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PREVENTIVE
DISEASE.

The science of hygiene only one case; a boy, aged two years, is the science of the with levocytosis and enlarged spleen,

prevention of disease, upon whom two preceding doses had prowrites Dr. Cyrus Edson in the North Amer duced no effect, had a temperature of ican Review, and it is the aim of all physi 105.4° F., and considerable cedema about cians now to so guard their patients as to the point of injection. These symptoms have no disease to treat. This has been ren promptly subsided after stimulants and dered possible by the discovery, by Pasteur cold baths. As a rule, the temperature and others, of the microbes of disease, which was observed to rise less than a degree a produce particular ailments in humanity. few hours after injection, and in 75 per This discovery was in two parts: First, that cent. of all cases this was all there was to be contagious diseases are caused by microbes; seen. Erythema around the point of insecond, that contagious diseases produce jection occurred in 23 cases. In 4 it was microbes which either as microbes or their very extensive, and closely resembled eryproducts will in turn produce the disease in sipelas. The average duration of this sympthose who are well.

tom was three days; in some cases it lasted This discovery of the microbes and of the only a few hours. It usually appeared on work they do, has naturally resulted in the the first day after antitoxin, and never community preparing itself for the fight later than the eighth. Urticaria occurred with these little enemies. The work of 28 times. The frequency, severity, time boards of health is very different to-day of appearance and duration of this sympfrom that which similiar bodies performed tom varied greatly with the brand of serum twenty-five years ago. Of course, the fact employed. of the contagion of disease was known a In three instances the erythema was paputhousand years back, and the experience of lar and very closely resembled measles. In mankind was reflected in such institutions two instances an eruption like scarlet fever as the quarantine. But the efforts put was present. Occasionally a child whose forth against contagion rested with

skin remained clear after the first or secquarantine for a long time. It is ond or third immunization broke out with owing to the discovery of the laws of an erythema or an urticaria after a subsehygiene and their practical application that quent injection. The same brand of serum we are enabled to check disease when it may produce an urticaria, an erythema, or appears, to seize it and say it shall not no skin eruption whatever in the same spread.

subject, as proved in more than one inThe American Journal

stance where repeated injections were of Medical Sciences for

given. Pain (at times intense) was noticed ANTITOXIN. November publishes the

about the point of injection in 16; ædema results of an extensive experience in

in 7; axillary or inguinal glands enlarged the use of antitoxin as an immunizant in 3 ; general malaise (in 1 instance a mild in the wards of the Boston Children's delirium) in 3. Pain in the articulations Hospital. A total of 438 injections were

in less than 1 per cent. Nausea, with or given between January 13th and May

without vomiting, in 2 per cent. Diarrhoea 13th-of these 109 were of Gibier's serum,

(ephemeral) in less than 3 per cent. In104 of Behring's, 74 of Aronson's, and creased frequency of micturition was noted, 151 of the antitoxin prepared by the Mas

and in 80 per cent. of the cases albumen sachusetts State Board of Health. The subsequently was found in the urine. largest number administered to one child Experience tended to show that the was 7. Many of these patients were under

serum, when fresh, immunizes against treatment for acute diseases at the time of clinical diphtheria for thirteen days. injection croupous and broncho-pneumonia, grippe, tubercular peritonitis, emp

The employment of pelvio yema, typhoid, and various surgical con

mensuration as a routine

TIONS. ditions.

practice in every case of Dangerous symptoms were observed in confinement is advocated by Dr. Austin

IMMUNIZING
EFFECTS OF

PELVIC CONTRAC

TENDON

GRAFTING.

Flint, Jr., in the N. Y. Medical Record. His tion of a continued fever closely simulating advice is as follows :

typhoid has been repeatedly observed. In pelves with a true conjugate of less than three and a half inches, operative in

Tendon grafting, as reterference usually is imperative. Only four

ported by Dr. Samuel such cases were spontaneously delivered.

