Miscellany

DR. BRANSFORD LEWIS has been elected Professor of Genito-urinary Surgery, H. H. Born, Professor of Anatomy, and Dr. J. S. Myerl, Professor of Physiology in the Marion-Sims College of Medicine.

THE following is the program for the St. Louis Medical Society of Missouri, Saturday evening, June 3, 1899: "Removal of Superior Cervical Ganglion for Glaucoma, with Report of a Case," by Dr. James Moores Ball. Discussion, by invitation, by Drs. Hillard, Bartlett and E. C. Renaud. "A Report of Actual Cases Demonstrating the Relief, by Modern Methods, of Patients Hopelessly Afflicted for Many Years with Deafness from Catarrh, Running Ears, Low-Speaking Voice, Dizziness, Noises in the Head and Ears, Worse Hearing in Quiet Places, Aural Distress, etc.," by Dr. Robert Barclay.

Nor long since, O. Wellington Archibald, formerly superintendent in the North Dakota Hospital for the Insane, was removed upon charges which upon subsequent investigation were found to be untrue. After full consideration of the entire matter, the board unanimously elected him superintendent of the hospital. Dr. Archibald decided, however, to decline the position, being quite content with the vindication contained in the resolutions of the board.

THE next meeting of the Railway Surgeons' Association will be held in Richmond, Va. The route of travel will be by the way of the Chesapeake & Ohio, from Cincinnati. The last issue of the Railway Surgeon gives a full account of the proposed meeting and the points of interest through which the trains will pass, and also a map of Richmond, showing the surroundings with the points at which the principal battles around the city were fought during the Rebellion.

THE beautiful structure known as Lookout Mountain Inn, situated on the summit of Lookout Mountain, which has proven such an attraction to tourists in the past, is to be discontinued. It was found that the patronage was not sufficient to meet the expense, and this necessitated the close of the Inn for the greater part of the year. It is stated that the Order of Railway Conductors have purchased the Inn, and it will be turned into a university for the education of the children of railway conductors and an asylum for disabled and aged conductors.

THE physicians of Iowa have organized what is known as the Association of Iowa Physicians. This association has been carefully organized in each of the counties, and it is hoped to include practically all of the three thousand physicians within the boundaries of the State in its membership. The business of the association is the promotion of wise and efficient

legislation upon subjects pertaining to the public health and a closer union of the physicians of the State. The membership of the body is made up of the physcians of the three schools of practice in the State, and eligibility to membership is determined by the profession in each county. The annual fee is one dollar. It is to hold its meetings on the evening preceding the first day's session of the Iowa State Medical Society.

THE following cases of small pox have been reported to the Surgeon-General of the U. S. Marine Hospital Service during the week ended May 27, 1899:

United States.-Nicetown (Pa.), 25; Louisville, 18; Portsmouth, 14; Cleveland, 13; St. Louis, 12; Sayannah, 10; Norfolk, 9; Evansville, 7; Philadelphia, 6; New Orleans, 5; Los Angeles, Ponce, Newport News, Spokane, 4; West Tampa, 3; Washington, Milwaukee, 2; Swampscott (Mass.), St. Paul, Johnstown, 1.

THE sensational exploiting of medical discoveries in the lay press is not confined to this country. A recent number of the Paris Figaro announces that one Dr. Bra has found the microbe of cancer, and the journal in question expresses hope, with which we feel sure all lay and professional journals will join, that the discovery will soon lead to a certain cure of the dreaded disease. Dr. Bra expresses himself modestly when he states that months must elapse before he can make a definite announcement, but he claims to have succeeded in isolating and cultivating a parasite from cancerous tumors and to have inoculated the parasite into animals and to have in this way produced a growth which resembled cancer. We are informed that Dr. Bra has spent four years in the study of cancer and its origin. The above item has been extensively reproduced in the medical press of this country, and it found its way into our literature through La Presse Médicale, which evidently published the item as a bit of news in France, because it is evident that Dr. Bra's work has not attracted much attention in that country, and the report bears a striking resemblance to some of the recent published work of Sanfelice and some other Italian writers.

