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"POISONS" IN OHIO.

Under the statute of Ohio requiring the "poison and cross-bones" label on all medicines "the indiscriminate or careless use of which would be destructive of human life," the commissioner of that state recently instituted suits against two Toledo druggists for selling certain proprietary preparations in samples of which analyses made by two department chemists disclosed the presence of poisons as follows, the results of the two analyses being given under each preparation:

Mrs. Winslow's Soothing Syrup:

1. Contains morphine, about 1 10th grain to the ounce.

2. Per cent alcohol, 65-10; morphine, calculated as morphine sulphate, grain to

the bottle.

Ayers' Cherry Pectoral.

1. Contains morphine, about 1-10th grain to the ounce.

2. Morphine, as morphine sulphate, per cent, 0.364; about 2 grains to 11⁄2 fluid ounces. Scott's Emulsion of Cod Liver Oil:

1. Contains about 1-10th grain morphine to the ounce.

2. Morphine, 1 grain to 1 ounce. Calculated as morphine sulphate.

Dr. Birney's Catarth Powder:

1. Contains cocaine hydrochlorate, 2.50 per

cent.

2. Conforms to label. Cocaine hydrochlorate, 2.45 per cent.

Dr. Agnew's Catarrh Powder:

1. Contains menthol, bismuth and cocaine hydrochlorate.

2. Cocaine hydrochlorate, 5.32 per cent. Bromidia:

1. Contains 15 grains chloral hydrate to every fluid dram.

2. Conforms to label. Chloral hydrate practically 15 grains to 1 fluid dram. Νο alkaloids or coal tar preparations present. Dr. Wheeler's Nerve Vitalizer: 1. Contains bromide potash and chioral hydrate.

2. Alcohol about 10 per cent; chloroform, about 1 dram to 1 pint; chloral hydrate, about 5 grains.

We understand that the essential correctness of the above analyses is disputed by none of the manufacturers excepting Messrs. Scott & Bowne for their "emulsion," who, in a convincing interview, have entered a vehement denial, asserting that morphine has never entered into the manufacture of their product, and if any was found it must have been put there for a purpose.

The act of the commissioner has been fiercely assailed, but, it would seem, without sufficient cause. On the reports of his chemists he had no alternative but to take summary action by immediate prosecutions. These reports in the cases of the notorious catarrh powders, of the soothing syrup, "cherry pectoral," and "nerve

vitalizer" occasioned no surprise, and as to "Bromidia," the analysis merely verified the accuracy of its label; but the sensation was in the alleged discovery of morphine in an emulsion which was very extensively advertised as a food. Should the analyses of this emulsion prove to be correct, the men responsible for the terrible wrong inflicted upon the innocent Victims of their deception could not be buried in infamy too deep or lashed with punishment too severe. We cannot believe, however, that a reputable mercantile firm could be guilty of such criminal folly. We cannot but believe that the analyses are wrong, and if right, that they are of samples innocently obtained from a source hostile to the fame and prosperity of the manufacturers. This belief is strengthened by the sworn protests of the manufacturers, whose challenge for a complete investigation is so specific and positive as to compel the conclusion that they are the victims of a grave injustice.

But whatever may be the accuracy or otherwise of these reports, we agree with the Western Druggist in the declaration that the principle underlying the law and these prosecutions in Ohio is sacredly right. Too long have the makers of catarih powders and other infamous compounds pursued their way with. impunity. Morphine and cocaine in innocent disguise have been luring their tens of thousands to moral and physical destruction, and all because the people have been too indifferent or our legislators too busy or too readily influenced by the corrupt pleadings of a nostrum-fed press to come to the rescue. Every state has laws against the indiscriminate sale of poisons, which are not to be delivered to minors, nor to be sold without registration of the "quantity, kind and alleged purpose," but these same poisons, if sold under a disguised name or under false representations and promises, may be sold without limit or restriction if only put up and offered as a patent medicine. What peculiar sanctity attaches to a proprietary package or label that it should enjoy these remarkable immunities and privileges? A poison is a poison if sold honestly as a poison; it is more than a poison if concealed under the disguise of a "syrup," a "vitalizer," or any other of the seductive utles that human greed can devise. If we need laws against the sale of open poisons, we need them infinitely more aga nst these venomous secrets whose sting is in the dark and whose victims are the unsuspecting, the innocent and the helpless.

