Sulphate of Spartein in the Treatment of Dropsy. TYSON says that three drugs-digitalis, theobromin, and the active principle of broom-are the most important remedies in the treatment of dropsy. Digitalis takes preference in the cardiac forms of the disorder, while theobromin and spartein are especially recommended in the renal varieties. Spartein he regards as the efficient principle of broom, and he thinks it is advisable to employ the active principle, as the fluid extract is nauseating and the dose is exceptionally large. The dose of spartein sulphate which he recommends is considerably in excess of that usually employed. For the purpose of relieving renal dropsy, he recommends not less than onefourth of a grain for a single dose, and that the total quantity in twenty-four hours should never be less than two grains.

Alcohol as an Antidote for Carbolic Acid.Occasional reports of carbolic acid poisoning, which appeared in recent issues of the current medical press, remind us of the success achieved by PHELPS in antidoting carbolic acid by the use of alcohol. He states that the hands may be washed with impunity in ninetyfive per cent. carbolic acid and that no escharotic effect will result if they be immediately dipped in alcohol. He has employed injections of pure carbolic acid in suppurating cavities and has then washed them out with alcohol.

The procedure has not been accompanied by carbolic acid intoxication. The method has been found to be very efficient in immediately sterilizing suppurating cavities, and many cases have been followed by a rapid absorption of the walls of the abscess and an obliteration of its cavity. The importance of the discovery in relation to accidents with carbolic acid cannot be over-estimated. The frequency of accidental poisoning with this drug have greatly increased of late years, and the occasional accidental spillings of the contents of a bottle of strong carbolic acid over some portion of the body is by no means infrequent. The application of alcohol to these cases is said to furnish a perfect antidote. Carbolic acid, when swallowed, if followed at once by alcohol, is said to be immediately antidoted.

The Ambulatory Treatment of Fractures.Some confusion exists in the minds of many as to the value of this method, and even when its worth is admitted, many doubt its practicability. A wise conservatism is thought necessary by many in the management of all fractures. The result is that good methods are often neglected from the fear that any departure from time-honored methods, if followed by untoward results, would reflect unfavorably on the surgeon and might form the basis of a mal-practice suit. In the minds of the laity, a bone must be "set" and retained immovably by splints. These time-hon

ored tenets have been followed by the profession, and while the surgeon has exhibited a riotous fancy in material for splints, the essential idea of immobilization of the fractured limb has been strictly carried out. The evils attending a strict enforcement of the recumbent position in fractures of the lower extremities have been fully recognized, but they have been thought necessary; if a patient's leg was properly "set" and he was not allowed to get about, and then the leg did not heal, it was the patient's and not the physician's fault. This view is no longer possible, as the results achieved by the ambulatory treatment of fractures in the lower extremities are so striking and satisfactory and from such worthy sources, that one cannot doubt the value of the method. Such a splint, if correctly constructed, brings the weight of the body upon the apparatus. This may be constructed of any material which will conform accurately to the shape of the leg, and in applying the splints the physician must have in mind the thought that the leg is a truncated cone with the apex downward; that the weight of the leg must be carried not upon the bottom of the foot, but must bear equally upon all parts of the internal surface of the splint. Of course the bottom of the foot should be carefully padded as well as the heel and all bony protruberances. With the splint applied in this way, it is possible for a patient who has a fracture of the tibia or of both tibia and fibula to move about with considerable freedom and without the slightest danger of injury or displacement of the injured bone. effect upon the general nutrition of the patient and upon the healing power is very favorable, and in cases so far reported results are much more favorable than those obtained by absolute rest in bed and fixation of the fragments. In a large majority this treatment avoids the wasting of muscle, fixation of joints, and the prolonged convalescence incident to older methods.

The

THE officers of the Illinois State Medical Society are: Harold N. Moyer, Chicago, President; J. T. McAnally, Carbondale, First Vice-President; Weller Van Hook, Chicago, Second Vice-President; Edmund W. Weis, Ottawa, Permanent Secretary; Geo. N. Kreider, Springfield, Treasurer.

