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his physician to demonstrate its use, as there are many fatal terminations to attempts at lay introduction of probes, lead pencils and syringe nozzles into the uterus, which instead puncture the culdesac.

She was much impressed with the idea, but demanded to know as to its use, "What do your books say?" I had to tell her that my advice was not from literature but from reason, and pressed for an answer told her of Zola's novel, "The Son of a Gun," founded on similar condition. a She wanted to know if such operation had ever really been done, and I told her that every expert horse-breeder in the land kept and used an impregnator."

Then she was angry, gloriously, imperiously angry, because I had compared her to a beast, a brute! It took some time to pacify her I added ten dollars to my fee because of her temper-but when she did understand that no offense was intended, she apologized.

She wrote me that pregnancy followed in six weeks treatment, and when in due time

the child was born, the parents sent me a handsome honorarium.

Since I have considered similar treatment for some other cases in which there is no other adequate reason for the sterile condition, here arises a delicate, a very delicate question:

If the semen from another man be used, is it more culpable to inject it in the usual manner than with a syringe ?

In the instance cited in a former paper of this series, the husband was impotent, or rather sterile. In such cases would the woman be justified in resorting to mechanical impregnation? Would it be permissible for a physician to secure semen by milking a prostate and then injecting it?

In the novel by Zola, aforementioned, the priest furnished the semen to the physician, the woman was impregnated, and the plot hinges on the question of the child's legitimacy. By the way, the Jewess is now pregnant with her third child, according to a recent letter.

We shall do so much in the years to come,
But what have we done today?
We shall give our gold in a princely sum,
But what did we give today?

We shall lift the heart and dry the tear,
We shall plant a hope in the place of fear,
We shall speak the words of love and cheer,
But what did we speak today?

-Nixon Waterman.

THE DOCTOR'S AMUSEMENTS.

Edwin Thomson, Kansas City, Mo.

Physicians are sometimes amused
By what they hear folks say;
For medical terms are abused
By laymen every day.

They're barbarously misconstrued
Beyond identity,

And frequently laughs subdued
When heard by the M. D.

Post-mortem hemorrhages would
Be freakish things, indeed;

But when words are misunderstood
'Tis easy to mislead.

Post-partem is the term that they
Mean to communicate;

Alluding thus they misconvey,
And make a bad mistake.

And these are easy recognized,
Although quite frequently
Pronounced and sad epitomized
In ways most horribly;
Typhord is just colloquial
For typhoid, and so is
Cerebral known as cerberal;

Some say they've rheumatiz!

Incorporating

The Kansas City Medical Index-Lancet

An Independent Monthly Magazine

Under the editorial direction of

CHARLES WOOD FASSETT and S. GROVER BURNETT

ASSOCIATE EDITORS

P. I. LEONARD, St. Joseph
JNO. E. SUMMERS, Omaha

CONTRIBUTING EDITORS
JOE BECTON, Greenville, Texas
HERMAN J. BOLDT, New York
A. L. BLESH, Oklahoma City
JACOB BLOCK, Kansas City
G. HENRI BOGART, Paris, Ill.

ST. CLOUD COOPER, Fort Smith, Ark.
T. D. CROTHERS, Hartford, Conn.
O. B. CAMPBELL, St. Joseph
W. T. ELAM, St. Joseph
JACOB GEIGER, St. Joseph

S. S. GLASSCOCK, Kansas City, Kan.
J. D. GRIFFITH, Kansas City
JAS. W. HEDDENS, St. Joseph
GEO. H. HOXIE, Kansas City
DONALD MACRAE, Council Bluffs
L. HARRISON METTLER, Chicago.
DANIEL MORTON, St. Joseph

D. A. MYERS, Lawton, Okla.

JOHN PUNTON, Kansas City

PAUL V. WOOLEY, Kansas City

W. T. WOOTTON, Hot Springs, Ark. HUGH H. YOUNG, Baltimore

DEPARTMENT EDITORS

KANSAS CITY

P. T. BOHAN, Therapeutics
C. C. CONOVER, Diagnosis

DON CARLOS GUFFEY, Obstetrics
H. C. CROWELL, Gynecology
FRANK J. HALL, Pathology

J. E. HUNT, Pediatrics

JOS. LICHTENBERG, Ophthalmology
HERMAN E. PEARSE, Surgery

J. ELLIOTT ROYER, Neurology
R. T. SLOAN, Internal Medicine
R. L. SUTTON, Dermatology
EDW. H. THRAILKILL, Rectal Diseases
ST. JOSEPH

J. M. BELL, Stomach

C. A. GOOD, Medicine

A. L. GRAY, Obstetrics

J. W. MCGILL, Rectal Diseases

L. A. TODD, Surgery

OMAHA

H. M. McCLANAHAN, Pediatrics H. S. MUNRO, Psychotherapy

DES MOINES

WALTER L. BIERRING, Medicine

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

Vol. XXXII

FEBRUARY, 1913

EPIDEMIC MENINGITIS.

