THE

TEXAS MEDICAL JOURNAL.

Established July, 1885.

F. E. DANIEL, M. D.,

Editor, Publisher and Proprietor.

PUBLISHED MONTHLY.-SUBSCRIPTION $1.00 A YEAR.

VOL. XXII.

AUSTIN, JULY, 1906.

No. 1.

The publisher is not responsible for the views of contributors.

George R. Tabor, M. D., State Health Officer and Surgeon General of Texas.

BY THE EDITOR.

Dr. Tabor was born in Caldwell county, Texas, August 30, 1864. His parents moved to Bryan in 1867, where he was reared. He was educated in private and public schools and the Agricultural and Mechanical College. He graduated in medicine at Louisville Medical College in 1888, and held the honor of being president of the graduating class. After graduating he returned to Bryan and practiced medicine, and was appointed County Health Officer of Brazos county, and City Health Officer of Bryan for a number of years, during which time he encountered several epidemics of smallpox and some yellow fever. Prior to his appointment as State Health Officer he made an enviable record as a health officer in Central Texas, and made a special study of contagious diseases, in which he spent four or more months in New Orleans during one summer for that purpose; therefore, he came into the office well equipped for the work ahead of him. During his stay in New Orleans he was acting as special inspector for the State of Texas, having been appointed to that position by Governor Sayers, who afterwards appointed Dr. Tabor State Health Officer, which was a few days after his return from New Orleans, to succeed Dr. Blunt, who resigned from office.

Yellow fever was introduced into Laredo and San Antonio from Mexico, but he succeeded in confining it to certain limits, preventing its spreading throughout the State. After the epidemics at Laredo and San Antonio he conducted a systematic sanitary campaign right up to the time of the New Orleans epidemic.

Dr. Tabor originated the uniform system of quarantine between the Gulf States. When he went into office there was no uniform system of quarantine, but through his efforts the regulations at Mobile, New Orleans, and Texas ports are now uniform. The first conference of the States of Alabama, Louisiana, and Texas was instigated and called by him and the representatives of the Health Departments of the States of Louisiana and Alabama met with him in Galveston, where they formulated the regulations, which are now in effect, governing the inspection and disinfection of vessels arriving at all of these ports, which places all Southern ports on the same basis. The representatives of the States of Alabama, Louisiana, and Texas meet once each year to discuss these regulations, alternately at Galveston, New Orleans and Mobile. Previous to these regulations there were constant bickerings at the several Gulf ports as to the advantages of one and the disadvantages of the other, resulting, of course, in a lack of harmony in the quarantine service, and, primarily, lack of protection to the people, but now each port is equal to the other in matters of shipping and commerce. This was a victory for Galveston, for Texas and her State Health Officer had enforced safe quarantine while the other ports had been quite lax in order to attract commerce. When uniformity came Galveston and other Texas ports went on the same footing with New Orleans, Mobile and other Gulf ports. Several conferences have been held since the first, in which the rules have been changed to meet the new conditions.

The second achievement of Dr. Tabor was his successful campaign with the Mexican health authorities for a cleaner Mexico. He treated with the Mexican authorities at length, visiting their country at the head of a commission of the Southern States health officials, which was organized by Dr. Tabor, and was treated with great courtesy and consideration by Dr. Eduardo Liceaga, President of the Superior Board of Health of Mexico, and his brother Mexican health officials. They visited a number of towns, including some of the formerly infected districts, and made numerous recommendations as to what should be done. Most of these suggestions were adopted, which resulted in modern sanitary methods being adopted and the complete eradication of yellow fever at Mexican places and near Texas, thereby removing a serious and constant danger to the health of this State, and all other Southern States through Texas.

At the time of the bubonic plague infection in San Francisco,

and when the country was stirred with the prospect of its becoming epidemic in the United States, Dr. Tabor was the first State Health Officer to suggest to Surgeon-General Wyman, of the United States Public Health and Marine Hospital Service, to visit San Francisco and look into the matter personally. Dr. Tabor was joined in this by Dr. Souchon, late President of the Louisiana State Board of Health, and together they went to Washington to urge upon Surgeon-General Wyman to look into the matter personally. The Surgeon-General, with Dr. Tabor, visited San Francisco and made a thorough investigation, and Dr. Tabor told the California authorities that he had implicit faith in Dr. Gardner, and that any report Dr. Gardner might make of the bubonic plague situation would be accepted as exact, and all the other States would abide with it. It was not long after this that the Governor of California did appoint Dr. Gardner as President of the State Board of Health of California, and there was immediate harmony in quarantine regulations at the Texas border, against which California merchants and importers at San Francisco had complained bitterly. Thus Dr. Tabor's visit had much to do with the satisfactory adjustment of the bubonic plague quarantine situation.

