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the superior parathyroid bodies and the apex of brought about, owing to the wide dissemination the thymus.

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Ethylhydrocuprein in Pneumonia. Not long ago there appeared in this department favorable mention of ethylhydrocuprein as a remedy for pneumonia. Among other writers reporting on its use is H. J. Vetlesen, of Christiania, who (Berlin. Klin. Woch., 1913, No. 32) thinks it has proven of service in croupous pneumonia, provided it be given in the earlier stages of a pneumococcus infection; although in pulmonary infections of other kinds it has seemed to be useless. He urges a trial on the part of others.

The Infectiousness of Tuberculosis. That there is considerable change of opinion concerning the ready transmissibility of tuberculosis, is demonstrated by Bosanquet in his fine Lancet paper (Jan. 31, p. 289), his conclusions being summarized as follows:

1. Infection with tuberculosis is very widespread and takes place largely in infancy and early childhood.

2. It is partly due to bacilli derived from human sources, partly of bovine origin, but the former type greatly predominates.

3. Direct communication from one human patient to a healthy individual does not occur in adult life under good sanitary conditions, with the possible exception of a few instances in which there has been very close and prolonged contact. Under bad hygienic conditions, direct infection may occur, children being especially susceptible. 4. The exact mode of transmission of the bacillus is unknown, but inhalation affords the simplest explanation, although the localization of the chronic form of the disease in the lungs is not in itself evidence of direct implantation there.

5. The chronic form of the disease met with in adults is due to their increased resistance, as compared with children who suffer from the acute variety of tuberculosis, and this increased resistance may be the result of early inoculation with sublethal doses of the bacilli.

6. The outbreak of tuberculosis in later life may be due either to reinfection from without or to recrudescence of a latent focus of old infection.

of the disease among European nations; and the fall in the death-rate is largely due to this factor and to improved hygienic conditions.

From these conclusions we may further deduce the practical moral that the most hopeful measures that can be taken, with a view to combating the disease, are such as are directed toward improving the general wellbeing, and especially the housing conditions, of the poorer classes.

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Carriers of Amebic Dysentery. From an excellent abstract in the New York Medical Journal we learn that L. Landouzy and R. Debré report (in Presse Medicale) the case of a man thirtyeight years of age, born and passing his entire life on canal barges in the north of France. A diagnosis of hepatic cancer was made, and the true condition, amebic dysentery with hepatic abscess, not recognized until the autopsy. The condition had remained practically latent, the only phenomena noted being relatively mild digestive. disturbances, hepatic enlargement, hemoglobin in the stools, and progressive cachexia. There had been no fever, dry tongue, hepatic tenderness or pain, cough, or distortion of the liver (though an X-ray examination had been made). This man had never left France, nor associated with dysenteric subjects who had returned from tropical colonies. Such a case illustrates the danger from ameba carriers, even in countries of the temperate zone, and suggests keeping in mind the possibility of amebic infection as a cause of hepatic enlargement, the giving of emetine as a therapeutic test, and of conducting a complete examination of the stools (including inoculation of a cat by rectum). Returning colonists should be repeatedly examined for amebic infection, to prevent dissemination of the disease.

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Pathology of the Polyglandular System.While relatively little is as yet positively known. about the diagnostics and etiology of the bloodglands, except that there is a synergism between adrenalin and hypophysin, according to K. Csépai, of the University of Pesth (Deut. Arch. f. Klin. Med., Bd. 111, H. 3), this author points out the frequent co-existence of the status thymicolymphaticus and diseases of the polyglandular system; a fact suggesting a connection between the hemic changes observed and the ductless glands. VE VE VE

For Asystol Pulmonary Congestion.-Liquor ammonii anisati, ether, of each 2 grams; punch, 60 grams; distilled water, enough to make 150

7. A general rise in resistance has been grams. Dose: A dessertspoonful every hour.

Volume XXXVII. Number 7.

The

Medical Standard

JULY 1914

WHALEN-OUR CONGRATULATIONS. Chicago is just through the throes of another of its typically red-hot elections, demonstrating again that in the political game, as elsewhere, our local physicians take first rank.

