1

etc. The twentieth generation reaches into the millions. Allowing thirty years for a generation, and counting backward thirty generations, or to about the time of the Norman conquest of England, the number reaches the enormous aggregate of over a thousand millions of individuals. And this number is not the total of ancestors of all the intervening generations, of course, but only the number of individuals of that single generation who stand in ancestral relationship with the individual of today. This computation is approximately accurate, but while it represents fairly well the actual number of ancestors, the number of different individuals would be somewhat less. A single individual might be counted at more than one point in this ancestral complex. It may also be noted here as an instance of the loose, slipshod phraseology of the stirpiculturists that some of them call this vast complex which in a single generation embraces millions of individuals situated in all parts of the world, "a chain of heredity." There is and can be no such thing as a "chain" of heredity in sexual reproduction. At least a few other very marked instances of equally loose and unscientific phrasing of the stirpiculturists might be noted here, but for lack of space.

It must be evident that unless degeneracy is a modern trait due to acquired peculiarities, it has been operating through all these generations of the individual's ancestry, and presenting in each generation about the same percentage of abnormal individuals as the percentage of abnormals in the community at large at that time and place. Hence it is impossible for the stirpiculturists to find any sound basis to begin with. One man's ancestry is about as good as another's. To exterminate the worst specimens of a single generation or half a dozen generations is mere child's play. The very best specimens of today have an unmistakable ancestral taint, the worst specimens an overwhelming preponderance of normal ancestors. Trace the ancestry of the normal and of the degenerate backward any considerable number of generations and the percentage of normal and abnormal individuals in the ancestry of each cannot differ very much. It is not even sure that this slight difference if found would always be in favor of the normal individual. If the slight ancestral taint of the degenerate is dangerous to the future welfare of society, the equal or nearly equal taint of the normal individual cannot be declared safe. The difference is utterly inadequate to form a rational basis of human culture.

Degeneracy is undoubtedly with considerable frequency a trait acquired during the lifetime of the individual. The tendency is unquestionably very strong in modern biology to deny that traits of this acquired character can be transmitted to offspring. Weismann is perhaps the ablest defender of this view at present, but the view represents no sudden revolution in biological opinion. This tendency to denial has been growing ever since the days of Lamark, who laid great stress on the inheritance of acquired traits as one of the prime factors of evolution. Darwin while not discarding this factor introduced others more prominent in evolutionary processes, and relegated the hereditary transmission of acquired characters to a subordinate place. Weismann and others following Darwin and accepting all the principal factors of organic evolution challenged the possible transmission of acquired traits. It is too early yet, I believe, to decide upon the merits of this controversy. But it is not too much to say that Weismann has destroyed the validity of the evidence upon which his opponents formerly rested their case. The whole ground must at least be gone over again. No careful and conscientious scientist would care to rush in upon this field with radical remedies until "Weismannism" is disposed of. Biological science asserts with ever increasing clearness that there

is absolutely no evidence for the assumption until recently so generally received, that acquired characters can be transmitted.-Weismann.

This assertion applies only to transmission by and through the laws of heredity. Germ infection by contact and by bacterial invasion is not denied; but this is a vastly different thing from hereditary transmission as commonly accepted.

*ADDRESS ON THE TREATMENT OF PNEUMONIA.

C. F. WAINRIGHT, M. D., Kansas City, Mo.

Professor Diseases of the Chest, University Medical College.

The subject of the treatment of pneumonia concerns every physician, the specialist as well as the general practitioner. There are more deaths from this disease than from smallpox, appendicitis, acute obstruction of the bowels, diseases of the ovaries and gynaecological diseases put together. I claim that no disease for which so much can be done with careful study-no disease in the treatment of which we have more success, happier results when intelligently handled, than in the treatment of pneumonia; nor one in which any more serious results when mismanaged, yet the mortality stands at about what it was twenty and forty years ago. The rate of mortality has not been materially reduced by treatment. This I believe to be due to the fact that as soon as a diagnosis is made of pneumonia the cause of death is reported as pneumonia. Some authors say that pneumonia is the terminus of life, but day after day patients die of diabetes, some fall of Bright's disease or some chronic ailment, yet the patient is reported as passing away from pneumonia. In looking over this subject for the purpose of reading this paper I noticed that physicians all over the country treat pneumonia from the standpoint of an infectious disease. This we can do in a limited number of cases, but not in the majority. Sepsis has only been recognized as a factor of pneumonia in the past few years and since antiseptic treatment has been introduced the rate of mortality has not been reduced. And that some cases do well we will all admit and that the heart suffers complications is true, but that is not the cause for the large majority of deaths in pneumonia. The treatment and management of the case depends upon the pathological changes.