Milliken, of New York, The nature of the operation depends both in the New York Medical Record for Oct. 26, on the degree of contraction and the size opens up a new field in the treatment of seof the child's head. Just under three and quellæ of infantile paralysis. The writer exa half inches either forceps may be used or presses the belief that this is the first case version done. The infant mortality in the reported where a healthy muscle has been use of forceps was a little more than made to do the work of one which was twenty-five per cent., and in version a completely paralyzed without interfering little more than thirteen per cent. This with its own function. seems to show that version is the better The history was the usual one of infanoperation ; but a larger number of observa tile paralysis, the subject being a boy of tions may demonstrate the reverse. Pelves nine years. The trouble was with the anin which the true congugate is much less terior tibial group of muscles, the right fuot than three and a half inches call for more dropping into the position of equinus. The severe operations, and each case must be tibialis articus was most involved. Owing treated according to its individual require to this muscle being paralyzed, the power ments. At present the indeterminate factor of flexing the foot on the anxle was limited is the size of the child's head. It is to be to the three remaining muscles of the hoped that the instrument recently in group, viz., the extensor proprius pollicis, vented by Farabeuf for measuring the size extensor longus digitorum, and perineus of the head will prove of value.

tertius. In addition to the extreme valgus

into which the foot was forced, there was Drs. V. C. Vaughan and a marked “hammer toe."

G. D. Perkins, in the The operation consisted in taking part of INFECTION.

Medical News of Nov. 16, the extensor pollicis and grafting it into publish an article on “Food Infection with the tendon of the tibialis articus, which Toxicogenic Germs.” They say:

was paralyzed. Brilliant results followed. Only a few years ago we were seeking for The lad is now an expert on roller skates; the cause of the summer diarrhoeas of in walks without a limp, and can adduct the fancy in mysterious telluric and meteoro foot to almost normal. logic conditions, but now we know that these diseases are solely due to infected,

Dr.J. E. McCuaig, in the and consequently poisonous, food. For

Medical News of Nov. merly many cases of food-poisoning were

16, writes: In no class supposed to be due to the accidental or of

of insanity is the prognosis criminal addition of some metallic or vege so favorable as in those occurring in table poison to the food, and unjust accusa the puerperal state, either during pregtion, possibly in some instances unjust nancy or lactation, the so-called puerperal punishment, has resulted. Now we know insanity. Of 69 cases having this etiologic that not only the symptoms of gastro-intes factor admitted to the State Hospital for tinal irritant, inorganic poisons, but those the Insane at Danville, Pa., during the of typhoid fever and typhus fever. scarlet decade between 1883 and 1893, 53 were confever, and other acute exanthemata, and sidered curable, as having a duration of two even those of pneumonia, may be closely years or less before coming under treatsimulated by the symptoms induced by in ment. Of these latter 32 were classified as fected foods.

mania and 21 as melancholia. Of the forThe effects of poisonous foods as gastro mer, 28 showed insanity of less than one intestinal irritants are too well known to year's duration. Of this number 23 were demand illustrative examples. The produc- discharged restored, and 1 as so far im

FOOD

PUERPERAL

INSANITY.

cases

RESEAROHES.

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TREATMENT OF

TYPHOID FEVER.

his ex

proved as to give a reasonable probability organisms, the toxins, anti-toxins, bacterioof complete recovery at home, making a proteins, toxalbumins, etc., has become percentage of 85.4 of recovery.

most important. In the early bacteriDr. A. A. Smith, of New

ological work it was thought the bacteria BACTERIOLOGICAL York, writes, in the New

themselves were the direct cause of the

manifestations of disease. It has now been York Medical Record of

proven, however, that these manifestations Oct. 26, on “The Practice of Medicine in

are due to the toxins produced by the the Light of Bacteriological Researches.'

bacteria. It is through the study of the The following is an interesting excerpt:

action of these substances that our modern “ The changes brought about by our pres

ideas of immunity have been envolved. ent knowledge of bacteria are more marked

Many observers hold that it is by the in surgery than in internal medicine. The

artificial production of immunity that we discovery of the organisms of suppuration,

shall be able to combat the infectious of the effects produced upon them by bi

diseases in the future." chloride of mercury, carbolic acid and other substances, and the demonstration

Dr. H. G. McCormick, that an operator can go almost anywhere

of Williamsport, Pa., in the body so long as he keeps everything

contributes to the Therclean and aseptic-these facts have revolu

apeutic Gazette, of Oct. 15, tionized surgery and obstetrics.

perience of the management of typhoid “In obstetrics, if proper precautions are fever cases, and combats the view that taken, the many dangers from sepsis which

nothing could be done except regulate the formerly surrounded the patient have been

diet and treat them symptomatically. His reduced to the minimum. In internal

treatment of 17 cases was as follows : Calomedicine, on the other hand, there has mel was given first each two hours been no such marked progress. While the until the bowels were thoroughly moved. discovery of the bacterial nature of certain

