THE COLUMBUS MEDICAL JOURNAL. A MONTHLY MAGAZINE OF MEDICINE AND SURGERY. EDITORS. JAMES U. BARNHILL, A. M., Ph. D., M. D., 248 E. State Street. COLLABORATORS. W. D. INGLIS, B. S., M. D. ERNEST SCOTT, B. Sc. M. D. H. H. SNIVELY, B. A., M. D. C. W. MCGAVRAN B. S., M. D. L. G. GUIBERT DE LA MACHE, B. A., M. D. Communications relating to the editorial department should be addressed to Dr. J. U. Barnhill 248 East State Street; those relating to business management should be addressed to Dr. W. J. Means, 715 North High Street. Per annum, in advance, subscription price, including postage 15 cents. Bound volumes. .$1.00 2.00 Original articles, scientific and clinical memoranda, correspondence and news items are cordially solicited from the profession. APRIL, 1905. Editorial. PREVENTION OF TUBERCULOSIS. The Instructive District Nurses association of this city is rendering valuable service by its effort to educate the public as to proper methods of preventing tubercular infection. The recent lecture of Dr. Knopf of New York, on prevention of tuberculosis and care of tuberculous patients, was appreciated not only by the profession, but by the public in general. The lecture was well attended, there being many physicians, nurses and teachers in the audience. It was highly instructive and practical throughout. The lecturer presented the subject in a terse and most impressive manner, inculcating sane in regard to this dread disease, and the best methods of preventing its further spread. He pointed out its infectious and communicable character and said. that it was not hereditary and was one of the most curable of diseases. Taken in its early stages from seventy five to ninety per cent. of tuberculosis cases may be cured. He pointed out in a very clear way the methods of communicating the disease, stating that promiscuous expectoration on the sidewalks, in the street cars and other public places should be rigidly controlled by ordinances. "Give your young people plenty of fresh air; find them employment that furnishes exercise and outdoor life." "In your homes," he said, "raise the windows, night air is as good as the air of day. Use plenty of covering and lots of fresh air." "It is not necessary to go to Colorado, Florida, California or Arizona, but if you go, stay there. Don't come back, for a cure effected there may not serve for here. You may be cured here just as well, and once so cured, the chances of permanency are greatly increased." He called attention to the fact that a poorly ventilated church was as dangerous a place as any other filled with impure air. He pointed out the duty of municipalities, governments and philanthropists in establishing hospitals for the treatment of tuberculous patients. "No other disease so generally threatens the public health and no other method of handling the scourge is so efficient as the sanatorium." He appealed in strong terms for philanthropists to turn aside for awhile from endowing colleges and building libraries and contribute to the erection of preventive hospitals. Incidentally, Dr. Knopf, in strong terms, pointed out the dangers of the use of patent medicines and quack methods of treating tuberculosis, and also appealed to the public press to bar from their pages advertisements of fraudulent preparations. The District Nurses association has an educational committee which is doing much to enlighten the public as to the best methods of prevention and cure of this prevalent disease. This association is thus doing a commendable work in popularizing scientific facts relating to sanitation and giving to the laity the opportunity of learning from authoritative sources important facts relating to the common diseases and the laws of health. Another example of this "commendable tendency" is found in a series of lectures now being given by Professor W. T. Sedgwick before the Lowell Institute on "Sanitation of Cities." It is said that this discussion, so far as it appears, is a peculiarly happy statement of scientific facts in popular language. REMOVAL OF NORMAL APPENDIX. There seems to be some difference of opinion as to the advisability of removing the normal appendix when the abdomen is opened for other reasons. "One surgeon," says Dr. Gordon, (Brooklyn Medical Journal, November, 1904), "who believes that the appendix should always be removed when the abdomen is opened, quotes from six hundred operations, and finds twenty-seven normal appendices, and gives it as his honest opinion that a large per cent. of the small number left would have been found abnormal if the pathologist had had an opportunity to examine them, and feels like making an apology for having left twenty-seven patients out of six hundred in possession of their appendices. While a surgeon of equal ability, but not so radical, quotes from as large a number and shows from two to four per cent. of appendices in an abnormal state." There is, no doubt, an increased risk in removing the normal appendix at the time of some other operation. "The anesthetic," as stated by this author, "must be prolonged anywhere from five to ten minutes, which is, to some patients, a decided risk; increased shock must also be taken into consideration, and search for the appendix, after removal of pus tubes or other structures that are infected, may carry infection on instruments or the hands of the operator to clean structures; also infection from the interior of the appendix may gain access to the clean peritoneum. There is, too, a slight risk that adhesion may form