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After preparing the arm with soap and tion more definitely for a few hours. In water, alcohol and iodine, a tourniquet is old cases, there is seldom anything to retightened about it above the elbow and the mark. In repeated examinations of the vein dilated, the syringe is filled with the urine in the evening following the injecsterile freshly distilled water, the air tion albumin is almost always absent. forced out of it, and the needle (No. 26 Bur- From the foregoing we contend that salroughs and Wellcome platinum needle) varsan or neosalvarsan is of use in all the plunged into the vein. The water is then stages of syphilis, that it should be fortislowly injected to make sure that the needle fied by the use of mercury, and possibly is in the vein, the tourniquet very carefully iodine, and that the intravenous method is removed, the receiving tube of the syringe the method of choice in administering it. put into the bottle of salvarsan solution, which has been made with the freshly distilled water and properly alkalinized, the syringe is drawn full of the solution, the stop-cock turned to direct the current into

A Merger of Medical Colleges.-The Atthe vein and slowly injected. The filling

lanta College of Physicians and Surgeons and emptying process is continued slowly without removing the needle from the vein,

and the Atlanta School of Medicine have

been consolidated under the name of the until the whole amount is injected. In about one

Atlanta Medical College. Dr. W. S. Elkin case in ten, especially in

will be dean of the new institution, and Dr. women with fat arms, it is necessary to

W. F. Westmoreland, president. cut down upon the vein. In this case canula is inserted and the vein afterwards County Hospitals.- No state could devote ligated. It is always better, when possible, its funds to better purposes than to see that to use the needle, as no scar is left and it is every county in the State were provided possible to make a subsequent injection in with the proper hospital facilities. These the same vein. If the vein be cut down county hospitals would not only provide to upon, it is a good practice to end the opera- the sick and injured of the community tion by putting in a half syringeful of the proper facilities for the relief of disease and water, to wash out any of the solution the results of accidents, but they would which may have a tendency to stop in the also furnish education to the community in *dead end” formed by ligating the vein, the matter of right living and as to the and possibly might set up a phlebitis. nature of disease, and an incentive to the

As for the relative use of salvarsan and medical men to do better work, not in comneosalvarsan, the only difference, when petition with, but in emulation of, their used intravenously, seems to be that the professional brethren. Any one who has latter must be used in somewhat heavier had any hospital experience knows how dosage; that it does not have to be al- residence in a well-appointed and well-conkalinized, and that the whole amount of ducted hospital raises the respect that the solution is smaller (about 150 instead of average patient has for the profession, and 240 c.c.). As far as the therapeutic value knows that the patient leaves the hospital goes, I do not know of any difference. better prepared to care for himself in the

We never have any reaction of any mo- future. If the object of government is the ment to follow the injection. Rarely is welfare of man, surely the health and life there more than one degree of fever. A of man should be the first care of states. few complain of nausea, and about one in men. There are many counties in the twenty vomits. Only two in the entire United States where medical missionaries series have had a chill. If given during are needed worse than they are in Asia, the fading period of a secondary eruption, Africa, or the islands of the sea.-Lancetit sometimes seems to bring out the erup- Clinic.


MAHA will entertain this society at its 26th annual meeting, September 18, 19, 1913. Dr.

W. O. Henry was appointed chairman of the arrangement committee. The meeting will

be held under the auspices of the Omaha-Douglas Co. Medical Society, and the Presi. dents of all State Societies in our province have been especially invited to attend. Evening addresses will be given by Dr. Chas. Mayo and Dr. A. C. Croftan, the mere mention of whose names is sufficient to presage two interesting and instructive talks. The program will include a Symposium on Pregnancy. A cordial invitation is extended to the profession of near-by states. H. B. Jennings, Pres., Council Bluffs, Iowa. Chas. Wood Fassett, Sec'y, St. Joseph, Mo.

Original Contributions THE TREATMENT OF PRE-TUBERCU. stage constitute the prophylactic treatment LOUS STAGE OF CONSUMPTION.

of consumption. Just as drainage and the

application of lime to an impoverished ALFRED S. GUBB, M.D., L.R.C.P. Lond., M. R.C.

land wards off mildew and blight that atS. Eng., D.H.P., etc., Aix-le-Bains, Savoie, France.

tack imperfectly nourished vegetables, so Except for the discovery of the bacillus hygienic measures and the administration of tuberculosis, the most interesting out of lime salts to persons who are threatcome of recent research has been to show ened with consumption tend to enable the that the germs of tuberculosis will only tissues to resist their natural enemies. grow on suitable soil, that is to say, soil That this is no more theoretical concepwhich has been prepared for infection by tion is shown by the comparative case with inherited or acquired debility. It is this which threatened consumption, and even stage of liability to infection that consti- the incipient stage of the actual disease, tutes the so-called pre-tuberculous period, can be averted or cured by appropriate the investigation of which has revealed treatment. Remove the cause, said Hipposeveral interesting facts.

