September 11, 1897), i.e., tuberculosis as ordinarily defined. "(a) Tuberculin determines the presence of growing bacilli. To-day, as then, these words are true. All tuberculin determines is the presence of tubercle bacilli. Hundreds of cattle stand in their stalls with the precedent state. Thousands may likewise stand in favorable conditions to produce this state. Of these tuberculin says nothing. "This leads to another question: Has tuberculin value in diagnosis? No. Illustration: Mr. B. has the precedent state, i.e., tuberculosis as defined by the writer-no growing bacilli, induced by suspension of atmospheric influence. (Please observe, Mr. B. has the symptoms of tuberculosis as found in the first stage of the disease.) "An injection of tuberculin is made; no reaction. What does this injection determine? "(b) Tuberculin has no value in diagnosis. "But if there be stages in the disease tuberculosis, the first designated by absence, the second by presence, of growing tubercle bacilli; if tuberculin determine the presence or absence of these, is not the extract useful? "When the writer remembers the first stage is subject to control, the second simply amenable to treatment, this fact appears valuable should we possess an accurate means of determination. It is known to every practitioner that tuberculosis in its first stage is difficult to detect. The stage being determined, the physician knows for a certainty the result to expect from treatment—a valuable acquisition. "Can we with certainty differentiate the first stage by means of tuberculin? No. Illustration: Mr. C. is sick and calls on his physician. The symptoms simulate malaria. The blood is examined; no plasmodium found. A tentative injection of tuberculin is made; no reaction. What does this determine? The absence of growing bacilli. It has been shown that growing bacilli are absent in health. They are absent in many diseases. The mere absence of growing bacilli does not determine the first stage of tuberculosis; therefore : (c) Tuberculin has no certain value in differentiation of first stage." If, then, the microscope cannot determine the first stage of tuberculosis, if tuberculin has no value in diagnosis of the disease, what shall we do? Must we go back to our forefathers in order to diagnose? By no means. We must use the perceptives and recognize the true cause of tuberculosis. By this means we can accomplish much. What is tuberculosis? A constitutional disease dependent largely on the evils of civilization and governed by the following law: The death-rate from tuberculosis is in direct ratio to suspension of atmospheric influence. No suspension, no tuberculosis. Have we made this plain? In other words, the evils of civilization cause suspension; suspension induces the state that allows the tubercle bacilli to enter the system and grow. When the bacilli are found growing in one's system this is ordinarily called tuberculosis. The writer recognizes this as correct, but claims this condition is the second stage of the disease-in the present condition of medical science an incurable state. We then recognize a disease. when it is practically beyond our control. Why not recognize the disease earlier? Why not diagnose while the patient is curable? Why trust to tuberculin at all? What avails the statement, "He died of tuberculosis?” The postmortem so verifies. What hope to mankind, He has an incurable disease? Tuberculin so determines. In the language of R. H. Stodard, "What's the world to a man when his wife is a widow." Invitations are extended throughout the land to attend the slaughter of dumb animals. These animals are condemned by means of the scientific tuberculin test. They are incurable cases of tuberculosis. We are told in published statements there are no mistaken diagnoses. Science is lauded to the skies in its efforts for humanity. Could these dumb animals, like Baalam's ass, speak to the assembled multitude the writer thinks there would be a scientific awakening. Something of like miraculous nature must occur before science is willing to give up its idols. Medical science is so wedded to its present notions that reason and common sense are left in the back-ground. In answer to the question, what shall we do under existing circumstances, the reply must ever be-recognize the true cause of tuberculosis, abandon the germ theory of the disease in its entirety; diagnose by means of family history, environment, occupation and condition. of the patient, and use common sense and a clear knowledge of therapeutics in the treatment of the disease. We pledge our ideal reputation if these suggestions are clearly followed tuberculosis will lose its terrors and the germ theory will be as the phlogiston of a past history. On the Absorption of Iron. Austin (Boston Med. and Surg. Journal, March 2, 1899) concludes a paper on this subject as follows: i. That iron is constantly being eliminated both in urine and feces even during fasting. 