Sometimes salts were substituted, and the diseases has been of great value in prophy bowels were kept moving from two to four laxis, and has demonstrated the futility times in twenty-four hours. In not a of certain lines of treatment, no material single instance was anything given to advance has been made in the actual treat control the bowel movements. They ment of disease by internal medication. were given internally, guaiacol 4 drops Exception may be made in the case of

and eucalyptol 8 drops every three diphtheria. This is chiefly due to the fact hours. Their diet consisted of milk, beef that in diseases we do not find the specific tea, beef peptonoids, and buttermilk. organisms localized in limited and acces Some of them were given stimulants, as the sible areas. Where surfaces are accessible, occasion demanded. If the circulation was such as the skin and mucous membranes, weak, hypodermics of strychnine in tand cavities like the pleural and peritoneal grain doses was ordered every three hours. cavity, specific local treatment based on The colon was washed out each day. Water the knowledge of the microbe origin of was given them in as large quantities as many diseases affecting them, has been of they desired. After the first week, when great practical utility. We have not yet they became somewhat stupid, water was found an agent which, if given internally, given them as regularly as their food. The will surely and rapidly kill the micro-or injections into the bowels were given for a ganisms, and not at the same time kill or treble purpose : for cleanliness, for the reinjure the living tissues of the body. Anti duction of temperature, and for nourishseptic and aseptic methods are, for this ment. reason, only beginning to be employed in For the reduction of temperature only internal medicine. The tendency now is local applications of guaiacol were used. to prevention of the spread of the disease These applications were made over the right by individual prophylaxis.

iliac region, and in not a single instance “ The study of the products of micro did they fail to reduce the temperature.

CATHETERIZATION

OF THE

EYE

STRAIN,

This reduction would last from three to four hours. The stools were carefully disinfected. The patients were kept clean by a bath each day. When hemorrhage occurred they were given hypodermic injections of ergotol. When hemorrhage occurred, besides giving the hypodermics, a large enema of icewater was given, which cleaned out the colon, stimulated contraction of the bowel, carried off the clots of blood-a fruitful soil for propagating the poison--and rendered the whole alimentary canal as nearly aseptic as possible. If the prostration was great following the hemorrhage, the transfusion of a warm salt solution quickly strengthened the heart's action, filled the blood-vessels with a fluid which went to nourish the body, and the patient rapidly rallied. In one case transfusion was performed five times, in another four times, in another three, and in another one. All the cases recovered.

Dr. J. E. Jennings, in the November number of

the Medical Mirror, publishes a paper on “ Asthenopia, Eye Strain."

We often hear the remark, “Why is it we see so many people wearing glasses to-day?" The reason is clear, says the writer. We all know that a perfectly healthy individual is the exception and not the rule, and it is equally true that rarely do we find a perfect eye. But in the olden days there was a deeprooted prejudice against glasses. Mackenzie, in his work on the eye, published in 1854, says: “If the patient is a young lad, bound apprentice to sedentary trade, we may advise him to turn shopkeeper, to apply himself to country work, or to go to sea ; if a female, occupied constantly in sewing, to engage in household affairs or other healthy, active employment.”

But this prejudice, which so often changed the whole life-work of an individual, is gradually breaking down, and each year finds an ever-increasing number who seek relief at our hands.

Nearly ninety per cent. of all cases of headache, neuralgia and neuresthenia are but symptoms of asthenopia or eye strain, due to the excessive demands made upon the ciliary muscle, and the symptoms

usually at once yield when the refractive error has been corrected.

Dr. George E. Shoe

maker, of Philadelphia, URETER. in the November number of Annals of Surgery, writes on "An Improvement in the Technique of Catheterization of the Ureter in the Female."

After pointing out that ureteral catheterization is more easily performed by elevating the pelvis, thus causing distention of the bladder with air, and the gravitation upward of the pelvic contents raising the base of the bladder that the trigone and region of the ureteral orifices can be seen by direct light from a head mirror through a simple tubular speculum, Dr. Shoemaker describes a new appliance designed to overcome the annoyance caused by turbid urine obstructing the field of search. It consists essentially of an apparatus which will cause suction of air constantly through a fine tube, which extends to the internal opening of the speculum—that is, to the field of work. There are necessary a hand air-pump, a bottle with perforated cork through which two tubes pass. Two pieces of light rubber tubing, one connecting the pump with the air-bottle, the other connecting the air-bottle with the tube(or catheter) extending to the field of work. The apparatus is not unlike the ordinary surgical aspirator with all valves open.