Dr. Tabor's conduct in the last trying and successful campaign to keep yellow fever out of Texas made him a National reputation. His administration has been characterized by intelligence, vigor and zeal, and has been effective and eminently satisfactory. He combines, with a marked administrative and executive ability, the rare faculty of reconciling conflicting interests and opinions, and of making friends and supporters of both sides. In fact, he is the right man in the right place. The people of Galveston, as a mark of appproval and appreciation, gave him a large honorarium, and a trip to Europe for himself and his charming and accomplished bride, nee Miss Ann Barton, of Austin.

For Texas Medical Journal.

The Use and Abuse of the Stomach Tube.*

BY J. W. TORBETT, M. D., MARLIN, TEXAS.

The stomach tube is a means of doing much good if rightly used, but its promiscuous use in all classes of stomach troubles without a definite knowledge of the indications calling for its proper and beneficial use prompts me to write this article. Some physicians

*Read before the Brazos Valley Medical Society, May Meeting, 1906.

use the tube too much, while others never use it all; so, in this article I shall endeavor to point out and classify the indications for its use, which a rather large and varied study and experience of eight years in treating stomach troubles have taught me. I recognize the fact that eminent authorities differ quite frequently in the treatment of the same diseases. I recognize, also, with equal force that the patient's temperament and the physician's personality and judgment in applying the treatment are great factors that figure in all results obtained. Of course, it is best that I state in this article that I give the results of my experience in the application of certain lines of treatment, for which I claim no credit, however, as originator, only a few modifications in technique, which will be explained and illustrated hereafter.

ORIGIN OF TUBE.

The credit is due Dr. Philip S. Physick, of the University of Pennsylvania, for the invention and practical use of the stomach tube in about 1800. It was first used for removing poisons from the stomach. In 1867 it was first used with success by Kussmaul for therapeutic purposes, especially in gastric dilatation; and in 1871 was recommended by Leube for diagnostic purposes, thereby making possible since 1880 the correct diagnosis and treatment of gastro-intestinal diseases.

In selecting a tube it is best to choose one with a bulb, medium size, moderately stiff, with no sharp edges or cracks near the end to injure the mucous membrane. The tube should be thoroughly washed and disinfected after use and the same tube used only on the same patient so long as treatment is needed.

USES.

One of the most important uses of the tube is the removal of poisons which have been recently taken into the stomach. It can be used at once, before an emetic could have time to act, and the stomach repeatedly washed out until all traces are removed. It is best, however, to give an antidote before the tube is inserted. In one case of iodin poisoning in which I was called, I ordered starch water to be given at once before I arrived with the tube, and when the stomach was washed out the poison was entirely neutralized. In the same way I have ordered whisky or alcohol to be administered in a case where carbolic acid was taken by mistake.

Another important use of the tube is for diagnostic purposes.

All cases of stomach trouble that have continued for a few weeks and that do not get better by ordinary diet or treatment, or that steadily grow worse, should be examined by means of the stomach. tube.

The tube is introduced best by having the patient slightly elevate his chin, open his mouth, the end of the tube thoroughly wet in warm water, is passed back to the pharynx, the patient told to close his lips, breathe deeply through his nose and swallow, the tube is gently pushed into the stomach. A slight resistance is usually met at the cardiac entrance. The introduction of the tube shows: (1) The condition of the oesophagus, whether strictured or not; (2) by forcing air into the stomach through the bifurcated tube the percussion method will usually determine with readiness the size of the stomach, and the escape of the air through the whistle on the bifurcation not connected with the compressed air apparatus will show the contractility and motor power of the stomach much better, I think, than the use of iodid of potash or iodipin, as frequently recommended; (3) it serves to remove the test meal for chemical examination, and thereby makes a diagnosis possible which could not otherwise be made. In removing the test meal it is frequently much more easily done by having the patient recline on the left side with head some lower than the body, after the tube is in position, thereby securing the aid of gravity, as well as the suction of the bulb. This question can not be dealt with here, but will say in passing, that the test for HCl acidity, butyric, and lactic acids and the microscopical examinations can be made. quickly by most anyone and will be frequently all the chemical examination needed.

Not more than a pint of warm water should be introduced into the stomach and withdrawn by siphon and the quantity measured. If this be done before breakfast, as it should, and the amount be more than that introduced, it shows retention or hypersecretion, with or without stagnation, which calls for the continued use of the tube as a therapeutic agent.

There can be no doubt about the beneficial use of the tube in washing out those cases in which there is retention and fermentation found before breakfast in the morning. A stomach which never empties itself never rests. It is frequently best in such cases to wash it out about four hours after a light supper and let it rest during the night. The retention may be due to pyloric obstruction, which, if organic, can not be relieved by lavage, of course, but the fermentation may be relieved and the patient's