For a septic case the treatment would be creosote, quinine, the salicylates, and these are used with some success. The symptomatic treatment would be directed toward supporting the heart. In lobar pneumonia the right heart is apparently responsible for failure, and this organ should be carefully watched throughout.

In regard to local applications, no doubt in many cases this is soothing, but personally I have little confidence in local applications and none in counter

irritation.

The increased amount of labor on the right heart is due to the pathological changes in the diseased lung. The air cells undergo an inflammatory process and there is a certain amount of pulmonary engorgement. A chronic pulmonary emphysema and chronic hypertrophy will result from the overdistension of the air cells and the increased pulmonary obstruction with hypertrophy of the right ventricle.

The treatment is directed to the left ventricle. We place the patient in the recumbent position, keep him quiet and give cardiac stimulants, open up the systemic circulation, and in a little while compensation will be restored

*Address delivered before the Missouri State Medical Society at Jefferson City, May 22, 1901.

and the life of the patient preserved. In pneumonia the right heart makes an attempt to undergo changes, and if not accomplished, the pulmonary circulation suffers, and sooner or later the patient dies of pneumonia. We have an oedema of the lung and dilitation of the right ventricle and death. What is the right heart doing independently of the left? What produces the first sound of the heart and the radical pulse? The left ventricle is not involved at first but the right. When the left ventricle is involved it is secondary to the right and then it is too late to give cardiac stimulants. The right side of the heart can be studied under these circumstances by percussing over the right ventricle. There will be an extended area of dullness to the right. In the first stages the disease progresses. The patient develops fever.

This will continue throughout the disease, and if the left ventricle becomes involved then we will have symptoms of pulmonary engorgement and the patient may die of a heart clot. A clot forms in the heart and separation occurs while the patient is seemingly doing well, the respiration not being labored and little dyspnoea. An examination of the heart will show a clot in the right ventricle. Death was not caused by sepsis, but the clot. As for the treatment of the septic conditions, for the first few days the diet should be low. On account of the sudden onset and the arrested secretions, if we put food in the stomach it will not be digested and we will only have a disturbance attended with flatulency, etc. We should diet the patient until he has recovered from the shock, till the secretions are re-established and then we can give him food. Creosote is a good antiseptic having little effect on the pulmonary apparatus; it is a good intestinal antiseptic and prevents flatulency. The intravenous injection of normal saline solution is deemed valuable by some and has been recommended. It has been said that it is dangerous on account of placing too great a burden on the heart muscle. However, in pneumonia attended with exhaustion the injection of normal saline solution does do good. It will dilute the blood and there is therefore less tendency to coagulation. In sepsis where we have changes in the blood, the injection of normal saline solution will stimulate the heart to more vigorous contractions without endangering the organ itself; this is especially true in acute cases where there is no chronic disease of the heart muscle. Many cases get well without the use of drugs and by studying the heart you will understand when to administer drugs and when not. If the power of the right ventricle is lessened it is a decided indication for heart stimulants. For this purpose I prefer digitalis and strychnine. In administering these for the purpose of acting as a stimulant, however, we should never administer them along where there is any resistance in the circulation, as there is in these cases, because both have the property of contracting the arterioles as well as the arteries and we would only embarrass the heart that much more. If we had an ideal remedy for these cases we would be able to increase the systolic action of the heart and at the same time dilate the arteries. However we have no such drug. We can get a combination, however, from nitroglycerine, belladonna and nitrate of amyl. Of these, belladonna is the best because its effect is more lasting than that of nitroglycerine. The treatment of the right ventricle under these circumstances is exactly like that of the left in all forms of chronic conditions. We dilate the peripheral circulation that is the pulmonary circulation-and increase the propelling power of the right ventricle. Until this stage is reached the cardiac stimulants are not indicated. If used before they are indicated they do a damage to the heart. You withdraw what stored up energy there is and when it is needed you find the heart exhausted and weak. The treatment of pneumonia is based upon the state of the heart-the lung will take care of itself if you will take care of the heart..

AFTER TREATMENT OF OPERATIONS FOR HEMORRHOIDES.

J. M. FRANKENBURGER, M. D.

Professor of Rectal Surgery, University Medical College, Kansas City, Mo,

The main points to be considered in any operation are, first, danger to life; second, permanency of recovery, and, third, duration of time of recovery. In this day of active life, time is a great factor in any surgical operation, and any means which shortens time spent in recovery should be investigated and made use of by the surgeon. This is the excuse, if excuse be needed, for writign this paper upon a subject which, at first thought, would seem very unimportant.