2. That apparently raw meat furnishes an available form of iron for absorption under normal conditions. 3. That inorganic iron, as represented by ferrous sulphate, is non-absorbable, 4. That albuminates and peptonates of iron are absorbable, but to a limited extent. 5. That organic iron, of which hematin and hemoglobin are representatives, furnishes the most easily absorbable and most valuable of all iron preparations. - University Med. Magazine. To Remove Nitrate of Silver Stains from the Fingers. A correspondent of the Scientific American gives the following harmless process: First paint the blackened parts with tincture of iodine, let remain until the black becomes white. The skin will then be red, but by applying ammonia the iodine will be bleached, leaving white instead of black stains of nitrate of silver. Society Proceedings. THE ACADEMY OF MEDICINE OF CINCINNATI. Meeting of May 15, 1899. THE PRESIDENT, E. W. MITCHELL, M.D., IN THE CHAIR. ROBERT INGRAM, M.D., SECRETARY. Case of Lichen Ruber Moniliformis. DR. M. L. HEIDINGSFELD: A few months ago I had the pleasure to present to the Academy a case of lichen ruber verrucosus, which is an unusual type of this rather uncommon form of skin disease. It occurred in a young man, and the eruption at the time of the presentation was almost of one year's duration, and was distributed mostly over the lower extremities. In the earlier stages the forehead, forearms, small of back and buccal mucous membranes were also involved, and the efflorescences consisted of small, flat, polygonal, glistening papules, and at that time the type of the eruption was what has been designated as lichen ruber planus. This is by far the most common form of this disease, but other varieties or subdivisions are lichen ruber acuminatus, lichen ruber verrucosus, and lichen ruber moniliformis, the latter being an affection rarely recorded and seldom encountered. The eruption over the lower extremities manifested a tendency to grow warty, and at the time the patient was presented this character. was so prominent that the affection could be classed as a lichen ruber planus et verrucosus. To-night I have the pleasure to present a third type of lichen ruber, in which the glistening, purplish-red papules are arranged in linear form over the surface of the skin, which has been likened to strings of coral beads, and which distinctly presents that character designated as lichen ruber moniliformis. The glistening waxy papules in this particular case are rather large, quadrangular, longer than broad, sharply defined, many showing a central depression or delle. Their distribution is limited to the right leg, scrotum and penis, and the two largest patches are situated in the popliteal space and gluteal fold. The papules manifest a tendency to arrange themselves edge to edge, to form linear prominences, which, for the most part, run parallel to the underlying vessels and nerves, or the long axis of the body; intersecting branches are also given off, forming a sort of superficial network. The ap pearance is not unlike cheloid or a nevus neuriticus; the absence of an exciting cause rules out the former, and its spontaneous onset while the patient was two and a half years of age rules out the latter, and a history of progressive and regressive changes militates against both. The papules forming the lines are separated from each other by very narrow but sharply defined depressions, and the papules are joined by their narrow borders. Several have been excised for a microscopical examination. Pruritus, which has been an annoying symptom during the fourteen years of duration of the disease, has markedly subsided under the arsenical medication, which has been instituted in the form of Fowler's solution. Specimen of Tubo-Ovarian Abscess. DR. GILES S. MITCHELL: This specimen, a tubo-ovarian abscess, was removed this morning at the St. Mary's Hospital, Dr. Wenning assisting. Patient, Mrs. B., widow, aged thirtyeight years, gave the following history: Mother of one child, aged nine years. Had enjoyed uniformly good health until three years ago. At that time she had a severe attack of pelvic peritonitis, which lasted a number of weeks. Since that time she has been a semiinvalid, and suffered much pain, always exaggerated at the menstrual period. Menstruation always regular until eight weeks ago. Since that time pain has been constant and confined chiefly to right side. Saw patient for the first time two weeks ago. She was referred to me by Dr. Grimm. A digital examination revealed uterus enlarged to twice its normal size and only slightly movable, and a hard mass behind and to right of uterus. I requested her to go to the St. Mary's Hospital, informing her that an operation was necessary in order to restore her to