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biliary and circulatory organs, as statistical reports clearly show. The principal climatic condition of this section that causes this proclivity to disease of the air passages is the humidity and dampness of the atmosphere, associated with frequent, sudden, and often extreme variations in temperature, together with a lowered mean annual temperature.
Mucous tissue subjected to a damp atmosphere becomes more or less turgescent, and this becomes more pronounced if the tissue is diseased. This is due to two causes-namely, (1) to the endosmosis of the watery vapor of the air that takes place because it is much less dense than the blood, and (2) to the checking of the elimination of watery vapor from the mucous membranes. This turgescence of the tissue causes an increased supply of blood to the part, and supernutrition and hypertrophy of the tissues take place. As the mucous membrane of the nasal passages is much more exposed to atmospheric conditions than the deeper structures of the respiratory tract and is provided with a greater blood supply, it is subject to frequent turgescence, and is accordingly much oftener the seat of diseased conditions resulting therefrom. It is for this reason that catarrhal affections of the nasal passages are so much more prevalent in the region of the Great Lakes, where the air is excessively damp, than elsewhere.
RELATION OF Dr. F. H. Bosworth prints VASO-MOTOR DIS- in the New York MedTURBANCES TO ical Journal of Nov. 23
UPPER AIR TRACT
DISEASES a paper on this subject. In one hundred and fifty cases of ethmoid disease he found that between ninety and a hundred showed marked evidences of vasomotor disturbances in the air tract, either in the form of hay fever, asthma, or nasal hydrorrhoea. The pressure is apparently exerted in every direction, crowding upon the os planum and producing the distressing eye symptoms with which we are familiar; crowding upon the base of the brain and producing that curious symptom which has been termed aprosexia, one of the most common and constant symptoms of the disease. That this is due to certain disturbances in the circulation of the brain,
and possibly to some slight pressure upon that organ, is shown by the fact that the function of the brain is notably impaired. These patients complain that they cannot transact business in a clear-headed way, and describe a sensation of a blanket restfng over the brain which interferes with its iunctions.
The removal of this intracellular pressure is immediately followed by the greatest relief. The primary cause both of the polypus and reflex disturbances is to be sought in the inflammatory process involving the lining membrane of the ethmoid cells, and this results in the disturbance of the circulation at the base of the brain and the medulla together, with direct pressure upon either the primary or secondary vaso-motor nerve centres there found.
Dr. James E. Newcomb publishes a paper on this disease in the New York Medical Journal of Nov. 23.
The symptons of the condition, he writes, are constitutional and local. The former may be of either a sthenic or an asthenic type, following the general course of those of an asthenic fever. The local symptoms present the following diagnostic points:
1. A wooden-like induration of the affected region, sharply defined from the surrounding normal tissue.
2. The thrusting forward and upward by the accumulating inflammatory products of the tongue toward the palatal vault.
3. Severe dyspnoea with the attendant danger of laryngeal oedema.
4. The presence of a hard pad or buttonlike swelling at the internal aspect of the dental arcade. All of these occur with the general pain, redness, heat, and swelling in the cervical region-i. e., the classical features of a phlegmon. Swallowing is painful if not impossible. In fact, it is next to impossible to open the mouth at all, for the muscles by which this is normally done are partly imbedded in the infiltrated cellular tissue and partly participate in the inflammation. Notably is this true of the mylo-hyoid, which, being the muscular floor of the mouth, is raised in deglutition.
The prognosis is grave. Of those cases
on record, somewhat over forty-three per cent. have resulted fatally. The usual causes of death are oedema of the glottis and suffocation or general sepsis from local absorption.