One author on rectal diseases says, "It is wise to pass a small piece of wool saturated with iodoform ointment into the bowel, and then apply a pad of wool over the same. After the first week the finger well anointed must be passed into the bowel every day to make sure that no contraction is resulting from the operation."

Another says: "The stump should be dusted with iodoform, a piece of iodoform or bichloride gauze is now placed over the parts, one end of it being gently pushed into the anus and against the stumps."

Until within the last year I was in the habit of dusting the lower part of the rectum with iodoform, then taking a piece of iodoform gauze anointed with carbolized vaseline and introducing it into the rectum. I generally removed the dressing in from thirty-six to forty-eight hours, and sometimes when the patient was extremely troubled with flatulency have been compelled to remove it sooner and pass the rectal tube to allow escape of gas. The change of dressing was always accompanied by pain to the patient, no matter how careful I was in removing the dressing, or how long I soaked it with hot water before removal. Within forty-eight hours after operation the granulations would protrude through the meshes in the gauze and the withdrawal of the gauze was invariably followed by bleeding, caused by destruction of the tender granulations.

The dressing which I now use and have been using the past year consists of a tampon, and is made as follows: Take a piece of one-half inch rubber tubing, about four inches long, wrap the tube with antiseptic or sterile gauze until it is as large as desired, then pull over the whole a sterilized rubber covering; these covers can be had at the instrument houses, but an ordinary French capote, with the end cut off, answers the purpose just as well; fasten a string to the distal end and leave long enough to anchor tampon with; I have stopped using any dusting power immediately following a pile operation, as I have watched my cases very closely and am satisfied they get along just as nicely without it. To introduce the tampon, a bivalved dressing speculum is inserted into the rectum, the blade separated and the tampon placed in position; the speculum is then withdrawn and the rectal wall will very snugly

encircle the tampon. Some more gauze is placed around the external end of the tube, a pad placed over the anus and a T. bandage applied. It is well to have the string attached to the external end of the tube fastened to a piece of gauze on the outside of the dressings, as I had a little trouble once on account of the tube being drawn up a short distance in the rectum, necessitating the need of a pair of forceps in its removal.

During the past winter a very practical comparative test was given of this method of dressing hemorrhoids. I operated upon two cases, both similar on the same day, before my class at the Uinversity Medical College, and having only one tampon, dressed one case with the tampon and the other simply by placing a piece of sterile gauze in the rectum; at the end of 72 hours I changed the dressings before the class; in the case in which I had used the gauze, I first soaked it with hot water and then removed it as gently as possible. The patient complained bitterly of pain, quite a little capillary hemorrhage ensued, and it was quite easy to see the granulations which had been broken down by the removal of the gauze. In the other case the tampon was removed without any pain, not a drop of blood was lost, and no granulations injured.

A saline cathartic should be given the patient in about 72 hours. When he feels the desire to evacuate the bowels the dressings should be removed and an rectal enema of cool water given. After evacuation the parts should be well cleansed with cotton and sterilized water, and antiseptic gauze and the T bandage re-applied. The patient should, if possible, be kept in the recumbent position until the bowel is entirely well. In case it is impossible to keep them in the recumbent position until the parts are entirely healed, they should be closely watched, and if the healing is slow, some stimulating application, such as a two per cent solution of nitrate of silver, or iodoform, should be applied.

Some of the reasons why this tampon dressing is better than any other are as follows:

First. The granulations will not penetrate the rubber as they do the gauze, hence on removal of the tampon there will be no destruction of the granulations, and no bleeding.

Second. Its removal is painless.

Third. Recovery is quicker. From close observation in a large number of cases, I am satisfied that healing takes place much quicker than when any other dressing is used.

Fourth. Less pain in first evacuation of the bowels.

Fifth. Prevents flatulency, a very common complaint after a hemorrhoidal operation.

Sixth. The tampon being hollow, any bleeding inside of the bowel will promptly show itself on the dressings around the external end of the tampon. This will apply to any operation on the inside of the rectum. Any operator of any experience well knows that an alarming hemorrhage may take place after an operation inside of the rectum and its presence not be discovered until the patient is in a critical condition. By the use of the hollow tampon this danger is entirely obviated.

SYMPATHECTOMY.

Excision of the Superior Cervical Sympathetic Ganglion.

J. W. SHERER. M. D., Kansas City, Mo.

In a case of paralysis of the right cervical sympathetic nerve from gunshot wound recently reported by Harlan (Annals of Ophthal) the pupil of the right eye was contracted to 2.5 m. m. diameter as compared with the left