes the excretion of urea resulting from decomposition of azotic substances, very likely by exerting a special action upon the nervous system. 6. It is a powerful tonic, through the principles which it contains, and its employment is indicated in cases of anæmia, in chronic affections

of a debilitated form and in convalescence from acute disorders. 7. It favors digestion, either by augmenting the secretions of the gastric juice (eupeptic), or in acting on the smooth fibres of the stomach, which it would render less atonic in cases of dyspepsia. Under its influence rebellious anorexia disappears and the digestive functions become more regular. 8. Finally, it is an excellent anti-diarrhoea remedy and has rendered great service in chronic diarrhoea or sporadic cholera, although its action could not be explained physiologically.

TREATMENT OF THE THIRST OF FEVERS. SURGEON-MAJOR S. K. COTTER gives, in the Indian Medical Gazette, what seems to be a valuable hint in the treatment of the thirst of fevers, a thirst which is usually out of all proportion to the demands of the system for fluids. A patient suffering from enteric fever was awakened every ten minutes by the dryness of his tongue, which was parched and covered with sordes. The tongue was painted with glycerin, and, as a result of the first trial, sleep was maintained for two hours; when the patient awoke his tongue was again painted and with a similar result. The doctor ventures several theories to account for this favorable action, but neglects to refer to the strong affinity of glycerin for water, which, doubtless, explains its favorable action.

CHEKEN IN RHEUMATISM.

Cheken, originally introduced by DRS. RINGER and MURREL, of London, as a remedy for the "winter cough" of old people, is, probably, possessed of other valuable properties. In a letter from DR. H. H. RUSBY, botanist for PARKE, DAVIS & CO., and now in Valparaiso, Chili, the doctor states that cheken enjoys a high reputation as a remedy for rheumatism. The sudden and great climatic changes of that country make rheumatism very prevalent, and the drug is extensively employed for its relief. It is taken internally, and applied externally by means of a bath of hot water in which twigs of the shrub have been infused. In the absence of the twigs we suppose the fluid extract might be employed.

Notes.

The London Medical Times concludes an editorial article in which it reviews the squabble anent the International Medical Congress in this country, with the following paragraph: We do not wish, and we hope no one on this