Editorial

Dr. Sophian is the practical exponent of that knowledge acquired by the strictest attention to minute detail, and the most painstaking care and patience which characterizes the laboratory worker in the cause of scientific medical research. Experiment and observation constantly and indefatigably repeated, errors corrected and oversights remedied, for weeks and months at a time, until finally accurate conclusions are formed, which stand the test of criticism, and show the same results in the hands of other investigators. This is evidently the laborious path he has trod, and he has had the opportunity of demonstrating the practical value of laboratory work in the outbreak of the epidemic of cerebrospinal meningitis last year in Texas, where he acted as chief adviser to the Boards of Health in the afflicted communities-notably Dallas.

No. 2

In Dr. Sophian's lecture to the Buchanan. Andrew County Medical Society, given in the assembly hall of the Public Library, at St. Joseph, on January 15th, 1913, he said that the experimental work looking toward successful serum treatment of this disease was done in 1905-1906, and the first really practical work in 1907, by Flexner of the Rockefeller Institute, in New York, who established the fact that the serum must be injected into the spinal fluid to successfully combat the disease. It is a highly infec tious and contagious disease, and his observations, taken during the epidemic, showed that as many as 70 per centum of healthy people harboring the causative micro-organisms in their noses or throats. Natural immunity, with healthy mucous membranes, saved the majority of these people from contracting the infection. The portal of infection is through the nose or

throat to the blood current, causing a general bacteremia, later being carried to the meninges of the brain, producing meningitis. Treatment consists in the care of both the sick and healthy. The latter by means of reasonable quarantine regulations. He characterized arbitrary quarantine as a mistake, stating that accurate measures should be used by making suitable cultures, and quarantine enforced as long as the offending cocci persist in the nose and throat. Care should be taken to differentiate these cocci from pseudo and similar varieties, which are Gram negative. Differentiation must be made by suitable cultural examination.

Active measures of prophylaxsis are to prevent crowding in public places, prohibit spitting, and local spraying of the nose and throat, with mild antiseptic solutions, of persons suffering with colds, who are the most susceptible to infection.

Various antiseptic solutions have been used; among them being hydrogen peroxide, argyrol, menthol, chlorine water and pyocyanase. The anti-meningitis serum has also been used as a spray for the nose. The following are the detailed instructions for the disinfection of the nasopharynx as issued by the French Army in 1910:

1. All carriers must have the nasopharynx, mouth and tonsils carefully disinfected by antiseptic inhalations and swabbing.

2. For inhalation the following mixture is recommended: iodine 12 grms.; guaiacol, 2 grams; thymol, 25 per cent.; alcohol, 60 per cent (200 grams).

In order to dissolve the iodine six grams of iodide of potash should be added to the mixture. This mixture is put into a porcelain which is floated in a basin of boiling water. The patient is directed to sit with his head bent over this at a few inches distance and to inhale the fumes, treating slowly through each nostril. The sitting The sitting should last two or three minutes and should be repeated five times in twenty-four hours. Dr. Sophian states that in his experience very satisfactory results may be obtained by using a preliminary cleansing salt solution douche for the nose and gargle for the throat followed by spraying with peroxide 4 to 2 per cent. Internally urotropin (hexamethylenamine) in 15 to 30 gr. daily doses may be used. This drug finds its way into the cerebrospinal fluid and is also excreted by the nasal mucous membrane.

The anti-meningitis serum in doses of 5 to 10 c.c. injected subcutaneously may be used as a prophylactic. It produces a high and immediate immunity which however is

usually only temporary, lasting about two to three weeks. Another objection is the fact that it is frequently complicated by serum sickness and sensitizes the patient, so that he is exposed to the danger, remote as it may be, of anaphylaxis should he be later again injected with the serum.

However, vaccines injected subcutaneously in three doses at week intervals of 100 million, 500 million and 1000 million killed bacteria, have been used successfully, and give a high and prompt immunity to the individuals treated.

Active curative treatment is obtained by the production and injection into the spinal fluid of an immune serum. The serum is obtained by immunizing a horse by the methods indicated by Jachman, Wasserman septic phenomena and Flexner. The symptoms to combat are and hydrocephalis. Sepsis is best treated by subdural injections of the anti-meningitis serum at proper interval and in suitable doses.