MEDICAL REVIEW

A WEEKLY JOURNAL OF MEDICINE AND SURGERY

CONDUCTED AND EDITED BY

H. W. LOEB, M. D., 3559 OLIVE ST., St. Louis, Mo. H. N. MOYER, M.D., 103 STATE ST., CHICAGO, ILL.

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Entered at the St. Louis Postoffice as Second-Class Matter

THE IDENTIFICATION OF THE GONOCOCCUS.

The identification of the gonococcus is not quite as simple as has been generally supposed. The organism stains readily, and an ordinary cover glass preparation made from a urethral discharge containing many cocci, the larger number being found within the pus cells, is almost certainly the gonococcus. In doubtful cases, which will include the majority which have passed the acute period of the infection and in which a diagnosis is of the utmost importance, practically few organisms are found, and it is then much more difficult to identify them with certainty. The gonococcus is a diplococcus, in shape resembling a coffee bean, its long diameter being about one micro-milimeter. These always occupy an intracellular position, and they are completely decolorized by Gram's method. The procedure recommended by W. C. Mitchell apparently leaves but little to be desired in the certainty with which these organisms are identified. He recommends that the preparation be dried and fixed in the usual manner by passing through the flame of a Bunsen burner. Then they are stained by a solution composed of 100 c. c. of aniline water added to 11 c.c. of an alcoholic solution of gentian violet. (This aniline water is made by adding 5 c. c. to 100 c.c. of water; the mixture is then thoroughly shaken and filtered.) In this way the specimens are instantaneously stained. The surplus is then drained away and the cover glasses immersed for about half a minute in a solution containing one part of iodine and two parts of potassium iodide and three hundred. parts of water (Gram's solution). It is then washed in absolute alcohol until the blue color has entirely disappeared. The preparation made in this way leaves streptococci and other diplococci stained, but the gonococci are decolorized. This latter reaction is most important for the accurate identification of the gonococcus, taken in connection with the other findings and the presence of a large diplococcus in the pus cells, which is completely decolorized, by Gram's method, makes the identification of the organism quite complete.

INEBRIETY FROM THE STANDPOINT OF THE GYNECOLOGIST.

MR. LAWSON TAIT recently testified before a liquor commission, in which he gave a singular classification of women inebriates. The direct cause in each, he thought, was almost always due to physical or mental suffering. He analyzed 108 cases, and divided them into two groups, the smaller including only twelve cases, at an average age of twenty-six years, and a much larger number, in all ninety-six cases, with an average age of forty-eight years. He attributed the inebriety in the latter class, which included nearly ninety per cent. of all the cases, to suffering and nervous disturbances at the time of the climacteric. He by no means excluded physical suffering as the cause of the inebriety in the first class, and we are left to infer that, in his opinion, this disorder is largely due to diseases peculiar to women. The logical deduction from his remarks would be that a pelvic disturbance is largely responsible for inebriety, and surgery alone affords a relief for this condition, and therefore a surgical operation will cure the drunkenness. One who is accustomed to take broad views of sociological topics will be sur prised at the enormous superstructure of theory which Mr. Tait has built upon the narrow foundations of 108 cases. These were probably taken from his case books, and naturally included a class of persons who would seek the aid of a gynecologist for obvious disorders in the pelvis. It is but another of the defective theories based upon the narrow specialism of the day.

THE BEARD OF THE SURGEON AS A CARRIER OF INFECTION.

HUEBENER, in the Centralblatt für Chirurgie, No. 11, 1899, has recently been studying the beard as a source of infection in operations. He has devised a wire muzzle, which is covered with a double layer of gauze, designed to fit over the beard of the surgeon, and thus prevent germs from dropping into the field of operation. One French surgeon has taken up the defence of the beard, claiming that the muzzle devised by Huebener really favors infection, because of the friction between the beard and the covering; this would actually increase the number of germs that were loosened. In a further study of the subject, Huebener has actually determined that this is a fact, and that the danger of infection from the beard of the surgeon is by no means inconsiderable. He examined the beards of twenty-six surgeons, eleven of whom were found to have pathogenic bacteria in considerable numbers in their beards. None were found to be aseptic, but, for the most part, they were free from pathogenic bacteria, containing only those of the non-pathogenic sorts. Garre has advised