Osteopathy Once More.-The so-called osteopaths have recently made another bid for notoriety in this city. A noted (according to his own account) English bonesetter came to Chicago a few weeks ago, secured a suite of rooms in a prominent hotel, and in a spirit of philanthropy advertised that he would treat all cases without money and without price. He neglected, however, to go through the formality of obtaining a license to practice medicine, and so the state board of health, which has no bowels of compassion, rudely notified him to present his credentials, in default of which it would be compelled to refuse to allow him to carry on his great work of charity. In this high-handed action the bonesetter evidently saw a grand chance for free advertising, and he improved it. The interviewers thronged about him, and he expatiated upon his qualifications for practice (which have apparently not been verified), upon the cures he had wrought (which have not yet been demonstrated), upon the good he was about to do the suffering thousands of Chicago (which is thus far hypothetical), and upon the eminent medical men who were holding up his hands (one of whom is president of the notorious successor to the notorious Illinois Health University, and an. other the head of the so-called school of osteop. athy, which considers the knowledge of anatomy advisable but not essential, and whose cardinal requirement for graduation is apparently $300, and incidentally, if the student has time to spare, a little study).

The philanthropic gentleman, failing to succeed in his laudable endeavors, announced that he would treat patients by the hands of trained assistants under his direct supervision, but whether the afflicted could not swallow the transfer of his heaven-sent gifts to others, or whether they became aroused to the fact that even he was not possessed of divine attributes, at all events the patients did not materialize, the bonesetter shook off the dust of his feet against Chicago, and departed for the gray fields and foggy pastures of England.

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terraced lawns, with a broad driveway leading to the main entrance in the center of the Belden avenue facade.

The buildings, erected at a cost of nearly a quarter of a million dollars, are imposing in their simple and substantial elegance, of fireproof construction throughout, arranged according to the most approved hygienic plans and equipped with the most modern sanitary furniture and appliances. The only evidence of wood in the construction is in the doors and window frames; tiling, marble and plaster rendering the entire interior as well-nigh aseptic as possible through modern art. The heating, lighting and ventilation are perfect and effect a climax in the special operating room with an amphitheatre for students.

A great concourse of medical men and substantial citizens, patrons of the hospital, graced the occasion, the members of the staff acting as cicerones, with Dr. Fernand Henrotin as master of ceremonies. Among the many physicians present perhaps the most interesting was the tall, military figure of Dr. Ernst Schmidt, one of the founders of the hospital and the Nestor of the German medical profession in Chicago, together with his three stalwart sons, Dr. Otto L. Schmidt, the able and active physician in charge; Fred M. Schmidt, the well-known member of the state board of pharmacy, and last but not least, Richard Schmidt, the architect, to whose untiring energy and skill the noble edifice owes its construction. The hospital has a capacity of about 700 beds.

Anesthetics. The following statistics are given in the British Medical Journal by Mr. H. Bellamy Gardner, (Medical Review of Reviews): Chloroform..... 1 death in 3.258 1 death in 14,987 The personal experience of Dr. Gurlt of Berlin showed

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Abuse of Medical Charities.-The St. Louis

Medical Society appointed a committee to investigate the abuse of medical charity in that city. The work of this committee is voiced by Dr. Emory Lanphear in the American Journal of Surgery and Gynecology. The actions of this committee are endorsed by all save about one hundred members of the medical fraternity of St. Louis, and wherever charity abuse is practiced comes forth the cry "Amen! Brother Lanphear! and God speed you! The way of the reformer is hard, and Dr. Lanphear will doubtless be brought to realize how truly "Restorations are the most bloody of all revolutions." The Medical Standard heartily endorses the good work so heroically begun by this committee. To the Chicago Medical Society we would say, "Go ye and do likewise."

Specialism. The following declarations concerning the mutual obligations of the specialist and the physician have been formulated by the Medical Society of the Ninth District of Vienna (Med. Record): (1) The specialist is a physician who renounces practice in all branches of medicine with the exception of a well-defined part. (2) The specialist should undertake no treatment without an understanding with the physician of the patient or of his family. (3) The physician should be informed of the diagnosis made, and his advice should be sought for important interventions. (4) If it is not possible for the physician to direct the treatment to be followed, the specialist should permit him to take part in it to the extent of his aptitude. (5) The patient can not be sent by the specialist to a third physician unless with the consent of the physician in ordinary.

The Laryngoscope.-The editors of the Laryngoscope announce that with the January, 1898, issue a foreign edition of their journal will be published by Messrs. John Wright & o., of Eristol, England. This is a new departure in the field of special medical journalism, and is a distinct recognition of the esteem in which the American specialists in d seases of the nose, throat and ear are held abroad We congratulate the Laryngoscope, and wish it success in the new venture.