Hydrocephalis, due to pressure of the cerebrospinal fluid in the ventricles of the brain, is best relieved by lumbar puncture, and drawing off a portion of the offending fluid. In performing this operation the blood pressure should be taken and carefully watched by a competent assistant, as a drop of over 20 m. m. of mercury indicates extreme danger to the patient.

When injecting the anti-toxic serum the syringe method is open to objection, as it is difficult to control, and is more liable to be accompanied by a large fall in blood pres

If shock occurs during the operation the patient should be raised, the injecting needle left in place, and the fluid withdrawn till response is noted, with also the internal use of atropin and cocaine, as the latter is especially useful as a respiratory nerve center stimulant.

General anesthesia should not be given, when administering serum therapy, unless absolutely necessary, and then only with extreme caution, on account of its depressing action on the respiratory nerve centers. The repetition of the injection of the antitoxin serum should be made every twentyfour hours, usually to the extent of two or three days consecutively, being guided by the change in the cerebrospinal fluid and by the clinical condition of the patient. Improvement is indicated by the diminution, later disappearance of the meningococci in the cerebrospinal fluid and by their inclusion within the polymorphonuclear leucocytes. With each injection absolute aseptic precautions must be employed. As a substitute for the syringe method of injection

he suggested the use of a simple gravity apparatus devised by himself.

The serum acts locally by its phagocytic action on the meningococci, and this action can be suitable measured when it is possible to obtain the opsonic index of the cerebrospinal fluid.

General treatment of patient is with plenty of water by the mouth or rectum, and the administration of urotropin internally, with stimulants to keep up the action of the heart, and maintain the normal blood pressure.

Complications are, at times, extreme emaciation with an occasion lingering and chronic case. Early treatment will prevent these cases of chronic meningitis, but when they do occur vaccination with killed bac teria will be found useful.

A dry spinal puncture may indicate a very thick plastic exudate or drying up of the canal. The latter condition may be divided into a true drying up of the whole canal, including the subarachnoid space and ventricles, and into the condition of posterior basic meningitis. The latter consists of a dry subarachnoid space shut off from the ventricles which are distended with dammed up exudate. In the latter condition the ventricles should be directly. tapped by trephining the skulls of adults, or through the fontanelle in infants, with injection of serum antitoxin directly into the ventricles.

Joint complications are very common, occurring in as many as 1 per cent of the cases. In most instances the joint inflammation resolves quickly without special treatment. Occasionally, however, where there is very considerable persistent distension accompanied by general symptoms of sepsis, it may be necessary to aspirate the joint and introduce the anti meningitis serum into the synovial sac.

Pyelitis quite frequently occurs, and is shown by the appearance of pus and meningococci in the urine.

Pneumonia complications require general treatment, similar to that given for a pneumococci infection.

Persistent chronic bacteremias, where the meningococci are found circulating in the blood current, are difficult to handle, but can be treated, with advantage, by injection of antitoxic serum subcutaneously, and by vaccination.

To recapitulate: It is essential to make an early diagnosis of the disease.

Not to shock the patient in treatment. Push the serum treatment, as it shortens the course of the disease, and avoids com. plications.

Best results are obtained when treatment is begun during first three days of disease. Character of treatment is an essential factor. It should be of the best obtainable. Statistics show a mortality of about 20 to 30 per centum in cases treated, as against 70 to 80 per centum in the untreated.

Horses and household pets may become carriers of the disease.

A turbid cerebrospinal fluid is a good reason for the use of serum, where a microscopical examination is not practicable. HERBERT LEE.

LOCO DISEASE; WHAT IS IT? Loco, an adverb, a sign in music to return to a certain pitch after having played a higher octave.

Loco, a transitive verb; locoed; locoing; the changing of the mental status to one of discord; to an unreasonble, insane trend without return to the pitch designated by the musical notes of the normal mind after having played a discordant higher octave.

Loco, a noun, a name for poisonous plants and a name of the disease produced in animals feeding on the plants.

Loco-weed: a large number of leguminous, podded, bean producing, or, fabaceous herbs or plants as astragalus mollissimus, astragalus begelovii, aragallus spicatus and splendens are loco-weed producers. Botanically, astragalus mollissimus is one of the largest genera of seed plants, having more than 1,000 species. These plants are known as milk vetches and some species are loco-weeds.