crates, an the effect will disappear, and in Thanks in a great measure to Professor most instances it is possible to remove the Albert Robin of Paris, who made a special cause of the predisposition to phthisis. study of the physiological features of this But before we discuss the treatment there pre-tuberculous period, we know that it is is another physiological factor that calls characterized by a curious but striking in- for notice, namely, the persistently low stability of the mineral constituents of the arterial tension. So constant is this low tissues, notably the chlorides and phos- blood pressure that it is now regarded, in phates. This tendency to phosphaturia the absence of any other explanation, as course is by no means peculiar to tubercu- diagnostic of impending consumption. A losis for in a more or less fugitive form it young man apparently in the enjoyment of is met with in many morbid states, from a fair standard of health, whose blood pressimple dyspepsia to albuminuria. The dis- sure is persistently below 110 millimeters tinguishing character of the leakage of should be looked upon with suspicion, alphosphates occurring in connection with though for the time being there may be no tuberculosis is its constancy. It is this con- signs of pulmonary mischief accessible to stancy that constitutes it gravity, because, the stethoscope. in the long run, it determines pronounced The two principal features of the pre-tuimpoverishment of the tissues in respect berculous stage of pulmonary tuberculosis of their mineral constituents.


therefore, increased elimination of It would be rash to assume forthwith phosphates and a persistently low blood that the amenability of the tissues to tuber

pressure. culous infection is the direct, inevitable Other disturbances of the vital processes consequence of this loss of phosphates, be- have been noted-changes in the respiracause the inability to hold and to retain tory quotient, for instance-which likewise the mineral elements may, after all, be possess grave significance, but we need not merely an outward and visible effect of the dwell upon these, seeing that they have no same vital weakness that creates the prone- direct bearing on treatment. ness to infection, just as the loss of appe- Inasmuch as the phosphatic waste may tite determines a state of debility that pre- conceivably be due to tissue debility, it bedisposes to infection from lack of nourish- hooves us to place the organism under conment.

ditions favorable to its recuperation, and However produced, and whether due to these may be summed up in the theraan inherited inability of the tissues to peutical trinity: fresh air, good food, and maintain their nutrition or to the disturb- rest. These alone, however, may not suffice ing influence of chronic intoxications and to restore the nutrition of the tissues. other causes of organic debility, the per- There is lost ground and arrears of nutrisistent phosphatic waste engenders a state tion to be made up, and it is asking too of malnutrition that places the organism in much of the jaded organism to expect a manifest condition of inferiority.

it to pay in advance," that is to say, The recognition of this predisposing pro- not only to secure the adequate nutrition of cess affords a clear indication for treatment, the tissues which it has so far been unable and the measures that have for their object to obtain, but also to restore the debit balthe remedying of this source of debility and ance created by past depredations. the cutting short of the pre-tuberculous Medicinally the plan of campaign is al

ready traced. We are called upon to make Hotel Sherman and at each of these 'head. good the phosphate waste (and incidentally quarters the daily clinical program will be the chloride waste as well), and to stimu- bulletined one day in advance. On each late the processes of nutrition by raising evening of the week except Saturday, there the blood pressure to a higher level. will be scientific sessions, and on Tuesday, Higher arterial tension means freer irriga. Thursday and Friday evenings, special tion of the tissues, freer irrigation of meetings will be held for those interested the tissues, in its turn, means improve in surgery of the eye, ear, nose, throat and nutrition. Now lime and strychnine mouth. Dr. E. Wyllys Andrews is chairboth tend to raise the blood pressure, and man of the committee on arrangements and if they be given in the form of phosphates, Dr. Franklin H. Martin general secretary all the therapeutical indications will have of the Congress. been fulfilled.

Some phosphorus compounds, however, are more readily assimilated than others,

Removal. and for this reason it is better to employ A research laboratory has recently been the hypophosphites. In order to facilitate established in New York City, at No 428 their apprehension by the tissues the phos- Lafayette street, near Astor Place, with phorus should be administered in combin- Dr. Fenton B. Turck, formerly of Chicago, ation with various bases, and advantage as director, to continue his work on the may be taken of the opportunity to intro- various problems connected with the aliduce medicinal tonics, such as quinine, iron, mentary tract, under an endowment by two manganese, potassium, etc.

