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| author | nfenwick <nfenwick@pglaf.org> | 2025-01-22 21:10:31 -0800 |
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| committer | nfenwick <nfenwick@pglaf.org> | 2025-01-22 21:10:31 -0800 |
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- The Journal-Lancet. Vol. XXXV. No. 5. Mar 1, 1915,
- by W. A. Jones (Editor)—A Project Gutenberg eBook
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-
-<div style='text-align:center; font-size:1.2em; font-weight:bold'>The Project Gutenberg eBook of The Journal-Lancet, Vol. XXXV, No. 5, March 1, 1915, by Various</div>
-
-<div style='display:block; margin:1em 0'>
-This eBook is for the use of anyone anywhere in the United States and
-most other parts of the world at no cost and with almost no restrictions
-whatsoever. You may copy it, give it away or re-use it under the terms
-of the Project Gutenberg License included with this eBook or online
-at <a href="https://www.gutenberg.org">www.gutenberg.org</a>. If you
-are not located in the United States, you will have to check the laws of the
-country where you are located before using this eBook.
-</div>
-
-<p style='display:block; margin-top:1em; margin-bottom:0; margin-left:2em; text-indent:-2em'>Title: The Journal-Lancet, Vol. XXXV, No. 5, March 1, 1915</p>
-<p style='display:block; margin-top:0; margin-bottom:1em; margin-left:2em; text-indent:0;'>The Journal of the Minnesota State Medical Association</p>
-
-<div style='display:block; margin-top:1em; margin-bottom:1em; margin-left:2em; text-indent:-2em'>Author: Various</div>
-
-<div style='display:block; margin-top:1em; margin-bottom:1em; margin-left:2em; text-indent:-2em'>Editor: W. A. Jones</div>
-
-<div style='display:block; margin:1em 0'>Release Date: July 11, 2021 [eBook #65823]</div>
-
-<div style='display:block; margin:1em 0'>Language: English</div>
-
-<div style='display:block; margin:1em 0'>Character set encoding: UTF-8</div>
-
-<div style='display:block; margin-left:2em; text-indent:-2em'>Produced by: SF2001, and the Online Distributed Proofreading Team at https://www.pgdp.net (This file was produced from images generously made available by The Internet Archive)</div>
-
-<div style='margin-top:2em; margin-bottom:4em'>*** START OF THE PROJECT GUTENBERG EBOOK THE JOURNAL-LANCET, VOL. XXXV, NO. 5, MARCH 1, 1915 ***</div>
-
-<p><span class="pagenum" id="Page_109">[Pg 109]</span></p>
-<h1><span class="smcap">The<br />
-<big>Journal-Lancet</big></span></h1>
-
-<p class="center">The Journal of the Minnesota State Medical Association<br />
- <small>and Official Organ of the</small><br />
- North Dakota and South Dakota State Medical Associations
- </p>
-
-<p class="center"><small>PUBLISHED TWICE A MONTH</small></p>
-
-<p class="center">VOL. XXXV   <span class="smcap">Minneapolis, March 1, 1915</span>   No. 5
-</p>
-
-<hr class="chap x-ebookmaker-drop" />
-
-<div class="chapter">
-<h2 class="nobreak" id="FEEDING_OF_THE_HEALTHY_INFANT1">
- FEEDING OF THE HEALTHY INFANT
- <a id="FNanchor_1" href="#Footnote_1" class="fnanchor">[1]</a>
- </h2>
- </div>
-
-<p class="center">
- <span class="smcap">By E. J. Huenekens</span>, A. B., M. D.<br />
- Instructor in Pediatrics, University of Minnesota<br />
- MINNEAPOLIS</p>
-
-<div class="footnote">
-
-<p><a id="Footnote_1" href="#FNanchor_1" class="label">[1]</a>
-Read before the Hennepin County Medical Society,
-Nov. 2, 1914.</p>
-
-</div>
-
-<p>The science of infant-feeding has been revolutionized
-in the last twenty years, and, in the
-process, it has advanced too radically in many
-directions. Lately, the pendulum has been
-swinging backward, so that the most advanced
-knowledge of today probably represents a middle
-ground between extreme radicalism and extreme
-conservatism. In no other direction is this more
-manifest than in the feeding intervals. The
-religious adherence to the four-hour feeding
-interval is giving way to a more rational system.
-I am one of the firmest adherents of the longer
-interval: the food is better digested, the stomach
-has a period of rest, and the general well-being
-of the infant is better furthered than with more
-frequent feedings. But there are certain infants
-who do not receive enough nourishment in this
-interval, especially young breast-fed infants in
-whom it can be demonstrated by accurate weighing,
-before and after nursing, that they receive
-considerably more milk in twenty-four hours
-with the three-hour interval. This is the more
-important in that Rosenstern has demonstrated
-that a large proportion of infants up to the age
-of six weeks require more than the usual 100
-calories per kilogram of body-weight. One hundred
-calories represents 150 grams of breast-milk,
-so that a five-kilo, or eleven-pound, baby should
-receive a minimum of 750 c.c. of breast-milk in
-twenty-four hours.</p>
-
-<p>By far the best food for the healthy infant
-in every way—and this cannot be emphasized too
-strongly—is mother’s milk. There are certain
-alimentary disturbances in which it may be advisable
-to replace breast-milk with certain artificially
-prepared foods, such, for instance, as
-albumin milk in alimentary intoxication; but this
-is never true of the normally healthy infant.
-While, as regards growth and freedom from
-digestive disturbances, certain artificially prepared
-foods may, when used with exceeding care,
-produce as good results as breast-milk; nevertheless,
-this is only one function of breast-milk.
-The other function which can be imparted to no
-artificial food is the passive immunization of the
-child against infection. Ehrlich (<i>Zeit. f. Hyg.
-u. Infectionskr.</i>, 1892, xii, 183) has proved that
-antibodies, antitoxin, and agglutinins are transmitted
-directly through the milk from mother to
-child; and it has been shown that the blood of
-a breast-fed child is considerably more bactericidal
-than the blood of a bottle-fed infant.</p>
-
-<p>The practice of weaning the baby for trivial
-reasons has increased in the last decade, and can
-be laid largely at the door of the medical profession.
-For all practical purposes the only absolute
-indication for weaning the baby is open
-tuberculosis in the mother. For the last few
-years I have been making a systematic inquiry
-at the University Dispensary and Infant Welfare
-Stations as to reasons for weaning young infants;
-and in nine cases out of ten, the answer
-has been that “the milk gave out.” In only a
-very small proportion of cases has an ordinarily
-well-nourished mother insufficient milk; far
-oftener the fault lies with the child. Insufficient
-<span class="pagenum" id="Page_110">[Pg 110]</span>
-and late development of the sucking reflex prevents
-these infants from completely emptying
-the breast, which in time “dries up.” This
-period can be tided over by nursing from both
-breasts, by temporarily increasing the number of
-nursings, or temporarily employing “allaitement
-mixte.” In cases in which, after long, patient
-effort the supply of milk is still insufficient, either
-supplementary or complementary feeding of
-cow’s milk can be given. Where this mixed feeding
-is employed a minimum amount of cow’s
-milk should be given; and the opening in the
-nipple should be as small as possible, otherwise
-the child gets too much cow’s milk, and with too
-little effort, and gradually refuses the breast.</p>
-
-<p>Another excuse, and one fostered to some extent
-by physicians, is, that certain breast-milks
-are “poison for the baby.” This has even less
-foundation in fact; and here again the fault must
-be looked for in the baby rather than in the
-mother. Outside of certain variations in the
-fat-content, all breast-milks are alike in composition.
-In proof of this Finkelstein has fed these
-babies at the breast of tried wet-nurses with absolutely
-no benefit, while the children of the wet-nurses
-would thrive at the breast of the “poison-milk
-mother.”</p>
-
-<p>Abscess of both breasts may force a temporary
-cessation of nursing, but the breast should be
-regularly emptied until the inflammation has
-subsided; and then the nursing should be re-established.
-Cracked or sunken nipples may
-render nursing impossible, but they do not stop
-the flow of milk. In both these latter conditions
-the milk may be manually expressed or removed
-with the breast-pump. In this connection I wish
-to recommend the improved Jaschke pump, in
-which, by means of a releasing valve, the sucking
-movements of the child can be very closely
-imitated.</p>
-
-<p>Where artificial feeding must be started early,
-cow’s milk is almost universally employed.
-Whenever possible, “certified milk” should be
-used; the ordinary milk, however, can be boiled
-with little or no harm. In diluting and preparing
-this milk, we have the choice of several methods.
-The so-called percentage feeding, favored
-in America, is difficult and cumbersome, and has
-no advantages over its simpler rivals. Pfaundler’s
-rule may be safely employed. It is as follows:
-One-tenth body-weight of milk, one one-hundredth
-body-weight of sugar diluted up to
-one liter; give 200 c.c. five times in twenty-four
-hours. Even simpler is the following: One-third
-milk for the first month, one-half for the
-second month, two-thirds for the third and
-fourth months, each with the addition of 4 to 6
-per cent sugar. Either milk-sugar or ordinary
-granulated sugar may be employed. The malt
-sugars and extracts should be reserved for sick
-children. After the second month, oatmeal
-water may be used as a diluent in place of plain
-water.</p>
-
-<p>Recently Friedenthal, a Berlin physiologist,
-has attempted an exact imitation of mother’s
-milk, including that important element, the salt,
-which had, until recently, been entirely neglected.
-Langstein is very enthusiastic over this milk as a
-food for healthy infants; but Finkelstein, in a
-personal communication, assured me that it has
-not as yet proved itself. Schloss, dissatisfied
-with the results of the Friedenthal milk, has
-modified it in the direction of casein milk by replacing
-the milk-sugar with the malt preparations,
-and increasing the protein content. He claims
-good results, and is supported by Leopold, of
-New York, who has used it extensively. But we
-must leave the final word as to both these milks
-for the future to decide. From the sixth to the
-ninth month for both breast-fed and bottle-fed
-babies, cooked cereals, toast, and vegetables
-should be gradually added to the diet. At the
-ninth month, unless this is one of the hot summer
-months, the nursling should be weaned, and a
-small amount of cow’s milk substituted. The
-weaning should be gradual by omitting one nursing
-period each week. The one important exception
-to the foregoing rules for the first year of
-life, is the premature infant. In the ninth month
-of fetal life, reserves of calcium and iron are
-stored up in the body, which the infant gradually
-uses up during the first nine months of extra-uterine
-life. The premature infant lacks this
-store, and manifests it in different ways. As
-early as the second or third month a breast-fed
-premature infant may develop a most extensive
-craniotabes. This is not due to a true rachitis,
-i.e., disturbance of calcium metabolism, but to a
-want of calcium in the body. Small amounts of
-cow’s milk, which contains much more calcium
-than human milk, or calcium in the form of
-calcium lactate or chloride, will remedy this condition.
-A similar process happens in the case of
-iron. The premature infant is born with a hemoglobin
-percentage of 100 to 110; by the third or
-fourth month this may sink to 40 per cent, and
-for this reason green vegetables should be added
-to the diet as early as the fourth month.</p>
-
-<p><span class="pagenum" id="Page_111">[Pg 111]</span></p>
-
-<p>The diet of healthy children in the second year
-should include cooked cereals, vegetables, toast,
-cooked fruits, and meat-juices; and the quantity
-of cow’s milk should be limited to one and one-half
-pints in twenty-four hours. The question
-of the addition of meat to the diet is important.
-Some authors have recently advocated the giving
-of meat as early as the ninth month. During the
-past year, working in Finkelstein’s laboratory, I
-have been able to gather some facts which have a
-direct bearing on this question. (<i>Zeitschrift für
-Kinderheilkunde</i>, July, 1914.) By means of the
-new electrometric determination of absolute
-acidity (that is, the number of H ions), I was
-able to show that the acidity of the stomach before
-the eighteenth month of life is insufficient
-to permit any peptic, i. e., protein, digestion.
-Solomon, working in the same clinic, in a report
-not yet published, has shown the same thing from
-a clinical standpoint. He found that on a meat
-diet up to the end of the second year large quantities
-of muscle fibers passed through with the
-bowel-movement unchanged; but after that age
-they rapidly decreased in number. It is, therefore,
-worse than useless to add meat to the diet
-before the beginning of the third year.</p>
-
-<p>Eggs frequently produce profound disturbances
-in young infants, perhaps on account of the
-absorption of egg albumin, unchanged, in the
-blood-stream; and they should be kept from the
-diet-list until the beginning of the fourth year.</p>
-
-<p>These rules for feeding are generalized, and
-there may be many exceptions. Each child is to
-some extent a law unto itself, and this is especially
-true of those children with nervous or exudative
-diathesis.</p>
-
-<p>In conclusion, I wish to make a plea for greater
-uniformity in our rules for infant-feeding. Even
-more than in strictly medical affairs has the public
-the right to demand information. Heretofore,
-every new book and every public lecture on
-infant-feeding has deviated markedly from its
-predecessors, until the confused laity, and even
-general practitioners, have turned in disgust to
-proprietary foods and formulas. Pediatrics is
-a new science, and as such is bound to undergo
-rapid changes and conflicting opinions. But that
-need not hinder us from agreeing on certain
-fundamental facts which can be given as guides
-to the general practitioner and to the public.</p>
-
-<p>I believe that the simple rules for infant-feeding
-here laid down are neither too conservative
-nor too radical to serve as a basis of agreement
-upon which the medical profession may show to
-the public a united front on this important question.
-Such uniformity of opinion—and the
-sooner it can be reached the better—will not fail
-to have a beneficial effect on both the profession
-and the public.</p>
-
-<h3>DISCUSSION</h3>
-
-<div class="blockquot">
-
-<p><span class="smcap">Dr. Jacob Hvoslof</span>: I would like to ask about the
-value of lime-water added to the milk. I recently had
-an experience where I mixed an ounce of lime-water to
-a pint of milk, as I thought that would improve it. but
-for some reason or other the baby would not digest his
-milk. After a while I left the lime-water out, and
-everything went well. Whether this is a “post” or
-“propter” I should like to find out.</p>
-
-<p><span class="smcap">Dr. O. R. Bryant</span>: In case of an exudative diathesis,
-where you probably will start solids early, you
-will also be able to use meat earlier. An infant that
-does well on solids at six months can probably have
-meat once a day at fifteen months and show a normal
-stool.</p>
-
-<p><span class="smcap">Dr. S. R. Maxeiner</span>: I would like to ask Dr. Huenekens
-where he classes eggs and egg albumin.</p>
-
-<p><span class="smcap">Dr. C. G. Weston</span>: I have been very much interested
-in Dr. Hueneken’s paper. I care only for the babies
-during the three or four weeks after birth; and of late
-years many of them have passed from me directly into
-the hands of the pediatrists. I formerly had the babies
-nursed every three hours, but finding that the baby
-specialist immediately, on assuming charge, put them
-on the four-hour schedule, I changed, about a year and
-a half ago, to that interval; and I thought my troubles
-would cease, but such has not been the case, and it
-has been my impression, as well as that of the nurses
-who have had the care of the infants, that it has made
-very little difference.</p>
-
-<p>The four-hour schedule is not a new thing in Minneapolis.
-Many of the older members of this Society
-may remember that twenty years ago Dr. R. O. Beard
-always fed his babies in this way.</p>
-
-<p>It seems to me that we should make no hard and
-fast rules for the feeding of babies, except the one that
-mother’s milk should be used whenever possible. We
-should individualize with the babies. If they do well
-on the four-hour schedule, follow it, as it makes the
-care of the child easier for the mother; if, however,
-the child does not get sufficient milk on this interval to
-properly nourish it, diminish the latter to three hours.</p>
-
-<p>The only way to accurately determine how much milk
-the nursing infant is getting, is to weigh the baby before
-and after nursing. One is often surprised at the varying
-amounts obtained by the same baby at different
-nursings with no obvious difference in the condition of
-the breasts. We have had a baby obtain as much as
-three ounces in the first five minutes of nursing, and at
-the next feeding take only one or one and a half ounces
-in twenty minutes.</p>
-
-<p>The green and frequent stools, with evidences of
-colic, etc., are often found to be due to too much
-milk, or taking it too rapidly; and the weighing method
-is the only way to determine this.</p>
-
-<p>I most heartily endorse what Dr. Huenekens said
-with reference to the importance of encouraging in
-every way maternal nursing. Many a mother gives up
-the attempt to nurse her baby on account of some soreness
-of the nipples or because she has thought she had
-<span class="pagenum" id="Page_112">[Pg 112]</span>
-too little milk to be of any use. Most of these cases
-may become, by the means recommended by the reader,
-good milkers, and many a baby’s life may thus be saved.</p>
-
-<p><span class="smcap">Dr. E. K. Green</span>: I would like to ask a question in
-regard to putting babies on cow’s milk. I have adhered
-very closely to the principle that modified cow’s milk is
-absolutely the best food for infants, if it is impossible
-to get mother’s milk, but many times when I have had
-the opportunity to follow these cases carefully I have
-had all sorts of stomach and bowel disturbances on
-cow’s milk until someone would suggest some other
-food, such as malted milk, or Mellin’s Food, or even
-condensed milk, which seems to be the farthest from
-the natural food, and then the babies would get along
-fairly well. Is this a common experience, or is there
-something wrong with my method? We have in our
-own home two children brought up on the bottle, one
-with malted milk and the other with Mellin’s Food. In
-both these cases I tried, not only once, but several times
-to use the modified cow’s milk, but failed absolutely. I
-would like to know if you consider the fault usually
-with the modified milk, or does the individual have
-considerable to do with the case?</p>
-
-<p><span class="smcap">Dr. A. S. Fleming</span>: I would like to ask if in the
-case of the healthy infant the mother’s diet would modify
-the constituents of the milk otherwise than in the
-facts stated. For instance, will it modify the character
-of or the percentage of the sugar, or will any of the
-aromatic constituents disturb the infant’s digestion?</p>
-
-<p><span class="smcap">Dr. M. J. Jensen</span>: Dr. Huenekens dealt with the
-feeding of the healthy infant only. I would like to
-ask if it is not true that nearly all infants born alive,
-are born as healthy and sound as any infant ever is, so
-far as the functions of its organs and tissues are concerned?
-Nature frequently decides on producing premature
-births and “still”-births, rather than running the
-risk of producing a sick or sickly infant. In young infants
-it is very often difficult to determine when to
-classify them as healthy or unhealthy, realizing the
-conditions of their environment and usual care that is
-given in the homes.</p>
-
-<p>In regard to the sterilization or boiling of cow’s milk:
-I do not think that children fed on pasteurized or
-boiled milk develop as well as those who are fed upon
-raw milk as it comes from the cow. Dr. Palmer, of
-Chicago, fed seven hundred children on raw milk during
-the midsummer months and only lost three of the
-number. The miserable, atrophied children began to live
-the moment treatment with raw milk was begun. If
-the process of milking was carried out in a sanitary
-manner, or by means of a suction apparatus, then cooled,
-and placed in sterilized bottles, I believe we would prohibit
-the development of bacteria, and save the food
-which exerts so marked a protective influence upon
-the infant’s organs.</p>
-
-<p>When raw milk free of all objections cannot be obtained,
-it is sometimes advisable to use another milk
-product namely, buttermilk.</p>
-
-<p><span class="smcap">Dr. S. Marx White</span>: There is just one point I have
-been thinking about in the discussion on the question
-of infant-feeding, and that is whether Dr. Huenekens
-really means us to believe that in practically all cases
-the mother can furnish sufficient milk for the child.
-He passed that over in saying that in nine out of ten
-cases the mother gave as a reason for discontinuing
-the milk that the milk gave out. Is it not true that in a
-good many instances the mother needs treatment quite
-as much as the infant? I do not mean medical treatment,
-but management. Is it not true that an overworked,
-tired, nervous, worrying mother is unable to
-supply sufficient milk for the child? It has been my
-impression from a very limited experience in this field,
-that the mental and nervous and physical state of the
-mother is a very large factor in the production of the
-milk. When upset and under deleterious influences she
-is really not a proper producer for the child; and the
-management of the mother is often quite as important
-a factor as any other.</p>
-
-<p><span class="smcap">Dr. W. H. Aurand</span>: In such cases as Dr. White
-just mentioned, what are we going to do to increase
-the supply of milk? Also, I would like to ask Dr.
-Huenekens if he means to feed to the new-born baby
-200 c.c. at a feeding?</p>
-
-<p><span class="smcap">Dr. Huenekens</span> (closing): As regards lime-water:
-I cannot recommend its use. Wherever there is a
-specific demand for calcium, as in premature infants or
-spasmophilic cases; or where it may help to produce a
-firm stool; or, as in diarrheal disturbances, it may be of
-great value, but in the normal healthy infant it is of no
-benefit whatever.</p>
-
-<p>Dr. Bryant mentioned the giving of meat in exudative
-diathesis: His statement that such infants can
-probably have meat once a day at fifteen months, and
-show normal stools, is beside the question. A normal
-macroscopic stool does not necessarily mean that the
-meat has been digested. However, I am now working
-on this problem, that is, to determine whether an early
-solid diet produces an earlier digestion of meat.</p>
-
-<p>I would classify eggs and egg albumin as proteins,
-and therefore not digestible until the beginning of the
-third year: but, over and above this, there is danger of
-anaphylaxis from the absorption of the unchanged egg
-albumin into the blood-stream.</p>
-
-<p>What Dr. Weston says of the feeding intervals is
-very interesting. I do not want to be considered an
-enemy of the four-hour feeding, for I use it wherever
-possible, and I think it the best interval; but when
-the infant cannot get enough in that period, we have to
-choose between two evils. I think the lesser evil is to
-give the child more milk at shorter intervals, and take
-the risk of a slightly poorer digestion. We should, also,
-wherever possible, control the amount of breast-milk by
-weighing the child before and after nursing. It is highly
-important to determine whether the baby is getting
-too much or too little.</p>
-
-<p>As to Dr. Green’s statement, “Modified milk” is a very
-general term. What is usually meant is milk with a
-high percentage of fat and a low percentage of sugar,
-while malted and condensed milk have a high percentage
-of carbohydrate. In my opinion, if he had used cow’s
-milk without the addition of cream and with large
-amounts of cane sugar, he would not have had this
-trouble. But a large number of children will not do
-well on this diet. We have special rules for abnormal
-children with exudative and nervous diathesis.</p>
-
-<p>In reply to Dr. Fleming’s question regarding the mother’s
-diet and its effect on her milk: What the mother
-eats has absolutely no effect on the composition of the
-milk in any way whatever, except perhaps in the percentage
-of fat. Now-a-days we do not advise any particular
-foods for the mother’s diet,—anything she
-likes, and can digest, plus large quantities of fluid;—otherwise
-<span class="pagenum" id="Page_113">[Pg 113]</span>
-there is no single food we advocate—none
-that will make the milk richer or better, or increase
-the quantity.</p>
-
-<p>I cannot agree with Dr. Jensen that raw milk is so
-far superior to boiled milk. Of course, wherever it is
-possible, we should use certified milk, which does not
-require boiling; but, if we have inferior cow’s milk
-contaminated with bacteria, we can boil the milk with
-very little harm. It is just as well digested, and the
-food value just as great. There is of course slight
-danger of scurvy; but that is very easily diagnosed, and
-very easily cured by a little fresh milk or small doses
-of orange juice. Where we have inferior milk, it should
-be boiled in every case.</p>
-
-<p>Dr. White brought up a very interesting point in
-regard to nervous mothers. Their milk supply is subject
-to wide fluctuations; but, if the breasts are well
-emptied at each nursing, they will secrete sufficient
-milk. I will admit that these cases are difficult to
-handle, for the infants usually have nervous diathesis,
-and do not respond well to ordinary food. The one
-important point is to completely empty the breasts; and
-that is the only measure we can take to increase the
-supply of milk.</p>
-
-<p>In reply to Dr. Aurand: I would feed a new-born
-infant 200 c.c. at a feeding if the milk is sufficiently
-diluted. The liquid part of the food passes very quickly
-into the duodenum, so that, before the infant has finished
-feeding, a part of this quantity has already left
-the stomach.</p>
-
-<p>In conclusion: We have an opportunity in our infant-feeding
-to practice the really scientific prophylactic
-medicine of the future. We can do more in preventing
-infant-mortality by proper feeding than by any
-other single measure; and we should encourage mothers
-to bring their new-born infants to the physician for
-advice on feeding, and to continue to consult him at
-longer or shorter intervals during the whole of the
-first year of life.</p>
-</div>
-<hr class="chap x-ebookmaker-drop" />
-
-<div class="chapter">
-
-<h2 class="nobreak" id="THE_INEBRIATE">
- THE INEBRIATE
- <a id="FNanchor_2" href="#Footnote_2" class="fnanchor">[2]</a></h2>
-
-</div>
-
-<p class="center">
- <span class="smcap">By George H. Freeman</span>, M. D.<br />
- Superintendent of the Minnesota State Hospital for Inebriates<br />
- WILLMAR, MINNESOTA</p>
-
-<div class="footnote">
-
-<p><a id="Footnote_2" href="#FNanchor_2" class="label">[2]</a>
-Read at the 46th annual meeting of the Minnesota
-State Medical Association, St. Paul, October 1 and 2,
-1914.</p>
-
-</div>
-
-<p>The Minnesota Legislature of 1907 passed a
-bill establishing the Hospital Farm for Inebriates,
-placing its management under the State
-Board of Control, and providing for its maintenance
-by setting aside 2 per cent of the saloon-license
-money for that purpose. Later, a law
-was enacted providing for the issuance of certificates
-of indebtedness; and active construction
-work soon commenced. The Hospital was
-opened on Dec. 26, 1912, with Dr. Tomlinson,
-formerly Superintendent of the St. Peter State
-Hospital, at its head. Through his untimely
-death, five months later, Minnesota lost one of
-her most faithful officials. The principles underlying
-the work at Willmar, are, with but
-slight change, those that he so earnestly advocated.</p>
-
-<p>This paper is based upon the study of the
-patients admitted from the opening of the Hospital
-until the close of the biennial period, on
-July 31, 1914,—approximately eighteen months.</p>
-
-<p>Patients are admitted to the Hospital following
-an examination in a probate court. In such cases
-there is no expense to the patient’s relatives, except
-that they are expected to furnish clothing,
-and a little money for the purchase of tobacco
-and small luxuries. Voluntary patients are also
-received following their own application in a
-probate court. They pay at the rate of $1.00 a
-day, each month in advance. No distinction is
-made in the treatment of the two classes of patients,
-except that a voluntary patient cannot be
-detained if he wishes to leave. Any resident of
-Minnesota who is habitually addicted to the use
-of alcohol, morphine, cocaine, or other narcotics,
-may be admitted to the institution, provided the
-history of the patient, as furnished by a probate
-court, indicates that the man can be benefited
-by treatment. It is presumed that anyone can
-be benefited who wants to be, unless afflicted
-with irremediable chronic disease.</p>
-
-<p>The requirement that the history be furnished,
-and the ability to refuse admission, have kept
-out of the Hospital many undesirable individuals
-who could be cared for only under the discipline
-of a well-regulated reformatory. However, some,
-no matter how carefully the history is taken,
-slip by. The majority of those discharged as
-not proper subjects, come from that class. As
-there are no accommodations for individuals
-suffering with tuberculosis, no one known to be
-suffering with that disease is admitted. Once
-in a while a tuberculosis individual gains admittance,
-but, if not too ill to be released, he is
-discharged.</p>
-
-<p>During the eighteen-month period, 209 men
-and 32 women were regularly committed; and 18
-men and 3 women were received as voluntary
-patients. In addition to those classified as voluntary
-patients, a considerable number have, of
-<span class="pagenum" id="Page_114">[Pg 114]</span>
-their own volition, applied for treatment, and,
-being unable to pay, have submitted to commitment,
-in order to obtain treatment for their
-habit.</p>
-
-<p>There has been a fairly uniform increase in
-the number of patients received each month,
-which is gratifying, as showing the need of such
-an institution and also as an appreciation of the
-benefit that may be expected. During the last
-month of the period, twenty-five patients were
-admitted.</p>
-
-<p>While the causes of inebriety are diverse, it
-is a significant fact that 182 patients, out of
-262, assign associates as their reason for drinking;
-and observation of their history clearly
-shows that they have drifted along, drinking
-now and then and more and more each year.
