A JOURNAL OF MEDICINE AND SURGERY

Published Monthly by Western Medical Review Company, Omaha, Nebr. Per Annum, $2.00. The Western Medical Review is the journal of the Nebraska State Medical Association and is sent by order of the Association to each of its members.

The invasion of the nasal cavity by a diphtheritic membrane has long been a well known complication of diphtheria, but, that the disease may be limited to the nasal mucosa, is not so generally recognized and consequently many cases escape notice and are not isolated or quarantined. There are also many cases in which the specific organism is present in the secretions of the nose or throat without causing a membrane to form and without producing any marked local or general symptoms. These cases constitute what are known as "diphtheria carriers,' for they mingle freely and unsuspected with other people. This will help to explain the regular periodic outbreaks of diphtheria in schools in spite of rigid quarantine of all authentic

cases. It is a well known fact that diphtheria, although much less fatal, is about as prevalent as it was before the causative agent was discovered, and its method of transmission known.

Time and again sporadic cases or epidemics of diphtheria are discovered where no probable source can be discovered, and it seems highly probable that the disease is perpetuated by these "carriers," who are not sick, have very slight local symptoms, yet are capable of communicating the disease in a more or less virulent form, to others.

In Omaha, almost every year diphtheria appears soon after the opening of the public schools in September. This year is no exception to the rule. Out of 125 cases reported recently to the Board of Health, in which cultures were made and found positive, eighteen were nasal in character. A majority of these nasal cases have occurred since the opening of the public schools. It is extremely probable that these eighteen cases are only a small fraction of the actual number that have occurred, as the most of them have escaped observation, but, in all probability, were factors in the spread of the infection. Other cities, where nasal cultures are made, are finding similar conditions and it seems probable that before long this condition will be recognized as the most important source of recurrent outbreaks of diphtheria.

This condition of affairs emphasizes the necessity of careful medical inspection of school children, especially at the beginning of the fall term. The examination of cultures from the nose and throat of suspicious cases will often reveal the presence of a "carrier" before actual infection of other children has occurred, and thus save precious lives, as well as time, money and anxiety in combating an actual outbreak.

The Indianapolis City Board of Health has recently adopted the following set of health rules governing schools, which will be mailed to each school principal by Dr. C. S. Woods, secretary of the board:

"Any child having a communicable disease shall be excluded from school.

"All children of a household where there is diphtheria, scarlet fever or small-pox shall be excluded from school.

"All children of a household where there is whoopingcough, chicken-pox or mumps may attend school except the child having the disease.

"All children of a household where there is measles may attend school except the child having the disease and the child who has not had the disease."

The medical inspection of schools is growing in popularity and in those cities and towns where the practice prevails the people are beginning to appreciate its advantages and give it moral and financial support. Usually when medical inspection is first adopted it is carried on by some interested physician who does the work without remuneration. But the work requires time as well as knowledge and it is imposing on the public spirit and generosity of medical men to request such services without remnueration. The medical inspector is as deserving of pay as the teacher or anyone else who works for the school.

Nothing New Under Old Sol,

For the benefit of those who are so zealously disseminating information and misinformation, as is more often the case, in reference to the "white plague," the following is herewith appended. We clipped it from an exchange: "Hippocrates (400 B. C.) advised a combination of exercises and rest in the treatment of patients afflicted with tuberculosis. Celsus, in the first century of the Christian era, recommended tuberculous persons to go on a sea voyage, or, failing in that, to live in the country. Pliny, the elder, had great faith in the curative power of the sun and the air. Galen thought that the first thing to be done was to get all tuberculous persons in the open air. Sydenham and Willis sent their patients to the French Riviera, and advised them to take plenty of exercise in the open air. Boerhaave made it a rule to get the patient out of the locality in which he had contracted the disease. In the eighteenth century, the authorities burned the furniture and bedding of persons who had

died from consumption, and a decree was issued ordering the isolation of all consumptives and the disinfection of their personal effects. Regulations were also enforced requiring notification of consumptive cases."-St. Louis Med. Review.

The Practice of Abortion.

Another charge against the medical profession is that it is guilty of the practice of abortion. That the entire profession is guilty of this practice is, of course, false. That a large number of physicians-the percentage is, of course, impossible to state with definiteness, but I would say anywhere from 10 to 25 per cent are practicing it habitually, is true. But I would

not blame the profession very strongly for it. It is the state that is to blame for this condition of affairs. Wherever there is a demand there is a supply, and the demand for abortions is tremendous. The layman has no idea of the frequency and of the tremendous pressure that is brought to bear upon the medical profession. I venture to say that for every abortion performed by a physician, at least one hundred demands, requests and pleading supplications are refused. If this were not so we would not have the thousands and thousands of non-medical, male and female abortionists, who thrive throughout the country. A million abortions, at a very conservative estimate, are performed annually in the United States; and I am sure that 75 to 90 per cent of them are performed by non-medical and professional abortionists, who are outside the pale of the medical profession.-Denver Med. Times.

"When I thought I was learning to live, I was but learning to die."

"Long is that life that is well spent."

"Just as a day well spent gives joyful sleep, so does life well employed give joyful death."

"Deem me not vile because I am not poor. Poor is the man who overmuch desires."

--Leonardo da Vinci.

Some Remarks on Drainage.

*By H. P. HAMILTON, M. D., Omaha.

1. Def. To draw off-remove liquid from a receptacleto remove the fluid from a part gradually or constantly—to keep the fluid constantly removed from a part or cavity.

2. The purposes of surgical drainage may be divided into the following groups:

1. To prevent pressure. 2. To prevent the accumulation from coming in contact with healthy tissue. 3. To remove the accumulation from the part so that no irritation results therefrom, thereby encouraging healing.

The first mentioned, the prevention of pressure, is probably the most important one as all surgeons know that wherever an inflammatory area exists and pus is forming, the sooner the pressure can be removed the better for our patient.

The fever, the pain, the toxaemia most all come from the pressure exerted at the inflammatory focus. If this pressure be removed these symptoms subside at once, but as long as the inflammatory focus is subjected to pressure these symptoms will continue; and the greater the pressure the more alarming will these symptoms become.

The second purpose of drainage, viz., to prevent the infective liquid from coming into contact with healthy tissue is also important as it is a known fact that the seriousness of inflammation depend to a certain extent, at least, on the amount of tissue involved in the inflammation-this is especially noticeable where pockets of inflammation may be secreted where prssure is sure to take place and hard to relieve.

The third group, viz., the removal of the accumulation of fluid from an inflamed or suppurating part and keeping it removed from that part is very essential for rapid healing. If the pressure is all removed healing will usually take place, although bathed in pus all the time, as the pus loses its virulence with the pressure gone, Take away all this irritating material and keep it away as fast as it accumulates, the repair is greatly hastened. This we all observe every day in our practical work with wound and infections.

KINDS OF DRAINAGE:

There has been no progress made so far as I know in the

*Read before the Nebraska State Medical Association, Omaha, May 2, 3 and 4, 1911.