it.

Every infectious disease and every severe acute ailment require

To constitute a reliable urinalysis the following tests are neces

sary:

Specific gravity, taken by a certificated hydrometer.

Presence of albumen and sugar.

Quantity for twenty-four hours and the

Microscope, most necessary of all.

If these rules are observed, we will have more accurate diagnosis, better treatment and prognosis, and truly scientific reports in place of the present unreliable data of kidney cases.

BACTERIOLOGY, ITS RELATION TO MEDICINE AND SURGERY.*

BACTE

J. B. BROWN, M.D.

Denver, Colo.

ACTERIOLOGY is practically a new science and one of incalculable importance to medicine and surgery. Though much has been accomplished along this line, rich stores of knowledge lie waiting for the patient investigator.

When Louis Pasteur in 1858 proclaimed to the world that microorganisms were the cause of fermentation, the profession became convulsed, and a bitter controversy ensued. "Pasteur claimed that every fermentation has invariably its specific ferment; that this ferment consists of living cells; that these cells produce fermentation by absorbing oxygen from the substance acted upon; that. putrefaction is caused by an organized ferment; that all organized ferments are carried about in the air, and that to exclude the air entirely prevents putrefaction and fermentation." Lemaire found by adding phenic acid that all fermentation ceased, thus leading him to believe that fermentation must be due to living organisms. Next came the carefully conducted experiments of Lister, which showed that upon filtering the air putrefaction ceased. These experiments led directly up to the antiseptic method of treating disease and as the result of this method was born aseptic surgery. Being a profound thinker and investigator, Pasteur was not deterred from the pursuit of his theories by the adverse criticism. He made no statements which he could not prove. At that time some of the agricultural interests of France were in danger of extinction from

*Read before the Denver Homeopathic Club.

the ravages of swine plague, charbon diseases of the silk worm and wine industries. Pasteur immediately applied the principles of his new discoveries to the eradication of these diseases and was entirely successful. As a result of these brilliant discoveries the people of France were saved millions of francs, and Pasteur crowned with glory. These demonstrations convinced many of his adversaries. Others began investigation along these lines which finally resulted in the birth of the science of bacteriology. Further research on this subject has given us serum therapy, protective innoculation, an increased knowledge of pathology and scientific surgery.

When Koch discovered the bacillus of tuberculosis and was able to reproduce the disease in a susceptible animal, he claimed that he had found the cause of that dread disease. Though there is a difference of opinion among the members of the profession, his germ theory is the one generally accepted, and the recognition of this fact has aided materially in the treatment of tuberculosis, especially in regard to prophylactic measures.

Other investigators working on the microbic theory of disease have been able to prove the cause of many of the contagious and infectious diseases we have to-day.

The development of the microscope, with the discovery by Koch of the cultural methods which make differentiation of bacteria possible, has practically proven the bacterial cause of tuberculosis, diphtheria, typhoid fever, cholera, pneumonia, erysipelas, gonorrhoea, the plague, charbon, influenza, glanders, pyogenic processes, epidemic meningitis, epidemic dysentery, tetanus, malignant œdema, and leprosy. While in such diseases as syphilis, smallpox, chickenpox, measles, scarlet fever, German measles, mumps, whooping. cough, hydrophobia, typhus fever and dengue, the bacterial cause has not been proven as yet; perhaps further research will soon demonstrate the causative factor. Some recent investigators claim that possibly the microbes are so minute that the modern microscope fails to reveal them. The discovery of the parasites that infect man and beast has been the means of a more exact knowledge of the clinical phenomena of disease. It has given us the cause of malaria, actinomyces and amebic dysentery. This knowledge of the nature of parasites, developed further by Munson, gives us the invaluable fact that malaria is transmitted by the mosquito of the genus "anopheles."

The recognition of the rôle the mosquito plays in malaria stimulated further effort in its relation to many other infections. In Cuba, in 1900, Reed and Corroll working on this basis proved that the mosquito, of the genus "stygomia fasciata," was the means of

the transmission of yellow fever from man to man; and for the first time the past year has found Havana practically freed from this disease. With this knowledge and the proper precaution against infection, yellow fever will soon be eradicated from civilized communities. But, the mosquito is not the only transmitter of disease; the common house fly has been convicted of carrying the germs of typhoid fever from open sewers and cesspools to our kitchens and thus contaminating our food and infecting us with the fever, and perhaps, various other diseases. From these facts it is plain that bacteriology is the foundation upon which scientists worked in making these discoveries, thus giving us the cause and method of transmitting disease. The old theory of spontaneous generation is no longer worth considering. With this knowledge the scientist will, in the future, make more rapid progress in studying the phenomena of disease; in perfecting more rigid sanitary rules; in promoting the system of preventive medicine and perhaps such pests as the plague, cholera and yellow fever will be entirely stamped out. Since the discovery of bacteriology, medicine has made rapid strides. It has proven a great stimulus to the study of pathology, and the physical and chemical changes of the fluids and tissues of the body. Associated with this the clinical diagnosis by aid of the microscope has been also a great factor in revolutionizing medical science. Through the indefatigable labors of Professor Koch, Behring and others, serum therapy was established. An immunizing serum has been manufactured for Asiatic cholera, tetanus, diphtheria, the plague, erpsipelas, streptococcic infection and other diseases. Aside from the diphtheritic antitoxine, these serums do not appear to be efficacious. Greater good has resulted from protective innoculation. This system not only benefits mankind but is invaluable in the animal industry. Bovine vaccine was discovered over a century ago, but it remained for bacteriology to perfect its production and method of innoculation. Those who believe in statistics cannot doubt the protective influence that vaccination produces against smallpox.