TREATMENT OF Editorially, the New York Medical Journal VERATRUM VIRIDE. of Nov. 23 says: "Dr. Edgar's recent declaration, that he did not believe there was any drug, with the possible exception of chloroform, that was of as much value as veratrum viride in eclampsia, coupled with Dr. Chandler's testimony to its efficiency, goes far to show that experienced obstetricians in general are less forgetful of the virtues of veratrum than its comparative inconspicuousness in current literature might lead one to suppose was the case. It is very sure that an overwhelming preponderance of our therapeutical resources does not reside in the novelties that have been introduced so profusely within the last few years-perhaps no preponderance at all."
Prof. Thos. Hunt Stucky TIONS AS ALTER- in the New York Medical Journal of Nov. 23 writes on the "Gold Combinations as Alteratives." His conclusions respecting the preparations known under the name of arsenauro and mercauro, are as follows: In the action of the combination of bromide of gold and arsenic we have an entirely different action from any therapeutical agent known; as compared with mercury, iodine, or the combinations of the iodides, the action of gold in the combinations named is greater and intensified; that these combinations enter direct into the circulation as gold and arsenic, and spend their force and exert their influence in an alterative way upon the glandular system; that a marked alterative effect is exerted upon all scleroses non-malignant; that it is not only a blood maker, but a blood builder, and a vasomotor stimulant; that it not only increases the quantity of corpuscles, but the quality of corpuscles; that under its use hæmoglobin is markedly increased; that it is eliminated by the kidneys; that it produces no irritation either when given per os or hypodermically.
Cases are cited which show (1) increase in the number of red corpuscles; (2) increase in the quality of the corpuscles as demonstrated in the increase of hæmoglobin. The following is an example of the results obtained by Professor Stucky: "After five weeks' use of solutions of arsenic, bitter tonics and alcoholic stimulants, the patient had 4,000,000 red corpuscles to the cubic millimetre and hæmoglobin 47 per cent. Under the administration of bromide of gold and arsenic the hæmoglobin increased to 85 per cent. and the red corpuscles to normal."
In the course of a discussion on this subject before the Post-Graduate Clinical Society, and reported in the FostGraduate for November, Dr. Reynold W. Wilcox said that he had been very much interested in creosote for a number of years. About three years ago he had looked over the literature of the subject quite extensively and had found nearly 300 papers on creosote and its various derivatives. The striking feature of all these papers was that there was a considerable unanimity of opinion as to the value of creosote. On the other hand, when it was first used, in the period between 1830 and 1885, only a few papers expressed much enthusiasm regarding creosote. Bouchard had administered creosote hypodermatically in large quantities, and intralaryngeal applications were subsequently made by three Italian observers. Still more recently creosote had been administered by rectal injections. If statistics were of much importance, the five thousand cases of Somerbrodt, to which he added sixteen hundred cases a year later, and Van Brun subsequently added about two thousand more, ought to count for something. The speaker said that his own experience with creosote dated back to 1881. For many years he had administered creosote in pills covered with keratin, or in pills made up with paraffin. In this way the pills were not dissolved until they were carried into the bowel. About four or five years ago he had begun the administration of guaiacol, and yet, notwithstanding the fact that it was the larger constituent of creosote, he had never obtained the
CREOSOTE IN PHTHISIS.
same results from it as from creosote. He had tried quite a number of different preparations of guaiacol with like results. The creosote carbonate he had used in about three hundred cases. The dose limit was far higher than with even the best creosote. He had himself taken as high as two drachms without discomfort. On the other hand, he had never observed any gastric disturbance from it among his patients, although there had been dark-colored urine, and the absence of the sulphates when large doses were administered.
Personally, he was of the opinion that twenty minims of creosote carbonate, three times a day, in a little whiskey, was all that was necessary in an average case of pulmonary tuberculosis. All the other preparations of creosote he had now abandoned. His object in using the creosote was for the bronchitis and dyspepsia which almost uniformly accompanies pulmonary tuberculosis. He felt convinced that creosote had a large field of usefulness in tuberculosis, because it was the only drug which he had felt warranted in continuing to use during the ast twelve years.