that before operation the beard should be bathed in a sublimate solution. Other continental surgeons favor the application of a linen bag, or various forms of muzzles, into which the septic whiskers are thrust. It is claimed that by many of these applications the danger is lessened, though, of course, it cannot be argued that the esthetic appearance of the operating room is thereby improved. Mikulicz is said to wear a most complicated muzzle, by which the mouth, nose and beard are covered in such a way that a stray bacterium can scarcely reach the operative field. Amid all the discussion regarding the beard as a source of infection, there is very little said about the hair, though American surgeons have paid some attention to this point, and it is no infrequent sight to see the heads of our surgeons swathed in gauze bandages of undoubted antiseptic potency. Quite a number of them are so bald as to make the use of any of these applications entirely unnecessary. One suggestion for the beard, that we have not seen mentioned, is the application of a razor on the morning of an operation. This actually precludes infection from this source. It is hardly probable that the surgeons who are not bald will consent to have their heads shaved, and wear a wig in the intervals of their operating, yet it would undoubtedly add something to the asepsis of the operating room. In these columns we referred, not long since, to a glass operating room, with a glass roof; the spectators were to sit on the outside and look through the roof, while a lecturer, on the outside, explained what was going on. We cannot see the value of such precaution, when a set of bushy whiskers and luxuriant head of hair is to be shaken over the abdomen for a considerable time.

AN EARLY OPERATION FOR APPENDICITIS. For several years the discussion regarding the advisability of early operation in this disorder has been gaining in strength, and, we had almost said, in acrimony. Certain it is that those who are opposed to early operation are, if anything, more confirmed in their opinion by recent statistics, while the same figures convince those who believe in immediate operation that it is the only rational way of dealing with the disorder. The latter contend that an early operation, while it may occasionally lead to the removal of an appendix where the case might have rcovered without operative interference, yet the difficulty of making a prognosis that shall hold good for a few hours in this disease is so great that the saving of life in early operations is much greater than where a certain proportion of the cases are treated by the expectant method. Without doubt the tendency on the part of operators in this country is toward conservatism, the ranks of this class being headed by

Pofessor Keen of Philadelphia, than whom there is no one with riper surgical experience or more accurate judgment.

For the past three months there has been an active discussion on the whole subject in the French Academy of Medicine, and it is significant that in this discussion Dr. Dieulafoy, one of the leading physicians of Paris, who, it is claimed, sees more cases of this disease than any other practitioner of France, though not a surgeon, insists that all cases shall be operated upon within twenty-four hours after the first symptoms in acute cases, and in less than thirty-six hours in those of slower development.

At the last meeting of the Illinois State Medical Soicety the topic came up for discussion. While there was not sufficient time for a large number to take part, yet it developed that there were two general views: those who advocated, uncompromisingly, immediate operation, and those who preferred temporizing.

Unfortunately, the data which are accumulated by surgeons and physicians in this disease do not lend themselves to statistical treatment, as they do not always deal with precisely the same conditions. There are many cases of catarrhal inflammation of the mucous membrane of the head of the colon which are classed as appendicitis. In these cases the appendix may not be involved at all, and yet some of the symptoms attending appendicitis may be present. It is apparent that such a condition of the large bowel will yield to medicinal treatment, especially saline purgatives. A number of such cases would give one a very favorable view of the efficiency of medicinal treatment. On the other hand, a succession of suppurating appendices would lead to the inevitable conclusion that early operation was of the utmost importance.

It is probable that here the golden rule will lie somewhere between the extremes. What is needed is an accurate symptom of suppurative inflammation. When we are in possession of this, the question of operation can be accurately determined.

LEGISLATION IN TEXAS.

MATTHEW N. SMITH, in the annual oration before the Texas State Medical Society, chose as his topic, The Invisible Enemy," by which he understood the infectious diseases and the ceaseless warfare waged by the medical profession against epidemic diseases. He spoke rather disparagingly of the assistance afforded by the legislature of the State, which, he stated, had learned that there existed a fatal disease to cattle known as the "black leg," and that they at once appropriated a handsome sum of money to employ a bacteriologist to study the disease and to ascertain, if possible, its cause and to suggest a remedy for its

eradication.