Briefly reviewing micro-organisms, their action, morphological characteristics and habitat, it is inconsistent to aver that such microscopical bodies cannot produce injury to the animal kingdom. In medicine we have to deal with infinitesimal quantities and their cumulative effect.

Every physician of the new school is well aware of the rapid and efficient action on the human system of an infinitesimal amount of medicine prescribed according to the law of similars. Why, then, should we be loath to accept the theory that the infinitesimal

bacterial cells can cause disease? Nuttall and Buchner, in their scientific demonstrations and pathological researches, discovered that the blood serum was germicidal to certain bacteria and named this substance "Alexin." Perhaps this explains Nature's method of combating disease. Accepting this theory we are able to form an idea as to how certain medicines act so rapidly. Being reduced to microscopical bodies the medicines are in such a form as to be readily assimilated by the blood and fixed tissue cells, thus stimulating them to throw off a greater amount of alexins, thereby increasing phagocytosis and reinforcing the body to eradicate the disease. Perhaps there are other methods of cure. However, the above method seems plain.

This paper would be incomplete without further remarks concerning the relation of bacteriology to surgery. Lister, when working upon his antiseptic theory, possibly did not realize that he would become famous through his discoveries and be heralded the father of aseptic surgery. His experiments with antiseptics proved to be a valuable addition to surgical science, and as a result of these researches we have the system of asepsis which has practically perfected that science.

Though dissention among the members may occur in regard to the bacterial cause and method of transmitting disease, there can be but one belief among those who have investigated this subject concerning the action of bacteria in the field of surgery. We know that pyogenic bacteria cause pus.

Since the discovery of bacteriology the surgeon can invade any part of the body, and thousands of lives are saved through the skill and knowledge of perfect cleanliness, whereas a quarter century ago similar cases succumbed from infection or were considered inoperable.

It is doubtful if the surgical achievements at the present time could have resulted from any other source than bacteriological.

To recapitulate: bacteriology, though young in years, has worked wonders for the profession. It has made the application of medicine more exact, has enhanced the art of diagnosis, augmented preventive medicine, revolutionized pathology and made surgery paramount among the sciences.

WILLIAM TOD HELMUTH, M.D.,

CONDUCTED BY

GEORGE W. ROBERTS, PH.B., M.D.

PRELIMINARY WORD ON THE SURGERY OF THE

THE

PROSTATE.*

BY HORACE PACKARD, M.D.,

Professor of Surgery, Boston University School of Medicine.

'HE following brief article is intended only as a prelude to a subsequent communication, and as a prophecy regarding the future of the surgery of the prostate gland. The management of sufferers from the effect of prostatic hypertrophy has been something of a reproach to the medical profession in the past.

It has been the prevalent custom, and is such even at the present time, for physicians to introduce these patients to the catheter habit, with the understanding that they will drift along until the condition becomes more and more grave, and until either some sort of an operation must be performed in the face of an absolutely impervious urethra and menacing retention, or a gradual deterioration of strength until death ends the scene.

During the last five years I have given much serious thought to this subject, and it has been my ambition to devise, or find out, some way of meeting the menacing conditions which we find in these cases. They surely appeal to one's deepest sympathy. There can be hardly any other condition which entails so much of suffering and discomfort, as the advanced years of manhood accompanied by obstruction to the free flow of urine from prostatic hypertrophy.

Many men who have led exemplary lives, who have been industrious, who have amassed a comfortable competency, and 'who, at the age of sixty or sixty-five have anticipated that they might retire in comfort to enjoy their old age, find themselves confronted with this menace. The initial symptoms are hardly sufficiently severe to cause them anxiety, and years are likely to slip by-from two or three to six or eight-without serious damage to the health. But all this time the way is being paved to the serious sequela which most always manifest themselves.

Little by little the patient finds himself unable to completely empty the bladder. This results in the accumulation of residual urine, with little space remaining for reaccumulation, and within a short time, a half an hour or an hour, there comes again the great

* Written especially for THE NORTH AMERICAN JOURNAL OF HOMEOPATHY.