To the suction tube is attached, in one arrangement, the end of a ureteral catheter constructed with a single opening, and that at the point and not at the side. If now the air-pump be kept constantly and gently at work while seach is being made with this catheter through the speculum, any urine which may appear in the field is at once whipped off by suction through the ureteral catheter to the bottle, and the field will thus be kept dry indefinitely. It is not intended that a decided vacuum be established, but that the pump be kept going constantly and gently, the bottle serving only as an air chamber to equalize suction between strokes, and as a reservoir for waste urine. As soon as the ureter is entered, the suction tube is to be slipped off the catheter and the specimen collected in the ordinary way.

WOMEN.

WIRING THE

1

Dr. J. B. Mattison, of The treatment depended upon the indiMORPHINISM IN Brooklyn, read a paper vidual case, for the patient, as well as her

on this subject at the disease, must be treated. Speaking generlast meeting of the New York Academy ally, a more prolonged treatment was reof Medicine. Morphinism in women was not quired than for men. The extremes of rerare. He had not found it less frequent than covery under his management had been in men. Physical necessity, relief of pain, five weeks and six months. Abruptly and not a tendency to do wrong, was the taking away all opium was brutal, entailed chief cause among the better class. Usually needless suffering and sometimes fatal colthe diagnosis was not difficult, but some lapse. The withdrawal should be more or morphinists were able to hold out for years less gradual. with little departure from mental or physical health. In refusing a second trial of

Dr. Wm. W. Keen, in Carlyle Harris, Recorder Smyth had said

the November issue of that if a wife were a morphinist the hus

PATELLA.

Annals of Surgery, pubband would surely know it. This was a

lishes details of three cases of wiring of the grave judicial error, for the writer had known again and again of morphinism on

patella for old fracture. In each case the the part of the wife, of years' duration

operation was completely successful, and

he remarks : without the knowledge of the husband.

My experience in these cases is very There were two tests of morphinism, one

favorable to the combined triple operation by urine analysis, the other by enforced

of wiring the fragments of the patella, secabstinence. The urine test consisted in

tion of the quadriceps muscle, and chiselrendering the specimen alkaline by addi

ling loose the tibial attachment of the ligation of bicarbonate of sodium; to this add a

mentum patellæ when the two fragments certain proportion of chloroform or amylic

cannot otherwise be brought into apposialcohol, shake thoroughly, let settle, draw

tion. No reaction followed the larger viooff, add a small proportion of hydriodic

lence, and the only unfavorable point was acid. If morphine were present

there

in connection with the section of the quadwould be a violent tinge to the urine. Re

riceps at the upper end of the incision. This garding enforced abstinence from morphine

leads me to suggest the following modificano morphinist could stand it for forty-eight

tion of the technique : hours without showing reflex symptoms.

First, I shall hereafter make an anterior Morphinism in women, as in men, was flap of skin, beginning on a level with the disastrous. Regarding its effects upon the upper border of the patella and extending functions peculiar to the sex, he said men downward an inch below the tubercle of struation was almost always disturbed, the tibia. When this is dissected up, the often long absent; sooner or later there was

operative procedures in wiring the patella, sterility, although to this rule there had

and, if need be, chiselling loose the tubercle, been some marked exceptions. The case

could be undertaken as usual, and then the reported by the late Dr. Earl, of Chicago,

line of union of the patella and the wire was referred to, in which the newly-born and the point at which the tubercle is children had the disease and died.

chiselled loose, will not be exposed to possiThe prognosis of morphinism in women ble infection or other accident by lying imeligible for treatment was good, and based mediately behind the line of incision, but on his personal experience it was better will be entirely covered by a solid flap. If than in men. Recovery took place some it is necessary to divide the tendon of the times in apparently hopeless cases. In fact quadriceps or of the rectus alone above the the most hopeless case which he had ever patella, this can be done by an entirely inseen was cured completely, and was well dependent incision, which could be drained, to-day, eleven years after the treatment. if need be, and the possibility of contaminIt was the only case in which he had ever ation of the knee joint by accumulation of seen hallucination of touch. Hallucination blood-clot through the long incision be of sight and hearing was common.

avoided.

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