In the same session, it was stated that a fatal disease to cotton, known as "bolus weevili," had occurred in epidemic form in certain sections of the State, and, notwithstanding the low prices obtained for cotton, the legislature promptly appropriated money to employ an expert entomologist to study the cotton disease and to learn, if possible, the life history of the microbe and the methods for its destruction. At the same session of the legislature, a well-directed effort on the part of the Texas State Medical Soclety to secure some legislation for the promotion of public health and the regulation of admission to the medical profession, was incontinently tabled, or else so disfigured by amendments as to make them worse than useless.

An editorial in the Texas Medical Journal states the profession is thoroughly roused to the necessity of more thorough organization, to the end that adequate laws may be placed upon the statute books governing the local practice and the control of epidemic diseases. A committee on organizing the county societies was appointed, and it is evident that some such movement is contemplated as has been inaugurated in Iowa, though it is evidently intended in Texas to keep the organization within the State Medical Society.

The committee on legislation reported on the diffi culties attending the passage of a bill and the failure which had attended their efforts at the last session of the legislature. It is significant that the report of this committee stated that more or less opposition was shown to legislation of this character, on the part of many members of the profession, and the opposition of a small minority, it is known, makes the passage of a law of this character one of great difficulty. This is the same trouble which attended the passage of such a law in Illlnois. It is believed by the members of the committee who had that bill in charge that if it had not been for the opposition within the ranks of the profession, a quite perfect bill could have been placed on the statute books.

THE BUBONIC PLAGUE.

There is no disguising the fact that European sanitarians are much exercised over the extent of the plague in Bombay and a few other places in India. The extent and virulence of the infection is sufficient to excite the gravest fears that it may be carried along the usual routes of travel and become firmly fixed in the poorer quarters of some of the larger occidental cities.

That there is danger of a pandemic such as characterized the progress of this disorder in the middle ages, is not generally believed. Even though the exact manner in which the plague is propagated is not definitely known and consequently the modes

of restriction cannot be accurately formulated, yet our knowledge of the infectious diseases generally, and methods of disinfection, have now reached such a degree of perfection that it may be confidently asserted that no such widespread and fearful epidemics as were noted in the middle ages are now possible.

It may be safely asserted that the plague is not a water-borne disease. The weight of evidence to date is strongly in favor of the view that it is essentially a disease of rats. These animals, so strongly immune against many forms of infection, succumb at once to the bubonic bacillus. It is not necessary that they be inoculated, but mere contact is sufficient to spread the infection among them. Man is much more resistent to the infection, and it is believed that the bacillus increases in malignancy by being passed through the rat and then inoculated into human beings. A possible means of contagion has been suggested in the bite of fleas, which are known to infest rats as well as human beings. That there is danger of epidemics of considerable proportions is shown by the experience in Bombay, where a frightful mortality among the natives has attended the outbreak. Of course, conditions among the native population in India is very different from that found in the West, and caste precludes that thorough supervision which is essential in the management of an epidemic, yet it is to be remembered that the fight in Bombay has been conducted by some of the ablest sanitarians in England. While some of the difficulties which have been encountered in India will not be met in the West, the sanitary conditions of some of the crowded quarters of the larger American cities, the dwellings in many cases constructed of wood, infested with rats, and always containing a profusion of decaying garbage, are sufficient to incite the gravest apprehensions in the event of the plague being imported.

THE STOMACH AS AN ELIMINATING ORGAN.

