Journal of Medicine and Surgery J. J. CASSIDY, M.D., EDITOR, 69 BLOOR STREET EAST, TORONTO. Oral Surgery-E. H. ADAMS, M.D., D.D.S., Toronto. Gynecology and Obstetrics-GEO. T. MCKEOUGH, M.D., Medical Juriqrudence and Toxicology-ARTHUR JUKES W. A. YOUNG, M.D., L.R.C. P. LOND.. GENERAL MANAGER, 145 COLLEGE STREET, TORONTO. Pharmacology and Therapeutics-A. J. HARRINGTON M.D., M.R.C.S.Eng., Toronto. Medicine-J. J. CASSIDY, M.D., Toronto, Member Ontario St. Michael's Hospital, and Victoria Hospital for Sick Mental and Nervous Diseases-N. H. BEEMER, M D.. Public Health and Hygiene-J. J. CASSIDY, M.D., Toronto Professor of Diseases of Children Woman's Medical Ophthalmology and Otology-J. M. MACCALLUM, M D., Laryngology and Rhinology-J. D. THORBURN, M.D., Address all Communications, Correspondence, Books, Matter Regarding Advertising, and make all Cheques, Drafts and Post-office Orders payable to “The Canadian Journal of Medicine and Surgery,” 145 College St., Toronto, Canada. Doctors will confer a favor by sending news, reports and papers of interest from any section of the country. Individual experience and theories are also solicited. Contributors must kindly remember that all papers, reports, correspondence, etc., must be in our hands by the fifteenth of the month previous to publication. Advertisements, to insure insertion in the issue of any month, should be sent not later than the tenth of the preceding month. VOL. XIII. TORONTO, FEBRUARY, 1903. Editorials. NO. 2. ONE OF THE FREAKS OF MEDICAL NOMENCLATURE. IN Volume XXV., No. 20, The Literary Digest, appeared an allusion to a paper read by Dr. Charles W. Stiles at the recent Sanitary Conference of American Republics at Washington. Reference was made in this paper to uncinariasis, a disease said to be prevalent in the Southern States, where, according to Dr. Stiles, it is commonly mistaken for malaria, and is responsible for many of the peculiarities of the "poor whites," including chronic laziness, "dirt eating," etc. 66 In describing the symptoms of the disease, Dr. Stiles asserted that it created an abnormal appetite for different things in individual cases, and that the dirt eaters were almost all sufferers from it. The disease itself, he asserted, was not due to the habit of eating dirt, as some physicians have claimed, but that, reversely, the habit itself was due to the disease. The famous "pickle-eaters" of North Carolina were also sufferers from the disease, and their abnormal and peculiar appetite was the result of a certain stage of the disease. We are not disposed to discuss the statements made by Dr. Stiles, the value of which will have to be settled by clinical and experimental evidence. In this article we wish to draw attention to the word "uncinariasis." In the Literary Digest it is spoken of as a parasitic disease. Curious to learn what might be the real character of this parasite, we looked for uncinariasis in the American Illustrated Medical Dictionary, 1901, but failed to find such a word. Webster's International Dictionary, 1902, was also silent on uncinariasis. The etymology of the word suggests a disease produced by hooklets (uncus, a hook). Finally, in an article on diseases of the stomach, etc., which appeared in Progressive Medicine, December, 1902, Max Einhorn threw some light on uncinariasis. He says: "As is well known, uncinariasis is a chronic disease due to the infection by a small thread worm, known as the uncinaria duodenalis (ankylostoma duodenale), which is characterized clinically by intense anemia, dyspnea, weakness, gastro-intestinal disturbances, and in advanced cases by edema of the face and extremities, and serous effusions into the cavities of the body. Dr. Einhorn goes on to say: "It must not be supposed that all those who are infected show symptoms of uncinariasis; far from it, as many are strong and healthy. The weak and poorly nourished are those who are least able to withstand the loss of blood occasioned by the parasite." Once understood as the equivalent of the ankylostomiasis, the term uncinariasis is intelligible enough. We do not agree with Dr. Einhorn, however, that this fact is well known, and we would refer Dr. Einhorn to the dictionaries already mentioned and to the Practice of Medicine, by Anders, Fourth Edition, 1900, where under the heading Ankylostomiasis, a description is given of the Ankylostoma duodenale (Dochmius duodenalis), with the pathology, symptoms, diagnosis and treatment of the disease; Anky but no allusion is made to uncinariasis. Anders says: lostomiasis is not uncommon in tropical countries (Italy and Brazil). In Italy it has been termed tunnel or mountain anemia; in Belgium it is known as brickmaker's anemia,-again it occurs among workers in coal mines-miner's cachexia. In this country it is rare, although alleged to have been seen in the Southern States. The importation of infected Italian, Hungarian, and Polish laborers may, at some future time, cause the propagation of the ankyloma parasite in the United States." It is quite evident, therefore, that Dr. Stiles totally differs from this view, as he thinks uncinariasis, the disease produced by the presence of the ankylostoma duodenale, is common in the Southern States. As already stated in this article, the correctness or falseness of Dr. Stiles' theory with regard to the peculiar form of anemia affecting the poor whites" of the Southern States should be easily settled by an examination of the feces of the anemic patients for nematodes or their ova. 66 If it can be proved that "dirt eating" in South Carolina, and pathologic "pickle eating" in North Carolina are due to the influence of the ankylostoma duodenale, the correctness of Dr. Stiles' position on this question