health. After entering the hospital she began menstruating, and the flow continued quiet profusely for eight days. During this time the pain became intense, and her temperature ranged from 100° to 101° in evening and 99° in morning. The diagnosis was obscure except as to her septic condition. An exploration of pelvis after an abdominal incision was made revealed enlarged uterus and hard inflammatory mass in region of right broad ligament, covered over by loops of intestine matted together by inflammatory adhesions, the most dense I have ever encountered. Indeed, it was next to impossible to differentiate any of the structures, and I was almost willing to abandon the case as an inoperable one, but after persistent efforts I finally succeeded in enucleating the mass which I exhibit this evening. I consider myself fortunate indeed in being able to enucleate it without rupture. The tube on left side was distended with pus, and was liberated with much difficulty. The wound was closed by three rows of cat-gut sutures and a continuous sub-cuticular suture of silkworm-gut. Patient reacted promptly, and at six o'clock this evening her condition was satisfactory. Specimen of Ovarian Cyst with Twisted Pedicle. DR. RUFUS B. HALL: I have here a specimen of ovarian cyst that was twisted on the pedicle and the tumor was leaking into the patient's abdomen before removal. I think the history of the case will not be without interest. This cyst was removed from a young married woman, twenty-two years of age, living in Camargo, Ill. I received a telegram from her physician, Dr. I.W. Hall, last Thursday evening, May 11, asking me to come and operate for a tubal pregnancy. Her history is as follows: The woman was delivered of a child seventeen months before this attack, and since that time discovered that she had a small tumor in her left iliac region about the size of a goose egg. It was movable, but not painful, and she said as long as it did not hurt her she was not going to bother with it. Four days preceding the operation she was taken with an uneasy sensation in her abdomen, which gradually increased until the end of twelve to fourteen hours, and after sixteen hours had passed she was obliged to send for her physician, who gave her a hypodermic of morphine, she was suffering so severely. The tumor at that time was about the size of a closed hand. She rapidly grew worse, and at the end of eighteen hours she went into collapse. The pulse for several hours was above 140, and it looked like she was going to die. In two days' time the tumor had increased from the size of a closed hand to quite a good deal larger than an adult head, and that, with the history of collapse, led the doctor to believe that he had a ruptured tubal pregnancy, and that this increase in size so rapidly was due to a blood-clot. Now, the rapid increase of the tumor can only be explained satisfactorily by the twisting of the pedicle of the tumor. It was twisted four or five times on itself, and on removal had very much the appearance of the umbilical cord of an infant which was twisted. The twist of the pedicle cut off the return flow of the venous blood, but did not affect the blood-supply through the arteries. The blood-vessels which ruptured bled into the tumor itself, and then, to add to the gravity of the case, the cyst gave way. a multilocular three-wall cyst, and, as you will see, one of the cysts gave way and the women bled into the abdomen. There was about half a gallon of fluid in the tumor itself and about the same quantity in the abdomen. The tumor was as black as a man's hat when removed, but after washing it with salt solution and placing it in formaldehyde solution it has become comparatively lighter in color. I washed the patient's abdomen out and drained it. The patient, I am glad to say, has improved rapidly since. It was This case illustrates in a marked manner the danger which may come from a small tumor with a long pedicle. There could hardly be a worse accident than a twisted pedicle in an ovarian cyst. Specimens of Eruption of Smallpox DR. B. F. LYLE: In connection with the topic for this evening I wish to present these specimens. This one is a fetus of five months' utero-gestation, and the eruption of smallpox is plainly visible on the skin. This is an infant twenty-one days old, which came into the hospital when five days old with its mother, who had smallpox in the pustular stage. The baby was fourteen days old when the papular eruption was noticed, and died at the age of twenty-one days, the eruption being in the pustular stage. DR. LYLE then read a paper (see p. 25) entitled Some Points on Smallpox. DISCUSSION. DR. BYRON STANTON: I did not expect to say anything to-night, and consequently did not prepare myself to make any remarks. What I have had to say on the present epidemic I said. before this society a few weeks