Such a com- former patients of London, England. pound is presented in the well-known Fel- Dr. Turck has removed his office and resilows' syrup, which must have been devised dence from Chicago to 14 East 53d street, in deference to the principles enunciated New York, there devoting his morning above, and has justified its existence by

hours to office practice, the later hours of the results that follow its employment. the day being take by the research work at

Its succees, in all probability, is due to the laboratory. the fact that, by enhancing arterial ten- The director is at present assisted by the sion, it enables the tissues to avail them- following staff: Organic Chemistry: A. R. selves of the accompanying phosphorus Rose, formerly University Minnesota, Yale; salts and so to reconstitute their nutrition. Arthur Kunston, formerly University MisUnder its influence, indeed, the subject souri and Columbia; Katherine R.Coleman, gains in weight while his digestion, in com- formerly Columbia University. Physiomon with the other vital functions im- logical Chemistry: Vincent Greco, Univerproves; and the state of physiological sity Palermo, Italy. Bacteriology: Otto misery gradually disappears.

Maurer, K. Oberrealschule, Heilbroun,

Germany and University Wisconsin, and Clinical Congress of Surgeons.

W. W. Browne, formerly of Brown Uni

versity. General Pathology: P. J. FriedThe Clinical Congress of Surgeons of man, formerly of Department Health City, · North America will hold its fourth annual New York Research Laboratory, and Earle session in Chicago, November 10-15. A Kiser, University of Toronto, Canada. complete program of clinics is to be held on each day from 8 a. m to 5 p. m., covering every branch in surgery. The general

For prickley heat, apply with sponge, headquarters of the Congress will be at the

two or three times a day, a 2 per cent soluHotel La Salle, where the eighteenth and

tion of sulphate of copper. nineteenth floors have been reserved for registration room, bulletin rooms, etc. The A goblet of oatmeal water, taken every headquarters of the section on surgery of morning before breakfast, cures constipathe eye, ear nose and throat will be at the tion, it is stated.

ANSAS CITY will entertain this society on October 7-8,1913, Dr. W. T. Wootton of Hot

Dr. J. A. Witherspoon, president A. M. A. will deliver an evening address. Sessions will be held at the Coates House, which will also be headquarters. Clinics will be held in the hospitals before and following the meeting. A cordial welcome extended to visiting physicians.

K Springs,



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Under the editorial direction of




P. T. BOHAN, Therapeutics

C. C. CONOVER, Diagnosis

DON CARLOS GUFFEY, Obstetrics JOE BECTON, Greenville, Texas

H. C. CROWELL, Gynecology HERMAN J. BOLDT, New York

FRANK J. HALL, Pathology A. L. BLESH, Oklahoma City

J. E. HUNT, Pediatrics JACOB BLOCK, Kansas City

JOS. LICHTENBERG, Ophthalmology G. HENRI BOGART, Paris, Ill.

HERMAN E. PEARSE, Surgery ST. CLOUD COOPER, Fort Smith, Ark.

R. T. SLOAN, Internal Medicine T. D. CROTHERS, Hartford, Conn.

R. L. SUTTON, Dermatology O. B. CAMPBELL, St. Joseph

EDW. H. THRAILKILL, Rectal Diseases W. T. ELAM, St. Joseph JACOB GEIGER, St. Joseph

ST. JOSEPH S. S. GLASSCOCK, Kansas City, Kan.

J. M. BELL, Stomach J. D. GRIFFITH, Kansas City

C. A. GOOD, Medicine JAS. W. HEDDENS, St. Joseph

A. L. GRAY, Obstetrics GEO. H. HOXIE, Kansas City

J. W. MCGILL, Rectal Diseases
DONALD MACRAE, Council Bluffs

L. A. TODD, Surgery

D. A. MYERS, Lawton, Okla.

H. M. MCCLANAHAN, Pediatrics
JOHN PUNTON, Kansas City

H. S. MUNRO, Psychotherapy
PAUL V. WOOLEY, Kansas City
W. T. WOOTTON, Hot Springs, Ark.

HUGH H. YOUNG, Baltimore

Address all communications to Chas. Wood Fassett, Managing Editor, St. Joseph, Missouri.


AUGUST, 1913

No. 8


THE CARNEGIE INVESTIGATION. showed a marvelous aptitude for exaggeratSome years ago the Carnegie fund which ing these faults and minimizing the real was intended to furnish pensions for retired

work they were doing. professors of colleges was somewhat Finally the Carnegie Foundation fund startled at the number of applicants, claim- joined with the council of the A.M.A. to ing help from this source. Many of them reform medical colleges ostensibly to raise were from medical colleges. It was then the standards of medical education, but the decided to make investigation and deter

methods used were not of a high character. mine the colleges whose professors were Now we are confronted with a newspaper entitled to pension funds. This has lead to statement evidently inspired by the presithe great revolution in medical instruction dent of this foundation, which has been reand a publicity concerning the various col- peated and sent far and near in the press leges that has caused considerable irrita- that is still more startling and deplorable. tion.