-A few assign illness, domestic trouble, or financial
-worry as a cause for drinking. In only 6
-instances was heredity noted. In 132 cases the
-parents were abstainers.</p>
-
-<p>We have found it impossible to formulate any
-system of classification of the unfortunates under
-our care. In order that some idea may be obtained
-as to the number using alcohol and the
-various drugs, we have constructed the following
-table:</p>
-
-<h3>FORMS OF INEBRIETY</h3>
-
-<table class="autotable" summary="">
-<tr>
-<td class="tdl"></td>
-<td class="tdr">Men</td>
-<td class="tdr"> Women</td>
-</tr>
-<tr>
-<td class="tdl">Steady drinkers</td>
-<td class="tdr">130</td>
-<td class="tdr">2</td>
-</tr>
-<tr>
-<td class="tdl">Periodical drinkers</td>
-<td class="tdr">76</td>
-<td class="tdr">8</td>
-</tr>
-<tr>
-<td class="tdl">Morphinism</td>
-<td class="tdr">3</td>
-<td class="tdr">11</td>
-</tr>
-<tr>
-<td class="tdl">Alcohol-morphine</td>
-<td class="tdr">5</td>
-<td class="tdr">2</td>
-</tr>
-<tr>
-<td class="tdl">Alcohol-cocaine</td>
-<td class="tdr">3</td>
-<td class="tdr">..</td>
-</tr>
-<tr>
-<td class="tdl">Alcohol-heroin</td>
-<td class="tdr">3</td>
-<td class="tdr">..</td>
-</tr>
-<tr>
-<td class="tdl">Alcohol-morphine-cocaine</td>
-<td class="tdr">3</td>
-<td class="tdr">1</td>
-</tr>
-<tr>
-<td class="tdl">Alcohol-morphine-cocaine-heroin</td>
-<td class="tdr">1</td>
-<td class="tdr">..</td>
-</tr>
-<tr>
-<td class="tdl">Alcohol-morphine-veronal</td>
-<td class="tdr">1</td>
-<td class="tdr">..</td>
-</tr>
-<tr>
-<td class="tdl">Morphine-cocaine</td>
-<td class="tdr">..</td>
-<td class="tdr">1</td>
-</tr>
-<tr>
-<td class="tdl">Morphine-cocaine-heroin</td>
-<td class="tdr">2</td>
-<td class="tdr">..</td>
-</tr>
-<tr>
-<td class="tdl"></td>
-<td class="tdr">——</td>
-<td class="tdr">——</td>
-</tr>
-<tr>
-<td class="tdl">Total</td>
-<td class="tdr">227</td>
-<td class="tdr">35</td>
-</tr>
-</table>
-
-<p>The treatment of the inebriate naturally divides
-itself into two stages: the treatment, first,
-of the immediate effects of indulgence, and, second,
-such treatment as will tend to prevent a
-repetition of the indulgence. The treatment of
-the immediate effect of alcoholic indulgence is
-regarded as the easiest part of the work. While
-patients are at times received under the influence
-of intoxicants, in no case have they been unruly.
-For an obstreperous intoxicated person the
-quickest soberer is apomorphine judiciously used;
-but we have never yet resorted to it. Generally,
-a fairly rapid reduction in the amount of alcohol
-consumed is made, instead of immediate withdrawal.
-Only in the most exceptional cases is
-alcohol given over three or four days. As a
-rule, during the first day it is given fairly freely.
-The treatment received during this period depends
-entirely upon the individual; and the treatment
-of one may be entirely different from that
-of another. Many receive baths at a temperature
-of 98° to 100° F. for thirty or sixty minutes
-for nervousness and sleeplessness. Some
-receive the coal-tar hypnotics, veronal or sulphonal;
-the more restless, hyoscine; and for others
-paraldehyde is used,—and occasionally chloral
-is used in combination with hyoscine and cannabis
-indica.</p>
-
-<p>As long as he receives alcohol, the patient remains
-in bed and receives only liquid diet. In
-cases of considerable digestive disturbance, capsicum
-is freely used, but we have seldom found
-it necessary.</p>
-
-<p>All receive preliminary catharsis, but no attempt
-is made at prolonged elimination in that
-way.</p>
-
-<p>For about a month tonic treatment with strychnine
-nitrate is used in doses of 1-20 to 1-40 gr.
-three times a day. Any other medication depends
-entirely upon the physical condition of
-the patient as revealed on examination. Only
-under the most exceptional circumstances are
-drugs given in alcoholic vehicle.</p>
-
-<p>In morphine or cocaine users, the reduction
-is usually made more gradually, requiring a
-week to ten days. Generally, we find a patient
-comfortable with one-half the drug he has been
-accustomed to taking. In some cases we find
-it best to reduce the quantity to about one-half
-grain, and then abruptly cease.</p>
-
-<p>Under this plan, diarrhea, cramps, restlessness,
-and insomnia are much less marked. We regard
-the free use of the prolonged warm bath as more
-advantageous to those addicted to drugs than
-to alcohol. Generally, it is the only measure
-that seems to offer relief. We particularly do
-not use hypodermic medication in any drug users.</p>
-
-<p>Heroin users, who seemingly are more numerous,
-receive their drug only once in twenty-four
-hours. The withdrawal of the drug does not
-cause the discomfort that the withdrawal of morphine
-causes. Vague sensations of discomfort,
-some perspiration, and insomnia are met with in
-such cases.</p>
-
-<p>No users of cocaine only have been met with,
-<span class="pagenum" id="Page_115">[Pg 115]</span>
-but in mixed forms this drug is at once withdrawn.</p>
-
-<p>The removal of alcohol or drugs is the easiest
-part of the work. Under the regular discipline
-of the institution, and the absence of temptation,
-the great majority of patients get along without
-any trouble because of abstinence. But there is
-the future to fear. The patient must go out
-into the world again, and engage in the daily
-struggle for his livelihood. One must aim to
-put him in such condition that he may be able
-to resist the temptations that will surround him
-on every hand. Our work, then, is to build up
-and re-educate, to strive to form a new character,
-to encourage a habit of sobriety, instead of drunkenness,
-to teach the man to work, to occupy himself,
-to obtain for him a new outlook on life,
-and to teach him his duty to himself, to his family,
-and to his neighbor. Here is where our difficulty
-begins. Nearly every inebriate has a firm
-belief in his ability to abstain from alcohol or
-drugs at any time and under any condition, because
-he thinks he is not really responsible for
-the condition into which he has fallen, and that,
-had not certain things happened, he would not
-have been drinking.</p>
-
-<p>He is insistent in iterating and reiterating that
-he has now made up his mind to stop drinking,
-and that is all that is necessary. Though admitting
-that, for five, ten, or fifteen years, he has
-been going steadily downward, he has full confidence
-in himself, and he believes injustice is
-being done him when his parole is refused and
-he learns that he is expected to remain until he
-has strength to resist temptation.</p>
-
-<p>In this upbuilding of body and character the
-following are essential: regularity of habits, discipline,
-work, food, and recreation, together with
-the personal influence of the physician and those
-coming into close and personal contact with the
-patient.</p>
-
-<p>Regular work is one of the most valuable of
-the remedial agents at our command. It should
-be suited to the individual, and, as a rule, should
-not be that to which the man has been accustomed.
-Particularly is this true of the man who
-is used to mental labor only,—the clerk, the
-physician, the pharmacist, the merchant, etc. For
-them out-of-door work on the farm, lawn, or
-in the garden, is the very best, and next comes
-indoor shop-work. We must provide something
-that engages time and attention, that provides
-some new outlook upon life, and enlarges some
-field of endeavor in which the patient has labored
-before coming to the Hospital. Thus far the
-work has been on the farm or the improvement
-of the grounds, or has been carpenter, cement,
-or some construction work. The women do all
-the mending, and make all needed articles, such
-as bedding, towels, etc. They also work in the
-laundry. At present we are teaching embroidery
-of various kinds, no one of our patients having
-ever learned any such work.</p>
-
-<p>The future must see us provided with shops,
-especially for winter work. With a capacity of
-ninety-nine men we are able to keep them fairly
-well occupied during the winter months, but any
-increase will have to be cared for under special
-conditions.</p>
-
-<p>A very important factor is the length of time,
-as mentioned above under prognosis, that a patient
-remains under care. As a general thing,
-it is expected that the average patient will remain,
-approximately, six months. The period of detention
-is determined only after a study of the individual.
-An endeavor is made to consider all
-factors that may influence the future life of the
-patient,—the length of time and the amount he
-has been drinking, the effect on his character
-and physical health, the surroundings and occupation
-to which he must return. Some patients
-are paroled at the end of six months, some remain
-seven months. Drug users require treatment
-for a much longer period of time than
-users of liquor; and they remain from nine
-months to a year. The law provides that a patient
-shall not be paroled in less than two months,
-nor shall he be detained longer than two years
-without parole. This, of course, introduces the
-disagreeable aspect of the work. The detention
-is compulsory; and in some patients antagonism
-possibly over-balances the benefit of detention.</p>
-
-<p>“One of the most pronounced features of inebriety
-is, however, the inability of many inebriates
-to appreciate the necessity for treatment;
-and the more severe the inebriety, the less easy
-it is first to get the patient under treatment at
-all, and, secondly, to get him to remain long
-enough for any treatment to have a permanent
-curative effect. One has only to work among
-inebriates, no matter to what class of society
-they belong, to know that fear of interfering with
-the liberty of a subject who has no real liberty,
-in that he is a slave habitually or periodically to
-the drink craze, results in the interference with
-the liberty of all those who have to put up with
-his irresponsible behavior under the influence of
-alcohol and other narcotic drugs.</p>
-
-<p>“Were the treatment of the inebriate only possible
-in a free sanatorium, only a small minority
-<span class="pagenum" id="Page_116">[Pg 116]</span>
-of inebriates would come under treatment at all,
-and these would be of the less severe type.”
-(Pathological Inebriety, by J. W. Ashley Cooper,
-1913.)</p>
-
-<p>Discipline is of great importance, but great
-care must be taken in its enforcement. It is of
-more value for one to perform a certain duty because
-one regards it either as the proper thing or
-as likely to benefit one’s self or others.</p>
-
-<p>The personal influence of those who come into
-close contact with the inebriate can hardly be
-overestimated. He is easily influenced, often
-easily led, and a few thoughtless words or careless
-actions can undo the result of patient work.</p>
-
-<p>All factors that may influence the future life
-of the patient must be taken into consideration,—the
-length of time and amount he has been drinking,
-the effect on his physical health and character,
-and the surroundings and occupation to
-which he must return. Very often the cause
-of the commencement of the patient’s excessive
-drinking may be removed or may have disappeared.
-Such would favorably influence the prognosis.</p>
-
-<p>The presence or absence of irremediable disease
-is important. For instance, a woman recently
-committed to our care suffered from what was
-supposed to be, or was, neuralgia. She still has
-occasional twinges of pain; but we believe when
-the dentist has finished his work these will disappear,
-and her prospect be reasonably bright.
-A man, 56 years of age, four years ago, suffering
-from stone in the bladder, was given morphine,
-following an operation. The bladder condition
-was permanently relieved, but he became a morphine
-user. Such a case is a promising one. In
-him the destruction of character is but little
-marked.</p>
-
-<p>A boy, chasing around the city, acquired the
-cocaine habit, and became a loafer, drinker, and
-follower of loose women. For him the future
-offers practically no prospect. Were he a little
-younger, and had the attempt to rescue him been
-made earlier, there would have been much more
-promise. But I doubt whether he can withstand
-the lure of his former life. With a few drinks, his
-judgment becomes paralyzed, and he is back to
-cocaine again.</p>
-
-<p>Another man, an alcoholic, a printer, became
-nervous and exhausted after six months of linotype
-work. He probably will not get over his
-drinking permanently unless he changes his occupation.</p>
-
-<p>One of the most important factors as regards
-recovery is the length of time a patient remains
-at the Hospital. It is sheer folly to expect that
-in a few short weeks a man shall have entirely
-recovered from the effect of excesses extending
-over a period of years, to expect him to regain
-a lost will power in that time.</p>
-
-<p>Another important factor is the insight a patient
-obtains into his own condition. We cannot
-claim to make a man stop drinking. All we
-can do, is to place him in such mental and physical
-health that it is unnecessary for him to resort to
-stimulants.</p>
-
-<h3>RESULTS</h3>
-
-<p>The result of treatment in a disease of the
-nature of inebriety, can hardly be estimated in
-such time as the Hospital has been open. Our
-statistics are simply offered to show possibilities.
-As the statute under which the Hospital operates,
-contemplates a period of detention and treatment
-for not less than two months,—and that
-period is even too short in the vast majority of
-cases,—anyone resident in the Hospital for less
-than two months has been placed in a separate
-class, and we can learn that only two of these are
-doing well. Of 172 men, aside from those who
-have been discharged as not proper subjects, 54
-were paroled, of whom 37, or 68 per cent, are reported
-as doing well, 27 were released under
-bond, of whom 17, or 63 per cent, are reporting.
-Over one-half of the voluntary patients are reporting.</p>
-
-<p>Averaging all, we find 57 reporting as doing
-well; 30 fail to report; 29 are escaped, and we
-can learn nothing of them; and 56 were here
-less than two months, 38 of these being escaped;
-7 voluntary patients; and 8 were released under
-bond. A percentage of abstainers of 25, is to be
-regarded as most excellent; and as one-third of
-those who have left here are still abstaining,
-the greater number of failures occurring in the
-first month, the outlook for the future is very
-encouraging.</p>
-
-<p>So far, we have been speaking of what we are
-trying to do for the more hopeful class of patients.
-But what are we to do in the future with
-the incurable, the recidivists? Are we to send
-them back into the world time and again, let
-them abuse themselves, perchance their families,
-and let them be, as it were, a constant menace to
-society? No, society has a right to protect itself
-and to protect an individual against himself.
-There should be provision made for this class.
-They should be cared for in an institution under
-strict discipline, and made to support themselves
-there and to contribute to the support of those
-who may be dependent upon them.</p>
-
-<p><span class="pagenum" id="Page_117">[Pg 117]</span></p>
-
-<p>As soon as considerable numbers are received
-at an institution, the more apparent becomes the
-need of means for classification, especially as to
-character. It is decidedly unwise to allow the
-intermingling of the young lad who has just commenced
-to drink, with the incorrigible or the
-sodden, whose every thought may lie bestial.</p>
-
-<p>The most practical means of classification is
-by the use of cottages; and it is on that plan
-that Minnesota’s institution has been started. If
-two cottages were built at Willmar we should
-be able to make four groups of patients with
-decided advantage to our inmates. Not more
-than forty inmates should be cared for in each
-cottage: and I am strongly in favor of separate
-rooms for sleeping-quarters, instead of dormitories.</p>
-
-<h3>SUMMARY</h3>
-
-<p>The essential in the treatment of the inebriate
-as we meet him, is upbuilding of body and character,
-which requires time, and in which drugs
-play only a small part.</p>
-
-<p>Compulsory abstinence is of great value if we
-expect to care for a majority of the inebriates.</p>
-
-<p>It would be wise for the State to undertake
-the custody, care and control of all non-criminal
-inebriates in one institution, provided adequate
-facilities for classification were available.</p>
-
-<h3>DISCUSSION</h3>
-
-<div class="blockquot">
-
-<p><span class="smcap">Dr. C. R. Ball</span> (St. Paul): I have been very much
-interested this afternoon in this symposium on the
-treatment of fractures, the last word in obstetrics, and
-the inebriate, only it seems to me the Program Committee
-put the cart before the horse, and should have
-put the inebriate first, and the other things would naturally
-follow afterwards.</p>
-
-<p>Dr. Freeman has splendidly presented his work and
-results at the Willmar institution. It is a subject to
-which I think medical men pay too little attention. I
-have more and more come to look upon the inebriate
-as a type of nervous disease and, in the great majority
-of cases, a functional nervous disease. It may be classified
-as we classify nervous diseases. We classify in
-one way functional nervous diseases as to their cause,—acquired,
-hereditary and acquired, or wholly hereditary.</p>
-
-<p>The inebriate may be also classed in the same way.
-There are perhaps a few cases in which the habit of
-taking alcohol is absolutely acquired, but they are comparatively
-few. There are also a few cases of nervous
-prostration or functional nervous conditions from overwork,
-from a depleted condition, where the nervous
-condition comes on; and we may say it is acquired, and
-the prognosis in both of these cases is good. It requires
-but little effort to put them on their feet. Then
-we have that larger class of neurasthenic or functional
-nervous conditions, belonging to the second group, in
-which the nervous disease, as well as the inebriety, is
-partially acquired and partially hereditary. There is a
-large class here. They have an unstable nervous system,
-and whether they drink or break down depends
-a great deal upon the environment and physical condition.
-This type of inebriate must be treated along the
-same broad lines that we treat a person who is a
-neurasthenic, who is subject to repeated nervous breakdowns.</p>
-
-<p>There is another type which, unfortunately, is rather
-large; and this is the wholly hereditary, and in this
-type we may classify the dipsomaniac. I have looked
-for a long time upon dipsomania as a periodical
-nervous disturbance, similar to periodical attacks of
-migraine or epilepsy, or periodical attacks of insanity.
-Often where a son is an inebriate we find a history of
-migraine in the mother. Very often there is insanity,
-and very often there is epilepsy, so that when we come
-to consider the dipsomaniac we have a tremendous
-problem. He does not drink for the fun of it, but
-chiefly because of mental depression, mental restlessness,
-which is so great that he turns to alcohol to buoy
-up his spirits and get rid of the feeling which rather
-than suffer with, he would often prefer to die. I have
-a man of that description who came to me, and said
-that at a certain time he became depressed and suspicious,
-began to hate himself, went along the back
-streets, absented himself from his usual associates, and
-always did this at the beginning of his drinking bout.
-That is the case with all dipsomaniacs. It is a disease
-similar to epilepsy, and our success in treating this
-type is just about as good as in treating epilepsy. It is
-not the alcohol: it is an inherited condition; it is a
-periodical nervous disturbance, just as epilepsy and
-migraine are.</p>
-
-<p>We hear a great deal about the prevention of tuberculosis,
-and much is done to prevent it. I think we
-hear much more about the evil effects of syphilis than
-of alcohol, but, in my experience, I would place alcohol
-at the top of the list as being the most damaging both
-to the individual himself and to his offspring. We
-have heard a great deal about the effect on the offspring.
-In my clinic at the Free Dispensary I have
-many epileptic children, and I should say in sixty per
-cent of the cases one parent is an alcoholic. An address
-of Dr. Rogers, of Faribault, with reference to
-the ill effects of one intoxication, when a conception
-occurs during that time, put the subject of drinking
-before me in a new light. Much interesting experimentation
-has within recent years been done with rabbits
-and guinea-pigs to show the harmful effect of a
-single dose of alcohol given to either the male or
-female parent before conception, on the after-coming
-litter.</p>
-
-<p>Not long ago I read an article by some man in New
-York in which he stated he had traced seven cases of
-epilepsy to the evil results of a single intoxication in
-seven different parents. That was something rather
-new to me, as I thought, in order to get the bad effects,
-on the descendants, of alcohol, it was necessary to
-be a chronic alcoholic, and I believe very few of the
-laity understand that, if conception happens to occur
-during one drunk, the parent being otherwise a temperate
-person, the ill effects may be visited on the offspring
-to as great an extent as if the parent were a
-chronic inebriate. These are some of the things which
-would do good if given publicity.</p>
-
-<p>In regard to the treatment: I can fully agree with
-<span class="pagenum" id="Page_118">[Pg 118]</span>
-Dr. Freeman in everything he has said. There is certainly
-no specific when you come to consider the nature
-of the trouble. The treatment must be carried along
-the same general lines of physical and moral upbuilding
-as those we seek to follow in functional nervous
-disease.</p>
-
-<p><span class="smcap">Dr. W. A. Jones</span> (Minneapolis): I wonder how
-many members of the State Association have visited
-the hospital for inebriates at Willmar. I would like
-to ask all those who have, to hold up their hands. Five
-or six of this audience, representing the twelve hundred
-doctors belonging to this Association. That gives one
-a fair estimate of those familiar with the State farm
-for inebriates. I should like to know further how
-many members of the legislature have visited this institution,
-and how many have tried to condemn it or
-perhaps to take it for a tuberculosis hospital. That is
-what they will do unless we physicians stand by Dr.
-Freeman and the institution.</p>
-
-<p>There is too much sentiment, too much sympathy
-among friends, relatives, courts, juries, and charity
-workers, as to the inebriate; but once he gets to Willmar
-and is under a proper regimen, his attitude changes
-totally toward himself and toward the world. After
-one has watched the treatment at Willmar and has seen
-the benefit these patients derive, he wonders why so
-many women and so many men are sent to quack institutions
-for inebriety and drug habits. Willmar costs
-the patient practically nothing, except a small per
-capita borne by the State. The average quack institution
-charges $150.00 for a cure, so called, whether the
-cure lasts for three days, or, as in some of the more conservative
-(?) quack institutions, the period is extended
-to ten days, and in the notoriously drink-habit cures,
-to thirty days. This ought to appeal to a doctor forcibly,
-inasmuch as all these claims of cures made by quack
-institutions are limited to thirty days at the outside, an
-absolutely absurd statement, and, for that reason, if
-for none other, we should all support and entertain
-anything that tends to increase the efficiency of the
-State farm for inebriates at Willmar.</p>
-
-<p>One thing which Dr. Freeman wants to emphasize
-is the necessity at times of forcible restraint in a building
-especially constructed for detention cases. There
-is a small class of people who are, perhaps, suffering
-from a disease state, who are irresponsible. Most of
-them are common drunkards, who create all sorts of
-disturbances and who really need discipline—who need
-to be detained forcibly for a sufficient length of time
-to enable them to recover their normal physical tone,
-and until they recover something of their natural
-mental tone. If this could be incorporated in the rules
-and regulations of the governing body of the inebriate
-farm it would make a great increase in the total number
-of improvements and recoveries.</p>
-
-<p>Dr. Freeman has emphasized the necessity of getting
-the physical condition up to a high point. He has said
-all that is really needed on the subject. I believe drugs
-and drink should be reduced rapidly in almost every
-case. If you look over some of the literature of some
-institutions that take these people, you will find they
-reduce the morphine down from fifty grains to forty,
-and then to thirty-nine, until, finally, after a period of
-so many weeks or months, they cut it down to the
-two-hundredth of a grain, and give it hypodermically.
-You can readily see the absurdity of that treatment.
-The average man can have the total reduction made
-within thirty-six or forty-eight hours.</p>
-
-<p>I hope you will take more interest in the inebriate
-farm, and see that your legislator is interested as well.</p>
-
-<p><span class="smcap">Dr. Haldor Sneve</span> (St. Paul): I have listened with
-a great deal of pleasure to Dr. Freeman’s paper, and
-especially because there are some statistics as to what
-can be accomplished in such an institution even in a
-comparatively short time. Personally, I think that six
-months as an average time to stay in this institution
-would be too short. It will be found, however, in time,
-whether this is true, but just now the institution is in
-the experimental trial stage.</p>
-
-<p>A great many legislators are, as Dr. Jones said, trying
-to convert this institution either into an insane
-asylum or a tuberculosis sanatorium; and it is up to
-the profession of the state to back up the establishment
-of this institution for the treatment of a class
-which is growing.</p>
-
-<p>Personally, I think drink is a vice and not a disease,
-and until we can eradicate from the minds of the laity
-and from the minds of some physicians the idea that a
-man who drinks is some sort of a nervous invalid, the
-sooner we shall get better results in the handling of
-this question. Even the dipsomaniac has periodic
-brain-storms, which Dr. Ball has likened to attacks of
-migraine; that is a good simile, they do not always
-take to drink, but go off in other ways.</p>
-
-<p>I have treated from twenty to fifty cases of delirium
-tremens at the City Hospital every year for twenty
-years, and I have had considerable experience in institutions;
-and yet I cannot find anything to criticize
-about the principles of treatment that Dr. Freeman has
-put forth here today. The idea in the minds of the
-laity is that inebriety is a disease, and they want drugs
-for it to make them well, and that is one reason why
-so many patients go to Keeley cures and get well. They
-go there because they find a drug that cures <i>disease</i>.
-I find that the Towne-Lambert treatment is an excellent
-<i>mental</i> treatment for the inebriate in private practice.
-It can be used in the institution at Willmar, as
-well as in private practice, and putting a patient upon
-the Towne-Lambert treatment satisfies his desire to
-cure the disease he is suffering from.</p>
-
-<p>I think the profession will have to keep their eyes
-on the legislators, perhaps on the new governor, and
-see that this institution is not thrown into the waste-basket,
-so to speak, or converted into some other sort
-of institution, because we need a place of this kind.
-Even if Minnesota can go prohibition pretty soon—and
-I rather think it will—we shall not get rid of our
-drunkards for that reason. We shall still have to
-have a hospital for the treatment of the morphine,
-cocaine, and alcoholic habits. The doctors who send
-patients to Willmar, I think, ought to be careful, and
-not try to help some municipality out of taking care
-of old battered hulks, who cannot hope to recover, who
-cannot be made well simply because they have been
-drinking for so many years, and their other habits of
-life have resulted in such a deterioration of the brain
-that there is no possibility of bringing them back and
-making really good citizens of them. Those patients
-should be kept in a work-house or in a special department
-at Willmar or some other place. We should try
-to reclaim all of our young men and young women
-habitues.</p>
-
-<p>Owing to the absence of proper writeups about this
-<span class="pagenum" id="Page_119">[Pg 119]</span>
-hospital it is not generally known throughout the state
-that pay-patients can be received and treated just as
-in any sanitarium and at very moderate rates.</p>
-
-<p><span class="smcap">Dr. Freeman</span> (closing): I really have nothing to add
-in closing except to say a word with regard to prohibition.
-I have a second-hand statement from the police
-of one of the Twin Cities that he is positive in his city
-there are five thousand drug-users from his experience in
-the police court.</p>
-
-<p>With regard to the maintenance of discipline at the institution:
-We have sufficient law or authority for discipline,
-but we have not the facilities. The thing in my
-opinion that we mostly require is a building where
-we can take care of a man who is incorrigible, or a man
-who runs away. For two reasons: In the first place, I
-have known a number of men who came there unwillingly,
-who later were greatly benefited by their compulsory
-stay; second, the effect of disciplinary measures
-upon the population in general. If a man knows that,
-when he goes there, he must stay, he naturally gets over
-his constant thought that he is going to sneak away, and
-put it over. The custodial cottage to take care of forty
-people would allow, in all, four classes of patients. We
-should have a reception-ward in which to examine all
-new patients; one ward for the incorrigible; and we
-should have two other places to care for two classes of
-men received. This would prevent the influence of the
-older men who have gone further in their habits upon
-the young boy who has just started.</p>
-</div>
-<hr class="chap x-ebookmaker-drop" />
-
-<div class="chapter">
-
-<h2 class="nobreak" id="INTRACRANIAL_COMPLICATIONS">
-DIAGNOSIS OF INTRACRANIAL COMPLICATIONS IN DISEASES
-OF THE MIDDLE EAR AND ACCESSORY
-SINUSES OF THE NOSE
-<a id="FNanchor_3" href="#Footnote_3" class="fnanchor">[3]</a></h2>
-</div>
-
-<p class="center"><span class="smcap">By Joseph C. Beck</span>, M. D.<br />
-CHICAGO.</p>
-
-<div class="footnote">
-
-<p><a id="Footnote_3" href="#FNanchor_3" class="label">[3]</a>
-Read before the Sioux Valley Medical Association,
-July 22, 1914, and published in these columns at the
-request of the Association.</p>
-
-</div>
-
-<p>The most important causes of intracranial
-complication from the middle ear and nasal accessory
-sinuses, are suppurations, consequently
-I shall confine my remarks to that subject, and
-not take up the neoplasms, trauma, etc.</p>
-
-<p>In the diagnosis it is most important to recognize
-suppurative disease of the ear and sinuses,
-but this subject is not within the province of
-this paper, therefore I shall satisfy myself by
-mentioning only that the presence of the pus
-from the middle ear and nose, and Röntgenographic
-examination, are the most important
-signs of affections of these structures. The one
-symptom more than any other on the part of
-the patient of a threatening extension into the
-cranial cavity, is localized pain or headache,
-which is very persistent, instead of periodic.
-Especially important is this in connection with
-the cessation or diminution of the discharge.
