Medical contributions respectfully solicited from Regular Physicians. The editor or publishers will not be responsible for the opinions expressed by correspondents. No attention paid to annoymous communications. Reprints furnished only at actual cost. Entered in the Post Office at Minneapolis, Minnesota, as Second Class Matter. SUBSCRIPTION PRICE United States, Canada and Mexico, per annum, in advance, $1.00 1.50 N. B. Matter for the reading pages should reach office of publication on the 20th of the preceding month and display advertising on the 25th, to insure attention. Vol. 5. The Code. MINNEAPOLIS, MINN., AUG. 1903. The American Medical Association, at the meeting in New Orleans, eliminated the word "code" from its by-laws, and adopted an "advisory document," which shall not be "mandatory," but called "The Principles of Medical Ethics," and made in explanation the following report by its committee: "Your committee has given extended and careful thought to the proposed revision of the code of medical ethics referred to it for consideration. As you will note, on the caption of the report the word 'code' has been eliminated, and the expression, The Principles of Medical Ethics of the American Medical Association' adopted as adequately descriptive. In reference to this change, it is proper to say that such action on its part is based on the idea that the No 8. American Medical Association may be conceived to occupy some such relation to the constituent state associations as the United States, through its Consti tution, holds to the several states. The committee, for this reason, regards it as wiser to formulate the principles of medical ethics without definite reference to code or penalties, thus leaving the respective states, etc., to form such code and establish such penalties as they may regard to be fitting and proper for regulating the professional conduct of their members; provided, of course, that in so doing there be no infringement of the established ethical principles of the association. The com mittee regards as wise, and well calculated to facilitate the business of the present organization and to promote its harmony, this course which leaves to the state associations large discretion ary powers concerning membership and other admittedly state affairs. Your committee has retained, to a large extent, the phraseology of the existing code, while aiming at condensation of expression and a better understanding of some of its statements. "The report of the committee has been reached unanimously, without discussion or distrust on the part of its members, each aiming to formulate a result based on principle alone, and without regard to any past or present disagreements or misunderstandings whatsoever. Such being the case, the committee invites your candid and unprejudiced attention and action to the results of its labor, feeling that at least some good has been accomplished." Pure Water. Concerning the subject of pure water an editorial of special interest appeared in the Journal of the American Medical Association of July 4th, 1903, on ground or spring water, and pointing out some of the dangers from impurity that may exist, and be unsuspected and undiscovered unless revealed by an outbreak of sickness, or by an analysis of the water. There is usually unquestioned faith in the purity of water from drive wells, and natural springs, but the supply may be contaminated in various ways. The condition of the soil through which the water percolates may be such as to render the water impure and unfit for domestic use. In chalk formations there may be cracks that allow surface water and sewage from drains to leak, and this may flow a long distance before appearing on the surface as a spring. The only safety in the use of water from whatever source the supply, spring, well or river, is its frequent analysis and vigilant inspection for impurities. How to Purify Water. Niagara Falls, N. Y., June 13.-Professor Otto, of France, yesterday made a successful demonstration of the ozone process of purifying water. It was witnessed by fifty officials of this city and Lockport. An electric current of 50,000 volts was sent through a cylinder ozonizer through which air passed, and as the air met the electrical discharges the oxygen was burned, creating ozone. This ozone was carried to the sterilizing tower by two pipes. The unpurified water entered the tower at the top. and there, in spray form, first met the ozone. As it flowed downward through fine granite it again met the ozone, completing the process. The water product was clear as crystal. It is stated that from 30 to 40 electrical horse power will treat 6,000 tons of water a day. Later Professor Otto will demonstrate the process before the leading scientists of the country. Water Is Purified. Louis Johnson's new process for purifying water by aeration, sedimentation and the use of the electric current, disposes of from seventy to ninety per cent of the bacteria in water which is subjected to its action. But the part the electric current plays in this purification process has not yet been determined. Mr. Johnson explained and exhibited the application of his process. Water from the intake is run through an eightinch pipe into a tank on the floor of the pump house, and while running through this pipe is aerated through two air pipes entering the main pipe midway between the intake and tank, the air pipes operating on the injector system. Further aeration of the water is provided for by air pipes opening into the tank under pressure. While the water is in the pipe an electric current, 400 volts strong, is sent through it and it is Mr. Johnson's belief that this current is responsible for the disappearance of the germs. It is a part of his process, however, that the water be allowed to, stand in the tank before being used, and this completes the triple process of aeration, electrification and sedimentation. Samples from this tank allowed to stand two or three days, were given to Dr. Corbett and showed some surprising results. In these cases as high as 85 per cent of the germs had disappeared. But examination, by the same tests, of samples taken from the tank and tested almost immediately, did not show the same degree of purification. These results have led Dr. Corbett to believe that the part played by the electric current used by Dr. Johnson has not yet been determined, especially in view of the fact that water is such a good conductor of electricity. Whatever the relative amount of purifying done by the air, electric current and sedimentation may be, the city bacteriologist does not pretend to say. That the final result is a great improvement in the condition of the city drinking water is an established fact. "The process could not be put to practical use at the lower river pumping stations," said Dr. Corbett, "because the station wells are not big enough, but it could be used, and to great advantage, at the reservoir, and properly applied it would probably result in eliminating over go per cent of the disease germs now in the city water." Among those present at the East Side pumping station were Alderman McLaskey, Schoonmaker, Holmes and Mumm, Dr. Corbett, Health Commis sioner Hall, Supervisor of Waterworks McConnell, and Harry Robinson, of the General Electric Company. General surprise at the results obtained, and belief that the process could be successfully used at the reservoir were expressed. Dr. Corbett was furnished with other samples of water taken