This message boasts of the efforts to standThe A.M.A. joined in this effort to deter- ardize medical colleges and their success, mine the qualities of different colleges, but enforcing twenty-four colleges out of existwas singularly unfortunate in being repre- ence. They call it a campaign and describe sented by an investigator who was a detec- in very clear language their distinct efforts tive more than anything else. He started to force schools to stop their work. One out to find weaknesses in the various cole of the methods was to send broadcast re. leges of the country and succeeded, then ports of the inefficiency of these medical colleges, appealing to the students, to the it would be a curative medium in unadpublic press and to public opinion general- vanced tuberculosis, and that it would imly to suppress these schools, showing how munize against the disease in young subthey lacked in this and that. Another jects, was the flinging wide open the gatemethod was to secure the names of students way to the public press, to which the prowho attended them and circularize them fession of late looks for so much assistance with reports of the poor instruction, poor in "teaching the dear people" the profound teachers and unfavorable conditions of the secrets of great strides in medical advancecollege they attended. Another method ment. This Friedmann event remarkably which they have no hesitation about de- illustrates this catering and salaaming to the scribing was that of securing the assistance public press to exhibit the goods of regular of rival colleges who had better facilities medicine to the world is not without tempfor teaching and who could be ranked tatious results in defeating the object deamong the better ones, and following up sired, namely, clean regular men and a their suggestions, how the downfall of the clean regular, scientific and progressive weaker school could be brought about. medicine; for be it remembered, medical Teachers of these weak colleges were ap- men are human, many of them are very hupealed to, to resign and join in the effort to man, and in the midst of apparent or real concentrate for better college facilities. accomplishments the publicity spot light

These and other measures are reported may so mar the tediously developed outwith a brutal frankness that casts discredit lines on the canvas of science, and it may on the movement and ranks with the most so mar the developmental vision of the emdisreputable methods of the great trusts bryo scientist that he puerily sees only comwho force out rivals by just such means. pletion of his incomplete work and begins

The secretary of this foundation declares groping at phantasmal riches and reaps a that the elimination process has just begun, discredited regularity and failure, or an acthat 25 of the colleges have been annihi- credited full-fledged quackery. lated and of the 117 left a large proportion Dr. Freidmann was not an exception to the of them are to be driven out of business, rule, being but an obscure bacteriologist. possibly by the very same methods. As a He had plodded to the forefront with his news item representing both the president labor findings and presented them to the and secretary and describing their means Berlin Medical Society, as he had a right of procedure, there is something very to do, he being a properly registered physistartling about it, that is a sad reflection cian in Germany. The evidence of irreg. on scientific fairness and honesty.

ularity is not shown. The very relational While the medical profession as a whole value of his findings to that unconquered is striving earnestly to improve college fa- destroyer of human life, if true or not, cilities and raise the standard of medical ripened the psychological moment for a instruction, disreputable ways of doing this world wide press sensation. No matter how do not appeal to their sense of justice and disgraceful the exploitation or what the end fairness of dealing.

results might be in human suffering, 110 The Carnegie Fund Foundation needs re- newspaper would pass up such an attracformation itself and the work should be on tion, though the editor knew in his "in a higher plane than this. College perse- ners" the statements were false. It matcution and college battles should be things ters not how deleterious are the powerful of the past and the great law of the "sur- suggestions of the press on the psychologi. vival of the fittest" will go on irrespective cal receptivity of the reader, just so the of personality and selfishness. T.D.C. sensation, the money-maker and newspaper

bread and butter getter, is made. To accuse Dr. Friedmann of fostering and foist

ing the press activity is untenable, as he, FRIEDMANN, DUKET, THE PRESS

like all doctors, had little money and less THESE THREE.

business sense.

He would have needed the Dating from the reading of Dr. Freid- money of a Carnegie had he paid for the mann's paper before the Berlin Medical publication space.

That the stuff printed Society last November, continuing by in- was believed by the readers is shown in the spiring hopes and apathetic thuds up to offer of a million dollars by an American date, one of the most spectacular and la- for the cure. And thus forced into an inmentable publicity stunts has been pulled ternational spot light our hitherto unheard off in the name of progressive medicine. of bacteriologist forgot the lowly labora. The simple announcement that an avirulent tory that gave him birth and seemingly tubercle bacillus had been found and that lost his head in believing he could do what

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