-The knowledge of the pathological change present
-in the sinuses and middle ear and mastoid, is
-of additional value as, for instance, tuberculosis,
-syphilis, and cholesteatoma.</p>
-
-<p>The frequency of intracranial complication in
-suppuration of the middle ear is much greater
-than that following sinus disease, about twenty-five
-to one in my experience.</p>
-
-<p>The intracranial complications which I shall
-consider are—</p>
-
-<ol>
-<li>Meningitis.</li>
-<li>Sinus thrombosis.</li>
-<li>Brain abscess.</li>
-</ol>
-
-<p>The meningitis may be serous or suppurative,
-and later localized or diffuse.</p>
-
-<p>The sinus thrombosis may be partial or parietal,
-and complete with or without involvement
-of the jugular bulb and vein. The brain abscess
-may be extradural or genuine within the brain
-substance proper. The complications may be
-further divided as to bacteriologic or etiologic
-factors as, for instance—</p>
-
-<ul>
-<li>Streptococcic</li>
-<li>Staphylococcic</li>
-<li>Pneumococcic</li>
-<li>Tuberculous</li>
-<li>Syphilitic</li>
-</ul>
-
-<p>These complications may arise following
-acute, or chronic and acute, exacerbation of
-chronic suppuration of the ear and sinuses. Meningitis
-and sinus thrombosis (this latter condition
-is very frequently associated with a localized
-meningitis) are usually complications following
-acute, or acute exacerbation of chronic,
-suppuration of the ear and sinuses. Brain abscess,
-however, is most frequently associated with the
-chronic form of the ear and sinus disease; but
-these become more manifest following an acute
-attack of ear or sinus trouble. Tubercular or
-syphilitic meningitis is chronic inflammation
-<i>per se</i>; but these conditions are also lit up by
-the acute processes within the ear and sinuses.</p>
-
-<p>The cardinal symptoms of any intracranial
-complications are—</p>
-
-<div class="blockquot">
-
-<p>1. <i>Pain or headache.</i>—This may be localized
-or diffuse; it is, however, very persistent and
-quite intense. It is in the recognition of this
-<span class="pagenum" id="Page_120">[Pg 120]</span>
-symptom that has helped me more than any
-other in suspecting intracranial trouble.</p>
-
-<p>2. <i>Nausea and vomiting.</i>—This symptom is
-quite constant, especially early in the disease;
-and projectile vomiting is quite characteristic of
-intracranial pressure or irritation.</p>
-
-<p>3. <i>General septic appearance.</i>—This of course
-will vary in the different conditions under consideration,
-but in all is it quite manifest.</p>
-
-<p>4. <i>The vision</i> is very frequently affected due
-to the choked disk that is present.</p>
-
-<p>5. <i>Temperature, pulse, and respiration</i> are
-very frequently disturbed.</p>
-
-<p>6. <i>Definite focal symptoms</i> of brain localization
-are of the utmost importance in the diagnosis.</p>
-
-<p>7. <i>Blood and spinal fluid examinations</i> give
-very valuable information.</p>
-
-<p>8. <i>Röntgenographic findings</i> are at times valuable.</p>
-
-<p>9. <i>Exploratory operation and treatment</i>, as
-in lues, is at times necessary to make a diagnosis.</p>
-
-</div>
-
-<h3>MENINGITIS</h3>
-
-<p>(a) <i>Serous meningitis.</i>—One of the first
-signs is the increasing headache, at first localized,
-usually near the seat of the perforation or
-path of infection, and soon becoming diffuse
-over the head. The patient loses his appetite, his
-tongue becomes coated, the emunctaries become
-sluggish in their action, and nausea is a very
-common symptom. The temperature rises, and,
-if the septic form is going to follow, this rise is
-often quite rapid, so that there may occur small
-chills from the infection of the cerebrospinal
-fluid. The pulse and respiration rate is now considerably
-increased. The patient is very irritable
-and restless, and does not sleep. As soon as the
-fluid increases within the cavity there is observed
-the characteristic syndrome of rolling the eyes,
-especially upward, the neck is drawn backwards,
-and finally the leg upon the thigh and
-thigh upon the abdomen. Attempts to straighten
-them out is resisted and appears to be painful,—Kernig’s
-sign.</p>
-
-<p>Stroking the bottom of the feet with some
-semisharp instrument or the finger-nail will
-cause the big toe to turn up instead of down,—Babinski’s
-sign.</p>
-
-<p>Taking the head and tilting it forward against
-the chest will cause the limbs to be drawn up,—Brudzinski’s
-sign.</p>
-
-<p>All the other symptoms, as pressing over the
-peroneal nerve and muscle (Gordon’s sign),
-which will cause the extension of the toes, the
-stroking of the anterior tibial surface (Oppenheim’s
-sign), or the stroking of the region of the
-external malleolus (Chaddock’s sign), will produce
-retraction of the toes. All these signs, I
-say, prove that the upper neuron (within the
-cranium) is involved. The patient now will
-lapse into unconsciousness, and be roused with
-more or less difficulty to again relapse in the
-same condition. The pupils become sluggish in
-their action, at first becoming small, then irregular,
-and finally dilated.</p>
-
-<p>Ophthalmoscopic examination may reveal a
-choked disk. Spinal puncture shows increased
-pressure by fluid very frequently coming through
-the hollow needle with a spurt, and clear or slightly
-cloudy. Following such a puncture the patient
-is very often much improved for from a half an
-hour to a whole day, but the symptoms soon return.
-A complete examination of the cerebrospinal
-fluid thus removed, will aid a great deal
-in diagnosis. This includes the following:</p>
-
-<div class="blockquot">
-
-<p>1. Remove about 25 c. c. at spinal puncture.</p>
-
-<p>2. Make several slides and stains for organisms,
-as septic and tubercular.</p>
-
-<p>3. Examine and count the endothelial cells,
-leucocytes, and pus cells.</p>
-
-<p>4. Make cultures.</p>
-
-<p>5. Make a Noguchi (butyric-acid) test for
-excess of albumin.</p>
-
-<p>6. Make a Lange colloidial test.</p>
-
-<p>7. Wassermann, Nonne, and Noguchi tests
-for syphilis.</p>
-
-<p>8. Test for sugar.</p>
-
-<p>9. Test for total acidity and relative acidity.</p>
-
-<p>10. Cholin may be tested for.</p>
-</div>
-
-<p>In the serous form one will find the cells increased
-somewhat, especially the leucocytes, but
-the micro-organisms are conspicuous by their
-absence.</p>
-
-<p>The Lange (colloidal-goldchloride) test will
-show the characteristic color reaction of a septic
-process.</p>
-
-<p>The Noguchi (butyric-acid) test will be positive.
-Excess of albumin.</p>
-
-<p>The Wassermann, Nonne and Noguchi tests
-for syphilis are negative. (Unless such a case
-should be a complicated one.)</p>
-
-<p>The test for sugar is very important in that in
-serous meningitis sugar is present.</p>
-
-<p>The relative acidity is not markedly affected,
-and cholin is not present, or, if so, in only small
-quantity.</p>
-
-<p>(b) <i>Septic meningitis.</i>—If this is <i>localized</i>,
-and there is a collateral serous meningitis associated
-<span class="pagenum" id="Page_121">[Pg 121]</span>
-with it, then the symptoms may be the
-same, as just described; however, the cerebrospinal
-fluid will show a greater degree of irritation,
-and the fluid may contain some micro-organisms.
-The majority of localized septic
-meningitis cases, however, are not as severe in
-their course as the serous or diffuse septic forms.
-The one important symptom is the localized
-headache, which is quite persistent, and the
-greater rise in the temperature. There are, undoubtedly,
-many cases of localized meningitis
-that show a perfectly normal cerebrospinal fluid,
-and most of the cardinal symptoms absent; and
-these are the cases that usually get well or lead
-to extradural abscesses subsequently.</p>
-
-<p>The <i>diffuse septic meningitis</i> is the most discouraging
-intracranial complication that we have
-to deal with, and the diagnosis as a rule is not
-difficult. It usually is preceded by the serous
-form, but within a very short time develops the
-graver symptoms of sepsis. The most positive
-symptom is the spinal puncture. The fluid comes
-out under pressure, but not so great as in the
-serous form, and is turbid. The turbidity varies
-in degree with the amount of infection. It has the
-appearance at times of pure pus; in fact, that is
-what it is. Bacteriologically one will find many
-micro-organisms of the character of the infection;
-and leucocytes or pus cells are very numerous.</p>
-
-<p>The sugar reaction is always absent, and the
-acidity is much increased as is the quantity of
-cholin.</p>
-
-<p>The pressure or irritative symptoms as the
-Kernig and Babinski tests, as well as the pupillary
-reactions, are practically the same as in the
-serous meningitis, only that they soon give away
-to the paralytic form, namely: pupils dilate,
-patient is in a constant stupor or coma, and the
-involuntary urination and bowel movements become
-very manifest. The patient is, as a rule,
-unable to take or be given nourishment. The
-outcome is, in my experience, with one exception,
-always fatal, due to diffuse cerebritis. I
-have had a case of diffuse septic meningitis in
-the early stages of a pneumococcic type which I
-operated on by the Haynes’ method of drainage
-of the cyscterna magna, and which recovered;
-and I believe that the success in that case was due
-to the very early intervention, because I have
-operated by the same method on eight other cases
-more advanced and of streptococcic and staphylococcic
-type of infection, which ended fatally.</p>
-
-<p><i>Sinus thrombosis.</i>—This complication is the
-one that is recognized as giving the best prognosis
-because it can be very readily recognized,
-and even exploration is warranted to make such
-diagnosis. It most frequently follows, or is associated
-with, acute infections of the middle ear
-and mastoid process. The most important symptoms
-are the chills and fever of a distinct septic
-type, and, as a rule, increasing in frequency.
-There is invariably a blood-picture of sepsis,
-namely, a very high leucocyte count and the
-polymorphonuclear type in marked excess.
-Blood cultures are, as a rule, positive of a bacteriemia.
-If the process has extended to the bulb
-and internal jugular vein, then one may feel a
-thickening or cord-like mass along the anterior
-border of the sterno-cleido-mastoid muscle. The
-fundus examination often reveals a choked disk,
-especially on the side where the thrombosis is
-located. A symptom recently described by Beck,
-of Vienna, and Crowe, of Baltimore, and proven
-by me to be of positive value in several cases, is
-the production or increase of a choked disk by
-compression of the healthy internal jugular vein.
-Urbanschitch has shown in quite a number of
-cases of sinus thrombosis that the blood-clotting
-time is very much enhanced. This of course is
-true of any case of bacteriemia or septic phlebitis
-anywhere in the body. I have proven this test to
-be of value to me in several cases of sinus thrombosis.
-The exploratory exposure of the lateral
-sinus is of distinct value, and the only fact to
-remember is to expose a sufficient area so that
-one is able to deal with the sinus in case it be
-opened accidentally, because such an accident
-when this precaution was not taken has led to
-serious consequences.</p>
-
-<p>The diagnosis of a thrombotic sinus when
-exposed is made first by its discoloration, usually
-of a grayish pink; secondly, it feels harder than
-normal and is not resilient when compressed,
-that is, it does not spring back. It, however, may
-be soft in case the thrombus has broken down;
-and in cases of parietal thrombosis it may spring
-back because there is blood circulating through it.
-One will at times find a small collection of pus
-about the sinus, a condition known as perisinus
-abscess, and in many instances of this condition
-the sinus itself is not thrombosed. The puncture
-of the sinus by a hypodermic needle and attempt
-to withdraw some blood, is not at present considered
-good practice owing to the danger of infecting
-a non-infected sinus. An incision is considered
-a wiser plan, and subsequently packing both
-sides (torcular and bulb) so they are shut off
-from the general circulation. There are many
-instances of secondary infection by embolism,
-<span class="pagenum" id="Page_122">[Pg 122]</span>
-either in or about the joints, and infection into
-the lungs, spleen, pancreas, etc., with the entire
-train of symptoms from such complications.</p>
-
-<p><i>Brain Abscess.</i>—This is most frequently associated
-with chronic suppuration of the middle ear
-and mastoid, and labyrinthine disease. As stated
-before, we must consider two principal types,
-namely, those outside the dura and those within.
-They may exist at the same time, or the intradural
-abscess may frequently follow, especially in
-acute exacerbations, the extradural abscess.
-The paramount symptom is the great pain in
-the head, most frequently localized at or in close
-proximity to the abscess. I have, however,
-found several instances where the patient located
-the pain in the anterior portion of the head, and
-operation or post-mortem examination disclosed
-it in the posterior cerebral fossa. This pain is
-not at all unlike that in brain tumor, and there
-are exacerbations in the headaches sometimes
-at night, other times in the mornings, and in one
-of my cases the patient would have about ten attacks
-of severe head-pains within twenty-four
-hours, and in the intervals be fairly comfortable.</p>
-
-<p>The next group of symptoms of importance
-are the focal lesions, which will correspond to
-the anatomicophysiologic locations and actions.
-These focal symptoms will vary in degree in that
-they be either irritative or destructive. So, for
-instance, a small abscess pressing over the motor
-area will cause clonic contraction and a still
-larger abscess, especially if it be intradural, will
-produce paralysis of that portion of the body
-governed by that particular area. Again, if it
-be located in the cerebellar region it will cause
-a train of symptoms of imbalance and loss of interpretation
-of direction, which must be carefully
-differentiated from the irritation of the
-labyrinth. In this department there has been
-much work done by Barany, Ruttin, Neumann,
-and other Viennese, and many others to make it
-possible to make a differential diagnosis; and
-there is a great deal more to be done. One of the
-most important recent contributions in this regard
-is the “pointing test” of Barany in connection
-with cerebellar lesions; and careful
-study and experimenting at every opportunity is
-very much recommended, in order to familiarize
-one’s self with this test. This in connection
-with the various labyrinth tests makes the differential
-diagnosis much more easy. One must remember
-that both labyrinthian irritation in connection
-with suppuration of the ear and cerebellar
-<span class="pagenum" id="Page_32">[Pg 32]</span>
-irritation from brain abscess may exist at the
-same time.</p>
-
-<p><i>Intracranial pressure</i>, being increased in brain
-abscess, will cause the cerebrospinal fluid to be
-increased and found to be so by spinal puncture,
-although no pus cells or micro-organisms will
-be found, unless there is also a concomitant
-diffuse septic meningitis or ventricular infection
-present. The ocular symptoms of intracranial
-pressure, such as pupillary (often one large and
-one small) and choked disk, are usually present.
-The <i>pulse rate</i> and <i>respiration</i> will be affected,
-as in brain tumor, according to the size of the
-abscess. The larger the abscess the slower the
-pulse and respiration. The temperature, as well
-as the pulse and respiration, will vary as to
-whether the abscess be intradural or extradural.
-Intradural abscesses will frequently cause considerable
-rise of temperature, and acceleration
-of the pulse and respiration, and a remission
-when the abscess has become partially walled
-off. As soon as a fresh invasion of brain tissue
-takes place another rise of temperature, etc.,
-occurs.</p>
-
-<p><i>Projectile vomiting</i> is, as in brain tumor, quite
-frequently encountered.</p>
-
-<p><i>The Röntgenogram</i>, especially a stereoscopic
-one, will be of some value in cases where through
-its chronicity a change of bone by pressure has
-taken place, or if one may follow the path of
-necrosis from the nasal accessory sinuses or the
-middle ear and mastoid process towards the
-brain. I will state, however, as I have stated on
-several occasions before, that not too much emphasis
-should be laid on the diagnostic value of
-the <i>x</i>-ray in intracranial lesions, especially
-abscess. I have been disappointed in this great
-method of diagnosis (<i>x</i>-ray) and much annoyed
-at the positiveness of some observers without
-sufficient evidence.</p>
-
-<p>As in sinus thrombosis, so in brain abscess
-one should not hesitate in the exploratory operation,
-because waiting too long will often reduce
-the patient’s ability to stand an operation later
-on. Should one not find the abscess, then the
-decompression has done a great deal to prevent
-destruction of brain tissue by pressure, besides
-the patient will be very much relieved of the
-severe head-pains. This may be said also of
-spinal punctures. In this way one may wait for
-development of localization for another operation.</p>
-
-<p>In conclusion, I would like to repeat the words
-<span class="pagenum" id="Page_123">[Pg 123]</span>
-of Prof. Neumann as to the differential diagnosis
-between meningitis, sinus thrombosis, and
-brain abscess: “A patient that has meningitis
-is one that wishes to be left alone and allowed
-to sleep, although when roused is not particularly
-irritable. If he has brain abscess then he
-is constantly very irritable and difficult to manage,
-while a patient that has sinus thrombosis
-when he is free from the chill and fever is very
-pleasant, apparently well.”</p>
-<hr class="chap x-ebookmaker-drop" />
-
-<div class="chapter">
-
-<h2 class="nobreak" id="THE_TREATMENT_OF_GONORRHEAL_OPHTHALMIA">
-THE TREATMENT OF GONORRHEAL OPHTHALMIA</h2>
-</div>
-
-<p class="center"><span class="smcap">
-Arthur Edward Smith</span>, M. D.<br />
-MINNEAPOLIS</p>
-
-<p>In ophthalmology, as in other branches of
-medical science, the advance in therapeutics has
-hardly kept pace, in recent years, with that in
-pathology and diagnosis. Comparatively few of
-the therapeutic innovations of the past decade
-have stood the test of time; and, in the main,
-the ophthalmological materia medica of today
-bears a striking resemblance to that of fifteen
-or twenty years ago. Our poverty of therapeutic
-resource has been notably exemplified in the
-generally accepted method of treatment of gonorrheal
-ophthalmia; and the results obtained with
-the conventional treatment as outlined in the
-current text-books are far from satisfactory.</p>
-
-<p>Gonorrheal ophthalmia, in both infants and
-adults, continues to cause an appalling amount
-of blindness; and only a part of this can, with
-justice, be ascribed to ignorance and neglect.
-The number of cases which, in spite of the
-most careful treatment, go on to corneal ulcer,
-perforation, panophthalmitis, and irreparable
-blindness, continues to be considerable. Further,
-a decided difference of opinion still exists among
-well-trained oculists of wide experience as to the
-best method of handling these cases. For over
-a hundred years silver nitrate has enjoyed an unquestioned
-pre-eminence in the treatment of the
-purulent ophthalmias, particularly those cases in
-which the gonococcus was the etiological factor;
-and even now to question its right to a place in
-the treatment of gonorrheal conjunctivitis seems
-to many to be as heretical as to abandon mercury
-in the treatment of syphilis. For many years the
-only difference of opinion in regard to silver nitrate
-seemed to be as to whether it should be employed
-in the first stage of the disease, or whether
-one should wait until the discharge became purulent.
-Of late years, however, a number of experienced
-oculists have gone on record as being
-of the opinion that the majority of these cases
-do distinctly better without the nitrate than with
-it. As is well known, the nitrate destroys only
-those gonococci lying upon the surface or in the
-most superficial layers of the conjunctiva; and,
-far from reaching those in the deeper layers,
-rather forms a film over the surface which protects
-them from the irrigating solution used later.
-It also appears to be certain that the use of the
-nitrate, for a time at least, increases the ratio of
-extra-to intracellular gonococci in the discharge,
-which furnishes another valid argument against
-its use. That a subsequent chronic conjunctivitis
-with hypertrophy is often a disagreeable sequel in
-cases in which an energetic course of silver nitrate
-has been used is a matter of common observation.
-The vogue of certain of the organic
-silver salts, such as argyrol, protargol, etc., is no
-doubt, not so much due to any intrinsic therapeutic
-merit which they possess as to the fact that
-the average case gets along better without the
-local application of strong chemical antiseptics.
-However one may feel about the abandoning of
-such a time-honored drug as the nitrate of silver
-in the treatment of this disease, it must be conceded
-that it is entirely inadequate to control the
-process in the severer cases, and as a therapeutic
-sheet-anchor leaves a great deal to be desired.</p>
-
-<p>The use of cold compresses in gonorrheal
-ophthalmia continues to be advocated in text-books
-and practiced in many clinics, especially in
-America, in spite of the fact that the progressive
-men in general medicine and surgery seem pretty
-generally to have abandoned the use of cold applications
-in the treatment of acute inflammations
-of bacterial origin. Any merit the cold
-compresses may have in the reducing of the edema
-and relieving pain are more than counterbalanced
-by the fact that the vitality of the tissues is
-at the same time lowered. In cases in which
-there is a sufficient swelling of the lids to cause
-a dangerous pressure on the eyeball, cold should
-not for a moment be depended upon to control
-the inflammatory edema but instant recourse had
-to canthotomy: in cases where this swelling is not
-marked cold compresses are unnecessary and
-apart from a certain analgesic effect, of no value.
-<span class="pagenum" id="Page_124">[Pg 124]</span>
-The skepticism, which is becoming more general,
-in regard to the value of silver nitrate and cold
-applications has not extended to the third member
-of the classic trinity,—irrigations,—the efficacy
-of which seems to be generally conceded.
-Various substances have been advocated for this
-purpose,—boric acid, potassium permanganate,
-bichloride of mercury, normal salt solution, etc.,
-and the consensus of opinion seems to be that it
-is practically indifferent which one of these is
-used, the action being mechanical rather than
-chemical. The ordinary method of half-hourly
-irrigations has been abandoned by Hosford,
-Ulbrich, and others in favor of the constant irrigation
-with the Hosford apparatus or some
-modification of it.</p>
-
-<p>The English adherents of the constant irrigation
-treatment, who, for the most part, dispense
-with the use of silver nitrate altogether, report
-excellent results; but the method is not without
-its drawbacks. The apparatus is awkward to
-use, requires as much or more attention than the
-intermittent irrigations, and undoubtedly disturbs
-the rest of the patient at night more. Further,
-since the lids are, of course, not held apart
-for the constant irrigation, but the flow of the
-solution across the palpebral fissure is depended
-on to cleanse the eye of secretion, one is inclined
-to question whether the mechanical cleansing is
-as thorough as when the lids are gently held apart
-while the eye is being irrigated.</p>
-
-<p>The more one sees of these cases, the more one
-is impressed with two things: first, that a certain
-percentage of them would make a complete and
-uncomplicated recovery, even if they were entirely
-untreated (undoubtedly this number is
-larger than we think, especially in children);
-second, that the usual treatment is entirely inadequate
-in those cases in which there is an
-especially virulent infection or a lowered resistance
-of the tissues. When antigonococcic serum
-was first developed and its action observed in
-cases of acute gonorrheal ophthalmia, the results
-were, as in acute urethritis, disappointing.
-Many oculists are of the opinion that the serum
-is entirely without value in acute blenorrhea,
-even though its use be indicated in metastatic
-eye disease of gonorrheal origin. Of late, however,
-at least two men in America have written
-enthusiastically of serum-therapy in acute gonorrheal
-conjunctivitis, advocating its employment
-in the usual manner and also its use locally, i.e.,
-dropped into the conjunctival sac in place of the
-usual antiseptics. It would seem that the data
-now available hardly warrant a positive statement
-in regard to the serum-therapy.</p>
-
-<p>The pathological findings in gonorrheal ophthalmia
-are simple but significant, in that the
-gonococcus of Neisser is found, not only on the
-surface and in the superficial cells of the conjunctiva,
-but also, often within forty-eight hours, has
-invaded the deeper layers of the epithelium and
-the subepithelial connective tissue. This at once
-makes clear the reason for the inefficacy of the
-local antiseptics, particularly those like silver
-nitrate, the action of which is very superficial.
-Organic silver preparations and irrigations of various
-kinds are equally powerless to reach any but
-the most superficially situated of the bacteria.</p>
-
-<p>Since the destruction of the bacteria lying on
-the surface is not sufficient to control the disease,
-it may be stated that the problem of the destruction
-or inhibition of the deep-lying bacteria is the
-essential problem in curing gonorrheal ophthalmia.</p>
-
-<p>The gonococcus numbers among its biological
-peculiarities an unusual intolerance of extremes
-of temperature, its growth in culture being
-inhibited by temperature above 38° C. or
-below 18° C. Text-books on bacteriology state
-that exposure to a temperature of 60° C. for a
-period of ten minutes destroys the gonococcus.
-Experimentation in the laboratory of the Dimmer
-Clinic in Vienna in April and May, 1913, with
-cultures from forty-two cases of acute gonorrheal
-urethritis, seemed to indicate that this point may
-be placed from one and one-half to two degrees
-lower than this, i.e.,—from 58° C. to 58.5° C.</p>
-
-<p>Thus, theoretically, at least, it would appear
-that, if the conjunctiva could be subjected to a
-temperature as near as possible to this without
-injury to the tissues, a marked effect should be
-observed in the course of the disease, particularly
-if the heat can be applied in such a way as to
-penetrate as deeply into the tissues as does the
-gonococcus. This theoretical requirement has, in
-my opinion, been perfectly met practically by the
-local use of steam as practiced in the Dimmer
-Clinic since February, 1913, with the apparatus
-devised by Lauber and modified by the writer.
-Goldzieher of Vienna was probably the first to
-employ steam in the treatment of the purulent
-ophthalmias; and in his first series of cases reported
-fifteen patients treated with the application
-of steam passing through a nozzle held at a
-distance of about four centimeters from the eye,
-the temperature of the steam striking the tissues
-being about 45° C. (113° F.). Although the results
-<span class="pagenum" id="Page_125">[Pg 125]</span>
-indicated that the method was a distinct
-step in advance there were still a number of important
-details to be worked out, in order to get
-the best possible results. First of all, experiment
-showed that the temperature of the steam at a
-given distance from the nozzle was not constant,
-so that an arbitrary distance could not be set.
-This suggested the advisability of providing the
-apparatus with a sliding-guard, which could be
-set at the exact distance from the nozzle where
-the steam was shown by the thermometer to be
-at the desired temperature. Secondly, it was determined
-that the tissues would sustain without
-injury a considerably higher temperature than
-that set by Goldzieher, and that the effect upon
-the diseased process was markedly better when
-the temperature was raised. Steam at from 50° C.
-to 53° C. gave the best results; and in one case in
-which a temperature of 55° C. was inadvertently
-reached no injury was done the tissues. Further
-experience naturally suggested other changes in
-the original technic. In the first place, the lids
-were held apart by an assistant in the usual
-manner; but, even with gloves on, the exposure
-of the fingers to the steam was more or less
-painful, and gauze wound on little sticks was
-substituted. The time of exposure was finally
-set at six minutes; and since the application of
-the steam could not be borne for longer than from
-forty-five to sixty seconds without severe pain it
-usually took twenty minutes or so to complete
-the six-minute exposure. This was done once
-every twenty-four hours, and was combined with
-half-hourly irrigations with potassium-permanganate
-solution. No other treatment was used.
-The results attained with this method in 34 cases
-(7 adults, 2 children and 25 infants) has left
-nothing to be desired. In no case has there been
-any corneal complication; swelling and pain subsided
-with unusual promptness; and the course
-of the disease was notably shortened, whereas,
-after the first application of silver nitrate a
-considerable increase in the number of gonococci
-in the discharge is often observed. A striking
-diminution in the number is noted after the initial
-application of the steam. In 8 of the cases in
-the series mentioned (all infants), the disease affected
-both eyes; and in 5 of these cases the experiment
-was made of treating one eye with
-steam in the manner described and the other
-with applications of silver nitrate in the usual
-manner, using the permanganate irrigations in
-both. The difference in the results attained was
-very striking. In every instance the eye in which
-the steam was used was brought much more
-quickly under control than the one under nitrate.
-In cases brought under treatment early the
-edema of the lids did not become severe; and the
-course of the disease seemed, in general, to be
-shortened by about one-third. There were no
-corneal complications, except in one case in which
-there was a corneal ulcer present when the man
-presented himself at the clinic. In no case was
-canthotomy necessary; and no case was followed
-by a chronic hypertrophic conjunctivitis. The
-application of the steam is undeniably painful, but
-not unbearably so.</p>
-<hr class="chap x-ebookmaker-drop" />
-
-<div class="chapter">
-
-<h2 class="nobreak" id="VAGINAL_HYSTERECTOMY">
-VAGINAL HYSTERECTOMY UNDER SPINAL ANESTHESIA:
-REPORT ON A CASE</h2>
-</div>
-
-<p class="center"><span class="smcap">
-By R. R. Cranmer</span>, M. D.<br />
-MINNEAPOLIS</p>
-
-<p>I wish to report this case of vaginal hysterectomy
-under spinal anesthesia on a patient whose
-age and physical condition were not favorable
-for the use of ether or chloroform. The case
-belonged to that comparatively small class in
-which a general anesthetic cannot be used; and
-it was because of this fact that spinal anesthesia
-was resorted to. Had it not been necessary
-for this patient to earn a livelihood by hard
-labor the operation would not have been done;
-but, in her case, it was necessary, and the condition
-of prolapse, therefore, was a source of continual
-pain and trouble. The fact that the diet
-was not restricted after the operation assisted
-greatly in shortening her stay in bed and her
-rapid recovery.</p>
-
-<div class="blockquot">
-
-<p>Patient, aged 59, married, mother of six children. She
-had been suffering from prolapsus uteri of a severe
-degree for five years. The cervix presented at the
-vaginal orifice at times. Mitral insufficiency and arteriosclerosis
-were present. She also had chronic bronchitis
-and a mild nephritis. Chloroform and ether being
-contra-indicated, spinal anesthesia was used, two
-drachms of 2 per cent novocaine solution being injected
-through the fourth lumbar interspace. The vagina
-was prepared for operation, and the hysterectomy
-started within four minutes after the spinal injection.
-The patient did not complain of any pain; and there
-was no shock or other untoward symptoms. She was
-immediately put upon a general diet and was able to
-leave the hospital on the twelfth day.</p>
-</div>
-<hr class="chap x-ebookmaker-drop" />
-
-<div class="chapter">
-<p><span class="pagenum" id="Page_126">[Pg 126]</span></p>
-
-<div class="bbox">
-
-<h2 class="nobreak" id="Masthead">
-<span class="smcap">The<br />
-Journal-Lancet</span></h2>
-
-<p class="center">The Journal of the Minnesota State Medical Association<br />
-<small>and Official Organ of the</small><br />
-North Dakota and South Dakota State Medical Associations</p>
-
-<p class="center"><small>PUBLISHED TWICE A MONTH   ESTABLISHED 1870</small></p>
-
-</div>
-</div>
-
-<table class="autotable" summary="Magazine Staff">
-<tr>
-<td class="tdc" colspan="2">
- W. A. JONES, M. D., <span class="smcap">Editor</span></td>
- </tr>
-<tr>
-<td class="tdc" colspan="2"><span class="smcap">Associate Editors:</span></td>
-</tr>
-<tr>
-<td class="tdl"><span class="smcap">R. D. Alway</span>, M. D.</td>
-<td class="tdr"><span class="smcap">Aberdeen, S. D.</span></td>
-</tr>
-<tr>
-<td class="tdl"><span class="smcap">H. J. Rowe</span>, M. D.</td>
-<td class="tdr"><span class="smcap">Casselton, N. D.</span></td>
-</tr>
-<tr>
-<td class="tdc" colspan="2"><span class="smcap">Publication Committee:</span></td>
-</tr>
-<tr>
-<td class="tdl">THOS. McDAVITT, M. D.</td>
-<td class="tdr"><span class="smcap">St. Paul</span></td>
-</tr>
-<tr>
-<td class="tdl">J. L. ROTHROCK, M. D.</td>
-<td class="tdr"><span class="smcap">St. Paul</span></td>
-</tr>
-<tr>
-<td class="tdl">F. A. KNIGHTS, M. D.</td>
-<td class="tdr"><span class="smcap">Minneapolis</span></td>
-</tr>
-<tr>
-<td class="tdc" colspan="2">W. L. KLEIN, <span class="smcap">Publisher</span></td>
-</tr>
-<tr>
-<td class="tdl">Subscription</td>
-<td class="tdr">$2.00 a year</td>
-</tr>
-<tr>
-<td class="tdc allsmcap" colspan="2"><strong>PUBLICATION OFFICE</strong></td>
-</tr>
-<tr>
-<td class="tdl"><strong><small>839-840 Lumber Exchange</small></strong></td>
-<td class="tdr"><strong><small> Minneapolis, Minn.</small></strong></td>
-</tr>
-</table>
-
-<hr class="chap x-ebookmaker-drop" />
-
-<div class="chapter">
-<h2 class="nobreak">
-<span class="smcap">March 1, 1915</span></h2>
-</div>
-
-<h3 id="NEW_REMEDY">A NEW REMEDY FOR PYORRHEA
-ALVEOLARIS</h3>
-
-<p>Diseased teeth and gums have an undoubted
-and pernicious effect upon the general health of
-the individual. This condition as a cause of
-disease has been the subject of many papers
-written by physicians and dentists.</p>
-
-<p>Now a new remedy has been proposed by Bass
-and Johns which promises relief in the majority
-of cases. Emetin is the drug that destroys the
-ameba of pyorrhea just as ipecac destroys the
-ameba of dysentery. The lesion should be attacked
-persistently until healed and the use of
-emetin continued to prevent reinfection.</p>
-
-<p>Emetin may be used hypodermically in one-half
-grain doses for at least three days and as
-often as is necessary to destroy the ameba.</p>
-
-<p>The presence of the ameba can be determined
-only by proper microscopic examinations. The
-healing process may require considerable time,
-according to the extent and character of the
-necrosis. Deep pockets require careful cleansing
-to clear the pus-forming cavities. After this has
-been accomplished and pus ceases to form Bass
-and Johns recommend the use of fluid extract
-of ipecac as a local application to prevent reinfection.