THE Missouri State Medical Association has elected the following officers: W. B. Dorsett, St. Louis, President; J. F. Binney, Kansas City, First VicePresident; G. M. Nichols, Higbee, Second VicePresident; W. C. Overstreet, Sedalia, Third VicePresident; C. R. Day, Mayview, Fourth Vice-President; E. L. Priest, Nevada, Fifth Vice-President; B. C. Hyde, Kansas City, Recording Secretary; Jesse S. Myer, St. Louis, Assistant Recording Secretary; E. S. Cave, Mexico, Corresponding Secretary; J. F. Welch, Salisbury, Treasurer.

VOL. XXXIX, No. 21 217

WHOLE NO. 926

Original Articles.

FAITH-CURE FAKIRS.

BY WILLIAM MARION REEDY,

Editor of the Mirror, St. Louis.

HE President of the New York Board of Health has begun a warfare against those persons who may be found practicing medicine without diplomas from recognized colleges. This is the first attack made upon the faith-cure fakirs who go about trying to cure by incantation, or by telling people that all ailment is only imagination. We know that imagination has some effect as causation and cure of disease, but it is to the foolish generalization, in practice, of a truth that applies limitedly to particular instances of nervous susceptibility, that all sensible people object.

The faith-curist is not justified by a few alleged cures under his suggestion. The law against these people is based upon the general feeling and observation of mankind, that all disease cannot be cured through the mind. The fact that disease is due to material change and decay, and to the obstruction of certain functions of the material body, is established by the unanimous experience of mankind, and the further fact is established that only through certain, systematic study can any one hope to assist or prevent or correct the operations of the functions of the body. The wisdom of the world is agreed that nature may be aided to cure its own defects through man's knowledge, gained by observation, of the normal operations of the body. Ignorant persons, therefore, are not allowed by the community to give remedies. Nor should ignorant persons be permitted to induce sufferers to reject the services of men of knowledge and experience, and to accept as a substitute the prayers of said ignorant persons. The fact is well established that medicine can help. A blue mass pill, in practice, annihilates all the arguments of faith cure. So does a hot lemonade, which produces a perspiration, or a glass of whiskey, which can be traced in the blood after it has been swallowed.

The efficacy of medicine is as well attested as the fact that the sun gives light and heat. Those who

S YEARLY SUBSCRIPTION, $1.00 SINGLE COPIES, FIVE CENTS

deny the former might, with equal justification, deny the latter. Those who assert that the will to live is life assert what is denied by an earth which is made up of the ruin of life, and a sidereal system which is, in wide expanses, a "sepulchre of stars." The belief that a man has the unlimited power of prolonging life is a delusion. The holder of such an opinion is wearing out his life by the mere fact of holding the opinion, for every thought exhausts the physical forces of man.

There is every justification of common sense, every inducement of regard for the public welfare, to sustain the authorities in making war upon those who advocate the surrender of the individual will in cases of illness to the will of God, which none can know, and which, by every rational presumption, is supposed to be manifest in a creation in which God has set men to grow, work, suffer, enjoy and improve-all by processes exhaustive of vitality. The faith-cure surrender to God's will is, in the first place, a blasphemy, for in reality it sets up the individual will as the last determining force in the bringing about of things. It is not God's will. at all that is glorified, but one's own. If the will to live were the secret of existence, we should only have to devote our intense thought to willing to live, and we should be able to live without food or drink or shelter. Will should prevent the cold from freezing, the heat from burning us. The will should be everything, and what use then for the body at all?

The facts of life are all against the faith-curists. The great fact of death is against them. If, as they say, death is a higher life, why attempt to evade it by holding on to the life-thought?" If there be no death, why try so desperately to live? If medicine cannot cure without the aid of the will of those medicined, why can it injure without the aid of the will? If medicine can injure the body, despite the mind, how is mind greater than body? And why can a little dose of medicine, injected into the body, or taken into the stomach, make the visual and auditory organs, through the brain, see things and hear things which are not? If faith can keep a person well, why are unbelievers healthy, happy and hearty? It is peculiar that we don't hear of intense believers in the salvatory effects of belief until their belief kills them.

There is absolutely no ground for the recognition,

of conscience, unless, of course, it should be maintained that the government could not break up a religious sect which believed in and practiced human sacrifice.