ago, and I have very little to add to what I then said. I regret that Dr. Probst could not be present with us this evening, for I think we could not find in Ohio a man who is as well prepared to speak on this subject as he, for he has devoted much of his time during the last thirteen months to the study of this epidemic. We have had up to the present time in the State of Ohio very nearly 1,700 cases; since the first of January there have been about 1,025 cases up to the latter part of last week. Out of that number, up to the present time there have been reported but nineteen deaths. You can see the mortality has been very low. This fact is not only peculiar to the epidemic as prevailing in Ohio, but as it has prevailed over the entire country. This disease spread over almost the entire United States, and in almost every State the mortality has been as low as it is in Ohio, with the exception of California. There the mortality has been greater; in Los Angeles there were fifteen deaths out of eighty-five cases. I do not know how many deaths have occurred since these. The greatest number of cases occurred in the State of Alabama, where they had up to the first of January this year about 6,000 cases. In North Carolina they did not have quite so many cases, with a mortality of 1 per cent. The peculiarity of this epidemic, referred to in my remarks before the Academy on a previous occasion, is the extreme mildness of the epidemic-the mild character of the disease, the low mortality, and the fact that many of these cases did not present the typical appearance of the eruption, so that if the physician had seen only some of the cases which occurred the diagnosis would be made with great difficulty, but it has happened in almost every family where the disease presented itself that mild cases have occurred together with marked cases of the disease. I saw one family in which there were seven cases. Three or four of the children were playing marbles while I was there, and the father was in bed with a very bad case of smallpox, about as bad as I have seen. All the other cases in this family were of a mild variety. The experiments which have been made by Dr. Lyle illustrate the character of the disease in this epidemic. Referring to vaccination the doctor said he had vaccinated one hundred cases of persons who had had smallpox, and in only one case did the vaccination take, showing there was something which protected the other ninety-nine from vaccinia. There is nothing which will prevent variola except successful vaccination. The fact that one person was successfully vaccinated does not show that the disease previously contracted was not smallpox, for investigations of this kind have been carried on in England, and there were a larger number of persons who had had smallpox who were successfully vaccinated. Smallpox will no more prevent the disease than will successful vaccination; indeed, there have been cases of persons who have been vaccinated successfully One of the difficulties which have been encountered in the recent epidemic, on account of the mildness of the disease, has been the matter of quarantine and disinfection. The old fogies in the profession had a large influence in this direction. There are some of these men who even go so far as to deny that we have had any smallpox in Cincinnati this winter, and the most opposition has come from the older physicians, and I hope this will be a warning to all of us not to grow old, or at least not to grow so old that we cannot make up our minds that diseases will change. Why there should have been these changes in the clinical features of this disease I cannot explain. I have heard some persons explain it on the theory that vaccination having been practiced for so many generations has rendered persons more or less immune to this disease, but this theory is not correct, and cannot be accepted as a satisfactory explanation for the mildness of this epidemic, for this change was too sudden. Smallpox was just as fatal a few years ago as it ever was (and this fatality has been shown by the statistics of Dr. Lyle), and the change has been too sudden to have been brought about by any such influence. RESINOL CHEMICAL CO., Gentlemen: I have been using your Resinol Ointment for about two years. I first used it in an obstinate case of scrotal eczema, and the result was magical. Since then I have prescribed it in cases of pruritus ani, pruritus vulvæ, eruption of poison oak, hemorrhoids, herpes and tinea capitis, and in all cases the results have been very gratifying. I think a fair trial will convince the most sceptical of the value of the ointment. It has given me better results, in the class of cases in which I used it, than anything I have used in twentytwo years' general practice. Wishing you the success your remedy deserves, I am, Yours very truly, Providence, R. I. |