-Ipecac will actually destroy the ameba
-if used persistently and is preferable to the many
-commercial preparations now in use. The teeth
-should be brushed in the ordinary way, after
-which one drop of fluid extract of ipecac should
-be applied to the wet brush, forcing some of
-the solution between the teeth and spitting out
-the excess without further washing of the mouth.</p>
-
-<p>The investigators have found that this simple
-procedure will keep the mouth free from pyorrhea.
-It stands to reason, however, that the teeth
-must be thoroughly cleaned in the usual manner
-by the dentist, otherwise it will be impossible for
-the emetin or ipecac to penetrate the deep crusts
-which are found about old and uncared for
-mouths. It is remarkable how many people neglect
-the care of their teeth and it is equally
-strange that so little constitutional disorder is
-found in those who neglect an ordinary and
-simple sanitary toilet requisite. One of the first
-rules for hospital patients when they come under
-the supervision of the nurse is the provision of a
-tooth brush and a suitable mouth wash.</p>
-
-<p>Many patients from the country, a lesser number
-from the cities, never employ a tooth brush.
-Some even resent a suggestion of clean teeth.
-Nature gave them teeth and nature is supposed
-to keep them in order, but unclean teeth are the
-rule rather than the exception in hospital practice.</p>
-
-<p>Not infrequently animals need the services of
-a dentist, but their numbers are few compared to
-man. When a simple remedy for pyorrhea,
-like ipecac, promises to clear the teeth of amebas,
-there is no excuse for neglecting nature’s adornment.</p>
-
-<h3 id="LOWERING_MILK_GRADE">LOWERING THE MILK GRADE</h3>
-
-<p>A bill has been introduced in the Minnesota
-State Legislature for the purpose of lowering
-the butterfat requirement in milk from three
-and one-quarter to three per cent. This means
-a reduction of solids in milk from thirteen to
-eleven per cent, and it further means that more
-water will be added to much of the milk sold in
-Minnesota. A Minneapolis ordinance prescribes
-the butterfat content to be as high as three and
-one-half per cent. Minneapolis has enough water
-in its milk now, and, if this bill goes through,
-the city may expect to use skim-milk almost exclusively.</p>
-
-<p>It hardly seems credible that any one should
-desire the quality of milk to be reduced for any
-purpose whatever unless it is for commercial
-reasons.</p>
-
-<p>Fortunately, at this writing the bill is held up
-<span class="pagenum" id="Page_127">[Pg 127]</span>
-for consideration, and it is to be hoped that sufficient
-pressure will be brought to bear to insure
-its defeat. Too many cows give poor milk and
-any effort to standardize and legalize the inferior
-cow is a reflection on the integrity of milk sellers.
-Inferentially, there are too many under-fed children
-and yet if milk is reduced in quality, we
-must expect less vigor in the growing child.</p>
-
-<p>One wonders why such a bill should get into
-the Legislature; what are the real reasons for
-its passage?</p>
-
-<h3 id="LEAVES_OF_HEALING">“LEAVES OF HEALING!”</h3>
-
-<p>The late issue of “Leaves of Healing,” published
-by the Dowieites at Zion City, near Chicago,
-has been sent broadcast among physicians.
-This sheet is an antivaccination propaganda,
-and is profusely illustrated by horrible pictures
-of supposed diseased states caused by vaccination.
-The text is, as is all others of its ilk, full
-of misinformation, garbled extracts from known
-and unknown writers and speakers, and tirades
-against all who believe in vaccination.</p>
-
-<p>If these sheets would present a fair and broad
-view of the evils of vaccination they might find
-more adherents to antivaccination doctrines
-among medical men; but, as it contains so many
-misstatements and is so overbearingly one-sided
-in its efforts, the effect is nil, except when it is
-circulated among those unbalanced in mind and
-judgment. Physicians in general freely acknowledge
-that vaccination, or the introduction of a
-serum, may produce, in some people, unexpected
-and sometimes disastrous results. Most physicians
-hesitate to vaccinate people with active
-syphilis, or even those in whom the syphilis has
-been seemingly inactive for years, or those
-who have hereditary syphilis. These persons are
-quite apt to have an accentuation of their old
-blood disorder under slight infections or injuries;
-but that should not militate against vaccination
-when an epidemic is probable. Some of the pictures
-in “Leaves of Healing” were undoubtedly
-pictures of syphilis, and should have been so
-labeled; but that could not have been expected in
-a partisan publication.</p>
-
-<p>Physicians also know that people who have
-chronic eczema should not be vaccinated until
-the eczema clears up; and doubtless in hurried
-or extensive vaccinations that are deemed necessary
-to prevent the spread of smallpox in a community
-cases of eczema are overlooked. Children
-who are the victims of chronic digestive
-disorders, or who react to mild febrile or diarrheal
-conditions more than the average child, are
-commonly exempted from vaccination. On the
-whole, there are but few conditions that are made
-worse by careful vaccinations with proper dressings
-and after-care.</p>
-
-<p>When one considers what wonders in the way
-of control of smallpox have been recorded in
-medical history, the few mishaps that occur
-among the vaccinated, the proportion of illness
-due to vaccination is so infinitesimal that they
-cannot be classed among the “fearful” results of
-vaccination.</p>
-
-<p>“Leaves of Healing” leaves out of its vaporings
-the fact that Zion City had a smallpox epidemic
-not long ago, and was quarantined by the health
-authorities, and that the people submitted to vaccination
-with gratifying results. Nor does the
-above-mentioned magazine record the fact that
-the president and secretary of a local branch of
-antivaccinationists in Minneapolis, who were
-fighting a compulsory vaccination law before the
-Minnesota Legislature a few years ago, died of
-virulent smallpox during that meeting of the
-Legislature.</p>
-
-<p>The antivaccinationist usually has at his command
-a set form of speech that contains more
-vituperant adjectives, and less reason and judgment,
-than the average self-constituted reformer.
-Smallpox and other preventable diseases will continue
-to exist while the uneducated and ill-balanced
-minds are permitted their volley of wind-laden
-speech. Some day the people will wake up,
-cast the “reformer” aside, and climb on to the
-band-wagon of health and happiness.</p>
-
-<p>It will take our educators and sanitarians some
-time to harness the team to the wagon, but when
-it starts it will go on merrily to its destination.</p>
-
-<h3 id="OWNERSHIP">OWNERSHIP OF THE JOURNAL-LANCET</h3>
-
-<p>In answer to a number of inquiries the following
-statement is made:</p>
-
-<p>The stock of the <span class="smcap">Journal-Lancet</span> is held by
-a number of Twin City physicians, and the publisher,
-Mr. W. L. Klein.</p>
-
-<p>The <span class="smcap">Journal-Lancet</span> is the official organ of
-the State Medical Associations of Minnesota,
-North Dakota, and South Dakota. The responsibility
-for its reading matter and editorials rests
-with the publication committees of the state associations.</p>
-<hr class="chap x-ebookmaker-drop" />
-
-<div class="chapter">
-<p><span class="pagenum" id="Page_128">[Pg 128]</span></p>
-
-<div class="bbox">
-<h2 class="nobreak" id="MISCELLANY">MISCELLANY</h2>
-</div>
-</div>
-
-<div class="blockquot">
-
-<p><span class="smcap">To the Physicians of the State of Minnesota</span>:</p>
-</div>
-
-<p>The Committee on Public Policy and Legislation
-most earnestly asks the co-operation of
-every physician in the State of Minnesota in procuring
-the passage of the several bills that have
-been decided upon, and either have been or will
-be introduced into the legislature during this
-session. It is believed that there is not a man
-upon the roster of the State Medical Society, or
-indeed any physician in Minnesota, who does not
-see the necessity of certain legislation for the
-protection of the physicians in the State, and
-also that the common weal will be advanced
-by the passage of the telephone bill introduced
-by Senator Andrews, of Blue Earth, and
-by the passage of the bill relative to trachoma,
-which is a constant menace to the public health,
-and several other bills that are in course of preparation,
-but which await certain developments
-before their presentation. The committee earnestly
-begs of all the physicians in the State that
-they will write to their representatives and senators
-from time to time urging with great earnestness
-their support for the several measures
-advanced by the Committee on Public Policy and
-Legislation. It is believed that every physician
-can influence at least from 10 to 100 votes at a
-general election, and this fact, of itself, makes
-the physician a factor in the election of any candidate.
-It is believed by this committee that the
-medical men of the State, if they will but unite
-and act in concert, can measurably influence legislation.
-The time has come for the physician to
-take his place in the political system of the State,
-both as an active agent and, indirectly, through
-his influence of others.</p>
-
-<p>The telephone bill provides for physical connection
-between all telephone companies in the
-State without extra charge, except a small toll.
-It provides that telephone companies shall be
-placed under the direction of the Railroad and
-Warehouse Commission. It provides that no
-greater net income than 5 per cent shall be allowed
-upon the capital actually used in the operation
-of the telephone companies. It provides
-for intercity telephone service in the cities whose
-city limits adjoin without extra charge.</p>
-
-<p>The trachoma bill provides for the segregation
-of trachomats, and, under certain circumstances,
-for the maintenance by the State of special
-schools for their education in school districts
-having as many as 20 trachomats.</p>
-
-<p>There is also drafted and ready for introduction
-a bill requiring all persons who seek to
-practice medicine in any form whatever to pass
-the regular examination before the State Board
-of Medical Examiners.</p>
-
-<p>There is in contemplation a bill for the purpose
-of procuring certain lands for the building
-of cottages thereupon and establishing farms to
-be worked by lepers who may be or shall have
-been committed to the leprosarium farm, the intention
-being that those lepers in the State that
-are able to work shall have an opportunity to do
-so, and that the said lepers should care for lepers
-who are unable to work or earn a living. It is
-also proposed to purchase a small tract of land
-not far from the State University for the purpose
-of allowing an exhaustive study of certain forms
-of leprosy with the aid of the State University
-Medical Staff. The leprosarium farm would be
-under the direction of the State Agricultural
-School.</p>
-
-<p>The Chairman of this Committee will be very
-glad to receive advice and suggestions from the
-physicians in the State.</p>
-
-<p class="right">
-<span class="smcap">Cornelius Williams, M. D.</span>,<br />
-Chairman of the<br />
-Committee on Public Policy and Legislation.<br />
-St. Paul, Minn., February 3, 1915.<br />
-</p>
-
-<hr class="chap x-ebookmaker-drop" />
-
-<div class="chapter">
-<h2 class="nobreak" id="REPORTS_OF_SOCIETIES">REPORTS OF SOCIETIES</h2>
-</div>
-
-<h3>MINNESOTA ACADEMY OF MEDICINE</h3>
-
-<p>The Academy met at the St. Paul University
-Club, Feb. 3. Dr. C. M. Carlaw presided.</p>
-
-<p>Four doctors were proposed for membership:
-Drs. W. H. Condit and Stephen Baxter, of Minneapolis,
-and Drs. Wilhelm Lerche and F. C.
-Schuldt, of St. Paul. All four names were referred
-to the executive committee.</p>
-
-<p>Dr. Arnold Schwyzer showed some x-ray pictures
-of a penetrating gastric ulcer. He also
-made a report of a case where gall-stones gave a
-feeling of emphysematous crackling, due to small
-marble-sized stones with no more fluid than
-enough to fill the spaces between the stones (perhaps
-a teaspoonful in all).</p>
-
-<p>The paper of the evening was presented by
-Dr. A. E. Benjamin, the subject being “Goiter
-Operations with Simplified Technic.” The paper
-<span class="pagenum" id="Page_129">[Pg 129]</span>
-was thoroughly discussed, the whole evening
-being given over to its consideration.</p>
-
-<p>The reading of Dr. White’s thesis was deferred
-until another meeting.</p>
-
-<p>Twenty-seven were present.</p>
-
-<p class="right">
-<span class="smcap">Fred E. Leavitt, M. D.</span>, Secretary.<br />
-</p>
-
-<hr class="chap x-ebookmaker-drop" />
-
-<div class="chapter">
-<div class="bbox">
-<h2 class="nobreak" id="CORRESPONDENCE">CORRESPONDENCE</h2>
-</div>
-</div>
-
-<p>
-<span class="smcap">To the Editor</span>:<br />
-</p>
-
-<p>In the February 15th issue of <span class="smcap">The Journal-Lancet</span>
-is a discussion by Dr. Klaveness, of
-Sioux Falls, S. D., on a paper on “Syphilis and
-Its Relation to Society” by Dr. McLaughlin, of
-Sioux City, Iowa. In this discussion Dr. Klaveness
-states: “We are unfortunate here in South
-Dakota in this respect, that we do not have the
-population and the laboratory facilities for resorting
-to the Wassermann reaction at all times,
-and any man within the State who would systematically
-carry out a Wassermann reaction
-now and then would invalidate his findings very
-materially, inasmuch as it is very well established
-that, in order to obtain reliable readings, you
-must have a serologist or bacteriologist to follow
-this work exclusively in order to get accurate
-findings. It is immensely important, and it
-would be a boon to the suffering people, if we
-could have a state serologist.”</p>
-
-<p>This statement by Dr. Klaveness is contrary to
-the facts as they now exist and did exist at the
-time he discussed the paper at Watertown, S. D.,
-in May, 1914.</p>
-
-<p>We have a well equipped medical laboratory in
-South Dakota in connection with the medical department
-at the State University at Vermillion,
-and we have been doing the Wassermann test.</p>
-
-<p>This misstatement should have been corrected
-at the time it was made, but was not, as I was in
-Watertown but part of one day during the State
-Meeting last May and did not hear the paper or
-its discussion.</p>
-
-<p>Permit me to state through your columns that
-we do the Wassermann test at the State Health
-Laboratory and have been doing it on Thursday
-of each week since March 21, 1914. At that
-time a circular letter announcing the fact was
-sent to every physician in the State, including
-Dr. Klaveness. This announcement was made
-only after several months of experimental work
-in perfecting the technic and controlling all factors.</p>
-
-<p>We do the original Wassermann test, using
-the Nogouchi antigen. All our reagents are prepared
-in our laboratory and every possible control
-is carried out each time the test is set up.
-We therefore believe that our results will compare
-favorably with the best scientific work of
-this character.</p>
-
-<p>At the present time a fee of $5.00 for each
-test is charged, containers and instructions are
-supplied upon request.</p>
-
-<p>We have done the Wassermann test for the
-State Hospital for the Insane at Yankton from
-the first.</p>
-
-<p class="right">
-<span class="smcap">Mortimer Herzberg, M. D.</span>, Director.</p>
-<p>Vermillion, S. D., February 18, 1915.<br />
-</p>
-
-<hr class="tb" />
-
-<h3>THE LOYALTY OF NURSES</h3>
-
-<p>
-<span class="smcap">To the Editor:</span>
-</p>
-
-<p>My attention has just been called to an article
-published in <span class="smcap">The Journal-Lancet</span>, August 1,
-1914, it being an address by Dr. George D. Head
-to the graduating class of the Asbury Hospital.
-The advice Dr. Head gives to the nurses seems
-very good, and very elevating to our profession,
-but I would like to analyze it to show that it is
-not quite practical.</p>
-
-<p>It has taken considerable effort on the part of
-nurses to convince the people, and to convince
-some doctors, that they are any more than machines.
-Because we ask for three hours rest out
-of the twenty-four, and because we asked for a
-fixed rate for service, Dr. Head says that our
-loyalty to high ideals is diminishing. Unfortunately,
-in the nursing profession, as in all other
-professions, there are some who are incapable
-and unconscientious; and, if Dr. Head had the
-experience of having a nurse leave a patient, unattended,
-at a critical time, she probably was one
-of the few incapables, or was so overtired from
-loss of sleep that it was necessary for her to have
-rest. When Dr. Head says that a nurse should
-waive her rest hours for days or a week at a
-time, if necessary, I think he is making a mistake.
-A nurse cannot do her duty by a patient if she
-does not have proper rest. It is unfair to both
-the patient and the nurse. Dr. Head may say
-that most patients are not in need of constant
-attention for more than a few days or a week,
-and that a nurse can stand it for that length of
-time without rest hours. This is true; but we
-have to consider that the next case may be just
-as critical, and so the nurse must reserve some
-strength for the cases to follow. And more
-often than not, the nurse is obliged to take cases
-with very little or no rest between them.</p>
-
-<p><span class="pagenum" id="Page_130">[Pg 130]</span></p>
-
-<p>In the second place, Dr. Head thinks that the
-nurses ought to have a varying scale of charges
-for service. The doctors do it; why shouldn’t
-the nurses? Dr. Head does not seem to consider
-the fact that the nurse has one patient, while the
-doctor has many. Suppose a nurse takes care of
-a poor patient for five or ten dollars a week,
-where is the rich patient who is willing to pay
-forty or fifty dollars a week to make up the loss?
-The nurses have found that twenty-five dollars
-a week is the price that is necessary for them to
-live on in order to keep themselves clothed, pay
-for their laundry (no small item), and carry them
-over the few weeks of rest or over the dull season.
-The average life of a nurse, as a nurse, is,
-I believe, not more than ten years. In that length
-of time, at the wages she gets, she is not able to
-lay away a great amount for a rainy day, which
-usually comes all too soon.</p>
-
-<p>We have a number of good hospitals in Minneapolis
-where people in moderate circumstances
-can be very comfortably cared for at a considerably
-less expense than employing a nurse in
-their homes. The poor in our city, I think, are
-fairly well taken care of in the city hospitals and
-by the visiting nurses, who are paid for such
-work.</p>
-
-<p>As for nurses refusing cases because they are
-afraid of them: I think there is usually some
-just cause. If a nurse has a tendency towards
-tuberculosis, she should refuse such cases; or
-if she has a tendency towards throat troubles, she
-should refuse diphtheria and scarlet-fever cases.
-A nurse who is constantly with a patient runs
-considerably more risk of infection than the physician,
-whose visits are usually short. There are
-nurses who make a specialty of such cases, and
-usually there is no trouble finding such a nurse.
-Nurses who make a specialty of obstetrical cases
-or of children should not take contagious work.
-As for a nurse refusing a typhoid case because
-she is afraid of it: I cannot believe that any
-real nurse would do such a thing.</p>
-
-<p>It also seems to me very ridiculous, and it
-surely cannot be a common thing for a nurse to
-inquire before she consents to take a case whether
-or not the plumbing is modern and how many
-servants are kept.</p>
-
-<p>As to just what Dr. Head means by saying
-that a nurse should be willing to do any kind
-of service about a house. I do not know; but I
-do know that nurses are not usually physically
-fit for washing or scrubbing, yet, as a rule, nurses
-are glad to perform duties which are not just in
-their line, in order to help the household to run
-smoothly.</p>
-
-<p>Most of the nurses in general work are engaged
-in nursing because they are obliged to
-earn their living, and in most cases because they
-are especially interested in this particular field;
-and, although most nurses take some charity
-cases, it is impossible for them to take many,
-even to satisfy what Dr. Head calls “the inner,
-higher longings of the soul.”</p>
-
-<p class="right">
-<span class="smcap">Harriet M. Prime, R. N.</span><br />
-</p>
-
-<p>Minneapolis, February 4, 1915.</p>
-
-<hr class="chap x-ebookmaker-drop" />
-
-<div class="chapter">
-<div class="bbox">
-<h2 class="nobreak" id="BOOK_NOTICES">BOOK NOTICES</h2>
-</div>
-</div>
-
-<p class="hanging2"><span class="smcap">Manual of Obstetrics.</span> By Edward P. Davis, A. M.,
-M. D., Professor of Obstetrics in the Jefferson Medical
-College, Philadelphia. 12mo of 463 pages, 171 illustrations.
-Philadelphia and London: W. B. Saunders
-Company, 1914. Cloth, $2.25 net.</p>
-
-<p>As indicated by the name this is a handy book. It is
-well illustrated, the text is brief and well written, and
-as complete as could be expected in a work of its size.</p>
-
-<p>It presents no features which are especially new,
-though it takes up many of the most recent advances in
-obstetrics.</p>
-
-<p>It is a work that aims to give those who wish it a
-concise account of the status of obstetrics at the present
-time.</p>
-
-<p class="right">
-—<span class="smcap">Adair.</span><br />
-</p>
-
-<p class="hanging2"><span class="smcap">Balneo-Gymnastic Treatment of Chronic Diseases
-of the Heart.</span> By Prof. Dr. Theodor Schott, Bad-Nauheim.
-Published by Blakiston, Philadelphia.
-Price, $2.50.</p>
-
-<p>This brochure sets forth in the main, preceded by a
-short chapter on medical treatment, the philosophy,
-technic, and clinical results of balneogymnastic therapy
-in chronic heart-conditions.</p>
-
-<p>It would appear, inasmuch as Prof. Schott admits the
-non-establishment of the probable curative factors of
-either the carbon dioxide or mineral constituents, that
-possibly, as Dr. Anders in the foreword surmises, the
-curative properties may reside in the “advantage of being
-far removed from the cares and responsibilities growing
-out of the practical affairs of life at home.”</p>
-
-<p>Relative to the more firmly established value of the
-gymnastic element, it is quite evident that the “resistance
-movements,” are an improvement over the Zander
-mechanico-gymnastic, and of similar value to the so-called
-“Terrain Kur,” with the added advantage of personal
-application.</p>
-
-<p class="right">
-—<span class="smcap">Schneider.</span><br />
-</p>
-
-<p class="hanging2"><span class="smcap">Diseases of Bones and Joints.</span> By Leonard W. Ely.
-M. D., 220 pages, 94 illustrations. Surgery Publishing
-Co., N. Y. Price, cloth. $2.00.</p>
-
-<p>Few men are better fitted than Dr. Ely to write an
-authoritative book on joint and bone diseases. He has
-gone at his study from the only logical end; that is,
-the study of the underlying pathology. The book
-<span class="pagenum" id="Page_131">[Pg 131]</span>
-throughout shows the result of much conscientious work
-in the pathological and x-ray laboratories, carefully
-checked up from the clinical aspect.</p>
-
-<p>The average specialist who writes a manual for the
-use of the general practitioner seems to think he must
-mention every theory which has ever been brought out
-since the time of Hippocrates, together with a list of
-every form of treatment ever proposed. The bewildered
-family doctor gets about as much help as he would from
-the perusal of a few pages of the Index Medicus. One
-good theory, clearly stated, even if it is not universally
-accepted, may form a practical working basis which will
-be of great aid to the doctor in the understanding and
-care of his cases. In this particular Dr. Ely is most
-satisfactory. He has worked out the pathology of the
-tubercular and other chronic joint diseases in a clear and
-logical manner. While much may have to be altered
-in the light of further research, at least one can feel
-sure that Dr. Ely has convictions, and that his work
-will form a useful basis for further investigations.</p>
-
-<p>The illustrations are taken almost entirely from photographs
-or photomicrographs and are mostly original. So
-many works on Orthopedic Surgery appear which are
-filled with cuts handed down from one text-book to
-another, cuts of impossible people wearing impossible
-appliances, that it is hard to imagine that such a book,
-illustrated with such quaint old prints, can represent the
-latest word or offer anything new.</p>
-
-<p>Dr. Ely’s discussion of the pathology of joint tuberculosis
-is perhaps the most interesting thing in the book.
-His idea of the red bone marrow and the synovia being
-the sole tissues to be primarily involved does not agree
-with the recent work of Fraser, of Edinburgh. Evidently
-more work must be done in order to harmonize
-these findings.</p>
-
-<p>In general, while not much space is given to treatment,
-what there is, is clear and is carefully selected by
-the author, instead of leaving this important point to the
-discretion of the reader.</p>
-
-<p>His discussion of the chronic arthritides is quite full
-and very instructive. He points out particularly the resemblance
-between the pathological conditions found in
-various chronic infectious joints and in the various
-stages of joint tuberculosis.</p>
-
-<p>This little book will certainly be of use to anyone who
-has to treat bone and joint diseases.</p>
-
-<p>
-—<span class="smcap">Reed.</span><br />
-</p>
-
-<hr class="chap x-ebookmaker-drop" />
-
-<div class="chapter">
-<div class="bbox">
- <h2 class="nobreak" id="NEWS_ITEMS">NEWS ITEMS</h2>
- </div>
- </div>
-
-<p>Dr. Chas. Pierce, of Wadena, has moved
-to Menahaga.</p>
-
-<p>Dr. J. L. Stewart, of Spearfish, S. D., has
-located at Custer, S. D.</p>
-
-<p>Dr. Jas. Farrage, formerly of Deering, N. D.,
-has located at Park Rapids.</p>
-
-<p>Dr. Hugo Neukamp is leaving Fessenden,
-N. D., to locate in Beulah, N. D.</p>
-
-<p>The Dell Rapids Hospital was completed and
-opened the latter part of February.</p>
-
-<p>Dr. H. A. Gueffroy, of Chicago, has taken over
-the practice of Dr. D. F. Sullivan, of Frankfort,
-S. D.</p>
-
-<p>The new St. Alexius hospital, at Bismarck,
-N. D., was formally opened to the public February
-15th.</p>
-
-<p>The entire surplus of the old Homeopathic
-Hospital Association, amounting to $1,000, was
-voted to the support of the Maternity hospital,
-of Minneapolis, at a recent meeting.</p>
-
-<p>The Physicians’ Hospital company has been
-incorporated at Thief River Falls for the purpose
-of building and maintaining a hospital at that
-place. The company is capitalized at $25,000.</p>
-
-<p>In a previous issue we stated that Dr. G. P.
-Shepard, of Chicago, had located at Jamestown,
-N. D. Dr. Shepard is from Courtenay, N. D.,
-and not from Chicago, though he has been taking
-postgraduate work in that city for the past
-few weeks.</p>
-
-<p>The Medical Society of the State of New York
-invites all physicians of the country to its hundred
-and ninth annual meeting which is to be
-held in Buffalo, April 27-29. This will probably
-be the largest medical meeting of the year, except
-perhaps that of the A. M. A. in San Francisco.</p>
-
-<p>Messrs. J. D. Edgar, Arnold Hamel, R. A.
-Johnson, and H. A. Rudd, and Miss Olga Hansen,
-all of the class of 1915, have been elected to
-the Minnesota chapter of Alpha Omega Alpha,
-the national honorary fraternity in medicine, the
-membership of which is based solely upon
-scholarship.</p>
-
-<p>Dr. James E. Moore, who has practised in
-Minneapolis for thirty-two years, twenty-eight of
-which have been devoted to the exclusive practice
-of surgery, has given up his practice and will,
-hereafter, give his entire time to the Medical
-School of the University of Minnesota, except
-for a limited amount of consultation work.</p>
-
-<p>In our last issue we made the statement that
-the Ramsey County Medical Society would not
-admit a physician to membership until he had
-been a resident of the county for one year. This
-should have been written so as to convey the
-meaning that a physician must have been a resident
-of some county for at least a year, not necessarily
-Ramsey County.</p>
-
-<p>It is the desire of the publishers of the Journal-Lancet
-to make this department of news as interesting
-to its readers as possible. The items are
-obtained from a number of sources, and, though
-<span class="pagenum" id="Page_132">[Pg 132]</span>
-a great deal of care is given to their preparation,
-mistakes will necessarily occur. Will you not
-help to keep up the interest of this column by
-sending in anything which may be of interest to
-the readers? Notify us of mistakes as they occur
-that we may make a correction in the next issue.</p>
-
-<p>“The Mayo Foundation for Medical Education
-and Research, Incorporated,” with an initial
-endowment fund of $1,500,000, has recently been
-incorporated. It has for its object the endowment
-of the graduate medical instruction and research
-work which has for years been a feature
-of the Mayo Clinic, at Rochester. The founders
-are: William J. Mayo, Charles H. Mayo, Henry
-S. Plummer, Edward Starr Judd and Donald C.