from the tank in the East Side station and will continue his investigations. Latest Report of Dr. Corbett. In regard to the Johnson process of purification. I have been unable to take the process up step by step to determine the part played by each individual factor. It does not seem reasonable to suppose that any current of electricity could directly kill bacteria, when we consider the resistance of water to electricity and the relatively large sectional area of the stream of water. It is possible that the air is converted into ozone by the current and we know ozone has decided germacidal properties when applied to bacteria in water. I am inclined to the belief that sedimentation is a very important factor. However, water is cleared of bacteria in a much less time than we or dinarily obtain by sedimentation alone. At the beginning of the sedimentation process there is first an increase in the number of bacteria, then an enormous decrease. In the glass jar when sedimentation was carried on, a layer of dead bacteria could be found on the bottom. I believe light is an important factor. We have found 85 to 90 per cent of total bacteria to be destroyed by the complete process and eight to ten days sedimentation. Yours, J. FRANK CORBETT. Original Articles Value of Blood Examinations Since the great strides in laboratory methods have culminated in the perfection of microscopic work, it becomes. an important issue to the practitioner as to what extent this department of science can aid him in a practical way. He has no time or inclination to waste in undertaking doubtful or unreliable measures. He is looking for practical as well as scientific supports, and if the laboratory in the instance of examination of the blood can furnish such aid then it will be hailed with delight by the surgeon and adopted, possibly, as a routine measure. It will be done thoroughly, quickly and as surely as urinalysis is today. Only it must be shown that it is really a paying procedure; that facts will be elicited which are helpful and trustworthy to the surgeon. It is very noticeable that affairs have not reached that stage in surgery or medicine when blood examination has become universal. Except in some of the hospitals in the cities this practice of examining the blood is neglected for one reason or another. Not only is it not routine work, but also it becomes "last resort" work. When the surgeon has exhausted every other resource; when he does not know what else to do, he turns to the laboratory and studies blood pictures. There is something repulsive about it to the busy man. It is prosy and ultra A survey of the subject brings one face to face with a deluge of literature. Text books are as numerous as exhaustive, giving to each disease a definite blood finding and furnishing, apparently, ample evidence to prove that blood examination is imperative to a correct knowledge of the condition. But those who are its most ardent supporters do not claim for this method that it is an absolute criterion in the diagnosis of disease. They do not advocate the supplanting of the physical examination and do not wish to substitute this method, or other laboratory methods, for bedside examinations. It is their most urgent claim that this method became universal because it forms an important link in the chain of procedures, which together finally produce the true diagnosis. That the examination of the blood should become routine seems the more reasonable when it is understood that this is the only tissue we can examine during the life of the patient. Because it comes in contact with every other tissue it is reasonable to suppose that it represents the character of the metabolism taking place in these tissues. There are those diseases in which a blood examination is imperative to a correct diagnosis. In these the findings are definite and very characteristic. The finding of the parasite in the blood of a malarial patient is convincing and a classic demonstration of the value of blood examination. In the anemias, both primary and secondary, the value is as established as in the event of malaria. The blood picture for each of these diseases is almost constant and furnishes a means to distinguish the one from the other. Because the examination of the blood is so important to the diagnosis of pernicious anemia, chlorosis, leukemia, etc., it becomes almost as important in the consideration of the many conditions which so, closely resemble these diseases clinically. There are cases in which malignant growths present features very similar to pernicious anemia. An examination of the blood, however, reveals a difference in pathology. In the former we find that the reds are diminished to a less extent; that peikilocytosis and polychromatophilia are less marked. We find the usual number of whites, or more likely, a leukocytosis. find that the normoblasts outnumber the magaloblasts. We where confusion There are cases where arises in the consideration of leukemia and the number of affections it resembles. It may be mistaken for typhoid fever, chronic malaria, purpura, adenitis, and tumors of the spleen and kidneys, but the blood finding in leukemia is distinctive and makes possible the avoidance of an error. In the field of acute infectious diseases, the examination of the blood has not such a wide province of usefulness as in the consideration of the anemias, but nevertheless is invaluable. As a diagnostic sign in pneumonia, central or otherwise, the blood picture showing a leukocytosis is important. Sometimes a diagnosis can be made with considerable accuracy before consolidation and cough present themselves. As a prognostic sign, the absence of leukocytosis is a danger signal and its presence is neither good nor bad. Eosinophilia generally precedes the crisis a few days and is a favorable sign. In infectious fevers the toxicity of the blood and its coagubility have important bearings upon the diagnosis and prognosis, but these conditions are yet to be more thoroughly studied before their significance can be appreciated. The In typhoid fever the examination of the blood is most valuable. In addition to determining the Widal reaction, the quantitative and qualitative changes are important. The red count is generally low and in hemorrhage from the bowels it is especially so. hemoglobin is low. Lucopenia, a decrease in the white cells, is a most distinguishing feature of the disease and becomes more marked with the severity of the fever. A differential count would reveal a loss in the per cent of polynuclear forms and an increase in the percentage of the lymphocytes and a decrease in the eosinophiles. The latter increase in favorable cases, before the other forms assume correct proportions. The absence of leukocytosis in typhoid is a feature which serves to distinguish this fever from other fevers and from other local inflammations. It serves to eliminate pyemia; to exclude septicemia and to speak against pneumonia and appendicitis. With the Widal reaction it is almost positive evidence. Malaria presents no leukocytosis but the discovery of the parasite is convincing. In meningitis we find leukocytosis and no Widal reaction. In tuberculosis, miliary or local, there is no leukocytosis but the Widal reaction de cides the matter. In trichiniasis, we find an excess of the whites and a differential count shows many eosinophiles. It is apparent that the examination of the blood is a vital procedure in typhoid fever in order that a correct diagnosis be made. |