The faith-curists should be "regulated" for the public welfare. Believers in the faith-cure may have a right to accept the cure and die by it, but they and their curists have no right to endanger the lives of the many who do not believe. If we admit a man's right to suicide, we don't, necessarily, admit his right to murder other people. If regular medicine has never saved anyone from death, if recovery presupposes absence of illness, then faith-cure has done no better. Faith-cure, to make its case against regular medicine, should lose no cases, should do what it demands that medicine shall do. If only those who believe have a chance not to die, the unbelievers would all be dead. But here we are. People may die by the faith-cure if they will. The objection is not to the people who die thereby, but to the folk who kill them. The law should permit the proper authorities to inspect all cases of disease, and to imprison all miracle-mongers who may obstruct such inspection. The law should put a stop to this growing practice faith-curists have, of gathering many people around the sick and keeping out those who might know the deadliness of the germs working upon the victim of the faith-curists. The law should punish severely failure to report infectious and contagious disease. The law should punish severely all those who, in any way, foster the spread of infection.

There is no use dallying with them on the score of religious liberty. Government is run for sane people, in accord with the ideas of sane people. Insanity has no rights beyond pity and care. It certainly has no rights superior to the rights of health of the masses of people in a community. People who deny death, deny life. Why have patience with persons using that doctrine of insane denial solely to make money, or live at ease? The health authorities everywhere should insist that any person professing to be engaged in curing by faith, shall make report of his or her cases to the health office, so that an investigation may be made to determine the danger of infection or contagion, to determine whether the "patient" is under duress and denied the service of a regular physician, and to determine whether the application of the resources of the pharmacopeia, or of surgery, would not relieve pain. This would not be subject to

BACTERIOLOGY AND DEMONSTRATION OF THE DIPLOCOCCUS INTRACELLULARIS

MENINGITIDIS.*

BY DR. G. C. CRANDALL, St. Louis,

Professor of Principles and Practice of Medicine, MarionSims College of Medicine.

N considering the bacteriology of cerebro-spinal meningitis, I shall confine myself chiefly to that organism which, according to recent investigation, seems to be the essential cause of the epidemic form of the disease. According to Osler, "bacteriologically we may recognize four great groups of meningitis. Those due to the meningococcus (diplococcus intracelluaris meningitidis), the pneumococcus meningitidis, the form due to the tubercle bacillus and the streptococcus meningitidis. The gonococcus, the typhoid bacillus, the colon bacillus, and the staphylococcus also cause meningitis, but a great majority of all the cases are due to the first four "mentioned micro-organisms." Osler gives the following definition of the epidemic form of the disease: "A specific infectious disease, occurring sporadically and in epidemics, caused by the diplococcus intracellularis, characterized by inflammation of the cerebrospinal meninges and a clinical course of great irregularity."

Dana, in his work on nervous diseases, says: "Epidemic cerebro-spinal meningitis is an acute, infective disorder produced by a special micro-organism." The majority of the recent writers on the subject corroborate the views expressed by the authors quoted.

The definite history of the organism dates from 1887. Weichselbaum found it in the exudate of

cerebro-spinal meningitis, usually within the cells. Mallory and Wright described the organism as diplococcus, occurring as paired hemispheres, separated by well-marked unstained intervals. In cultures there is considerable variation in size; the large forms are thought to be involution or degenerate forms.

In cover-glass preparations from the meningeal exudate, the organisms are frequently situated inside the leucocytes, sometimes within the nucleus. The appearance is very much like gonorrheal pus, and decolorizes with Gram's stain. The organism grows

*Read before the St. Louis Medical Society, April 15, 1899.

very well on blood serum and agar, producing colonies which are round, colorless, shining, flat, moist, and viscid looking. In cultivation, the organism dies out in from two to six days. It has been observed by Flexner and others that there is considerable uncertainty in obtaining a culture from apparently virulent pus, even when the organisms are found quite abundant in cover-glass preparations. Sometimes they grow readily, and again not at all. The staining reaction of the organism is also peculiar. It stains very well with Loeffler's methylene blue, but all the organisms do not usually stain with equal intensity. In using the Gram's stain, they usually decolorize. They sometimes retain considerable stain and may cause confusion as to their identity. This peculiarity of staining is possibly due to the difference in vitality.