Yesterday, the Chicago Medical Society held its annual election. The candidates were both good men, one being Dr. Charles L. Mix, who is associated with Dr. John B. Murphy in his clinical work at Mercy Hospital, the other Dr. Charles J. Whalen, recently president of the Illinois State Medical Society and at one time Commissioner of Health of the City of Chicago. Professionally there is little to choose from between these candidates. Both are well known beyond the borders of our state; both are unusually able and distinguished as physicians. But looking at the two men from the standpoint of potential usefulness to the profession they are as far apart as the poles.

Whalen is a born politician, a fighter by nature and training, and essentially and temperamentally a man of the people. These are the facts that elected him. In Chicago, at least, the men in the medical profession-and by that term we mean the great, seething, struggling massare tired of being "governed" by people who profess to be better than they are, and are anxious to tell them what they need and ready to give it to them whether they want it or not. Whalen is one of us. He will fight with and for us, and he will not spare himself nor use his office for personal interest. That's why we preferred him to Mix, for whom, nevertheless, we have nothing but kindly words and good wishes. Our congratulations to Whalen. His good fortune is our good fortune.

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case that at last the Allegheny County Medical Society offered to cooperate with the authorities in securing the arrest and punishment of every physician known to be engaged in illegal prac tice of this character.

At this time the district attorney made the following statement: "It has been shown that a condition prevails in Pittsburgh that is a public scandal. This office is going to the bottom of the entire matter. Of course, we have only words of commendation for the medical profession as a class, as it is composed of men who do not countenance what is going on. They will be glad to have a thorough clean-up.'

That statement was made two months ago, and up to the present time nothing apparently has been done. The Cincinnati Medical News suggests that the promised enthusiastic cooperation on the part of the physicians of Pittsburgh has not materialized, and hints that "too many men in high places and medical societies and health boards might have been incriminated." He is of the opinion that "this sort of reprehensible practice is not confined exclusively to the plodding doctor who finds it hard to gain a subsistence in the practice of his profession."

We suspect that there is more than a germ of truth in what our colleague says. It is known that thousands of abortions are performed every year in large cities like Pittsburgh, Cincinnati, and Chicago. Somebody is doing this worksomebody that knows how. Never were so many specious reasons given to excuse and justify the practice as now. Never, apparently, has there been such eagerness to avoid the responsibilities of maternity. We fear-we very much fearthat if every abortionist could be brought to justice, many a high-priced doctor's car would go to the junk shop, many a professor's chair be vacant-because of pressing engagements else

where.

DANGER OF ANTIMENINGITIS SERUM. As the readers of this journal have noticed there have been an unusually large number of

the superior parathyroid bodies and the apex of brought about, owing to the wide dissemination the thymus.

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Ethylhydrocuprein in Pneumonia.-Not long ago there appeared in this department favorable mention of ethylhydrocuprein as a remedy for pneumonia. Among other writers reporting on its use is H. J. Vetlesen, of Christiania, who (Berlin. Klin. Woch., 1913, No. 32) thinks it has proven of service in croupous pneumonia, provided it be given in the earlier stages of a pneumococcus infection; although in pulmonary infections of other kinds it has seemed to be useless. He urges a trial on the part of others. 慌慌慌

The Infectiousness of Tuberculosis. That there is considerable change of opinion concerning the ready transmissibility of tuberculosis, is demonstrated by Bosanquet in his fine Lancet paper (Jan. 31, p. 289), his conclusions being summarized as follows:

1. Infection with tuberculosis is very widespread and takes place largely in infancy and early childhood.

2. It is partly due to bacilli derived from human sources, partly of bovine origin, but the former type greatly predominates.

3. Direct communication from one human patient to a healthy individual does not occur in adult life under good sanitary conditions, with the possible exception of a few instances in which there has been very close and prolonged contact. Under bad hygienic conditions, direct infection may occur, children being especially susceptible. 4. The exact mode of transmission of the bacillus is unknown, but inhalation affords the simplest explanation, although the localization of the chronic form of the disease in the lungs is not in itself evidence of direct implantation there.

5. The chronic form of the disease met with in adults is due to their increased resistance, as compared with children who suffer from the acute variety of tuberculosis, and this increased resistance may be the result of early inoculation with sublethal doses of the bacilli.

6. The outbreak of tuberculosis in later life may be due either to reinfection from without or to recrudescence of a latent focus of old infection.

7. A general rise in resistance has been

of the disease among European nations; and the fall in the death-rate is largely due to this factor and to improved hygienic conditions.