Dr. Fenton B. Turck, of Chicago, in the New York Medical Journal of Nov. 23, writes on "The Diseases of the Mouth, Nose, and Throat." The bacteriology of the nose and throat, in his opinion, has yet to be worked out. Kyle, of Philadelphia, has undertaken a very extensive study of micro-organisms in the various inflammatory processes of the nasal cavities. Part of the work he has undertaken in membranous rhinitis. Newcomb found rod-shaped micrococci. Magnier found in the caseous material ejected from the nose granular débris with multitudes of bacteria and a large number of long, rod-shaped bacteria. Deletti found two different kinds of micro-organisms possessing pathogenic power in rabbits. The first, small round micrococci occurring in pairs, injected under the skin in rabbits, produced oedema in thirty-six hours; the second was a short thin bacillus with round extremities, also occurring in pairs. The injection of this produced a more diffuse cedema which disappeared
afterward. In cases of angina follicularis the various micro-organisms have been carefully studied. Sendtner made a careful study of the micro-organisms, and found the Streptococcus pyogenes in some cases and the Streptococcus erysipelatosus. Others have found the pseudo-diphtheritic organism.
Dr. Turck says the bacteriological examinations made, with the clinical study of the cases, show clearly that the infection of the nose was followed by infection of the stomach. His conclusions are :
1. Clinical observation in many cases indicates a marked relation between diseases of the mouth and post-nasal cavity and chronic inflammation of the stomach and intestines.
2. The invasion of the stomach from the infected mouth and pharynx is supported by the fact that many of the known pathogenic micro-organisms present identical biological and morphological forms in cases of gastritis as the micro-organisms found in diseases of the mouth and post-nasal cavities of the same patients.
The British Medical Journal for Nov. 2 says thatto those who are not in perfect health few things are more calculated to give rise to any malady to which they may have a tendency than sitting in a chilly church after a sharp walk, which the ineradicable tendency to starting late seems to impose on all churchgoers. Perhaps the worst error in warming churches is committed by those who put off the beginning of the process until Saturday night, or maybe Sunday morning, and then fire up hard to get things ready for eleven o'clock. The windows are kept closed for fear of losing heat; the stagnant air, with which those who visit churches on the week day are SO familiar, is warmed up for Sunday use, but the walls remain cold, and, when service begins, hot and even burned as the air may feel, there is no warmth in the building. Worshipers are thus subjected to the worst possible combination of surroundings-bad ventilation, foul atmosphere, draughts from internal currents, and the respiration of hot air while sitting in a building which is cold.
The problem is not how to warm the air alone, but how to warm the church itself. This is necessarily a slow process, and it is doubly slow, where, as is commonly the case, the attempt is made to use the same apparatus to warr the church that is employed for warming the incoming air.
The vermiform appendix is rich in lymphoid or adenoid tissue, which suggests the possibility of its being the center for the production of leucocytes or lymphocytes, writes Dr. D. A. Sutherland in London Lancet. Elsewhere in the alimentary canal the importance of adenoid tissue is fully recognized, and the action of the lymphocytes produced there has been fully explained. According to Berry's researches, the function of the appendix is, (1) leucocyte producing, and (2) secretory. Leucocytes he considers useful in the destruction of micro-organisms and the absorption of proteids. Such protective power would be of great service, for processes of decomposition going on unchecked in the cæcal region would probably result in symptoms of auto-intoxication that would be extremely common. With appendicitis regarded as a purely local condition, due to such local causes as catarrh, concretion, cystic dilatation, etc., the author thinks it also quite possible that the vermiform appendix may be acted upon by poison circulating in the blood and thus become acutely or chronically inflamed. Rheumatism may be such a poison.
USE OF THE VERMIFORM APPENDIX.
ARE CHARACTER- Dr. R. Nunn, in Medical Sentinel for November, TO OFFSPRING? discusses this question. If the question be asked, in what lies the cause of this variability on which natural selection operates, the answer must undoubtedly be that it lies in the germ cells. From the moment when the phenomena which preceded segmentation commence in the egg, the exact kind of organism which will be developed is already determined, whether it will be larger or smaller, more like its father or mother, which of its parts will resemble the one and which the other, even to the minutest detail.