Since lavage has been extensively used in the treatment of gastric affections, it has been learned, almost by accident as one might say, that the stomach eliminates certain substances. If morphine be administered hypodermically, a considerable proportion is found in the stomach. If this is washed out, it is found to re-accumulate, and in this way a certain amount of the poison may be gotten rid of. Of course, if it remains in the organ it will be re-absorbed and thus produce its poisonous effects. What is true of morphine is probably true of other toxic products. It is well known that many toxemias are accompanied by persistent vomiting. For years it

has been the custom to regard as reflex all cases of vomiting not due to the actual presence of some irri

tating substance in the stomach, or local changes in its mucous membrane. Consequently, treatment for vomiting has been directed to the control of reflex centers. The observations of Huchard teach us that lavage is a most important means of treating vomiting of nuremia. He believes that there is an active secretion of the toxic substances in these conditions of the mucous membranes of the stomach. If this is relieved, vomiting ceases until it again re-accumulates. These and similar observations should teach us the importance of this method in all cases of vomiting. While there may be some that are due to strictly reflex causes, yet auto-intoxication plays such an important role in many of these disorders, that we should not forget such an important and simple means of treatment, especially when an accurate differential diagnosis cannot be made.

THE STUDY OF TROPICAL DISEASES.

A recent report of the Marine Hospital refers to sanitary matters in Santiago de Cuba, Mantanzas, Cienfuegas, and Puerto Rico. In the reports for the week of May 12, in Havana, there were no deaths from yellow fever or from small pox. That from Santiago de Cuba, in the week ending April 29, showed a total of thirty-one deaths; the principal causes being tuberculosis, malaria, meningitis, enterocolitis, and pneumonia. While the recent reports show a comparative absence of the diseases peculiarly prevalent in tropical climates, yet the recent territorial acquisitions of the United States, especially the Philippines, make it important that there should be a body of medical men especially trained in the knowledge of diseases peculiar to the tropics. The sanitation of tropical countries raises additional difficulties, which can only be met by highly-trained students of the subject.

That England is alive to the necessity of having medical men especially trained in this department of medicine, is shown by the recent foundation by Mr. A. L. Jones, of a school for the tropical diseases, in Liverpool. It is to be conducted partly at the University College and partly at the Southern Hospital, and its course will include the study and management of tropical diseases. Nurses who desire, will be trained for the care of tropical diseases. Tropical

laboratory work will be carried on by the University College. That the Southern Hospital will afford excellent resources for the study of these diseases, is shown by the fact that within a comparatively short time forty-one cases of malarial fever have been admitted, and that its patients are largely recruited from sea-faring men, many of whom voyage to tropical countries. There is to be a London school devoted

to the same subject, which is to be opened on October 1st, and will have its headquarters at the Albert Docks.

The faculty of the Johns Hopkins Hospital Medical School have decided to give a course upon tropical medicine during the coming year. Within a short time Professor Barker, accompanied by two asso. ciates, has started for the Philippines for the purpose of making a careful study of the diseases of those islands.

LOCAL ANESTHESIA.

It is about two years since PROFESSOR SCHLEICH published his method of local anesthesia. The method at once appealed to surgeons, and not only was it extensively experimented with, but the medical press of the country soon teemed with articles, commending it, for the most part, in operations involving moderate dissection. Soon the popularity waned, the reports became less numerous, until of late scarcely anything has been heard of local anesthesia, though, without doubt, it is employed in cases in which it is difficult or dangerous to give a general anesthetic. The most serious objection to Schleich's infiltration method was the danger of sepsis, it being practically impossible to keep the solution aseptic, and if this is not done there must of necessity be infection of extensive areas. If the solution were sterile, the anesthesia of the skin by injections must certainly carry the infection from the deeper glandular structures into the skin, and in this way there is almost a certainty of infecting the deeper tissues.

The success attending the use of the Schleich mixtures is sufficient to encourage experimentation along these lines. Several local anesthetics, among which are holocain and orthoform, some of which are antiseptic, or capable of thorough sterilization, admirably lend themselves to the production of anesthetic solutions. It is possible that mixtures of these subsubstances may be discovered which are practically harmless for the tissues, and at the same time aseptic. That there is less importance attached to general anesthesia is shown by the result obtained by Roux, who scarcely resorts to it in extensive operations upon goitres. Indeed, he uses practically no anesthesia, except when dividing the skin and some of the muscles. The capsule, as well as the substance of the goitre, seem to be insensible to ordinary surgical manipulation, and he removes considerable portions of the glands or removes cystic tumors without giving the patient any considerable pain. He claimed, also, that in the extensive dissections required in these operations, considerable aid is obtained from the sensations of the patient, and without anesthetics they are made safer and more rapidly.