From these conclusions we may further deduce the practical moral that the most hopeful measures that can be taken, with a view to combating the disease, are such as are directed toward improving the general wellbeing, and especially the housing conditions, of the poorer classes.

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Carriers of Amebic Dysentery.-From an excellent abstract in the New York Medical Journal we learn that L. Landouzy and R. Debré report (in Presse Medicale) the case of a man thirtyeight years of age, born and passing his entire life on canal barges in the north of France. A diagnosis of hepatic cancer was made, and the true condition, amebic dysentery with hepatic abscess, not recognized until the autopsy. The condition had remained practically latent, the only phenomena noted being relatively mild digestive disturbances, hepatic enlargement, hemoglobin in the stools, and progressive cachexia. There had been no fever, dry tongue, hepatic tenderness or pain, cough, or distortion of the liver (though an X-ray examination had been made). This man had never left France, nor associated with dysenteric subjects who had returned from trop

ical colonies. Such a case illustrates the danger from ameba carriers, even in countries of the temperate zone, and suggests keeping in mind the possibility of amebic infection as a cause of hepatic enlargement, the giving of emetine as a therapeutic test, and of conducting a complete examination of the stools (including inoculation of a cat by rectum). Returning colonists should be repeatedly examined for amebic infection, to prevent dissemination of the disease.

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Pathology of the Polyglandular System.While relatively little is as yet positively known about the diagnosties and etiology of the bloodglands, except that there is a synergism between adrenalin and hypophysin, according to K. Csépai, of the University of Pesth (Deut. Arch. f. Klin. Med., Bd. 111, H. 3), this author points out the frequent co-existence of the status thymicolymphaticus and diseases of the polyglandular system; a fact suggesting a connection between the hemic changes observed and the ductless glands.

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Volume XXXVII. Number 7.

The

Medical Standard

JULY 1914

WHALEN-OUR CONGRATULATIONS. Chicago is just through the throes of another of its typically red-hot elections, demonstrating again that in the political game, as elsewhere, our local physicians take first rank.

Yesterday, the Chicago Medical Society held its annual election. The candidates were both good men, one being Dr. Charles L. Mix, who is associated with Dr. John B. Murphy in his clinical work at Mercy Hospital, the other Dr. Charles J. Whalen, recently president of the Illinois State Medical Society and at one time Commissioner of Health of the City of Chicago. Professionally there is little to choose from between these candidates. Both are well known beyond the borders of our state; both are unusually able and distinguished as physicians. But looking at the two men from the standpoint of potential usefulness to the profession they are as far apart as the poles.

Whalen is a born politician, a fighter by nature and training, and essentially and temperamentally a man of the people. These are the facts that elected him. In Chicago, at least, the men in the medical profession-and by that term we mean the great, seething, struggling massare tired of being "governed" by people who profess to be better than they are, and are anxious to tell them what they need and ready to give it to them whether they want it or not.

Whalen is one of us. He will fight with and for us, and he will not spare himself nor use his office for personal interest. That's why we preferred him to Mix, for whom, nevertheless, we have nothing but kindly words and good wishes. Our congratulations to Whalen. His good fortune is our good fortune.

DEALING WITH THE ABORTIONIST. Some weeks ago the people of Pittsburgh were aroused by newspaper reports of the death of a young woman in a so-called "house of mystery," following the performance of an abortion. There were such horrible revelations concerning this

case that at last the Allegheny County Medical Society offered to cooperate with the authorities in securing the arrest and punishment of every physician known to be engaged in illegal practice of this character.

At this time the district attorney made the following statement: "It has been shown that a condition prevails in Pittsburgh that is a public scandal. This office is going to the bottom of the entire matter. Of course, we have only words of commendation for the medical profession as a class, as it is composed of men who do not countenance what is going on. They will be glad to have a thorough clean-up."

That statement was made two months ago, and up to the present time nothing apparently has been done. The Cincinnati Medical News suggests that the promised enthusiastic cooperation on the part of the physicians of Pittsburgh has not materialized, and hints that "too many men in high places and medical societies and health boards might have been incriminated." He is of the opinion that "this sort of reprehensible practice is not confined exclusively to the plodding doctor who finds it hard to gain a subsistence in the practice of his profession.'