Councilman believes it to be a distinct organism and not to be confounded with the pneumococcus. Welch thinks it possible that the meningococcus is not the sole cause of the epidemic meningitis, and that the pneumococcus and meningococcus may be varieties of the same organisms. He also states that the pneumococcus, when present, may be a secondary infection and that the meningococcus may be overlooked.

In

Mallory and Wright's report upon thirty-five cases, in a Boston epidemic, has afforded the first thorough bacteriologic investigation of a series of cases. the thirty-five cases upon which post-mortem examinations were held, the meningococcus was demonstrated in all but four. In one of these they had been found before death, in the spinal fluid. The other three cases were chronic. In seven cases, the pneumococcus was found associated with the meningococcus. Lumbar puncture in fifty-five cases showed the diplococcus in thirty-eight. It has been observed that they may not be found by spinal puncture, and yet be found at post-mortem. In view of the observations already made, I think it very probable that the meningococcus is the specific organism of epidemic cerebro-spinal meningitis.

The specimens which I present to the Society are obtained from a typical case of the disease in an adult

man.

He manifested the most important symptoms, namely: severe headache, pain in back and limbs, anorexia, vomiting, full, strong pulse, temperature 101° to 103° F., hypersensitiveness to light and sound, stiffness of muscles of neck and back, hyperesthesia, petechial eruption over chest and shoulders. Some delirium, ultimately coma and death.

I punctured the spinal canal about the fifth day of the disease, drew off about one-half an ounce of the spinal fluid, from which I made cultures and coverglass preparations, which showed a pure infection with the meningococcus, as shown by specimens. The results of post-mortem corroborated the findings obtained by the examination of the spinal fluid.

THE SYMPTOMATOLOGY OF CEREBRO-SPINAL FEVER.*

厚

BY GIVEN CAMPBELL, M.D., St. Louis, Mo.

S in all other diseased conditions, so should it

be in epidemic meningitis that we consider the symptomatology as a series of effects depending on causes: and, keeping this fact in view, we should constantly try to reason back from the symptom (the thing we can see and estimate) to its cause, the altered physical or chemical condition on which the symptom depends. We should try to deduce from the symptom complex what knowledge we can as to the nature of the changes producing it, and then arguing from cause back to effect, we should hold the symptom up to the light thus obtained, estimate the gravity and the probability of its relief, and get what notions we can as to the best means to use for this relief. In other words, we should remember that, while it is through the symptom, and through the symptom alone, that we see the disease and observe the effect of our efforts to manage it, the symptomatology is, as it were, but a visible garment for the disease, which is itself invisible. When this is remembered, symptomatology becomes more than a mere disconnected enumeration of subjective and objective occurrences, and symptom treatment may be regarded from a different point of view.

Taking this stand, then, let me say that cerebrospinal fever is an infectious disease, in which the infectious material, in most cases the diplococcus intracellularis, gains access to the body and chooses as its special soil for growth the membranes of the brain and spinal cord. This being the case, the initial symptoms are those of a systemic infection, along with those referable especially to the nervous system. In cases of great virulence the patient is overpowered by the toxemia and dies sometimes in a few hours and before any distinctly meningeal In most cases, symptoms have had time to occur. however, the symptoms referable to the nervous system are among the first, and these are such as might be expected in a diffuse, irritative rather than destructive involvement of the central nervous system. We must remember that in the case of the brain a large part of its gray matter is spread out in the convolutions, and is thus in intimate contact with the meninges, and in this way its functionating part is brought into close and early relationship with the products of infection.

To speak more definitely and in detail as to the symptoms, it may be said that this disease, being an acute infection, is in some cases ushered in, as are many infectious diseases, by a prodromal period of one or two days duration, with malaise, nausea, More often this prodromal period is anorexia, etc.