Must Alcohol Go?-The Woman's Christian Temperance Union held their international annual meeting last month in Toronto. As usual fanaticism did not fail to crop out. Mrs. S. J. Cray, in her blue ribbon enthusiasm,

told the convention it was necessary to have the co-operation of the doctors in temperance work, and recommended that physicians be at once requested to immediately "use something other than alcohol as a basis in their prescriptions." Will the well-meaning but over-zealous Mrs. Cray of Compion, Que., be so accommodating as to supply the medical fraternity with an efficient substitute before she would have us discard an indispensable article? It is not difficult to condemn, but it is another thing to recommend.

The Communion Cup.-The Canadian Journal of Medicine and Surgery notes with satisfaction that at a meeting of the American Publ c Health Association in Philadelphia a resolution was adopted endorsing the actions of a number of churches in adopting the use of a number of individual cups in administering the communion wine. What will the good Deacon Doctor of the old school say to this? Are we not to be privit ged to eat at the Lord's Supper without having our minds distracted by the germ phobia? However, we endorse the action of these churches, and hope all will follow their example. Aside from the prevention of infection, such a custom recommends itself in its sense of refinement.

Actinomycosis in Man.- Dr. John Ruhrah of No. 953 Madison avenue, Baltimore, asks to be permitted to make use of the columns of this journal to obtain information concerning the occurrence of actinomycosis hominis in America. He has collected all the pub ished cases and feels sure that others have been observed. He will be grateful for ful notes on these cases. In addition to the general description he would like to know at what time the organism was observed, what the surgical and medical treatment was, and the result. He would also like any notes on cases already published where further developments have occurred, and will give full credit to the observers when the collected cases are reported.

Testimony and Compensation.-The Illinois supreme court has decided, in a test case, that unless a stipulation has been made, physicans must give expert testimony in court when called upon without other compensation than regular witness fees. This decision should p ompt the profession of the state to an active effort to secure the enactment of a statutory provison which will assure to physicians their undoubted rights in this relation.

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INFECTION AND INFLAMMATION OF THE REPRODUCTIVE ORGANS IN WOMEN.

GENERAL CONSIDERATIONS.

BY E. C. DUDLEY, A. M., M. D.,

PROFESSOR OF DISEASES OF WOMEN, NORTHWESTERN UNIVERSITY MEDICAL SCHOOL; GYNECOLOGIST TO
ST. LUKE'S HOSPITAL, CHICAGO,

ETIOLOGY.

Infection of any one of the reproductive organs is liable to have the closest relations to similar infection of a part or all of the others. For this reason an intelligent consideration and satisfactory explanation of the morbid processes in any one organ may necessitate a study of the infection of the pelvic organs as a whole.

The distinction between infection and inflammation is of the greatest practical importance. Infection is that condition in which foreign media of irritation have gained access to the body and, either mechanically or by means of their products, disturb its functions. These media are capable of being transmitted to other individuals; at least the invading irritant, if known, is of bacterial origin in most cases. The organisms unless arrested are prone to multiply, to spread into new territory, to transmit their toxine products to the general circulation and may even destroy life.

The local territory irritated by the organisms and their toxines, becomes a center to which leucocytes in large numbers rapidly migrate, and in this way the process often called seroplastic infiltration is established. By this infiltration a limiting wall is formed around the infected space. This wall confines the infective process to narrow limits and may protect the general system against the poison. The formation of the limiting wall gives rise to heat, redness, pain and swelling; this is inflammation. In view of these facts inflammation is not really the disease, but an effort to limit the disease. The almost universal use of the word inflammation to signify the disease makes it difficult in the description of the morbid processes to conform to the ideas above expressed. The attempt will, ho^ever, be made to use the two words, infection and inflammation, in their proper relations.

It is important to remember that the study of the infection of an organ or a group of organs is simply the study of their anatomy and physiology as modified by that infection. The inflammatory process has been defined as the

* Revised from an introductory lecture given at the Northwestern University Medical School.

reaction which living tissue exhibi s to morbid irritation. This definition being correct, two conditions must be essential for the development of the infection:

1. The soil must be prepared and ready to react to the morbid irritation. Clearly, tissue which has the power to resist the irritation and to hold it within physiological bounds will no: inflame.

2. The irritating influences must be presen'. These conditions divide themselves into predisposing and exciting causes. The predisposing causes may be systemic or local.

The Systemic Predisposing Causes include whatever tends to render the system less resistant to morbid influences. The so-called diatheses fall under this head; anemia diabetes, rheumatism, gout. lithemia and cholemia are examples.

The Local Predisposing Causes comprise whatever contributes to make the organs an accessible and receptive soil for infection. They are obvious in the following anatomical and physiological conditions: The genital tract, from the vulva to the peritoneum, is an open canal patent to the atmosphere below and terminating above in the free open ends of the, Fallopian tubes. It is open not only to such microbic germs as abound in the air and penetrate everywhere, but it is also a place of deposit for virulent bacteria.