We suspect that there is more than a germ of truth in what our colleague says. It is known that thousands of abortions are performed every year in large cities like Pittsburgh, Cincinnati, and Chicago. Somebody is doing this worksomebody that knows how. Never were so many specious reasons given to excuse and justify the practice as now. Never, apparently, has there been such eagerness to avoid the responsibilities of maternity. We fear-we very much fearthat if every abortionist could be brought to justice, many a high-priced doctor's car would go to the junk shop, many a professor's chair be vacant-because of pressing engagements else

where.

DANGER OF ANTIMENINGITIS SERUM. As the readers of this journal have noticed there have been an unusually large number of

deaths directly following the administration of antimeningitis serums. The evidence seems con

clusive that in some of these cases at least the patient succumbs as a direct result of the administration of the remedy. Naturally those interested in this serum, which undoubtedly is the most effective remedy we have ever secured for epidemic meningitis, have been anxious to determine wherein lay its source of possible danger.

This matter has recently been discussed at length by Dr. Worth Hale, of the Hygienic Laboratory of the United States Public Health Service. He has arrived at the conclusion that deaths are due to one of two causes, the first being an increase of intracranial tension, the second, the use of tricresol as a preservative.

As regards the first suggested cause, intracranial tension, Hale is of the opinion that it is less likely to be a source of danger than the use of tricresol. However, he advises that the syringe method of using the serum be abandoned and that the gravity method be employed, this permitting of introduction of the serum into the spinal canal much more slowly and much more gently than is possible when the syringe is resorted to.

Tricresol seems, however, to be the principal danger. As every reader of this journal knows, this is a preservative almost universally employed. in sera of all kinds. While from time to time certain rabid critics of serum therapy have contended that this powerful antiseptic is capable of killing the patient when it is injected, there has never been any considerable evidence that it did harm when used in the diphtheria, tetanus and other conditions in which serum treatment is indicated. However, when this substance is injected into the spinal canal it comes immediately into contact with peculiarly sensitive nerve strictures and the possibilities of toxic action are greatly augmented.

There is no doubt that it is desirable, as Hale has pointed out, that if possible, antimeningitis serum should be prepared for the market without the tricresol. This can be made possible by marketing the serum in sterile air-tight containers, and doubtless this method will be adopted by manufacturers of this product.

The antimeningitis serum is one of the triumphis of modern therapy. By its use the mortality of epidemic cerebrospinal meningitis has been reduced from an average of 75 per cent to an average of 25 per cent. As compared with the mortality of the disease without serum treatment the dangers from the use of this remedy

are of minor account. No physician should hesitate to use it in cases of this character. Indeed, it is his duty to use it, tricresol or no tricresol.

TYPHOID TIME APPROACHING.

Last year the deaths from typhoid fever in Chicago were 10.5 per 100,000, as compared with 7.5 in 1912, and an average of 15.5 per 100,000 from 1906 to 1910, inclusive. In other words, while the general tendency, as regards the mortality from this disease, is downward, the record for 1913 was not as good as it should have been. The reasons for the increase our sanatarians seem not quite able to explain. Our drinking water apparently has not suffered, and efforts. are constantly being made to improve it.

With the new light that has been thrown upon the methods by which typhoid fever is spread and the development of efficient means for preventing the disease it would seem quite possible to suppress it almost entirely. Of course there will always be sporadic cases, but there should be no more epidemics. While the water supply is an important factor in disseminating typhoid fever we now know that it is not the only factor, and perhaps not the most important one. The human carrier is probably primarily responsible for the spread of the disease in most cases. For instance, last summer a cook on a Lake Erie steamship was shown to be the source of more than one hundred cases of typhoid fever and severe alimentary disturbances occurring among passengers during and following one brief excursion. This epidemic was reported in detail by the United States Public Health Service. In most instances, where an exhaustive study of an epidemic has been possible, some essential human factor has been found at the bottom of the trouble.

From an etiologic standpoint, therefore, the study of the carrier is most important. How shall we locate him? How shall we deal with him when found? These are questions which have thus far not been easy to answer.

Fortunately we now have several quite efficient means of preventing this disease. First of all comes prophylactic vaccination. The effectiveness of this measure has been demonstrated beyond cavil. It is now employed in the American, English, French and other armies, and the brilliant results obtained are among the greatest triumphs of modern medicine. It is now accepted as almost axiomatic that any person properly vaccinated against the disease is immune to attack for a period of at least two years. With this fact so generally known it is one of the

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