-Balfour. The board of temporary trustees having
-in charge for the present the investment of
-the fund is composed of Bert W. Eaton, George
-W. Granger and Harry J. Harwick. The board
-of scientific directors is composed of Louis B.
-Wilson, William F. Braasch, E. Hessel Beckman,
-A. H. Sanford, and Walter D. Sheldon.
-For the present the expenses of the foundation
-will be met by annual contributions from the
-Mayo Clinic, the income from the endowment
-being allowed to accumulate and increase the
-principal.</p>
-
-<p class="center">PHYSICIAN WANTED</p>
-
-<p>To locate in a thriving North Dakota town. For full
-information correspond with Andrew Erickson, Makote,
-N. D.</p>
-
-<p class="center">OFFICE FURNITURE FOR SALE</p>
-
-<p>A good roll-top desk and other office furniture is
-offered for sale at a reasonable price. 616 Syndicate
-Bldg., Minneapolis.</p>
-
-<p class="center">PRACTICE FOR SALE</p>
-
-<p>An established practice in a town of 2,000 for sale
-for the price of the office outfit. If you mean business,
-write at once. Address 205, care of this office.</p>
-
-<p class="center">SANITARIUM FOR SALE</p>
-
-<p>A new, strictly modern, 50-bed sanitarium with three
-acres of land on a beautiful lake, located near the Twin
-Cities, for sale cheap. Address 206, care of this office.</p>
-
-<p class="center">WANTED</p>
-
-<p>An eye, ear, nose, and throat man who is willing to
-work. Must be sober, competent man. State the salary
-expected, and give credentials in the first letter. Address
-the C. A. Hoffman Co., 814 Nicollet Ave., Minneapolis,
-Minn.</p>
-
-<p class="center">PRACTICE WANTED</p>
-
-<p>In Minnesota or South Dakota town, with some future
-and where English is spoken. This is wanted by physician
-who has had several years’ experience in practice,
-and has done laboratory and hospital work. Address
-198, care of this office.</p>
-
-<p class="center">WANTED</p>
-
-<p>A physician and surgeon to locate at Judson, North
-Dakota. No doctor located within seven miles on the
-west and twenty-three miles or more in other directions.
-One who could start small drug-store in connection
-with his practice preferred. Address First State Bank,
-Judson, N. D.</p>
-
-<p class="center">WANTED TO EXCHANGE</p>
-
-<p>Contract mining practice, on Iron Range, with modern
-hospital, complete equipment, autos, good roads, drive
-all the year, best contracts, $600 to $800 cash each
-month; future very bright. Owner wishes to correspond
-with an A 1 physician and surgeon with a good
-stand in or very near the Twin Cities, with the view of
-effecting an exchange for part of the year. Address,
-204, care of this office.</p>
-
-<p class="center">FOR SALE</p>
-
-<p>To a man with surgical ability, one-half interest in
-my private practice and well-equipped hospital, located
-in a live up-to-date county-seat town in Minnesota;
-population 2,500; two railroads; good schools and roads;
-good fees. This is an excellent opportunity to get into
-a place with a good future. Price, $5,000 for one-half
-interest in hospital building, equipment, office fixtures,
-and practice; $2,500 cash. Don’t write unless you mean
-business and have the cash. Address 202 care of this
-office.</p>
-
-<hr class="tb" />
-
-<p>Doctor: If you want practical post-graduate work
-during the fine season in the delightful city, write for
-particulars. Twenty-eighth annual session opens September
-28, 1914, and closes June 5, 1915. New Orleans
-Polyclinic, P. O. Drawer 261, Post-graduate Medical
-Dept., Tulane University of Louisiana.</p>
-
-<hr class="chap x-ebookmaker-drop" />
-
-<div class="chapter">
-<p><span class="pagenum" id="Page_133">[Pg 133]</span></p>
-
-<div class="figcenter illowp100" id="i-battle-creek" style="max-width: 28em;">
- <img class="w100" src="images/i-battle-creek.png" alt="Text of advertisement transcribed below." />
-</div>
-</div>
-
-<div class="chapter">
-<h2 class="nobreak">The Battle Creek Method in Diabetes</h2>
-</div>
-
-<p>Diabetes, though not always curable, is controllable. Practically
-all diabetics can be made sugar-free and the acidosis disappears
-with the sugar. By a special regimen the reappearance of the
-sugar and the acidosis may be prevented.</p>
-
-<p>The Battle Creek method is based upon experience gained in the treatment of many
-hundreds of cases supplemented by the observations and discoveries of Von Noorden,
-Falta, Guelpa, Benedict, Allen, and numerous other investigators. The essential
-features of the method are—</p>
-
-<p>1. A thorough preliminary examination and repeated examinations comprising (a)
-complete quantitative examination of the urine daily, (b) differential study of the blood,
-(c) chemical, microscopic and bacteriological examination of the feces and study of the
-pancreatic function, (d) X-ray examination of the stomach and intestine with special
-reference to stasis.</p>
-
-<p>2. Study of the patient’s metabolism by the respiration apparatus to determine his
-respiratory quotient, CO<sub>2</sub> tension and basal ratio.</p>
-
-<p>3. Establishment, by the aid of metabolism studies of each case, of a regimen adapted
-to the individual by determining the proper proportion of protein, fats and carbohydrates
-to keep the urine free from sugar. The kind of protein, fat and carbohydrate
-is considered important, as well as the amount.</p>
-
-<p>4. The patient’s metabolism is regulated by baths, voluntary and automatic exercise,
-photo- and thermotherapy and other physiologic means.</p>
-
-<p>5. The results of the regimen and treatment are accurately controlled by a “Metabolism
-Graphic” which shows the daily variations in the amount of urine, amount of sugar,
-acidosis, coefficient of sugar utilization, coefficient of carbohydrate utilization, nitrogen
-balance, glucose nitrogen ratio, weight balance and energy balance. These factors
-are all worked out by expert chemists and dietitians and with this data before
-him, and a great variety of special foods of known energy value suited
-to diabetics at ready command, and the assistance of a strong corps of
-specially trained dietitians, the physician is able easily to arrange a dietary adapted
-to each case and to note each patient’s progress with the most careful scrutiny.</p>
-
-<p>Under this comprehensive management the sugar usually disappears from the
-urine in two or three days, and does not return so long as the prescribed
-regimen is followed.</p>
-
-<p>A few weeks’ treatment usually suffices to train the patient to a suitable
-dietary which he may safely follow under the guidance of his home
-physician.</p>
-
-<p>We will be glad to send full information concerning the Battle
-Creek Method in Diabetes to any physician who will mail
-to us the attached coupon.</p>
-
-<hr class="dotted" />
-
-<p>The Battle Creek Sanitarium, Battle Creek, Mich.</p>
-
-<p>
-Box 350<br />
-The SANITARIUM,<br />
-Battle Creek,<br />
-Michigan<br />
-</p>
-
-<p>Please send to the undersigned
-full information concerning
-the Battle Creek method
-of treating diabetes.</p>
-
-<p>Dr..............................</p>
-
-<p>Street..........................</p>
-
-<p>City............................</p>
-
-<p>State...........................</p>
-
-<hr class="chap x-ebookmaker-drop" />
-
-<div class="chapter">
-<p><span class="pagenum" id="Page_134">[Pg 134]</span></p>
-<div class="bbox">
-<h2 class="nobreak" id="PUBLISHERS_DEPARTMENT">PUBLISHER’S DEPARTMENT</h2>
-</div>
-</div>
-
-<h3>QUAKER OATS</h3>
-
-<p>Doctors all over the country are advising the use of
-oat foods for the old as well as the very young child.
-It is for young folks developing, for grown-ups, who are
-hard workers, and for the old folks who wish to keep
-young. You can safely use Quaker Oats. It costs no
-extra price, and when you use it you are certainly getting
-the very best in oat foods. Physicians should read
-their page announcement in this paper.</p>
-
-<h3>ELECTRO-THERAPY</h3>
-
-<p>The Scheidel-Western X-Ray Coil Co. announce on
-another page that they have the latest appliance in
-electro-therapeutics, namely, the Columbia Treatment
-Transformer No. 9.</p>
-
-<p>The apparatus is illustrated and described on another
-page, and more fully in the Company’s new catalog.</p>
-
-<p>As the Company is the largest manufacturer of x-ray
-apparatus in the world, their catalog should be in
-the hands of every man using this line of treatment.</p>
-
-<h3>BOREMETINE—A NEW EMETINE PREPARATION
-FOR PYORRHEA</h3>
-
-<p>Every doctor and dentist in the United States should
-know about this new preparation for the local treatment
-of pyorrhea alveolaris. Boremetine is a 1-2 per
-cent solution of emetine hydrochloride, together with
-boric acid, zinc sulphocarbolate, and aromatics.</p>
-
-<p>The emetine is amebicidal, the boric acid bactericidal,
-and the zinc sulphocarbolate astringent. These three
-drugs meet the three essential factors necessary for the
-successful treatment of pyorrhea. Boremetine should
-be used in every case, either alone, or (in some severe
-cases) in association with the subcutaneous injection of
-Emetine Hydrochloride (Abbott).</p>
-
-<p>A special free booklet on “Pyorrhea Alveolaris: How
-to treat it successfully with Emetine” will be sent on
-request. Send for it today. The Abbott Alkaloidal
-Company, Chicago.</p>
-
-<h3>OCONOMOWOC HEALTH RESORT</h3>
-
-<p>The State of Wisconsin has an enviable reputation for
-not a few things in which it excels all the other western
-or middle-western states. One of these is its sanatoriums,
-or health resorts. The climate, the beautiful
-scenery, the pure water, the proximity to the large cities
-of Milwaukee and Chicago, and the high-grade medical
-specialists made it possible to found such institutions
-in southern Wisconsin long before other parts of the
-middle west had the population or transportation facilities
-to make success in this line either probable or possible.</p>
-
-<p>The Oconomowoc Health Resort is one of the best
-equipped and best managed of these institutions. It
-accepts only nervous and mild mental cases. It is under
-the management of Dr. Arthur W. Rogers as resident
-physician. Dr. Rogers has both the professional equipment
-and the personality that are necessary in the treatment
-and care of persons suffering from nervous and
-mental disorders.</p>
-
-<h3>BATTLE CREEK SANITARIUM</h3>
-
-<p>Fifty years ago examination was largely a matter of
-pulse finding; now it is possible to weigh and measure
-the organic functions of the body with as much accuracy
-as is possible in the testing of an intricate mechanism.
-This becomes possible through a series of tests in many
-of which elaborate equipment is required. Perhaps no
-other institution has a more complete organization for
-diagnosis than the Battle Creek Sanitarium.</p>
-
-<p>The physical inventory possible there is a very thorough
-and accurate stock taking of the vital functions.
-Many business and professional men visit the sanitarium
-each year in order to take full advantage of the diagnostic
-facilities.</p>
-
-<p>An interesting booklet, “The Measure of a Man,” is
-offered free by the sanitarium to those who care to know
-more regarding the system of examination.</p>
-
-<h3>ARMOUR & COMPANY</h3>
-
-<p>Why Pituitary Liquid should be specified:</p>
-
-<p>It is a pure preparation.</p>
-
-<p>It is free from objectionable chemicals.</p>
-
-<p>It is made from absolutely fresh raw glands. It does
-not require preservatives.</p>
-
-<p>It is standardized physiologically.</p>
-
-<p>It is sold in dated packages, permitting the physician
-to discard old goods.</p>
-
-<p>Pituitary Liquid is required in such particular classes
-of cases that the practitioner can afford to use the best
-only.</p>
-
-<p>The use of Pituitary Liquid obviates the necessity of
-forceps in a great many cases.</p>
-
-<p>Pituitary Liquid is of great service in parturition
-uterine inertia—peristalic paralysis.</p>
-
-<p>We shall be pleased to send you a sample of Pituitary
-Liquid with literature.</p>
-
-<p>Note the name of the perfect pituitary preparation—<i>Pituitary
-Liquid (Armour)</i>.</p>
-
-<h3>THE DELICATE SCHOOL GIRL</h3>
-
-<p>Even the most robust and generally healthy children
-show the deleterious results of the modern system of
-educational “forcing” that prevails in most of our larger
-cities. The child that starts the school year in excellent
-physical condition, after the freedom and fresh air
-of the summer vacation, in many instances, becomes
-nervous, fidgety, and more or less anemic, as the term
-progresses, as the combined result of mental strain and
-physical confinement in overheated, poorly ventilated
-school-rooms. How much more likely is such a result
-in the case of the delicate, high-strung, sensitively
-organized, adolescent girl? It is certainly a great mistake
-to allow such a girl to continue under high mental
-pressure, at the expense of her physical health and well-being,
-and every available means should be resorted to
-to conserve the vitality and prevent a nervous breakdown.
-Regularity of meals, plenty of sleep, out-of-door
-exercise without fatigue, open windows at night and
-plenty of nutritious food, should all be supplied. Just
-as soon as an anemic pallor is noticeable, it is a good
-plan to order Pepto-Mangan (Gude) for a week or two,
-or as long as necessary to bring about an improvement
-in the blood state, and a restoration of color to the
-skin and visible mucous membranes. This efficient
-hematinic is especially serviceable in such cases, because
-it does not in the least interfere with the digestion nor
-induce a constipated habit.</p>
-
-<hr class="chap x-ebookmaker-drop" />
-
-<div class="chapter">
-<div class="transnote">
-<p>Transcriber’s Notes:</p>
-<p>A number of typographical errors have been corrected silently.</p>
-<p>The cover image was created by the transcriber and is placed in the public
-domain.</p>
-<p>References to other pages noted in the Publisher's Department section
-were not available for transcription</p>
-
-<p>The two lines below were swapped from the original:<br />
- by a chronic hypertrophic conjunctivitis. The<br />
- canthotomy necessary; and no case was followed<br />
- </p>
-</div>
-</div>
-
-<div style='display:block; margin-top:4em'>*** END OF THE PROJECT GUTENBERG EBOOK THE JOURNAL-LANCET, VOL. XXXV, NO. 5, MARCH 1, 1915 ***</div>
-<div style='text-align:left'>
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+<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" + "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd"> +<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> + <head> + <meta http-equiv="Content-Type" content="text/html;charset=UTF-8" /> + <meta http-equiv="Content-Style-Type" content="text/css" /> + <title> + The Journal-Lancet. Vol. XXXV. No. 5. Mar 1, 1915, + by W. A. Jones (Editor)—A Project Gutenberg eBook + </title> + <link rel="coverpage" href="images/cover.jpg" /> + <style type="text/css"> + +body { + margin-left: 10%; + margin-right: 10%; +} + + h1,h2,h3 { + text-align: center; /* all headings centered */ + clear: both; +} + +p { + margin-top: .51em; + text-align: justify; + margin-bottom: .49em; +} + +hr { + width: 33%; + margin-top: 2em; + margin-bottom: 2em; + margin-left: 33.5%; + margin-right: 33.5%; + clear: both; +} + +hr.tb {width: 45%; margin-left: 27.5%; margin-right: 27.5%;} +hr.chap {width: 65%; margin-left: 17.5%; margin-right: 17.5%;} +hr.dotted { width: 90%; margin-left: 5%; margin-right: 5%; + border-top: medium dotted black; } +@media print { hr.chap {display: none; visibility: hidden;} } + +div.chapter {page-break-before: always;} +h2.nobreak {page-break-before: avoid;} + +table { + margin-left: auto; + margin-right: auto; +} +table.autotable { border-collapse: collapse; } +table.autotable td, +table.autotable th { padding: 4px; } + +.tdl {text-align: left;} +.tdr {text-align: right;} +.tdc {text-align: center;} + +.pagenum { /* comment the next line for visible page numbers */ + visibility: hidden; + position: absolute; + left: 92%; + font-size: smaller; + text-align: right; + font-style: normal; + font-weight: normal; + font-variant: normal; +} /* page numbers */ + +.blockquot { + margin-left: 5%; + margin-right: 10%; +} + +.bbox {border: medium solid; + margin-top: .5em; + margin-bottom: .5em; + } + +.center {text-align: center;} + +.right {text-align: right;} + +.smcap {font-variant: small-caps;} + +.allsmcap {font-variant: small-caps; + text-transform: lowercase;} + +.hanging2 {padding-left: 2em; + text-indent: -2em; + } + +/* Images */ + +img { + max-width: 100%; + height: auto; +} +img.w100 {width: 100%;} + +.figcenter { + margin: auto; + text-align: center; + page-break-inside: avoid; + max-width: 100%; +} + +ul { + list-style-type: none; /* Remove bullets */ +} + +/* Footnotes */ +.footnote {margin-left: 10%; margin-right: 10%; font-size: 0.9em;} + +.footnote .label {position: absolute; right: 84%; text-align: right;} + +.fnanchor { + vertical-align: super; + font-size: .8em; + text-decoration: + none; +} + +/* Transcriber's notes */ +.transnote {background-color: #E6E6FA; + color: black; + font-size:smaller; + padding:0.5em; + margin-bottom:5em; + font-family:sans-serif, serif; } + +/* Illustration classes */ +.illowp100 {width: 100%;} + + </style> + </head> +<body> +<div>*** START OF THE PROJECT GUTENBERG EBOOK 65823 ***</div> + +<p><span class="pagenum" id="Page_109">[Pg 109]</span></p> +<h1><span class="smcap">The<br /> +<big>Journal-Lancet</big></span></h1> + +<p class="center">The Journal of the Minnesota State Medical Association<br /> + <small>and Official Organ of the</small><br /> + North Dakota and South Dakota State Medical Associations + </p> + +<p class="center"><small>PUBLISHED TWICE A MONTH</small></p> + +<p class="center">VOL. XXXV   <span class="smcap">Minneapolis, March 1, 1915</span>   No. 5 +</p> + +<hr class="chap x-ebookmaker-drop" /> + +<div class="chapter"> +<h2 class="nobreak" id="FEEDING_OF_THE_HEALTHY_INFANT1"> + FEEDING OF THE HEALTHY INFANT + <a id="FNanchor_1" href="#Footnote_1" class="fnanchor">[1]</a> + </h2> + </div> + +<p class="center"> + <span class="smcap">By E. J. Huenekens</span>, A. B., M. D.<br /> + Instructor in Pediatrics, University of Minnesota<br /> + MINNEAPOLIS</p> + +<div class="footnote"> + +<p><a id="Footnote_1" href="#FNanchor_1" class="label">[1]</a> +Read before the Hennepin County Medical Society, +Nov. 2, 1914.</p> + +</div> + +<p>The science of infant-feeding has been revolutionized +in the last twenty years, and, in the +process, it has advanced too radically in many +directions. Lately, the pendulum has been +swinging backward, so that the most advanced +knowledge of today probably represents a middle +ground between extreme radicalism and extreme +conservatism. In no other direction is this more +manifest than in the feeding intervals. The +religious adherence to the four-hour feeding +interval is giving way to a more rational system. +I am one of the firmest adherents of the longer +interval: the food is better digested, the stomach +has a period of rest, and the general well-being +of the infant is better furthered than with more +frequent feedings. But there are certain infants +who do not receive enough nourishment in this +interval, especially young breast-fed infants in +whom it can be demonstrated by accurate weighing, +before and after nursing, that they receive +considerably more milk in twenty-four hours +with the three-hour interval. This is the more +important in that Rosenstern has demonstrated +that a large proportion of infants up to the age +of six weeks require more than the usual 100 +calories per kilogram of body-weight. One hundred +calories represents 150 grams of breast-milk, +so that a five-kilo, or eleven-pound, baby should +receive a minimum of 750 c.c. of breast-milk in +twenty-four hours.</p> + +<p>By far the best food for the healthy infant +in every way—and this cannot be emphasized too +strongly—is mother’s milk. There are certain +alimentary disturbances in which it may be advisable +to replace breast-milk with certain artificially +prepared foods, such, for instance, as +albumin milk in alimentary intoxication; but this +is never true of the normally healthy infant. +While, as regards growth and freedom from +digestive disturbances, certain artificially prepared +foods may, when used with exceeding care, +produce as good results as breast-milk; nevertheless, +this is only one function of breast-milk. +The other function which can be imparted to no +artificial food is the passive immunization of the +child against infection. Ehrlich (<i>Zeit. f. Hyg. +u. Infectionskr.</i>, 1892, xii, 183) has proved that +antibodies, antitoxin, and agglutinins are transmitted +directly through the milk from mother to +child; and it has been shown that the blood of +a breast-fed child is considerably more bactericidal +than the blood of a bottle-fed infant.</p> + +<p>The practice of weaning the baby for trivial +reasons has increased in the last decade, and can +be laid largely at the door of the medical profession. +For all practical purposes the only absolute +indication for weaning the baby is open +tuberculosis in the mother. For the last few +years I have been making a systematic inquiry +at the University Dispensary and Infant Welfare +Stations as to reasons for weaning young infants; +and in nine cases out of ten, the answer +has been that “the milk gave out.” In only a +very small proportion of cases has an ordinarily +well-nourished mother insufficient milk; far +oftener the fault lies with the child. Insufficient +<span class="pagenum" id="Page_110">[Pg 110]</span> +and late development of the sucking reflex prevents +these infants from completely emptying +the breast, which in time “dries up.” This +period can be tided over by nursing from both +breasts, by temporarily increasing the number of +nursings, or temporarily employing “allaitement +mixte.” In cases in which, after long, patient +effort the supply of milk is still insufficient, either +supplementary or complementary feeding of +cow’s milk can be given. Where this mixed feeding +is employed a minimum amount of cow’s +milk should be given; and the opening in the +nipple should be as small as possible, otherwise +the child gets too much cow’s milk, and with too +little effort, and gradually refuses the breast.</p> + +<p>Another excuse, and one fostered to some extent +by physicians, is, that certain breast-milks +are “poison for the baby.” This has even less +foundation in fact; and here again the fault must +be looked for in the baby rather than in the +mother. Outside of certain variations in the +fat-content, all breast-milks are alike in composition. +In proof of this Finkelstein has fed these +babies at the breast of tried wet-nurses with absolutely +no benefit, while the children of the wet-nurses +would thrive at the breast of the “poison-milk +mother.”</p> + +<p>Abscess of both breasts may force a temporary +cessation of nursing, but the breast should be +regularly emptied until the inflammation has +subsided; and then the nursing should be re-established. +Cracked or sunken nipples may +render nursing impossible, but they do not stop +the flow of milk. In both these latter conditions +the milk may be manually expressed or removed +with the breast-pump. In this connection I wish +to recommend the improved Jaschke pump, in +which, by means of a releasing valve, the sucking +movements of the child can be very closely +imitated.</p> + +<p>Where artificial feeding must be started early, +cow’s milk is almost universally employed. +Whenever possible, “certified milk” should be +used; the ordinary milk, however, can be boiled +with little or no harm. In diluting and preparing +this milk, we have the choice of several methods. +The so-called percentage feeding, favored +in America, is difficult and cumbersome, and has +no advantages over its simpler rivals. Pfaundler’s +rule may be safely employed. It is as follows: +One-tenth body-weight of milk, one one-hundredth +body-weight of sugar diluted up to +one liter; give 200 c.c. five times in twenty-four +hours. Even simpler is the following: One-third +milk for the first month, one-half for the +second month, two-thirds for the third and +fourth months, each with the addition of 4 to 6 +per cent sugar. Either milk-sugar or ordinary +granulated sugar may be employed. The malt +sugars and extracts should be reserved for sick +children. After the second month, oatmeal +water may be used as a diluent in place of plain +water.</p> + +<p>Recently Friedenthal, a Berlin physiologist, +has attempted an exact imitation of mother’s +milk, including that important element, the salt, +which had, until recently, been entirely neglected. +Langstein is very enthusiastic over this milk as a +food for healthy infants; but Finkelstein, in a +personal communication, assured me that it has +not as yet proved itself. Schloss, dissatisfied +with the results of the Friedenthal milk, has +modified it in the direction of casein milk by replacing +the milk-sugar with the malt preparations, +and increasing the protein content. He claims +good results, and is supported by Leopold, of +New York, who has used it extensively. But we +must leave the final word as to both these milks +for the future to decide. From the sixth to the +ninth month for both breast-fed and bottle-fed +babies, cooked cereals, toast, and vegetables +should be gradually added to the diet. At the +ninth month, unless this is one of the hot summer +months, the nursling should be weaned, and a +small amount of cow’s milk substituted. The +weaning should be gradual by omitting one nursing +period each week. The one important exception +to the foregoing rules for the first year of +life, is the premature infant. In the ninth month +of fetal life, reserves of calcium and iron are +stored up in the body, which the infant gradually +uses up during the first nine months of extra-uterine +life. The premature infant lacks this +store, and manifests it in different ways. As +early as the second or third month a breast-fed +premature infant may develop a most extensive +craniotabes. This is not due to a true rachitis, +i.e., disturbance of calcium metabolism, but to a +want of calcium in the body. Small amounts of +cow’s milk, which contains much more calcium +than human milk, or calcium in the form of +calcium lactate or chloride, will remedy this condition. +A similar process happens in the case of +iron. The premature infant is born with a hemoglobin +percentage of 100 to 110; by the third or +fourth month this may sink to 40 per cent, and +for this reason green vegetables should be added +to the diet as early as the fourth month.</p> + +<p><span class="pagenum" id="Page_111">[Pg 111]</span></p> + +<p>The diet of healthy children in the second year +should include cooked cereals, vegetables, toast, +cooked fruits, and meat-juices; and the quantity +of cow’s milk should be limited to one and one-half +pints in twenty-four hours. The question +of the addition of meat to the diet is important. +Some authors have recently advocated the giving +of meat as early as the ninth month. During the +past year, working in Finkelstein’s laboratory, I +have been able to gather some facts which have a +direct bearing on this question. (<i>Zeitschrift für +Kinderheilkunde</i>, July, 1914.) By means of the +new electrometric determination of absolute +acidity (that is, the number of H ions), I was +able to show that the acidity of the stomach before +the eighteenth month of life is insufficient +to permit any peptic, i. e., protein, digestion. +Solomon, working in the same clinic, in a report +not yet published, has shown the same thing from +a clinical standpoint. He found that on a meat +diet up to the end of the second year large quantities +of muscle fibers passed through with the +bowel-movement unchanged; but after that age +they rapidly decreased in number. It is, therefore, +worse than useless to add meat to the diet +before the beginning of the third year.</p> + +<p>Eggs frequently produce profound disturbances +in young infants, perhaps on account of the +absorption of egg albumin, unchanged, in the +blood-stream; and they should be kept from the +diet-list until the beginning of the fourth year.</p> + +<p>These rules for feeding are generalized, and +there may be many exceptions. Each child is to +some extent a law unto itself, and this is especially +true of those children with nervous or exudative +diathesis.</p> + +<p>In conclusion, I wish to make a plea for greater +uniformity in our rules for infant-feeding. Even +more than in strictly medical affairs has the public +the right to demand information. Heretofore, +every new book and every public lecture on +infant-feeding has deviated markedly from its +predecessors, until the confused laity, and even +general practitioners, have turned in disgust to +proprietary foods and formulas. Pediatrics is +a new science, and as such is bound to undergo +rapid changes and conflicting opinions. But that +need not hinder us from agreeing on certain +fundamental facts which can be given as guides +to the general practitioner and to the public.</p> + +<p>I believe that the simple rules for infant-feeding +here laid down are neither too conservative +nor too radical to serve as a basis of agreement +upon which the medical profession may show to +the public a united front on this important question. +Such uniformity of opinion—and the +sooner it can be reached the better—will not fail +to have a beneficial effect on both the profession +and the public.</p> + +<h3>DISCUSSION</h3> + +<div class="blockquot"> + +<p><span class="smcap">Dr. Jacob Hvoslof</span>: I would like to ask about the +value of lime-water added to the milk. I recently had +an experience where I mixed an ounce of lime-water to +a pint of milk, as I thought that would improve it. but +for some reason or other the baby would not digest his +milk. After a while I left the lime-water out, and +everything went well. Whether this is a “post” or +“propter” I should like to find out.</p> + +<p><span class="smcap">Dr. O. R. Bryant</span>: In case of an exudative diathesis, +where you probably will start solids early, you +will also be able to use meat earlier. An infant that +does well on solids at six months can probably have +meat once a day at fifteen months and show a normal +stool.</p> + +<p><span class="smcap">Dr. S. R. Maxeiner</span>: I would like to ask Dr. Huenekens +where he classes eggs and egg albumin.</p> + +<p><span class="smcap">Dr. C. G. Weston</span>: I have been very much interested +in Dr. Hueneken’s paper. I care only for the babies +during the three or four weeks after birth; and of late +years many of them have passed from me directly into +the hands of the pediatrists. I formerly had the babies +nursed every three hours, but finding that the baby +specialist immediately, on assuming charge, put them +on the four-hour schedule, I changed, about a year and +a half ago, to that interval; and I thought my troubles +would cease, but such has not been the case, and it +has been my impression, as well as that of the nurses +who have had the care of the infants, that it has made +very little difference.</p> + +<p>The four-hour schedule is not a new thing in Minneapolis. +Many of the older members of this Society +may remember that twenty years ago Dr. R. O. Beard +always fed his babies in this way.</p> + +<p>It seems to me that we should make no hard and +fast rules for the feeding of babies, except the one that +mother’s milk should be used whenever possible. We +should individualize with the babies. If they do well +on the four-hour schedule, follow it, as it makes the +care of the child easier for the mother; if, however, +the child does not get sufficient milk on this interval to +properly nourish it, diminish the latter to three hours.</p> + +<p>The only way to accurately determine how much milk +the nursing infant is getting, is to weigh the baby before +and after nursing. One is often surprised at the varying +amounts obtained by the same baby at different +nursings with no obvious difference in the condition of +the breasts. We have had a baby obtain as much as +three ounces in the first five minutes of nursing, and at +the next feeding take only one or one and a half ounces +in twenty minutes.</p> + +<p>The green and frequent stools, with evidences of +colic, etc., are often found to be due to too much +milk, or taking it too rapidly; and the weighing method +is the only way to determine this.</p> + +<p>I most heartily endorse what Dr. Huenekens said +with reference to the importance of encouraging in +every way maternal nursing. Many a mother gives up +the attempt to nurse her baby on account of some soreness +of the nipples or because she has thought she had +<span class="pagenum" id="Page_112">[Pg 112]</span> +too little milk to be of any use. Most of these cases +may become, by the means recommended by the reader, +good milkers, and many a baby’s life may thus be saved.</p> + +<p><span class="smcap">Dr. E. K. Green</span>: I would like to ask a question in +regard to putting babies on cow’s milk. I have adhered +very closely to the principle that modified cow’s milk is +absolutely the best food for infants, if it is impossible +to get mother’s milk, but many times when I have had +the opportunity to follow these cases carefully I have +had all sorts of stomach and bowel disturbances on +cow’s milk until someone would suggest some other +food, such as malted milk, or Mellin’s Food, or even +condensed milk, which seems to be the farthest from +the natural food, and then the babies would get along +fairly well. Is this a common experience, or is there +something wrong with my method? We have in our +own home two children brought up on the bottle, one +with malted milk and the other with Mellin’s Food. In +both these cases I tried, not only once, but several times +to use the modified cow’s milk, but failed absolutely. I +would like to know if you consider the fault usually +with the modified milk, or does the individual have +considerable to do with the case?