will have been established. Under such circumstances, he might be allowed the privilege of coining a new name for ankylostoma, since he will have enormously extended the domain of this nematode. It is different with Dr. Einhorn, who uses uncinariasis and ankylostomiasis in the same terms, only he assumes, what he has no right to do, to give the preference to the former. We also notice that the editor of the Journal of the American Medical Association (Jan. 3, 1903), writes of "ankylostomiasis, or, more properly speaking, uncinariasis." Writers for the medical press should not use scientific terms with the airs of assured authority until these terms have received the stamp of the best usage. J. J. C. EICHHORST'S VIEWS ON THE TREATMENT Of diabetes. PROFESSOR EICHHORST announces his latest views on the treatment of diabetes in a communication to the Medical Society of Zurich, which has been published as a recent fasciculus of Therapeutische Monatshefte. He places all medicaments under the ban, as, according to him, salicylic acid, salol, carbolic acid, antipyrin, etc., which have been tried in mild, medium, and severe cases of diabetes, have been all found equally powerless in effecting the slightest diminution in the patient's glycosuria. He goes further. In a certain number of cases of this malady in syphilitic patients, in whom everything seemed to indicate the existence of a causal relation between the syphilitic infection and the diabetes, specific treatment with mercury and iodide of potassium did not nullify the glycosuria to the slightest extent. He even goes so far as to say that medicines are positively hurtful in this malady, inasmuch as they furnish the diabetic patient who trusts in their efficacy, a pretext for following his dietetic regimen less closely than he ought to. Eichhorst has no faith in the use of mineral waters as a cure for diabetes. He admits that after a season at Carlsbad or Neunahr diabetic patients observe a considerable diminution in and occasionally a complete absence of sugar from their urine. This result, however, he attributes to the rigorous dieting to which these patients are obliged to submit during their stay at these stations, so much so, that equally good results might have been obtained in their cases if they had followed a suitable diet at home. He does not advise alcohol in diabetes. As calorific agents, he prefers butter, lard, cream, ham, smoked salmon, fatty cheese, sausage, which have the advantage of introducing a certain amount of variety into the patient's diet. As a beverage, he orders plain water or an alkaline water, to which some lactic or citric acid has been added, and even whole milk, in spite of the fact that it contains sugar of milk. Weak coffee and tea are permissible. As to cocoa, it is necessary before ordering its regular use to ascertain if it increases or not the glycosuria. The well-known dietetic treatment, which it is unnecessary to describe, is, according to Eichhorst, the only rational treatment of diabetes. Cases differ, however, and the method of placing a diabetic patient under such a regimen is not the same for all. Should the strict dietetic treatment be commenced immediately or gradually? Eichhorst prefers to go slowly. In some cases he has observed that the sudden deprivation of farinaceous food and sugar has provoked serious digestive troubles, emaciation, and the appearance in the urine of diacetic acid and acetone, which indicate the evolu tion of an auto-intoxication leading in the direction of diabetic coma. None of these phenomena appear when the physician dimin ishes gradually the quantity of sugar and carbohydrates in the patient's diet, and gives the organism the time, so to speak, to adapt. itself, little by little, to the new conditions of alimentation. It sometimes happens that the total privation of sugar and the carbohydrates is badly borne by the patient, who becomes alarmingly thin. Eichhorst allows such patients small quantities of bread and sugar, for, in his opinion, a diabetic patient in fairly good health, with a small quantity of sugar in the urine, is preferable to one who loses flesh and strength, although his urine may be sugar-free. Eichhorst weighs his patients regularly, the scales being, according to him, the best means in the hands of the physician for learning how his patient stands the diet he is obliged to use. A diabetic patient who has lost flesh ought to hold his own after his diet is suitably arranged, and if the scales show a fresh loss of weight, the rigor of the diet must be lessened. Briefly expressed, Eichhorst's teaching is that, in the treatment of diabetes, the first point to attend to is the PROGRESSIVE establishment of a special diet, the effects of which ought to be controlled at intervals by weighing the patient; the second is to eschew all medicaments, alcohol included. J. J. C. PROFESSOR LORENZ IN NEW YORK. THE celebrated German orthopedic surgeon, Dr. Lorenz, came to New York on Monday, the 15th ult., and since that time has been busily occupied holding clinics in various places; at Cornell Medical College, at the Hospital for Ruptured and Crippled, at the Hospital for Cripples on East 59th Street, at Beth-Israel and other institutions. The visit of Lorenz to New York was hailed with a mixed feeling of cordiality and prejudice. Many have regarded the visit of this surgeon as little else than a boom to exploit some unheard of impracticable procedure, others believed that he could teach us much that was original with himself, that he was a real benefactor, in the broadest sense of the term, inasmuch as he made no secret of his methods and invited his professional brethren to come and judge for themselves. |