The rupture of the capillary vessels of the endometrium in menstruation and of the Graafian follicles in ovulation, although physiological, result in solutions of continuity and hemorrhage, and are therefore traumatisms. These traumatisms and the menstrual engorgement of the pelvic organs under healthy conditions pass by with little or no discomfort, but if some morbid irritation upset the normal balance of nutrition, the menstrual congestion may become pathological and may be the first stage of an inflammation, or the morbid congestion may be set up in the menstrual period independently of the menstrual congestion. The liability, however, to inflammation during the menstrual week is greater.

In addition to the physiological traumatisms already mentioned, the traumatisms of parturition, of abortion, of improper local treatment,

and of operations, still further open the way for the entrance of infections. Violent coitus, masturbation, the careless use of the unclean catheter, impure water in bathing and soiled linen in the toilet are some of the means by which gonorrhea syphilitic and other infections may develop in the genital tract.

The conditions of utero gestation, parturition and the puerperium are most perilous; hence, infection of the puerperal woman is more de. structive. Decomposed secretions and the products of fatty degeneration from involution and from the menopause favor the development of pathogenic microbes. Tumors, displacements, tight lacing and constipation are among the common local predisposing causes of morbid congestion in the pelvis. The predisposing causes already outlined clearly supply the first condition of infection-preparation of the soil.

The exciting causes comprise agents which have the power to produce and to maintain morbid irritation. Greatly preponderating, at least among these, are the pathogenic microbes and their products. The extent to which inflammation may be produced by irritants of non bacterial origin, without the presence of any bacteria whatever, is a question not fully settled. Among the pathogenic microbes not seldom found in the genitalia are the staphylococci and streptococci of suppuration, the bacillus tuberculosis, the bacillus coli communis and the pneumococcus of Fraenkel. Bladder parasites and the saprophytes from the rectum and colon have easy access. The bacillus coli communis lives in an acid media and can thus easily pass through the acid secretion of the vagina to the uterus.

The gonococcus of Neisser is one of the most frequent, destructive and insidious factors in genito urinary infection. Its chief power for harm lies in the lasting vitality of the germ long after apparent cure. The gonococcus may remain inactive in the mucous crypts, liable at any time, even while quiescent in the individual, to be communicated to another. Hence, many an innocent and previously healthy woman, shortly after marriage to a man who supposed himself to have been cured of gonorrhea years before, may by contact with the attenuated virus, get a destructive gonorrheal infection of the genito urinary organs.

Some most important observations have recently been made by Wertheim. He reports that human serum agar is the best culture ground for gonococci. In this culture, at 40 to 43 degrees Centigrade, they retain their full

reproductive capacity. A direct experiment from pure culture from a gleety discharge of two years' standing gave the following interesting results: (1) Attempted reinfection of the original urethra with this culture was always a failure. (2) The culture when transplanted to a coccus free urethra produced typical acute gonorrhea. (3) Infection from this back again to the original urethra gave a fresh gonorrhea, which, after a typical acute course of five or six weeks, again subsided into a chronic gleet. Thus by passing the gonococci through another individual-that is, through a new culture groundthey become again virulent to the urethra which was invulnerable to them before.

This explains the fact that an apparently healthy subject of chronic gonorrhea may infect his hitherto uninfected wife and become again infected from her; the gonococci by passing through the new culture of the wife again become virulent for the husband. In due time each becomes tolerant of the germ which, however, may develop acute infection in another person. The common notion that gonorrhea in women may be chronic from the beginning is weakened by the experiments of Wertheim. We can now understand why the gonococcus, even after years of apparent cure, may regain its full virulence.

It

The greatest danger is of extension to the Fallopian tubes. The microbe may be found in the uterus and tubes long after it has disappeared from the vagina. The pavement epithelium of the vagina and the presence of the lactic acid bacteria normally found there by Doederlein make the vagina relatively immune. The crypts of the uterine and tubal mucosa furnish a ready resting place for the germ1; even here, in many cases, it is only found during the exacerbations. Menstruation and the uric acid diathesis favor but do not insure its revival. may for a long period remain concealed in a semi quiescent state, a destroyer of health, a menace to life. The frequency of chronic gonorrhea-the latest gonorrhea of Noeggerath -has been variously estimated. There are reasons to fear, however, that the percentage is very high. Saenger announces that 25 per cent of his hospital and private patients have gonorrhea. Lomer found the diplococcus in fully 60 per cent of the cases in Schroeder's clinic. One observer places the average as high as 80 per cent.

The statistics above quoted are taken from clinics largely made up of prostitutes and semiprostitutes, a fact which will necessarily modify

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