</p> + +<p><span class="smcap">Dr. A. S. Fleming</span>: I would like to ask if in the +case of the healthy infant the mother’s diet would modify +the constituents of the milk otherwise than in the +facts stated. For instance, will it modify the character +of or the percentage of the sugar, or will any of the +aromatic constituents disturb the infant’s digestion?</p> + +<p><span class="smcap">Dr. M. J. Jensen</span>: Dr. Huenekens dealt with the +feeding of the healthy infant only. I would like to +ask if it is not true that nearly all infants born alive, +are born as healthy and sound as any infant ever is, so +far as the functions of its organs and tissues are concerned? +Nature frequently decides on producing premature +births and “still”-births, rather than running the +risk of producing a sick or sickly infant. In young infants +it is very often difficult to determine when to +classify them as healthy or unhealthy, realizing the +conditions of their environment and usual care that is +given in the homes.</p> + +<p>In regard to the sterilization or boiling of cow’s milk: +I do not think that children fed on pasteurized or +boiled milk develop as well as those who are fed upon +raw milk as it comes from the cow. Dr. Palmer, of +Chicago, fed seven hundred children on raw milk during +the midsummer months and only lost three of the +number. The miserable, atrophied children began to live +the moment treatment with raw milk was begun. If +the process of milking was carried out in a sanitary +manner, or by means of a suction apparatus, then cooled, +and placed in sterilized bottles, I believe we would prohibit +the development of bacteria, and save the food +which exerts so marked a protective influence upon +the infant’s organs.</p> + +<p>When raw milk free of all objections cannot be obtained, +it is sometimes advisable to use another milk +product namely, buttermilk.</p> + +<p><span class="smcap">Dr. S. Marx White</span>: There is just one point I have +been thinking about in the discussion on the question +of infant-feeding, and that is whether Dr. Huenekens +really means us to believe that in practically all cases +the mother can furnish sufficient milk for the child. +He passed that over in saying that in nine out of ten +cases the mother gave as a reason for discontinuing +the milk that the milk gave out. Is it not true that in a +good many instances the mother needs treatment quite +as much as the infant? I do not mean medical treatment, +but management. Is it not true that an overworked, +tired, nervous, worrying mother is unable to +supply sufficient milk for the child? It has been my +impression from a very limited experience in this field, +that the mental and nervous and physical state of the +mother is a very large factor in the production of the +milk. When upset and under deleterious influences she +is really not a proper producer for the child; and the +management of the mother is often quite as important +a factor as any other.</p> + +<p><span class="smcap">Dr. W. H. Aurand</span>: In such cases as Dr. White +just mentioned, what are we going to do to increase +the supply of milk? Also, I would like to ask Dr. +Huenekens if he means to feed to the new-born baby +200 c.c. at a feeding?</p> + +<p><span class="smcap">Dr. Huenekens</span> (closing): As regards lime-water: +I cannot recommend its use. Wherever there is a +specific demand for calcium, as in premature infants or +spasmophilic cases; or where it may help to produce a +firm stool; or, as in diarrheal disturbances, it may be of +great value, but in the normal healthy infant it is of no +benefit whatever.</p> + +<p>Dr. Bryant mentioned the giving of meat in exudative +diathesis: His statement that such infants can +probably have meat once a day at fifteen months, and +show normal stools, is beside the question. A normal +macroscopic stool does not necessarily mean that the +meat has been digested. However, I am now working +on this problem, that is, to determine whether an early +solid diet produces an earlier digestion of meat.</p> + +<p>I would classify eggs and egg albumin as proteins, +and therefore not digestible until the beginning of the +third year: but, over and above this, there is danger of +anaphylaxis from the absorption of the unchanged egg +albumin into the blood-stream.</p> + +<p>What Dr. Weston says of the feeding intervals is +very interesting. I do not want to be considered an +enemy of the four-hour feeding, for I use it wherever +possible, and I think it the best interval; but when +the infant cannot get enough in that period, we have to +choose between two evils. I think the lesser evil is to +give the child more milk at shorter intervals, and take +the risk of a slightly poorer digestion. We should, also, +wherever possible, control the amount of breast-milk by +weighing the child before and after nursing. It is highly +important to determine whether the baby is getting +too much or too little.</p> + +<p>As to Dr. Green’s statement, “Modified milk” is a very +general term. What is usually meant is milk with a +high percentage of fat and a low percentage of sugar, +while malted and condensed milk have a high percentage +of carbohydrate. In my opinion, if he had used cow’s +milk without the addition of cream and with large +amounts of cane sugar, he would not have had this +trouble. But a large number of children will not do +well on this diet. We have special rules for abnormal +children with exudative and nervous diathesis.</p> + +<p>In reply to Dr. Fleming’s question regarding the mother’s +diet and its effect on her milk: What the mother +eats has absolutely no effect on the composition of the +milk in any way whatever, except perhaps in the percentage +of fat. Now-a-days we do not advise any particular +foods for the mother’s diet,—anything she +likes, and can digest, plus large quantities of fluid;—otherwise +<span class="pagenum" id="Page_113">[Pg 113]</span> +there is no single food we advocate—none +that will make the milk richer or better, or increase +the quantity.</p> + +<p>I cannot agree with Dr. Jensen that raw milk is so +far superior to boiled milk. Of course, wherever it is +possible, we should use certified milk, which does not +require boiling; but, if we have inferior cow’s milk +contaminated with bacteria, we can boil the milk with +very little harm. It is just as well digested, and the +food value just as great. There is of course slight +danger of scurvy; but that is very easily diagnosed, and +very easily cured by a little fresh milk or small doses +of orange juice. Where we have inferior milk, it should +be boiled in every case.</p> + +<p>Dr. White brought up a very interesting point in +regard to nervous mothers. Their milk supply is subject +to wide fluctuations; but, if the breasts are well +emptied at each nursing, they will secrete sufficient +milk. I will admit that these cases are difficult to +handle, for the infants usually have nervous diathesis, +and do not respond well to ordinary food. The one +important point is to completely empty the breasts; and +that is the only measure we can take to increase the +supply of milk.</p> + +<p>In reply to Dr. Aurand: I would feed a new-born +infant 200 c.c. at a feeding if the milk is sufficiently +diluted. The liquid part of the food passes very quickly +into the duodenum, so that, before the infant has finished +feeding, a part of this quantity has already left +the stomach.</p> + +<p>In conclusion: We have an opportunity in our infant-feeding +to practice the really scientific prophylactic +medicine of the future. We can do more in preventing +infant-mortality by proper feeding than by any +other single measure; and we should encourage mothers +to bring their new-born infants to the physician for +advice on feeding, and to continue to consult him at +longer or shorter intervals during the whole of the +first year of life.</p> +</div> +<hr class="chap x-ebookmaker-drop" /> + +<div class="chapter"> + +<h2 class="nobreak" id="THE_INEBRIATE"> + THE INEBRIATE + <a id="FNanchor_2" href="#Footnote_2" class="fnanchor">[2]</a></h2> + +</div> + +<p class="center"> + <span class="smcap">By George H. Freeman</span>, M. D.<br /> + Superintendent of the Minnesota State Hospital for Inebriates<br /> + WILLMAR, MINNESOTA</p> + +<div class="footnote"> + +<p><a id="Footnote_2" href="#FNanchor_2" class="label">[2]</a> +Read at the 46th annual meeting of the Minnesota +State Medical Association, St. Paul, October 1 and 2, +1914.</p> + +</div> + +<p>The Minnesota Legislature of 1907 passed a +bill establishing the Hospital Farm for Inebriates, +placing its management under the State +Board of Control, and providing for its maintenance +by setting aside 2 per cent of the saloon-license +money for that purpose. Later, a law +was enacted providing for the issuance of certificates +of indebtedness; and active construction +work soon commenced. The Hospital was +opened on Dec. 26, 1912, with Dr. Tomlinson, +formerly Superintendent of the St. Peter State +Hospital, at its head. Through his untimely +death, five months later, Minnesota lost one of +her most faithful officials. The principles underlying +the work at Willmar, are, with but +slight change, those that he so earnestly advocated.</p> + +<p>This paper is based upon the study of the +patients admitted from the opening of the Hospital +until the close of the biennial period, on +July 31, 1914,—approximately eighteen months.</p> + +<p>Patients are admitted to the Hospital following +an examination in a probate court. In such cases +there is no expense to the patient’s relatives, except +that they are expected to furnish clothing, +and a little money for the purchase of tobacco +and small luxuries. Voluntary patients are also +received following their own application in a +probate court. They pay at the rate of $1.00 a +day, each month in advance. No distinction is +made in the treatment of the two classes of patients, +except that a voluntary patient cannot be +detained if he wishes to leave. Any resident of +Minnesota who is habitually addicted to the use +of alcohol, morphine, cocaine, or other narcotics, +may be admitted to the institution, provided the +history of the patient, as furnished by a probate +court, indicates that the man can be benefited +by treatment. It is presumed that anyone can +be benefited who wants to be, unless afflicted +with irremediable chronic disease.</p> + +<p>The requirement that the history be furnished, +and the ability to refuse admission, have kept +out of the Hospital many undesirable individuals +who could be cared for only under the discipline +of a well-regulated reformatory. However, some, +no matter how carefully the history is taken, +slip by. The majority of those discharged as +not proper subjects, come from that class. As +there are no accommodations for individuals +suffering with tuberculosis, no one known to be +suffering with that disease is admitted. Once +in a while a tuberculosis individual gains admittance, +but, if not too ill to be released, he is +discharged.</p> + +<p>During the eighteen-month period, 209 men +and 32 women were regularly committed; and 18 +men and 3 women were received as voluntary +patients. In addition to those classified as voluntary +patients, a considerable number have, of +<span class="pagenum" id="Page_114">[Pg 114]</span> +their own volition, applied for treatment, and, +being unable to pay, have submitted to commitment, +in order to obtain treatment for their +habit.</p> + +<p>There has been a fairly uniform increase in +the number of patients received each month, +which is gratifying, as showing the need of such +an institution and also as an appreciation of the +benefit that may be expected. During the last +month of the period, twenty-five patients were +admitted.</p> + +<p>While the causes of inebriety are diverse, it +is a significant fact that 182 patients, out of +262, assign associates as their reason for drinking; +and observation of their history clearly +shows that they have drifted along, drinking +now and then and more and more each year. +A few assign illness, domestic trouble, or financial +worry as a cause for drinking. In only 6 +instances was heredity noted. In 132 cases the +parents were abstainers.</p> + +<p>We have found it impossible to formulate any +system of classification of the unfortunates under +our care. In order that some idea may be obtained +as to the number using alcohol and the +various drugs, we have constructed the following +table:</p> + +<h3>FORMS OF INEBRIETY</h3> + +<table class="autotable" summary=""> +<tr> +<td class="tdl"></td> +<td class="tdr">Men</td> +<td class="tdr"> Women</td> +</tr> +<tr> +<td class="tdl">Steady drinkers</td> +<td class="tdr">130</td> +<td class="tdr">2</td> +</tr> +<tr> +<td class="tdl">Periodical drinkers</td> +<td class="tdr">76</td> +<td class="tdr">8</td> +</tr> +<tr> +<td class="tdl">Morphinism</td> +<td class="tdr">3</td> +<td class="tdr">11</td> +</tr> +<tr> +<td class="tdl">Alcohol-morphine</td> +<td class="tdr">5</td> +<td class="tdr">2</td> +</tr> +<tr> +<td class="tdl">Alcohol-cocaine</td> +<td class="tdr">3</td> +<td class="tdr">..</td> +</tr> +<tr> +<td class="tdl">Alcohol-heroin</td> +<td class="tdr">3</td> +<td class="tdr">..</td> +</tr> +<tr> +<td class="tdl">Alcohol-morphine-cocaine</td> +<td class="tdr">3</td> +<td class="tdr">1</td> +</tr> +<tr> +<td class="tdl">Alcohol-morphine-cocaine-heroin</td> +<td class="tdr">1</td> +<td class="tdr">..</td> +</tr> +<tr> +<td class="tdl">Alcohol-morphine-veronal</td> +<td class="tdr">1</td> +<td class="tdr">..</td> +</tr> +<tr> +<td class="tdl">Morphine-cocaine</td> +<td class="tdr">..</td> +<td class="tdr">1</td> +</tr> +<tr> +<td class="tdl">Morphine-cocaine-heroin</td> +<td class="tdr">2</td> +<td class="tdr">..</td> +</tr> +<tr> +<td class="tdl"></td> +<td class="tdr">——</td> +<td class="tdr">——</td> +</tr> +<tr> +<td class="tdl">Total</td> +<td class="tdr">227</td> +<td class="tdr">35</td> +</tr> +</table> + +<p>The treatment of the inebriate naturally divides +itself into two stages: the treatment, first, +of the immediate effects of indulgence, and, second, +such treatment as will tend to prevent a +repetition of the indulgence. The treatment of +the immediate effect of alcoholic indulgence is +regarded as the easiest part of the work. While +patients are at times received under the influence +of intoxicants, in no case have they been unruly. +For an obstreperous intoxicated person the +quickest soberer is apomorphine judiciously used; +but we have never yet resorted to it. Generally, +a fairly rapid reduction in the amount of alcohol +consumed is made, instead of immediate withdrawal. +Only in the most exceptional cases is +alcohol given over three or four days. As a +rule, during the first day it is given fairly freely. +The treatment received during this period depends +entirely upon the individual; and the treatment +of one may be entirely different from that +of another. Many receive baths at a temperature +of 98° to 100° F. for thirty or sixty minutes +for nervousness and sleeplessness. Some +receive the coal-tar hypnotics, veronal or sulphonal; +the more restless, hyoscine; and for others +paraldehyde is used,—and occasionally chloral +is used in combination with hyoscine and cannabis +indica.</p> + +<p>As long as he receives alcohol, the patient remains +in bed and receives only liquid diet. In +cases of considerable digestive disturbance, capsicum +is freely used, but we have seldom found +it necessary.</p> + +<p>All receive preliminary catharsis, but no attempt +is made at prolonged elimination in that +way.</p> + +<p>For about a month tonic treatment with strychnine +nitrate is used in doses of 1-20 to 1-40 gr. +three times a day. Any other medication depends +entirely upon the physical condition of +the patient as revealed on examination. Only +under the most exceptional circumstances are +drugs given in alcoholic vehicle.</p> + +<p>In morphine or cocaine users, the reduction +is usually made more gradually, requiring a +week to ten days. Generally, we find a patient +comfortable with one-half the drug he has been +accustomed to taking. In some cases we find +it best to reduce the quantity to about one-half +grain, and then abruptly cease.</p> + +<p>Under this plan, diarrhea, cramps, restlessness, +and insomnia are much less marked. We regard +the free use of the prolonged warm bath as more +advantageous to those addicted to drugs than +to alcohol. Generally, it is the only measure +that seems to offer relief. We particularly do +not use hypodermic medication in any drug users.</p> + +<p>Heroin users, who seemingly are more numerous, +receive their drug only once in twenty-four +hours. The withdrawal of the drug does not +cause the discomfort that the withdrawal of morphine +causes. Vague sensations of discomfort, +some perspiration, and insomnia are met with in +such cases.</p> + +<p>No users of cocaine only have been met with, +<span class="pagenum" id="Page_115">[Pg 115]</span> +but in mixed forms this drug is at once withdrawn.</p> + +<p>The removal of alcohol or drugs is the easiest +part of the work. Under the regular discipline +of the institution, and the absence of temptation, +the great majority of patients get along without +any trouble because of abstinence. But there is +the future to fear. The patient must go out +into the world again, and engage in the daily +struggle for his livelihood. One must aim to +put him in such condition that he may be able +to resist the temptations that will surround him +on every hand. Our work, then, is to build up +and re-educate, to strive to form a new character, +to encourage a habit of sobriety, instead of drunkenness, +to teach the man to work, to occupy himself, +to obtain for him a new outlook on life, +and to teach him his duty to himself, to his family, +and to his neighbor. Here is where our difficulty +begins. Nearly every inebriate has a firm +belief in his ability to abstain from alcohol or +drugs at any time and under any condition, because +he thinks he is not really responsible for +the condition into which he has fallen, and that, +had not certain things happened, he would not +have been drinking.</p> + +<p>He is insistent in iterating and reiterating that +he has now made up his mind to stop drinking, +and that is all that is necessary. Though admitting +that, for five, ten, or fifteen years, he has +been going steadily downward, he has full confidence +in himself, and he believes injustice is +being done him when his parole is refused and +he learns that he is expected to remain until he +has strength to resist temptation.</p> + +<p>In this upbuilding of body and character the +following are essential: regularity of habits, discipline, +work, food, and recreation, together with +the personal influence of the physician and those +coming into close and personal contact with the +patient.</p> + +<p>Regular work is one of the most valuable of +the remedial agents at our command. It should +be suited to the individual, and, as a rule, should +not be that to which the man has been accustomed. +Particularly is this true of the man who +is used to mental labor only,—the clerk, the +physician, the pharmacist, the merchant, etc. For +them out-of-door work on the farm, lawn, or +in the garden, is the very best, and next comes +indoor shop-work. We must provide something +that engages time and attention, that provides +some new outlook upon life, and enlarges some +field of endeavor in which the patient has labored +before coming to the Hospital. Thus far the +work has been on the farm or the improvement +of the grounds, or has been carpenter, cement, +or some construction work. The women do all +the mending, and make all needed articles, such +as bedding, towels, etc. They also work in the +laundry. At present we are teaching embroidery +of various kinds, no one of our patients having +ever learned any such work.</p> + +<p>The future must see us provided with shops, +especially for winter work. With a capacity of +ninety-nine men we are able to keep them fairly +well occupied during the winter months, but any +increase will have to be cared for under special +conditions.</p> + +<p>A very important factor is the length of time, +as mentioned above under prognosis, that a patient +remains under care. As a general thing, +it is expected that the average patient will remain, +approximately, six months. The period of detention +is determined only after a study of the individual. +An endeavor is made to consider all +factors that may influence the future life of the +patient,—the length of time and the amount he +has been drinking, the effect on his character +and physical health, the surroundings and occupation +to which he must return. Some patients +are paroled at the end of six months, some remain +seven months. Drug users require treatment +for a much longer period of time than +users of liquor; and they remain from nine +months to a year. The law provides that a patient +shall not be paroled in less than two months, +nor shall he be detained longer than two years +without parole. This, of course, introduces the +disagreeable aspect of the work. The detention +is compulsory; and in some patients antagonism +possibly over-balances the benefit of detention.</p> + +<p>“One of the most pronounced features of inebriety +is, however, the inability of many inebriates +to appreciate the necessity for treatment; +and the more severe the inebriety, the less easy +it is first to get the patient under treatment at +all, and, secondly, to get him to remain long +enough for any treatment to have a permanent +curative effect. One has only to work among +inebriates, no matter to what class of society +they belong, to know that fear of interfering with +the liberty of a subject who has no real liberty, +in that he is a slave habitually or periodically to +the drink craze, results in the interference with +the liberty of all those who have to put up with +his irresponsible behavior under the influence of +alcohol and other narcotic drugs.</p> + +<p>“Were the treatment of the inebriate only possible +in a free sanatorium, only a small minority +<span class="pagenum" id="Page_116">[Pg 116]</span> +of inebriates would come under treatment at all, +and these would be of the less severe type.” +(Pathological Inebriety, by J. W. Ashley Cooper, +1913.)</p> + +<p>Discipline is of great importance, but great +care must be taken in its enforcement. It is of +more value for one to perform a certain duty because +one regards it either as the proper thing or +as likely to benefit one’s self or others.</p> + +<p>The personal influence of those who come into +close contact with the inebriate can hardly be +overestimated. He is easily influenced, often +easily led, and a few thoughtless words or careless +actions can undo the result of patient work.</p> + +<p>All factors that may influence the future life +of the patient must be taken into consideration,—the +length of time and amount he has been drinking, +the effect on his physical health and character, +and the surroundings and occupation to +which he must return. Very often the cause +of the commencement of the patient’s excessive +drinking may be removed or may have disappeared. +Such would favorably influence the prognosis.</p> + +<p>The presence or absence of irremediable disease +is important. For instance, a woman recently +committed to our care suffered from what was +supposed to be, or was, neuralgia. She still has +occasional twinges of pain; but we believe when +the dentist has finished his work these will disappear, +and her prospect be reasonably bright. +A man, 56 years of age, four years ago, suffering +from stone in the bladder, was given morphine, +following an operation. The bladder condition +was permanently relieved, but he became a morphine +user. Such a case is a promising one. In +him the destruction of character is but little +marked.</p> + +<p>A boy, chasing around the city, acquired the +cocaine habit, and became a loafer, drinker, and +follower of loose women. For him the future +offers practically no prospect. Were he a little +younger, and had the attempt to rescue him been +made earlier, there would have been much more +promise. But I doubt whether he can withstand +the lure of his former life. With a few drinks, his +judgment becomes paralyzed, and he is back to +cocaine again.</p> + +<p>Another man, an alcoholic, a printer, became +nervous and exhausted after six months of linotype +work. He probably will not get over his +drinking permanently unless he changes his occupation.</p> + +<p>One of the most important factors as regards +recovery is the length of time a patient remains +at the Hospital. It is sheer folly to expect that +in a few short weeks a man shall have entirely +recovered from the effect of excesses extending +over a period of years, to expect him to regain +a lost will power in that time.</p> + +<p>Another important factor is the insight a patient +obtains into his own condition. We cannot +claim to make a man stop drinking. All we +can do, is to place him in such mental and physical +health that it is unnecessary for him to resort to +stimulants.</p> + +<h3>RESULTS</h3> + +<p>The result of treatment in a disease of the +nature of inebriety, can hardly be estimated in +such time as the Hospital has been open. Our +statistics are simply offered to show possibilities. +As the statute under which the Hospital operates, +contemplates a period of detention and treatment +for not less than two months,—and that +period is even too short in the vast majority of +cases,—anyone resident in the Hospital for less +than two months has been placed in a separate +class, and we can learn that only two of these are +doing well. Of 172 men, aside from those who +have been discharged as not proper subjects, 54 +were paroled, of whom 37, or 68 per cent, are reported +as doing well, 27 were released under +bond, of whom 17, or 63 per cent, are reporting. +Over one-half of the voluntary patients are reporting.</p> + +<p>Averaging all, we find 57 reporting as doing +well; 30 fail to report; 29 are escaped, and we +can learn nothing of them; and 56 were here +less than two months, 38 of these being escaped; +7 voluntary patients; and 8 were released under +bond. A percentage of abstainers of 25, is to be +regarded as most excellent; and as one-third of +those who have left here are still abstaining, +the greater number of failures occurring in the +first month, the outlook for the future is very +encouraging.</p> + +<p>So far, we have been speaking of what we are +trying to do for the more hopeful class of patients. +But what are we to do in the future with +the incurable, the recidivists? Are we to send +them back into the world time and again, let +them abuse themselves, perchance their families, +and let them be, as it were, a constant menace to +society? No, society has a right to protect itself +and to protect an individual against himself. +There should be provision made for this class. +They should be cared for in an institution under +strict discipline, and made to support themselves +there and to contribute to the support of those +who may be dependent upon them.</p> + +<p><span class="pagenum" id="Page_117">[Pg 117]</span></p> + +<p>As soon as considerable numbers are received +at an institution, the more apparent becomes the +need of means for classification, especially as to +character. It is decidedly unwise to allow the +intermingling of the young lad who has just commenced +to drink, with the incorrigible or the +sodden, whose every thought may lie bestial.</p> + +<p>The most practical means of classification is +by the use of cottages; and it is on that plan +that Minnesota’s institution has been started. If +two cottages were built at Willmar we should +be able to make four groups of patients with +decided advantage to our inmates. Not more +than forty inmates should be cared for in each +cottage: and I am strongly in favor of separate +rooms for sleeping-quarters, instead of dormitories.</p> + +<h3>SUMMARY</h3> + +<p>The essential in the treatment of the inebriate +as we meet him, is upbuilding of body and character, +which requires time, and in which drugs +play only a small part.</p> + +<p>Compulsory abstinence is of great value if we +expect to care for a majority of the inebriates.</p> + +<p>It would be wise for the State to undertake +the custody, care and control of all non-criminal +inebriates in one institution, provided adequate +facilities for classification were available.</p> + +<h3>DISCUSSION</h3> + +<div class="blockquot"> + +<p><span class="smcap">Dr. C. R. Ball</span> (St. Paul): I have been very much +interested this afternoon in this symposium on the +treatment of fractures, the last word in obstetrics, and +the inebriate, only it seems to me the Program Committee +put the cart before the horse, and should have +put the inebriate first, and the other things would naturally +follow afterwards.</p> + +<p>Dr. Freeman has splendidly presented his work and +results at the Willmar institution. It is a subject to +which I think medical men pay too little attention. I +have more and more come to look upon the inebriate +as a type of nervous disease and, in the great majority +of cases, a functional nervous disease. It may be classified +as we classify nervous diseases. We classify in +one way functional nervous diseases as to their cause,—acquired, +hereditary and acquired, or wholly hereditary.</p> + +<p>The inebriate may be also classed in the same way. +There are perhaps a few cases in which the habit of +taking alcohol is absolutely acquired, but they are comparatively +few. There are also a few cases of nervous +prostration or functional nervous conditions from overwork, +from a depleted condition, where the nervous +condition comes on; and we may say it is acquired, and +the prognosis in both of these cases is good. It requires +but little effort to put them on their feet. Then +we have that larger class of neurasthenic or functional +nervous conditions, belonging to the second group, in +which the nervous disease, as well as the inebriety, is +partially acquired and partially hereditary. There is a +large class here. They have an unstable nervous system, +and whether they drink or break down depends +a great deal upon the environment and physical condition. +This type of inebriate must be treated along the +same broad lines that we treat a person who is a +neurasthenic, who is subject to repeated nervous breakdowns.</p> + +<p>There is another type which, unfortunately, is rather +large; and this is the wholly hereditary, and in this +type we may classify the dipsomaniac. I have looked +for a long time upon dipsomania as a periodical +nervous disturbance, similar to periodical attacks of +migraine or epilepsy, or periodical attacks of insanity. +Often where a son is an inebriate we find a history of +migraine in the mother. Very often there is insanity, +and very often there is epilepsy, so that when we come +to consider the dipsomaniac we have a tremendous +problem. He does not drink for the fun of it, but +chiefly because of mental depression, mental restlessness, +which is so great that he turns to alcohol to buoy +up his spirits and get rid of the feeling which rather +than suffer with, he would often prefer to die. I have +a man of that description who came to me, and said +that at a certain time he became depressed and suspicious, +began to hate himself, went along the back +streets, absented himself from his usual associates, and +always did this at the beginning of his drinking bout. +That is the case with all dipsomaniacs. It is a disease +similar to epilepsy, and our success in treating this +type is just about as good as in treating epilepsy. It is +not the alcohol: it is an inherited condition; it is a +periodical nervous disturbance, just as epilepsy and +migraine are.</p> + +<p>We hear a great deal about the prevention of tuberculosis, +and much is done to prevent it. I think we +hear much more about the evil effects of syphilis than +of alcohol, but, in my experience, I would place alcohol +at the top of the list as being the most damaging both +to the individual himself and to his offspring. We +have heard a great deal about the effect on the offspring. +In my clinic at the Free Dispensary I have +many epileptic children, and I should say in sixty per +cent of the cases one parent is an alcoholic. An address +of Dr. Rogers, of Faribault, with reference to +the ill effects of one intoxication, when a conception +occurs during that time, put the subject of drinking +before me in a new light. Much interesting experimentation +has within recent years been done with rabbits +and guinea-pigs to show the harmful effect of a +single dose of alcohol given to either the male or +female parent before conception, on the after-coming +litter.</p> + +<p>Not long ago I read an article by some man in New +York in which he stated he had traced seven cases of +epilepsy to the evil results of a single intoxication in +seven different parents. That was something rather +new to me, as I thought, in order to get the bad effects, +on the descendants, of alcohol, it was necessary to +be a chronic alcoholic, and I believe very few of the +laity understand that, if conception happens to occur +during one drunk, the parent being otherwise a temperate +person, the ill effects may be visited on the offspring +to as great an extent as if the parent were a +chronic inebriate. These are some of the things which +would do good if given publicity.