as a result of the added operation, and intestinal obstruction call for a secondary operation. While all of these accidents are remote, no one can reasonably claim that they are not to be considered." The same author makes the following quotations from wellknown authors in support of his claim that the normal appendix should not be removed when the adbomen has been opened for other reasons. "Dr. Baldy, in considering over 100 abdominal operations where he left the appendix, says: "In no such case have I ever had to re-operate on account of the condition of the appendix. In none have I found symptoms remaining referable to that organ, and this in spite of the fact that in not a few of them. inflammatory products had invaded the underlying coats of the peritoneum." Dr. Vineberg: "My own practice is based on the principle never to remove a tissue unless its removal is indicated by disease. Whenever it is feasible in the performance of a laparotomy for other conditions than appendicitis, I search for the appendix for purposes of investigation, but do not excise it unless it shows some pathologic change." Dr. Carstens: "As far as I am able to find out, not more than one patient in a thousand that has had abdominal section is afterward affected with appendicitis. It is estimated that 2 per cent. of the population have appendicitis. If you operate on one hundred and remove all those appendices, of which only one or two would ever have appendicitis, I know that you will kill at least one or two, and I don't think that is good practice. I have been doing abdominal sections for many years and have only seen two cases that afterwards were affected with appendicitis, and I have had several thousand." Dr. Robert T. Morris opposes the removal of the normal appendix on three points: "I. Removal of the appendix delays the operation. 2. Adds a little to the danger. 3. And if the idea is taught by competent men, it will be carried out by those who will manage to get a death rate out of it. Leave the appendix alone until it is infected and then lose no time in having it inspected. If we are to get the lowest possible death rate in any sort of surgical work, we must let the patient off with the least attack of surgery that is possible." Dr. Kelly, in two hundred operations for other conditions, only found it necessary to remove the appendix twenty-five times. He says: "My reasons for not removing the normal appendix are as follows: Its removal involves a slight additional risk, owing to the fact that, no matter how good the patient's condition may be at the time the appendix is removed, there is no guarantee that it will remain so until the end of the operation, and should a condition of shock ensue, the additional five minutes consumed in the removal of the appendix will lessen the chances of recovery." In 1902 Dr. Kelly wrote to eighty well-known surgeons in different parts of the United States as follows: "When the abdomen is opened for other causes, and the perfectly normal appendix is easily accessible, is it your rule to remove it?" To the eighty inquiries, seventy-four answers were received, of which twenty-six answered "yes," and fortyfour "no." COUNCIL ON PHARMACY AND CHEMISTRY. We note with pleasure that the Board of Trustees of the American Medical Association has created an Advisory Board to be known as the Council on Pharamacy and Chemistry of the American Medical Association. It is the purpose of the Council to examine into the composition and status of the various medicinal preparations that are offered to physicians, and which are not included in the United States Pharmacopeia, or in other standard text-books or formularies. These preparations will include the synthetic chemical compounds, as well as the so-called proprietaries and pharmaceutical specialties put out under trademarked names. Preparations which conform to the standard established by the ten rules governing the matter, will be incorporated in "New and Non-Official Remedies," a book to be published by The Journal of the American Medical Association. "The plan for the work is briefly as follows: All available information regarding a product will be secured from the manufacturer and from other sources. This information, together with specimens of the article, will be submitted to a committee of experts, who will examine critically into the product, consider the claims made for it, and make a report. On the basis of this report, the Council will accept, reject, or hold for further consideration. If accepted, the information will be condensed and arranged somewhat on the plan of the United States Pharmacopeia, but with the addition of brief pharmacologic and therapeutic data. The Council believes that there are many articles, at present not recognized by the Pharmacopeia, which comply with the required standard and do not need any further investigation. In this class come many of the synthetics as well as many well-known pharmaceutical specialties. These are now being written up and it is proposed to issue the first edition of the book as soon as possible. No charge will be made for representation in the book. The following rules will govern the admission of articles: No article will be admitted unless its active medicinal ingredients and the amounts of such ingredients in a given quantity of the article, be furnished for publication. (Sufficient information should be supplied to permit the Council to verify the statements made regarding the article, and to determine its status |