Loco-disease: A chronic somewhat insiduous nervous disease produced in sheep, cattle and horses feeding on the loco-weed. The symptoms are defective vision, glassy staring eyes, an incoordinated or disturbed locomotion, as shown in a slow measured gait and high stepping and finally an insane delirium and general physical depreciation. Long ago the illiterate neighbor of the remote settlement met us on our first visit with the information that the patient was locoed." He had viewed a symptom picture of mental disease in the human as identical with that seen in the locoed animals. It was not uncommon knowledge to the layman as to what caused the disease and how symptoms and what kind of symptoms were produced though scientific research has at present solved little more than the clinical recognition.

Some four years ago Crawford of the Bureau of Plant Industry concluded experimentally that barium poisoning simu

Plans were discussed, and reports made upon cost, maintenance, and supervision, as well as upon the benefits to the profession of the clinical laboratories in the Western cities. A composite report will be submitted to the society at its next meeting in Kansas City, March 20. The members were guests of Dr. Morton at luncheon at the Elks Club.

lated pathologically and clinically the findings produced in rabbits poisoned by feeding them certain extracts of the loco-weed. Thus barium was construed as the poisoning agent in lieu of the former theory that toxtalbumins and the alkaloids of organic compounds were the mischief makers. Crawford's experimental investigations were both entertaining and fascinating in explanation of the formerly uninterpreted constituents of the milk vetches responsible MEDICAL SOCIETY OF THE MISSOURI for loco-disease. This, if true, meant much toward minimizing heavy losses to stockmen in many sections.

But it was not to be. The biologic report from the Bureau of Plant Industry by Alsberg and Black* indicates that barium does not stand sponsor for the toxicity following the ingestion of loco-weed. If this were true the poisoning of animals would be widespread inasmuch as many plants, other than milk vetches, throughout the West contain equally as much barium. The insolubility of barium as found in dried loco plants and even prepared extracts is demonstrated. Besides, the alkalin salts of calcium and potassium and metallic consti

tuents not barium are in sufficient quantity to account for Crawford's toxicity in the rabbit experimentation. Also it is shown that the pathologic findings and symptom picture of loco-disease as compared with brium poisoning are much the same only they are different-very dissimilar.

. The classical symptom complex was due to a toxicity not produced singly by barium. If barium was the active poison, it is reasoned, why should the insoluble compound formed by the sulphates not be antidotal? This question is experimentally answered negatively. So once again the refined and arduous labors of research has lead us around the circuit till we find ourselves facing the same rural informant who volunteers the same instinctive conclusion gleaned from the observation of the wiles of crude nature in all her simplicity, namely, that the deliriously or maniacally excited patient is still locoed. S.G.B.

CLINICAL LABORATORY COMMITTEE. The Missouri Valley Laboratory Committee held a meeting in St. Joseph, January 26, at which were present Drs. Daniel Morton, St. Joseph; Granville Ryan, Des Moines; E. H. Skinner, Kansas City, and A. B. McGlothlan, St. Joseph. Drs. C. W. Fassett and O. C. Gebhart, secretary and treasurer of the society, were also present.

*Laboratory Studies on the Relation of Barium to the Loco-Weed Disease, Bull. 246, 1912.

VALLEY.

Arrangements are

complete for the

Spring meeting of this society, in Kansas
City, March 20 and 21, under the presidency
of Dr. H. B. Jennings, of Council Bluffs.
The Arrangement Committee has wisely
chosen the Coates House for headquarters,
for the reason that the spacious banquet
hall will be utilized for the sessions, the
dinner will be served at this house, the
exhibits will be placed in the lobby and
thus we will have everything under one
roof so
to speak a great convenience
should the weather prove inclement.

An innovation has been introduced by presenting a large variety of subjects for the program committee, and in place of discussion, the papers will practically be confined to four topics, namely: Cancer, the Colon, Rheumatism, and Genital TuA glance at the preliminary program in another part of this issue will show an exceedingly interesting list of papers by men of Nation wide reputation.

berculosis.

A dinner will be given at the Coates at 6:30 p.m. Thursday, when members will be the guests of the Jackson Co. (Mo.) and Wyandotte Co. (Kas.) Medical Societies. Surgeon-General Rupert Blue will deliver an address after the dinner. Members will kindly notify the chairman of the ArHerman E. rangement Committee, Dr. Pearse, Rialto Building, of their intention to be present at the dinner.

The committee extends a cordial invitation to physicians in neighboring counties to attend this meeting.

"Come and break bread with us."

Perineal Sutures, according to Niewerth (Medizin. Klinik No. 46, 1912) should not be tied separately and cut off; they should be used of heavy silk, all tied together at the same time. and cut at the distal side of the knot. He found this procedure especially useful in those instances where it was necessary to remove the sutures without assistance. There is no tedious looking up of the suture nor an overlooking of sutures.

H.J.B.

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