*Read before the St. Louis Medical Society, April 15, 1899.

absent and the disease begins acutely, often very acutely, with a chill or chilly sensations, fever, a headache,and vomiting-symptoms that we should expect to find at the onset of any acute infection. But there are peculiarities about this vomiting and this headache which make the careful observer think at once of brain involvement. The vomiting is often present with a clean tongue, without any sign of stomach disorder to account for it, and frequently occurs without nausea, so that any food or liquid taken by mouth is at once rejected, but vomiting ceases when stomach is empty. The headache differs from that which is found in the onset of an ordinary infectious disease, in that the pain is usually much more intense and disproportionate to the amount of fever present.

To this headache is added delirium, coming on at varying periods after the onset of the disease. It is often a very early symptom; an important diagnostic point is that in meningitis the headache and delirium exist together, while in the ordinary febrile delirium and headache the headache stops when the delirium begins. In meningitis such is not the case, and this severe head pain continues in varying intensity, but often with severe exacerbations, right through the delirium and often well into the coma, from which state the patient is often roused by an access of severe pain and forced to emit a sharp cry-the hydrocephalic cry. In estimating the value of delirium as an aid to diagnosis, we must take into consideration the amount of the other causes that may be present, such as fever, toxemia, etc., and the readiness with which such causes produce delirium in a given patient. But the fact of severe headache and delirium being present at the same time in a patient renders it very probable that that patient has meningitis. The fever is usually not high, but runs a very irregular course and is apt to be highest at the onset of the disease, and a hyperpyrexia often precedes a fatal termination. Convulsions occur more often in children than in the cases occurring among adults. They are usually general in the early stages of the disease, and local convulsions may occur late and precede recovery. A characteristic hyperesthesia of the skin is usually an early symptom, and this same cutaneous irritability is probably the cause of over-activity of the skin muscles, causing goose-flesh. Photophobia is usually an early symptom in adults The eruptions commonly begin on the third or fourth day, but are subject to wide variations. The most characteristic, when present, are the purpuric spots, which have given to this disease the name of spotted fever. They usually indicate a severe infection. Herpes is a very frequent accompaniment of the disease, occurring on the lips and face and usually appearing on the third or fourth day.

The above described symptoms are what may be

called the general symptoms of this disease. They are not of such absolute value in rendering certain the diagnosis as are what may be called the localizing symptoms, such as strabismus, inequality of the pupils, and stiffness of the neck muscles, but they occur much earlier than do the localizing ones; the diagnosis must often be made before any localizing symptoms are present. symptoms are present. These general cerebral symptoms are significant by their degree and combination, since most of them may, as we have seen, be produced by causes commencing outside the nervous system. The significance of the headache depends on its persistent intensity; of the delirium, on its coincidence with the headache of convulsions, on their association with other symptoms; of vomiting, on its causeless recurring character and association with constipation. To these general symptoms are added, after a variable time, those pointing to local involvement of the brain or cord, or of the nerve trunks as they leave the central system. Among the earliest of these is pain and especially rigidity of the muscles of the back and back of the neck, with retraction of the head. These indicate irritation in the region of the medulla or pons. This retraction is usually slight, sometimes it is more on one side, causing bending of the neck to that side; but the rigidity with a certain amount of pain on attempting to flex the head is a very constant symptom, usually coming on early in the disease but occasionally not until late. Hearing is the earliest of the special senses that is involved, and the one most constantly affected; the deafness is caused in the majority of cases by an extension of the inflammation from the membranes to the labyrinth and middle ear, or by a simultaneous involvement of the internal ear. When there is not coincident weakness of the facial nerve, there is little probability of the deafness being due to damage of the auditory nerve at the base of the brain or in the medulla. important point in prognosis is that when deafness has been present in this disease, any return of long conduction of sound is a very favorable omen.

An

As the disease progresses, the symptoms which were at first all irritative are replaced by others that indicate destruction of nerve function. Thus the delirium merges into coma, and strabismus, which is a fairly early localizing symptom, changes from as spasmodic strabismus to one caused by paralysis of the eye-muscles, one muscle lagging behind the others. Nystagmus is occasionally present, and the pupils are often, but not by any means invariably, unequal, even late in the disease. A transient strabismus, nystagmus or unequal pupil is of as much diagnostic significance as a more permanent derangement. Ptosis is common, and occurs rather early. Some weakness of the face is not unusual. In most cases the cerebral symptoms continue much more prominent than do the spinal ones, owing probably to the