There remains a certain scope for the in
fluence of external conditions upon the organism; but the scope is limited, and forms but a small area around the fixed central point which is determined by heredity. Unhealthy sedentary habits make the factory hand pale; life on board ship, plenty of exercise and sea air, give the sailor a strong body; but when once the resemblance to father or mother, or to both, is once established in the germ cell it can never be effaced, let the habit of life be what it will.
The germ cells are continued in the organism, and the external influences which affect them are intimately connected with the state of the organism in which they lie hid. If it be well nourished, the germ cells will have abundant nutriment, and conversely, if it be weak and sickly, the germ cells will be arrested in their growth. It is even possible that the effects of these influences may be more specialized; that is to say, they may act only upon certain parts of the germ cells. But this is, indeed, very different from believing that the changes of the organism which result from external stimuli can be transmitted.
LOUIS PASTEUR, SCIENTIST.
BY GEORGE B. BRADLEY, M. D.
The death of Louis Pasteur, of France, leaves a blank in the ranks of the great scientific men of the world. Born of humble origin, the son of a tanner who had served in several military campaigns, Pasteur rose to the first rank of scientific men. His discoveries form a brilliant galaxy, and the results achieved will tend materially to ameliorate the condition of the human race. Fortunately for mankind, he has left behind him many apt pupils, who will doubtless take up his work of pathological study and research. These include Professor Roux, whose name is associated with the anti-toxine cure for diphtheria. Another of Pasteur's great pupils is Dr. Haffkine, the Russian bacteriologist and physician, whose experiments at Paris with the anti-cholera virus some two years ago, will be remembered. Already he has done valuable work in connection with cholera in India, where he has inoculated over 40,000 persons. So Koch, the German, Haffkine, the Russian, and Roux, the Frenchman, are destined to carry forward Pasteur's work to further triumphs.
Pasteur's name is probably associated more closely in the public mind with the cure of hydrophobia than with any other series of investigations. Pasteur proved that the real seat of the disorder was in the nervous system, and inoculation with antirabic virus has accomplished wonderful results and saved thousands of human lives. His investigations included lactic acid formations. He proved each formation to be due to a certain organism, and if the presence of these germs was prevented, fermentation could not take place. He considered the grave question of the vine disease in France, and, after ascertaining its etiology, pointed out a cure. His later work on anthrax, gangrenous septicemia and suppuration brought him directly into human medi
cine. Our ideas of sterilization are based on his work. All of Pasteur's discoveries have resulted either directly or indirectly in practical benefits to humanity. His record is the more remarkable when it is remembered that during upwards of twenty-five years of his life he was the victim of partial paralysis.
From the standpoint of the physician, Pasteur's studies in the germ theory of infective diseases, as a foundation for the prevention and cure of such diseases, possesses great interest. His investigations included not merely a study of infectious diseases and their exciting causes, but the artificial protection of the individual against their attack. The most varied methods were devised and elaborated for attenuating viruses of different kinds, and multitudes of domestic animals, as well as man, were protected from the most destructive diseases with which they are afflicted. The important step in this new method of treatment, Professor Frankland points out, was the discovery that the artificial cultures of pathogenic bacteria may be entirely freed from the micro-organisms and yet produce their characteristic poisonous effects. The symptoms of a particular infectious disease can be obtained through the injection of the toxic or poisonous products elaborated outside the body by the particular micro-organism associated with that disease. By this discovery the toxins of diphtheria and of several other diseases have been isolated. In a word, this discovery forms the foundation upon which the new anti-toxin treatment of disease is based.
Pursuing still further the line of investigation adopted by Pasteur, other investigators showed that animals could be gradually accustomed to specific toxins, and that they were able to withstand them