</p> + +<p>In regard to the treatment: I can fully agree with +<span class="pagenum" id="Page_118">[Pg 118]</span> +Dr. Freeman in everything he has said. There is certainly +no specific when you come to consider the nature +of the trouble. The treatment must be carried along +the same general lines of physical and moral upbuilding +as those we seek to follow in functional nervous +disease.</p> + +<p><span class="smcap">Dr. W. A. Jones</span> (Minneapolis): I wonder how +many members of the State Association have visited +the hospital for inebriates at Willmar. I would like +to ask all those who have, to hold up their hands. Five +or six of this audience, representing the twelve hundred +doctors belonging to this Association. That gives one +a fair estimate of those familiar with the State farm +for inebriates. I should like to know further how +many members of the legislature have visited this institution, +and how many have tried to condemn it or +perhaps to take it for a tuberculosis hospital. That is +what they will do unless we physicians stand by Dr. +Freeman and the institution.</p> + +<p>There is too much sentiment, too much sympathy +among friends, relatives, courts, juries, and charity +workers, as to the inebriate; but once he gets to Willmar +and is under a proper regimen, his attitude changes +totally toward himself and toward the world. After +one has watched the treatment at Willmar and has seen +the benefit these patients derive, he wonders why so +many women and so many men are sent to quack institutions +for inebriety and drug habits. Willmar costs +the patient practically nothing, except a small per +capita borne by the State. The average quack institution +charges $150.00 for a cure, so called, whether the +cure lasts for three days, or, as in some of the more conservative +(?) quack institutions, the period is extended +to ten days, and in the notoriously drink-habit cures, +to thirty days. This ought to appeal to a doctor forcibly, +inasmuch as all these claims of cures made by quack +institutions are limited to thirty days at the outside, an +absolutely absurd statement, and, for that reason, if +for none other, we should all support and entertain +anything that tends to increase the efficiency of the +State farm for inebriates at Willmar.</p> + +<p>One thing which Dr. Freeman wants to emphasize +is the necessity at times of forcible restraint in a building +especially constructed for detention cases. There +is a small class of people who are, perhaps, suffering +from a disease state, who are irresponsible. Most of +them are common drunkards, who create all sorts of +disturbances and who really need discipline—who need +to be detained forcibly for a sufficient length of time +to enable them to recover their normal physical tone, +and until they recover something of their natural +mental tone. If this could be incorporated in the rules +and regulations of the governing body of the inebriate +farm it would make a great increase in the total number +of improvements and recoveries.</p> + +<p>Dr. Freeman has emphasized the necessity of getting +the physical condition up to a high point. He has said +all that is really needed on the subject. I believe drugs +and drink should be reduced rapidly in almost every +case. If you look over some of the literature of some +institutions that take these people, you will find they +reduce the morphine down from fifty grains to forty, +and then to thirty-nine, until, finally, after a period of +so many weeks or months, they cut it down to the +two-hundredth of a grain, and give it hypodermically. +You can readily see the absurdity of that treatment. +The average man can have the total reduction made +within thirty-six or forty-eight hours.</p> + +<p>I hope you will take more interest in the inebriate +farm, and see that your legislator is interested as well.</p> + +<p><span class="smcap">Dr. Haldor Sneve</span> (St. Paul): I have listened with +a great deal of pleasure to Dr. Freeman’s paper, and +especially because there are some statistics as to what +can be accomplished in such an institution even in a +comparatively short time. Personally, I think that six +months as an average time to stay in this institution +would be too short. It will be found, however, in time, +whether this is true, but just now the institution is in +the experimental trial stage.</p> + +<p>A great many legislators are, as Dr. Jones said, trying +to convert this institution either into an insane +asylum or a tuberculosis sanatorium; and it is up to +the profession of the state to back up the establishment +of this institution for the treatment of a class +which is growing.</p> + +<p>Personally, I think drink is a vice and not a disease, +and until we can eradicate from the minds of the laity +and from the minds of some physicians the idea that a +man who drinks is some sort of a nervous invalid, the +sooner we shall get better results in the handling of +this question. Even the dipsomaniac has periodic +brain-storms, which Dr. Ball has likened to attacks of +migraine; that is a good simile, they do not always +take to drink, but go off in other ways.</p> + +<p>I have treated from twenty to fifty cases of delirium +tremens at the City Hospital every year for twenty +years, and I have had considerable experience in institutions; +and yet I cannot find anything to criticize +about the principles of treatment that Dr. Freeman has +put forth here today. The idea in the minds of the +laity is that inebriety is a disease, and they want drugs +for it to make them well, and that is one reason why +so many patients go to Keeley cures and get well. They +go there because they find a drug that cures <i>disease</i>. +I find that the Towne-Lambert treatment is an excellent +<i>mental</i> treatment for the inebriate in private practice. +It can be used in the institution at Willmar, as +well as in private practice, and putting a patient upon +the Towne-Lambert treatment satisfies his desire to +cure the disease he is suffering from.</p> + +<p>I think the profession will have to keep their eyes +on the legislators, perhaps on the new governor, and +see that this institution is not thrown into the waste-basket, +so to speak, or converted into some other sort +of institution, because we need a place of this kind. +Even if Minnesota can go prohibition pretty soon—and +I rather think it will—we shall not get rid of our +drunkards for that reason. We shall still have to +have a hospital for the treatment of the morphine, +cocaine, and alcoholic habits. The doctors who send +patients to Willmar, I think, ought to be careful, and +not try to help some municipality out of taking care +of old battered hulks, who cannot hope to recover, who +cannot be made well simply because they have been +drinking for so many years, and their other habits of +life have resulted in such a deterioration of the brain +that there is no possibility of bringing them back and +making really good citizens of them. Those patients +should be kept in a work-house or in a special department +at Willmar or some other place. We should try +to reclaim all of our young men and young women +habitues.</p> + +<p>Owing to the absence of proper writeups about this +<span class="pagenum" id="Page_119">[Pg 119]</span> +hospital it is not generally known throughout the state +that pay-patients can be received and treated just as +in any sanitarium and at very moderate rates.</p> + +<p><span class="smcap">Dr. Freeman</span> (closing): I really have nothing to add +in closing except to say a word with regard to prohibition. +I have a second-hand statement from the police +of one of the Twin Cities that he is positive in his city +there are five thousand drug-users from his experience in +the police court.</p> + +<p>With regard to the maintenance of discipline at the institution: +We have sufficient law or authority for discipline, +but we have not the facilities. The thing in my +opinion that we mostly require is a building where +we can take care of a man who is incorrigible, or a man +who runs away. For two reasons: In the first place, I +have known a number of men who came there unwillingly, +who later were greatly benefited by their compulsory +stay; second, the effect of disciplinary measures +upon the population in general. If a man knows that, +when he goes there, he must stay, he naturally gets over +his constant thought that he is going to sneak away, and +put it over. The custodial cottage to take care of forty +people would allow, in all, four classes of patients. We +should have a reception-ward in which to examine all +new patients; one ward for the incorrigible; and we +should have two other places to care for two classes of +men received. This would prevent the influence of the +older men who have gone further in their habits upon +the young boy who has just started.</p> +</div> +<hr class="chap x-ebookmaker-drop" /> + +<div class="chapter"> + +<h2 class="nobreak" id="INTRACRANIAL_COMPLICATIONS"> +DIAGNOSIS OF INTRACRANIAL COMPLICATIONS IN DISEASES +OF THE MIDDLE EAR AND ACCESSORY +SINUSES OF THE NOSE +<a id="FNanchor_3" href="#Footnote_3" class="fnanchor">[3]</a></h2> +</div> + +<p class="center"><span class="smcap">By Joseph C. Beck</span>, M. D.<br /> +CHICAGO.</p> + +<div class="footnote"> + +<p><a id="Footnote_3" href="#FNanchor_3" class="label">[3]</a> +Read before the Sioux Valley Medical Association, +July 22, 1914, and published in these columns at the +request of the Association.</p> + +</div> + +<p>The most important causes of intracranial +complication from the middle ear and nasal accessory +sinuses, are suppurations, consequently +I shall confine my remarks to that subject, and +not take up the neoplasms, trauma, etc.</p> + +<p>In the diagnosis it is most important to recognize +suppurative disease of the ear and sinuses, +but this subject is not within the province of +this paper, therefore I shall satisfy myself by +mentioning only that the presence of the pus +from the middle ear and nose, and Röntgenographic +examination, are the most important +signs of affections of these structures. The one +symptom more than any other on the part of +the patient of a threatening extension into the +cranial cavity, is localized pain or headache, +which is very persistent, instead of periodic. +Especially important is this in connection with +the cessation or diminution of the discharge. +The knowledge of the pathological change present +in the sinuses and middle ear and mastoid, is +of additional value as, for instance, tuberculosis, +syphilis, and cholesteatoma.</p> + +<p>The frequency of intracranial complication in +suppuration of the middle ear is much greater +than that following sinus disease, about twenty-five +to one in my experience.</p> + +<p>The intracranial complications which I shall +consider are—</p> + +<ol> +<li>Meningitis.</li> +<li>Sinus thrombosis.</li> +<li>Brain abscess.</li> +</ol> + +<p>The meningitis may be serous or suppurative, +and later localized or diffuse.</p> + +<p>The sinus thrombosis may be partial or parietal, +and complete with or without involvement +of the jugular bulb and vein. The brain abscess +may be extradural or genuine within the brain +substance proper. The complications may be +further divided as to bacteriologic or etiologic +factors as, for instance—</p> + +<ul> +<li>Streptococcic</li> +<li>Staphylococcic</li> +<li>Pneumococcic</li> +<li>Tuberculous</li> +<li>Syphilitic</li> +</ul> + +<p>These complications may arise following +acute, or chronic and acute, exacerbation of +chronic suppuration of the ear and sinuses. Meningitis +and sinus thrombosis (this latter condition +is very frequently associated with a localized +meningitis) are usually complications following +acute, or acute exacerbation of chronic, +suppuration of the ear and sinuses. Brain abscess, +however, is most frequently associated with the +chronic form of the ear and sinus disease; but +these become more manifest following an acute +attack of ear or sinus trouble. Tubercular or +syphilitic meningitis is chronic inflammation +<i>per se</i>; but these conditions are also lit up by +the acute processes within the ear and sinuses.</p> + +<p>The cardinal symptoms of any intracranial +complications are—</p> + +<div class="blockquot"> + +<p>1. <i>Pain or headache.</i>—This may be localized +or diffuse; it is, however, very persistent and +quite intense. It is in the recognition of this +<span class="pagenum" id="Page_120">[Pg 120]</span> +symptom that has helped me more than any +other in suspecting intracranial trouble.</p> + +<p>2. <i>Nausea and vomiting.</i>—This symptom is +quite constant, especially early in the disease; +and projectile vomiting is quite characteristic of +intracranial pressure or irritation.</p> + +<p>3. <i>General septic appearance.</i>—This of course +will vary in the different conditions under consideration, +but in all is it quite manifest.</p> + +<p>4. <i>The vision</i> is very frequently affected due +to the choked disk that is present.</p> + +<p>5. <i>Temperature, pulse, and respiration</i> are +very frequently disturbed.</p> + +<p>6. <i>Definite focal symptoms</i> of brain localization +are of the utmost importance in the diagnosis.</p> + +<p>7. <i>Blood and spinal fluid examinations</i> give +very valuable information.</p> + +<p>8. <i>Röntgenographic findings</i> are at times valuable.</p> + +<p>9. <i>Exploratory operation and treatment</i>, as +in lues, is at times necessary to make a diagnosis.</p> + +</div> + +<h3>MENINGITIS</h3> + +<p>(a) <i>Serous meningitis.</i>—One of the first +signs is the increasing headache, at first localized, +usually near the seat of the perforation or +path of infection, and soon becoming diffuse +over the head. The patient loses his appetite, his +tongue becomes coated, the emunctaries become +sluggish in their action, and nausea is a very +common symptom. The temperature rises, and, +if the septic form is going to follow, this rise is +often quite rapid, so that there may occur small +chills from the infection of the cerebrospinal +fluid. The pulse and respiration rate is now considerably +increased. The patient is very irritable +and restless, and does not sleep. As soon as the +fluid increases within the cavity there is observed +the characteristic syndrome of rolling the eyes, +especially upward, the neck is drawn backwards, +and finally the leg upon the thigh and +thigh upon the abdomen. Attempts to straighten +them out is resisted and appears to be painful,—Kernig’s +sign.</p> + +<p>Stroking the bottom of the feet with some +semisharp instrument or the finger-nail will +cause the big toe to turn up instead of down,—Babinski’s +sign.</p> + +<p>Taking the head and tilting it forward against +the chest will cause the limbs to be drawn up,—Brudzinski’s +sign.</p> + +<p>All the other symptoms, as pressing over the +peroneal nerve and muscle (Gordon’s sign), +which will cause the extension of the toes, the +stroking of the anterior tibial surface (Oppenheim’s +sign), or the stroking of the region of the +external malleolus (Chaddock’s sign), will produce +retraction of the toes. All these signs, I +say, prove that the upper neuron (within the +cranium) is involved. The patient now will +lapse into unconsciousness, and be roused with +more or less difficulty to again relapse in the +same condition. The pupils become sluggish in +their action, at first becoming small, then irregular, +and finally dilated.</p> + +<p>Ophthalmoscopic examination may reveal a +choked disk. Spinal puncture shows increased +pressure by fluid very frequently coming through +the hollow needle with a spurt, and clear or slightly +cloudy. Following such a puncture the patient +is very often much improved for from a half an +hour to a whole day, but the symptoms soon return. +A complete examination of the cerebrospinal +fluid thus removed, will aid a great deal +in diagnosis. This includes the following:</p> + +<div class="blockquot"> + +<p>1. Remove about 25 c. c. at spinal puncture.</p> + +<p>2. Make several slides and stains for organisms, +as septic and tubercular.</p> + +<p>3. Examine and count the endothelial cells, +leucocytes, and pus cells.</p> + +<p>4. Make cultures.</p> + +<p>5. Make a Noguchi (butyric-acid) test for +excess of albumin.</p> + +<p>6. Make a Lange colloidial test.</p> + +<p>7. Wassermann, Nonne, and Noguchi tests +for syphilis.</p> + +<p>8. Test for sugar.</p> + +<p>9. Test for total acidity and relative acidity.</p> + +<p>10. Cholin may be tested for.</p> +</div> + +<p>In the serous form one will find the cells increased +somewhat, especially the leucocytes, but +the micro-organisms are conspicuous by their +absence.</p> + +<p>The Lange (colloidal-goldchloride) test will +show the characteristic color reaction of a septic +process.</p> + +<p>The Noguchi (butyric-acid) test will be positive. +Excess of albumin.</p> + +<p>The Wassermann, Nonne and Noguchi tests +for syphilis are negative. (Unless such a case +should be a complicated one.)</p> + +<p>The test for sugar is very important in that in +serous meningitis sugar is present.</p> + +<p>The relative acidity is not markedly affected, +and cholin is not present, or, if so, in only small +quantity.</p> + +<p>(b) <i>Septic meningitis.</i>—If this is <i>localized</i>, +and there is a collateral serous meningitis associated +<span class="pagenum" id="Page_121">[Pg 121]</span> +with it, then the symptoms may be the +same, as just described; however, the cerebrospinal +fluid will show a greater degree of irritation, +and the fluid may contain some micro-organisms. +The majority of localized septic +meningitis cases, however, are not as severe in +their course as the serous or diffuse septic forms. +The one important symptom is the localized +headache, which is quite persistent, and the +greater rise in the temperature. There are, undoubtedly, +many cases of localized meningitis +that show a perfectly normal cerebrospinal fluid, +and most of the cardinal symptoms absent; and +these are the cases that usually get well or lead +to extradural abscesses subsequently.</p> + +<p>The <i>diffuse septic meningitis</i> is the most discouraging +intracranial complication that we have +to deal with, and the diagnosis as a rule is not +difficult. It usually is preceded by the serous +form, but within a very short time develops the +graver symptoms of sepsis. The most positive +symptom is the spinal puncture. The fluid comes +out under pressure, but not so great as in the +serous form, and is turbid. The turbidity varies +in degree with the amount of infection. It has the +appearance at times of pure pus; in fact, that is +what it is. Bacteriologically one will find many +micro-organisms of the character of the infection; +and leucocytes or pus cells are very numerous.</p> + +<p>The sugar reaction is always absent, and the +acidity is much increased as is the quantity of +cholin.</p> + +<p>The pressure or irritative symptoms as the +Kernig and Babinski tests, as well as the pupillary +reactions, are practically the same as in the +serous meningitis, only that they soon give away +to the paralytic form, namely: pupils dilate, +patient is in a constant stupor or coma, and the +involuntary urination and bowel movements become +very manifest. The patient is, as a rule, +unable to take or be given nourishment. The +outcome is, in my experience, with one exception, +always fatal, due to diffuse cerebritis. I +have had a case of diffuse septic meningitis in +the early stages of a pneumococcic type which I +operated on by the Haynes’ method of drainage +of the cyscterna magna, and which recovered; +and I believe that the success in that case was due +to the very early intervention, because I have +operated by the same method on eight other cases +more advanced and of streptococcic and staphylococcic +type of infection, which ended fatally.</p> + +<p><i>Sinus thrombosis.</i>—This complication is the +one that is recognized as giving the best prognosis +because it can be very readily recognized, +and even exploration is warranted to make such +diagnosis. It most frequently follows, or is associated +with, acute infections of the middle ear +and mastoid process. The most important symptoms +are the chills and fever of a distinct septic +type, and, as a rule, increasing in frequency. +There is invariably a blood-picture of sepsis, +namely, a very high leucocyte count and the +polymorphonuclear type in marked excess. +Blood cultures are, as a rule, positive of a bacteriemia. +If the process has extended to the bulb +and internal jugular vein, then one may feel a +thickening or cord-like mass along the anterior +border of the sterno-cleido-mastoid muscle. The +fundus examination often reveals a choked disk, +especially on the side where the thrombosis is +located. A symptom recently described by Beck, +of Vienna, and Crowe, of Baltimore, and proven +by me to be of positive value in several cases, is +the production or increase of a choked disk by +compression of the healthy internal jugular vein. +Urbanschitch has shown in quite a number of +cases of sinus thrombosis that the blood-clotting +time is very much enhanced. This of course is +true of any case of bacteriemia or septic phlebitis +anywhere in the body. I have proven this test to +be of value to me in several cases of sinus thrombosis. +The exploratory exposure of the lateral +sinus is of distinct value, and the only fact to +remember is to expose a sufficient area so that +one is able to deal with the sinus in case it be +opened accidentally, because such an accident +when this precaution was not taken has led to +serious consequences.</p> + +<p>The diagnosis of a thrombotic sinus when +exposed is made first by its discoloration, usually +of a grayish pink; secondly, it feels harder than +normal and is not resilient when compressed, +that is, it does not spring back. It, however, may +be soft in case the thrombus has broken down; +and in cases of parietal thrombosis it may spring +back because there is blood circulating through it. +One will at times find a small collection of pus +about the sinus, a condition known as perisinus +abscess, and in many instances of this condition +the sinus itself is not thrombosed. The puncture +of the sinus by a hypodermic needle and attempt +to withdraw some blood, is not at present considered +good practice owing to the danger of infecting +a non-infected sinus. An incision is considered +a wiser plan, and subsequently packing both +sides (torcular and bulb) so they are shut off +from the general circulation. There are many +instances of secondary infection by embolism, +<span class="pagenum" id="Page_122">[Pg 122]</span> +either in or about the joints, and infection into +the lungs, spleen, pancreas, etc., with the entire +train of symptoms from such complications.</p> + +<p><i>Brain Abscess.</i>—This is most frequently associated +with chronic suppuration of the middle ear +and mastoid, and labyrinthine disease. As stated +before, we must consider two principal types, +namely, those outside the dura and those within. +They may exist at the same time, or the intradural +abscess may frequently follow, especially in +acute exacerbations, the extradural abscess. +The paramount symptom is the great pain in +the head, most frequently localized at or in close +proximity to the abscess. I have, however, +found several instances where the patient located +the pain in the anterior portion of the head, and +operation or post-mortem examination disclosed +it in the posterior cerebral fossa. This pain is +not at all unlike that in brain tumor, and there +are exacerbations in the headaches sometimes +at night, other times in the mornings, and in one +of my cases the patient would have about ten attacks +of severe head-pains within twenty-four +hours, and in the intervals be fairly comfortable.</p> + +<p>The next group of symptoms of importance +are the focal lesions, which will correspond to +the anatomicophysiologic locations and actions. +These focal symptoms will vary in degree in that +they be either irritative or destructive. So, for +instance, a small abscess pressing over the motor +area will cause clonic contraction and a still +larger abscess, especially if it be intradural, will +produce paralysis of that portion of the body +governed by that particular area. Again, if it +be located in the cerebellar region it will cause +a train of symptoms of imbalance and loss of interpretation +of direction, which must be carefully +differentiated from the irritation of the +labyrinth. In this department there has been +much work done by Barany, Ruttin, Neumann, +and other Viennese, and many others to make it +possible to make a differential diagnosis; and +there is a great deal more to be done. One of the +most important recent contributions in this regard +is the “pointing test” of Barany in connection +with cerebellar lesions; and careful +study and experimenting at every opportunity is +very much recommended, in order to familiarize +one’s self with this test. This in connection +with the various labyrinth tests makes the differential +diagnosis much more easy. One must remember +that both labyrinthian irritation in connection +with suppuration of the ear and cerebellar +<span class="pagenum" id="Page_32">[Pg 32]</span> +irritation from brain abscess may exist at the +same time.</p> + +<p><i>Intracranial pressure</i>, being increased in brain +abscess, will cause the cerebrospinal fluid to be +increased and found to be so by spinal puncture, +although no pus cells or micro-organisms will +be found, unless there is also a concomitant +diffuse septic meningitis or ventricular infection +present. The ocular symptoms of intracranial +pressure, such as pupillary (often one large and +one small) and choked disk, are usually present. +The <i>pulse rate</i> and <i>respiration</i> will be affected, +as in brain tumor, according to the size of the +abscess. The larger the abscess the slower the +pulse and respiration. The temperature, as well +as the pulse and respiration, will vary as to +whether the abscess be intradural or extradural. +Intradural abscesses will frequently cause considerable +rise of temperature, and acceleration +of the pulse and respiration, and a remission +when the abscess has become partially walled +off. As soon as a fresh invasion of brain tissue +takes place another rise of temperature, etc., +occurs.</p> + +<p><i>Projectile vomiting</i> is, as in brain tumor, quite +frequently encountered.</p> + +<p><i>The Röntgenogram</i>, especially a stereoscopic +one, will be of some value in cases where through +its chronicity a change of bone by pressure has +taken place, or if one may follow the path of +necrosis from the nasal accessory sinuses or the +middle ear and mastoid process towards the +brain. I will state, however, as I have stated on +several occasions before, that not too much emphasis +should be laid on the diagnostic value of +the <i>x</i>-ray in intracranial lesions, especially +abscess. I have been disappointed in this great +method of diagnosis (<i>x</i>-ray) and much annoyed +at the positiveness of some observers without +sufficient evidence.</p> + +<p>As in sinus thrombosis, so in brain abscess +one should not hesitate in the exploratory operation, +because waiting too long will often reduce +the patient’s ability to stand an operation later +on. Should one not find the abscess, then the +decompression has done a great deal to prevent +destruction of brain tissue by pressure, besides +the patient will be very much relieved of the +severe head-pains. This may be said also of +spinal punctures. In this way one may wait for +development of localization for another operation.</p> + +<p>In conclusion, I would like to repeat the words +<span class="pagenum" id="Page_123">[Pg 123]</span> +of Prof. Neumann as to the differential diagnosis +between meningitis, sinus thrombosis, and +brain abscess: “A patient that has meningitis +is one that wishes to be left alone and allowed +to sleep, although when roused is not particularly +irritable. If he has brain abscess then he +is constantly very irritable and difficult to manage, +while a patient that has sinus thrombosis +when he is free from the chill and fever is very +pleasant, apparently well.”</p> +<hr class="chap x-ebookmaker-drop" /> + +<div class="chapter"> + +<h2 class="nobreak" id="THE_TREATMENT_OF_GONORRHEAL_OPHTHALMIA"> +THE TREATMENT OF GONORRHEAL OPHTHALMIA</h2> +</div> + +<p class="center"><span class="smcap"> +Arthur Edward Smith</span>, M. D.<br /> +MINNEAPOLIS</p> + +<p>In ophthalmology, as in other branches of +medical science, the advance in therapeutics has +hardly kept pace, in recent years, with that in +pathology and diagnosis. Comparatively few of +the therapeutic innovations of the past decade +have stood the test of time; and, in the main, +the ophthalmological materia medica of today +bears a striking resemblance to that of fifteen +or twenty years ago. Our poverty of therapeutic +resource has been notably exemplified in the +generally accepted method of treatment of gonorrheal +ophthalmia; and the results obtained with +the conventional treatment as outlined in the +current text-books are far from satisfactory.</p> + +<p>Gonorrheal ophthalmia, in both infants and +adults, continues to cause an appalling amount +of blindness; and only a part of this can, with +justice, be ascribed to ignorance and neglect. +The number of cases which, in spite of the +most careful treatment, go on to corneal ulcer, +perforation, panophthalmitis, and irreparable +blindness, continues to be considerable. Further, +a decided difference of opinion still exists among +well-trained oculists of wide experience as to the +best method of handling these cases. For over +a hundred years silver nitrate has enjoyed an unquestioned +pre-eminence in the treatment of the +purulent ophthalmias, particularly those cases in +which the gonococcus was the etiological factor; +and even now to question its right to a place in +the treatment of gonorrheal conjunctivitis seems +to many to be as heretical as to abandon mercury +in the treatment of syphilis. For many years the +only difference of opinion in regard to silver nitrate +seemed to be as to whether it should be employed +in the first stage of the disease, or whether +one should wait until the discharge became purulent. +Of late years, however, a number of experienced +oculists have gone on record as being +of the opinion that the majority of these cases +do distinctly better without the nitrate than with +it. As is well known, the nitrate destroys only +those gonococci lying upon the surface or in the +most superficial layers of the conjunctiva; and, +far from reaching those in the deeper layers, +rather forms a film over the surface which protects +them from the irrigating solution used later. +It also appears to be certain that the use of the +nitrate, for a time at least, increases the ratio of +extra-to intracellular gonococci in the discharge, +which furnishes another valid argument against +its use. That a subsequent chronic conjunctivitis +with hypertrophy is often a disagreeable sequel in +cases in which an energetic course of silver nitrate +has been used is a matter of common observation. +The vogue of certain of the organic +silver salts, such as argyrol, protargol, etc., is no +doubt, not so much due to any intrinsic therapeutic +merit which they possess as to the fact that +the average case gets along better without the +local application of strong chemical antiseptics. +However one may feel about the abandoning of +such a time-honored drug as the nitrate of silver +in the treatment of this disease, it must be conceded +that it is entirely inadequate to control the +process in the severer cases, and as a therapeutic +sheet-anchor leaves a great deal to be desired.</p> + +<p>The use of cold compresses in gonorrheal +ophthalmia continues to be advocated in text-books +and practiced in many clinics, especially in +America, in spite of the fact that the progressive +men in general medicine and surgery seem pretty +generally to have abandoned the use of cold applications +in the treatment of acute inflammations +of bacterial origin. Any merit the cold +compresses may have in the reducing of the edema +and relieving pain are more than counterbalanced +by the fact that the vitality of the tissues is +at the same time lowered. In cases in which +there is a sufficient swelling of the lids to cause +a dangerous pressure on the eyeball, cold should +not for a moment be depended upon to control +the inflammatory edema but instant recourse had +to canthotomy: in cases where this swelling is not +marked cold compresses are unnecessary and +apart from a certain analgesic effect, of no value. +<span class="pagenum" id="Page_124">[Pg 124]</span> +The skepticism, which is becoming more general, +in regard to the value of silver nitrate and cold +applications has not extended to the third member +of the classic trinity,—irrigations,—the efficacy +of which seems to be generally conceded. +Various substances have been advocated for this +purpose,—boric acid, potassium permanganate, +bichloride of mercury, normal salt solution, etc., +and the consensus of opinion seems to be that it +is practically indifferent which one of these is +used, the action being mechanical rather than +chemical. The ordinary method of half-hourly +irrigations has been abandoned by Hosford, +Ulbrich, and others in favor of the constant irrigation +with the Hosford apparatus or some +modification of it.</p> + +<p>The English adherents of the constant irrigation +treatment, who, for the most part, dispense +with the use of silver nitrate altogether, report +excellent results; but the method is not without +its drawbacks. The apparatus is awkward to +use, requires as much or more attention than the +intermittent irrigations, and undoubtedly disturbs +the rest of the patient at night more. Further, +since the lids are, of course, not held apart +for the constant irrigation, but the flow of the +solution across the palpebral fissure is depended +on to cleanse the eye of secretion, one is inclined +to question whether the mechanical cleansing is +as thorough as when the lids are gently held apart +while the eye is being irrigated.</p> + +<p>The more one sees of these cases, the more one +is impressed with two things: first, that a certain +percentage of them would make a complete and +uncomplicated recovery, even if they were entirely +untreated (undoubtedly this number is +larger than we think, especially in children); +second, that the usual treatment is entirely inadequate +in those cases in which there is an +especially virulent infection or a lowered resistance +of the tissues. When antigonococcic serum +was first developed and its action observed in +cases of acute gonorrheal ophthalmia, the results +were, as in acute urethritis, disappointing. +Many oculists are of the opinion that the serum +is entirely without value in acute blenorrhea, +even though its use be indicated in metastatic +eye disease of gonorrheal origin. Of late, however, +at least two men in America have written +enthusiastically of serum-therapy in acute gonorrheal +conjunctivitis, advocating its employment +in the usual manner and also its use locally, i.e., +dropped into the conjunctival sac in place of the +usual antiseptics. It would seem that the data +now available hardly warrant a positive statement +in regard to the serum-therapy.</p> + +<p>The pathological findings in gonorrheal ophthalmia +are simple but significant, in that the +gonococcus of Neisser is found, not only on the +surface and in the superficial cells of the conjunctiva, +but also, often within forty-eight hours, has +invaded the deeper layers of the epithelium and +the subepithelial connective tissue. This at once +makes clear the reason for the inefficacy of the +local antiseptics, particularly those like silver +nitrate, the action of which is very superficial. +Organic silver preparations and irrigations of various +kinds are equally powerless to reach any but +the most superficially situated of the bacteria.</p> + +<p>Since the destruction of the bacteria lying on +the surface is not sufficient to control the disease, +it may be stated that the problem of the destruction +or inhibition of the deep-lying bacteria is the +essential problem in curing gonorrheal ophthalmia.</p> + +<p>The gonococcus numbers among its biological +peculiarities an unusual intolerance of extremes +of temperature, its growth in culture being +inhibited by temperature above 38° C. or +below 18° C. Text-books on bacteriology state +that exposure to a temperature of 60° C. for a +period of ten minutes destroys the gonococcus. +Experimentation in the laboratory of the Dimmer +Clinic in Vienna in April and May, 1913, with +cultures from forty-two cases of acute gonorrheal +urethritis, seemed to indicate that this point may +be placed from one and one-half to two degrees +lower than this, i.e.,—from 58° C. to 58.5° C.</p> + +<p>Thus, theoretically, at least, it would appear +that, if the conjunctiva could be subjected to a +temperature as near as possible to this without +injury to the tissues, a marked effect should be +observed in the course of the disease, particularly +if the heat can be applied in such a way as to +penetrate as deeply into the tissues as does the +gonococcus. This theoretical requirement has, in +my opinion, been perfectly met practically by the +local use of steam as practiced in the Dimmer +Clinic since February, 1913, with the apparatus +devised by Lauber and modified by the writer. +Goldzieher of Vienna was probably the first to +employ steam in the treatment of the purulent +ophthalmias; and in his first series of cases reported +fifteen patients treated with the application +of steam passing through a nozzle held at a +distance of about four centimeters from the eye, +the temperature of the steam striking the tissues +being about 45° C. (113° F.). Although the results +<span class="pagenum" id="Page_125">[Pg 125]</span> +indicated that the method was a distinct +step in advance there were still a number of important +details to be worked out, in order to get +the best possible results. First of all, experiment +showed that the temperature of the steam at a +given distance from the nozzle was not constant, +so that an arbitrary distance could not be set. +This suggested the advisability of providing the +apparatus with a sliding-guard, which could be +set at the exact distance from the nozzle where +the steam was shown by the thermometer to be +at the desired temperature. Secondly, it was determined +that the tissues would sustain without +injury a considerably higher temperature than +that set by Goldzieher, and that the effect upon +the diseased process was markedly better when +the temperature was raised. Steam at from 50° C. +to 53° C. gave the best results; and in one case in +which a temperature of 55° C. was inadvertently +reached no injury was done the tissues. Further +experience naturally suggested other changes in +the original technic. In the first place, the lids +were held apart by an assistant in the usual +manner; but, even with gloves on, the exposure +of the fingers to the steam was more or less +painful, and gauze wound on little sticks was +substituted. The time of exposure was finally +set at six minutes; and since the application of +the steam could not be borne for longer than from +forty-five to sixty seconds without severe pain it +usually took twenty minutes or so to complete +the six-minute exposure. This was done once +every twenty-four hours, and was combined with +half-hourly irrigations with potassium-permanganate +solution. No other treatment was used. +The results attained with this method in 34 cases +(7 adults, 2 children and 25 infants) has left +nothing to be desired. In no case has there been +any corneal complication; swelling and pain subsided +with unusual promptness; and the course +of the disease was notably shortened, whereas, +after the first application of silver nitrate a +considerable increase in the number of gonococci +in the discharge is often observed. A striking +diminution in the number is noted after the initial +application of the steam. In 8 of the cases in +the series mentioned (all infants), the disease affected +both eyes; and in 5 of these cases the experiment +was made of treating one eye with +steam in the manner described and the other +with applications of silver nitrate in the usual +manner, using the permanganate irrigations in +both. The difference in the results attained was +very striking. In every instance the eye in which +the steam was used was brought much more +quickly under control than the one under nitrate. +In cases brought under treatment early the +edema of the lids did not become severe; and the +course of the disease seemed, in general, to be +shortened by about one-third. There were no +corneal complications, except in one case in which +there was a corneal ulcer present when the man +presented himself at the clinic. In no case was +canthotomy necessary; and no case was followed +by a chronic hypertrophic conjunctivitis. The +application of the steam is undeniably painful, but +not unbearably so.</p> +<hr class="chap x-ebookmaker-drop" /> + +<div class="chapter"> + +<h2 class="nobreak" id="VAGINAL_HYSTERECTOMY"> +VAGINAL HYSTERECTOMY UNDER SPINAL ANESTHESIA: +REPORT ON A CASE</h2> +</div> + +<p class="center"><span class="smcap"> +By R. R. Cranmer</span>, M. D.<br /> +MINNEAPOLIS</p> + +<p>I wish to report this case of vaginal hysterectomy +under spinal anesthesia on a patient whose +age and physical condition were not favorable +for the use of ether or chloroform. The case +belonged to that comparatively small class in +which a general anesthetic cannot be used; and +it was because of this fact that spinal anesthesia +was resorted to. Had it not been necessary +for this patient to earn a livelihood by hard +labor the operation would not have been done; +but, in her case, it was necessary, and the condition +of prolapse, therefore, was a source of continual +pain and trouble. The fact that the diet +was not restricted after the operation assisted +greatly in shortening her stay in bed and her +rapid recovery.</p> + +<div class="blockquot"> + +<p>Patient, aged 59, married, mother of six children. She +had been suffering from prolapsus uteri of a severe +degree for five years. The cervix presented at the +vaginal orifice at times. Mitral insufficiency and arteriosclerosis +were present. She also had chronic bronchitis +and a mild nephritis. Chloroform and ether being +contra-indicated, spinal anesthesia was used, two +drachms of 2 per cent novocaine solution being injected +through the fourth lumbar interspace. The vagina +was prepared for operation, and the hysterectomy +started within four minutes after the spinal injection. +The patient did not complain of any pain; and there +was no shock or other untoward symptoms. She was +immediately put upon a general diet and was able to +leave the hospital on the twelfth day.</p> +</div> +<hr class="chap x-ebookmaker-drop" /> + +<div class="chapter"> +<p><span class="pagenum" id="Page_126">[Pg 126]</span></p> + +<div class="bbox"> + +<h2 class="nobreak" id="Masthead"> +<span class="smcap">The<br /> +Journal-Lancet</span></h2> + +<p class="center">The Journal of the Minnesota State Medical Association<br /> +<small>and Official Organ of the</small><br /> +North Dakota and South Dakota State Medical Associations</p> + +<p class="center"><small>PUBLISHED TWICE A MONTH   ESTABLISHED 1870</small></p> + +</div> +</div> + +<table class="autotable" summary="Magazine Staff"> +<tr> +<td class="tdc" colspan="2"> + W. A. JONES, M. D., <span class="smcap">Editor</span></td> + </tr> +<tr> +<td class="tdc" colspan="2"><span class="smcap">Associate Editors:</span></td> +</tr> +<tr> +<td class="tdl"><span class="smcap">R. D. Alway</span>, M. D.</td> +<td class="tdr"><span class="smcap">Aberdeen, S. D.</span></td> +</tr> +<tr> +<td class="tdl"><span class="smcap">H. J. Rowe</span>, M. D.</td> +<td class="tdr"><span class="smcap">Casselton, N. D.</span></td> +</tr> +<tr> +<td class="tdc" colspan="2"><span class="smcap">Publication Committee:</span></td> +</tr> +<tr> +<td class="tdl">THOS. McDAVITT, M. D.</td> +<td class="tdr"><span class="smcap">St. Paul</span></td> +</tr> +<tr> +<td class="tdl">J. L. ROTHROCK, M. D.</td> +<td class="tdr"><span class="smcap">St. Paul</span></td> +</tr> +<tr> +<td class="tdl">F. A. KNIGHTS, M. D.</td> +<td class="tdr"><span class="smcap">Minneapolis</span></td> +</tr> +<tr> +<td class="tdc" colspan="2">W. L. KLEIN, <span class="smcap">Publisher</span></td> +</tr> +<tr> +<td class="tdl">Subscription</td> +<td class="tdr">$2.00 a year</td> +</tr> +<tr> +<td class="tdc allsmcap" colspan="2"><strong>PUBLICATION OFFICE</strong></td> +</tr> +<tr> +<td class="tdl"><strong><small>839-840 Lumber Exchange</small></strong></td> +<td class="tdr"><strong><small> Minneapolis, Minn.</small></strong></td> +</tr> +</table> + +<hr class="chap x-ebookmaker-drop" /> + +<div class="chapter"> +<h2 class="nobreak"> +<span class="smcap">March 1, 1915</span></h2> +</div> + +<h3 id="NEW_REMEDY">A NEW REMEDY FOR PYORRHEA +ALVEOLARIS</h3> + +<p>Diseased teeth and gums have an undoubted +and pernicious effect upon the general health of +the individual. This condition as a cause of +disease has been the subject of many papers +written by physicians and dentists.</p> + +<p>Now a new remedy has been proposed by Bass +and Johns which promises relief in the majority +of cases. Emetin is the drug that destroys the +ameba of pyorrhea just as ipecac destroys the +ameba of dysentery. The lesion should be attacked +persistently until healed and the use of +emetin continued to prevent reinfection.</p> + +<p>Emetin may be used hypodermically in one-half +grain doses for at least three days and as +often as is necessary to destroy the ameba.</p> + +<p>The presence of the ameba can be determined +only by proper microscopic examinations. The +healing process may require considerable time, +according to the extent and character of the +necrosis. Deep pockets require careful cleansing +to clear the pus-forming cavities. After this has +been accomplished and pus ceases to form Bass +and Johns recommend the use of fluid extract +of ipecac as a local application to prevent reinfection. +Ipecac will actually destroy the ameba +if used persistently and is preferable to the many +commercial preparations now in use. The teeth +should be brushed in the ordinary way, after +which one drop of fluid extract of ipecac should +be applied to the wet brush, forcing some of +the solution between the teeth and spitting out +the excess without further washing of the mouth.</p> + +<p>The investigators have found that this simple +procedure will keep the mouth free from pyorrhea. +It stands to reason, however, that the teeth +must be thoroughly cleaned in the usual manner +by the dentist, otherwise it will be impossible for +the emetin or ipecac to penetrate the deep crusts +which are found about old and uncared for +mouths. It is remarkable how many people neglect +the care of their teeth and it is equally +strange that so little constitutional disorder is +found in those who neglect an ordinary and +simple sanitary toilet requisite. One of the first +rules for hospital patients when they come under +the supervision of the nurse is the provision of a +tooth brush and a suitable mouth wash.</p> + +<p>Many patients from the country, a lesser number +from the cities, never employ a tooth brush. +Some even resent a suggestion of clean teeth. +Nature gave them teeth and nature is supposed +to keep them in order, but unclean teeth are the +rule rather than the exception in hospital practice.</p> + +<p>Not infrequently animals need the services of +a dentist, but their numbers are few compared to +man. When a simple remedy for pyorrhea, +like ipecac, promises to clear the teeth of amebas, +there is no excuse for neglecting nature’s adornment.</p> + +<h3 id="LOWERING_MILK_GRADE">LOWERING THE MILK GRADE</h3> + +<p>A bill has been introduced in the Minnesota +State Legislature for the purpose of lowering +the butterfat requirement in milk from three +and one-quarter to three per cent. This means +a reduction of solids in milk from thirteen to +eleven per cent, and it further means that more +water will be added to much of the milk sold in +Minnesota. A Minneapolis ordinance prescribes +the butterfat content to be as high as three and +one-half per cent. Minneapolis has enough water +in its milk now, and, if this bill goes through, +the city may expect to use skim-milk almost exclusively.</p> + +<p>It hardly seems credible that any one should +desire the quality of milk to be reduced for any +purpose whatever unless it is for commercial +reasons.</p> + +<p>Fortunately, at this writing the bill is held up +<span class="pagenum" id="Page_127">[Pg 127]</span> +for consideration, and it is to be hoped that sufficient +pressure will be brought to bear to insure +its defeat. Too many cows give poor milk and +any effort to standardize and legalize the inferior +cow is a reflection on the integrity of milk sellers. +Inferentially, there are too many under-fed children +and yet if milk is reduced in quality, we +must expect less vigor in the growing child.</p> + +<p>One wonders why such a bill should get into +the Legislature; what are the real reasons for +its passage?</p> + +<h3 id="LEAVES_OF_HEALING">“LEAVES OF HEALING!”</h3> + +<p>The late issue of “Leaves of Healing,” published +by the Dowieites at Zion City, near Chicago, +has been sent broadcast among physicians. +This sheet is an antivaccination propaganda, +and is profusely illustrated by horrible pictures +of supposed diseased states caused by vaccination. +The text is, as is all others of its ilk, full +of misinformation, garbled extracts from known +and unknown writers and speakers, and tirades +against all who believe in vaccination.</p> + +<p>If these sheets would present a fair and broad +view of the evils of vaccination they might find +more adherents to antivaccination doctrines +among medical men; but, as it contains so many +misstatements and is so overbearingly one-sided +in its efforts, the effect is nil, except when it is +circulated among those unbalanced in mind and +judgment. Physicians in general freely acknowledge +that vaccination, or the introduction of a +serum, may produce, in some people, unexpected +and sometimes disastrous results. Most physicians +hesitate to vaccinate people with active +syphilis, or even those in whom the syphilis has +been seemingly inactive for years, or those +who have hereditary syphilis. These persons are +quite apt to have an accentuation of their old +blood disorder under slight infections or injuries; +but that should not militate against vaccination +when an epidemic is probable. Some of the pictures +in “Leaves of Healing” were undoubtedly +pictures of syphilis, and should have been so +labeled; but that could not have been expected in +a partisan publication.</p> + +<p>Physicians also know that people who have +chronic eczema should not be vaccinated until +the eczema clears up; and doubtless in hurried +or extensive vaccinations that are deemed necessary +to prevent the spread of smallpox in a community +cases of eczema are overlooked. Children +who are the victims of chronic digestive +disorders, or who react to mild febrile or diarrheal +conditions more than the average child, are +commonly exempted from vaccination. On the +whole, there are but few conditions that are made +worse by careful vaccinations with proper dressings +and after-care.</p> + +<p>When one considers what wonders in the way +of control of smallpox have been recorded in +medical history, the few mishaps that occur +among the vaccinated, the proportion of illness +due to vaccination is so infinitesimal that they +cannot be classed among the “fearful” results of +vaccination.</p> + +<p>“Leaves of Healing” leaves out of its vaporings +the fact that Zion City had a smallpox epidemic +not long ago, and was quarantined by the health +authorities, and that the people submitted to vaccination +with gratifying results. Nor does the +above-mentioned magazine record the fact that +the president and secretary of a local branch of +antivaccinationists in Minneapolis, who were +fighting a compulsory vaccination law before the +Minnesota Legislature a few years ago, died of +virulent smallpox during that meeting of the +Legislature.</p> + +<p>The antivaccinationist usually has at his command +a set form of speech that contains more +vituperant adjectives, and less reason and judgment, +than the average self-constituted reformer. +Smallpox and other preventable diseases will continue +to exist while the uneducated and ill-balanced +minds are permitted their volley of wind-laden +speech. Some day the people will wake up, +cast the “reformer” aside, and climb on to the +band-wagon of health and happiness.</p> + +<p>It will take our educators and sanitarians some +time to harness the team to the wagon, but when +it starts it will go on merrily to its destination.</p> + +<h3 id="OWNERSHIP">OWNERSHIP OF THE JOURNAL-LANCET</h3> + +<p>In answer to a number of inquiries the following +statement is made:</p> + +<p>The stock of the <span class="smcap">Journal-Lancet</span> is held by +a number of Twin City physicians, and the publisher, +Mr. W. L. Klein.</p> + +<p>The <span class="smcap">Journal-Lancet</span> is the official organ of +the State Medical Associations of Minnesota, +North Dakota, and South Dakota. The responsibility +for its reading matter and editorials rests +with the publication committees of the state associations.</p> +<hr class="chap x-ebookmaker-drop" /> + +<div class="chapter"> +<p><span class="pagenum" id="Page_128">[Pg 128]</span></p> + +<div class="bbox"> +<h2 class="nobreak" id="MISCELLANY">MISCELLANY</h2> +</div> +</div> + +<div class="blockquot"> + +<p><span class="smcap">To the Physicians of the State of Minnesota</span>:</p> +</div> + +<p>The Committee on Public Policy and Legislation +most earnestly asks the co-operation of +every physician in the State of Minnesota in procuring +the passage of the several bills that have +been decided upon, and either have been or will +be introduced into the legislature during this +session. It is believed that there is not a man +upon the roster of the State Medical Society, or +indeed any physician in Minnesota, who does not +see the necessity of certain legislation for the +protection of the physicians in the State, and +also that the common weal will be advanced +by the passage of the telephone bill introduced +by Senator Andrews, of Blue Earth, and +by the passage of the bill relative to trachoma, +which is a constant menace to the public health, +and several other bills that are in course of preparation, +but which await certain developments +before their presentation. The committee earnestly +begs of all the physicians in the State that +they will write to their representatives and senators +from time to time urging with great earnestness +their support for the several measures +advanced by the Committee on Public Policy and +Legislation. It is believed that every physician +can influence at least from 10 to 100 votes at a +general election, and this fact, of itself, makes +the physician a factor in the election of any candidate. +It is believed by this committee that the +medical men of the State, if they will but unite +and act in concert, can measurably influence legislation. +The time has come for the physician to +take his place in the political system of the State, +both as an active agent and, indirectly, through +his influence of others.</p> + +<p>The telephone bill provides for physical connection +between all telephone companies in the +State without extra charge, except a small toll. +It provides that telephone companies shall be +placed under the direction of the Railroad and +Warehouse Commission. It provides that no +greater net income than 5 per cent shall be allowed +upon the capital actually used in the operation +of the telephone companies. It provides +for intercity telephone service in the cities whose +city limits adjoin without extra charge.</p> + +<p>The trachoma bill provides for the segregation +of trachomats, and, under certain circumstances, +for the maintenance by the State of special +schools for their education in school districts +having as many as 20 trachomats.</p> + +<p>There is also drafted and ready for introduction +a bill requiring all persons who seek to +practice medicine in any form whatever to pass +the regular examination before the State Board +of Medical Examiners.</p> + +<p>There is in contemplation a bill for the purpose +of procuring certain lands for the building +of cottages thereupon and establishing farms to +be worked by lepers who may be or shall have +been committed to the leprosarium farm, the intention +being that those lepers in the State that +are able to work shall have an opportunity to do +so, and that the said lepers should care for lepers +who are unable to work or earn a living. It is +also proposed to purchase a small tract of land +not far from the State University for the purpose +of allowing an exhaustive study of certain forms +of leprosy with the aid of the State University +Medical Staff. The leprosarium farm would be +under the direction of the State Agricultural +School.</p> + +<p>The Chairman of this Committee will be very +glad to receive advice and suggestions from the +physicians in the State.</p> + +<p class="right"> +<span class="smcap">Cornelius Williams, M. D.</span>,<br /> +Chairman of the<br /> +Committee on Public Policy and Legislation.<br /> +St. Paul, Minn., February 3, 1915.<br /> +</p> + +<hr class="chap x-ebookmaker-drop" /> + +<div class="chapter"> +<h2 class="nobreak" id="REPORTS_OF_SOCIETIES">REPORTS OF SOCIETIES</h2> +</div> + +<h3>MINNESOTA ACADEMY OF MEDICINE</h3> + +<p>The Academy met at the St. Paul University +Club, Feb. 3. Dr. C. M. Carlaw presided.</p> + +<p>Four doctors were proposed for membership: +Drs. W. H. Condit and Stephen Baxter, of Minneapolis, +and Drs. Wilhelm Lerche and F. C. +Schuldt, of St. Paul. All four names were referred +to the executive committee.</p> + +<p>Dr. Arnold Schwyzer showed some x-ray pictures +of a penetrating gastric ulcer. He also +made a report of a case where gall-stones gave a +feeling of emphysematous crackling, due to small +marble-sized stones with no more fluid than +enough to fill the spaces between the stones (perhaps +a teaspoonful in all).</p> + +<p>The paper of the evening was presented by +Dr. A. E. Benjamin, the subject being “Goiter +Operations with Simplified Technic.” The paper +<span class="pagenum" id="Page_129">[Pg 129]</span> +was thoroughly discussed, the whole evening +being given over to its consideration.</p> + +<p>The reading of Dr. White’s thesis was deferred +until another meeting.</p> + +<p>Twenty-seven were present.</p> + +<p class="right"> +<span class="smcap">Fred E. Leavitt, M. D.</span>, Secretary.<br /> +</p> + +<hr class="chap x-ebookmaker-drop" /> + +<div class="chapter"> +<div class="bbox"> +<h2 class="nobreak" id="CORRESPONDENCE">CORRESPONDENCE</h2> +</div> +</div> + +<p> +<span class="smcap">To the Editor</span>:<br /> +</p> + +<p>In the February 15th issue of <span class="smcap">The Journal-Lancet</span> +is a discussion by Dr. Klaveness, of +Sioux Falls, S. D., on a paper on “Syphilis and +Its Relation to Society” by Dr. McLaughlin, of +Sioux City, Iowa. In this discussion Dr. Klaveness +states: “We are unfortunate here in South +Dakota in this respect, that we do not have the +population and the laboratory facilities for resorting +to the Wassermann reaction at all times, +and any man within the State who would systematically +carry out a Wassermann reaction +now and then would invalidate his findings very +materially, inasmuch as it is very well established +that, in order to obtain reliable readings, you +must have a serologist or bacteriologist to follow +this work exclusively in order to get accurate +findings. It is immensely important, and it +would be a boon to the suffering people, if we +could have a state serologist.”</p> + +<p>This statement by Dr. Klaveness is contrary to +the facts as they now exist and did exist at the +time he discussed the paper at Watertown, S. D., +in May, 1914.</p> + +<p>We have a well equipped medical laboratory in +South Dakota in connection with the medical department +at the State University at Vermillion, +and we have been doing the Wassermann test.</p> + +<p>This misstatement should have been corrected +at the time it was made, but was not, as I was in +Watertown but part of one day during the State +Meeting last May and did not hear the paper or +its discussion.</p> + +<p>Permit me to state through your columns that +we do the Wassermann test at the State Health +Laboratory and have been doing it on Thursday +of each week since March 21, 1914. At that +time a circular letter announcing the fact was +sent to every physician in the State, including +Dr. Klaveness. This announcement was made +only after several months of experimental work +in perfecting the technic and controlling all factors.</p> + +<p>We do the original Wassermann test, using +the Nogouchi antigen. All our reagents are prepared +in our laboratory and every possible control +is carried out each time the test is set up. +We therefore believe that our results will compare +favorably with the best scientific work of +this character.</p> + +<p>At the present time a fee of $5.00 for each +test is charged, containers and instructions are +supplied upon request.</p> + +<p>We have done the Wassermann test for the +State Hospital for the Insane at Yankton from +the first.</p> + +<p class="right"> +<span class="smcap">Mortimer Herzberg, M. D.</span>, Director.</p> +<p>Vermillion, S. D., February 18, 1915.<br /> +</p> + +<hr class="tb" /> + +<h3>THE LOYALTY OF NURSES</h3> + +<p> +<span class="smcap">To the Editor:</span> +</p> + +<p>My attention has just been called to an article +published in <span class="smcap">The Journal-Lancet</span>, August 1, +1914, it being an address by Dr. George D. Head +to the graduating class of the Asbury Hospital. +The advice Dr. Head gives to the nurses seems +very good, and very elevating to our profession, +but I would like to analyze it to show that it is +not quite practical.</p> + +<p>It has taken considerable effort on the part of +nurses to convince the people, and to convince +some doctors, that they are any more than machines. +Because we ask for three hours rest out +of the twenty-four, and because we asked for a +fixed rate for service, Dr. Head says that our +loyalty to high ideals is diminishing. Unfortunately, +in the nursing profession, as in all other +professions, there are some who are incapable +and unconscientious; and, if Dr. Head had the +experience of having a nurse leave a patient, unattended, +at a critical time, she probably was one +of the few incapables, or was so overtired from +loss of sleep that it was necessary for her to have +rest. When Dr. Head says that a nurse should +waive her rest hours for days or a week at a +time, if necessary, I think he is making a mistake. +A nurse cannot do her duty by a patient if she +does not have proper rest. It is unfair to both +the patient and the nurse. Dr. Head may say +that most patients are not in need of constant +attention for more than a few days or a week, +and that a nurse can stand it for that length of +time without rest hours. This is true; but we +have to consider that the next case may be just +as critical, and so the nurse must reserve some +strength for the cases to follow. And more +often than not, the nurse is obliged to take cases +with very little or no rest between them.</p> + +<p><span class="pagenum" id="Page_130">[Pg 130]</span></p> + +<p>In the second place, Dr. Head thinks that the +nurses ought to have a varying scale of charges +for service. The doctors do it; why shouldn’t +the nurses? Dr. Head does not seem to consider +the fact that the nurse has one patient, while the +doctor has many. Suppose a nurse takes care of +a poor patient for five or ten dollars a week, +where is the rich patient who is willing to pay +forty or fifty dollars a week to make up the loss? +The nurses have found that twenty-five dollars +a week is the price that is necessary for them to +live on in order to keep themselves clothed, pay +for their laundry (no small item), and carry them +over the few weeks of rest or over the dull season. +The average life of a nurse, as a nurse, is, +I believe, not more than ten years. In that length +of time, at the wages she gets, she is not able to +lay away a great amount for a rainy day, which +usually comes all too soon.</p> + +<p>We have a number of good hospitals in Minneapolis +where people in moderate circumstances +can be very comfortably cared for at a considerably +less expense than employing a nurse in +their homes. The poor in our city, I think, are +fairly well taken care of in the city hospitals and +by the visiting nurses, who are paid for such +work.</p> + +<p>As for nurses refusing cases because they are +afraid of them: I think there is usually some +just cause. If a nurse has a tendency towards +tuberculosis, she should refuse such cases; or +if she has a tendency towards throat troubles, she +should refuse diphtheria and scarlet-fever cases. +A nurse who is constantly with a patient runs +considerably more risk of infection than the physician, +whose visits are usually short. There are +nurses who make a specialty of such cases, and +usually there is no trouble finding such a nurse. +Nurses who make a specialty of obstetrical cases +or of children should not take contagious work. +As for a nurse refusing a typhoid case because +she is afraid of it: I cannot believe that any +real nurse would do such a thing.</p> + +<p>It also seems to me very ridiculous, and it +surely cannot be a common thing for a nurse to +inquire before she consents to take a case whether +or not the plumbing is modern and how many +servants are kept.</p> + +<p>As to just what Dr. Head means by saying +that a nurse should be willing to do any kind +of service about a house. I do not know; but I +do know that nurses are not usually physically +fit for washing or scrubbing, yet, as a rule, nurses +are glad to perform duties which are not just in +their line, in order to help the household to run +smoothly.</p> + +<p>Most of the nurses in general work are engaged +in nursing because they are obliged to +earn their living, and in most cases because they +are especially interested in this particular field; +and, although most nurses take some charity +cases, it is impossible for them to take many, +even to satisfy what Dr. Head calls “the inner, +higher longings of the soul.”</p> + +<p class="right"> +<span class="smcap">Harriet M. Prime, R. N.</span><br /> +</p> + +<p>Minneapolis, February 4, 1915.</p> + +<hr class="chap x-ebookmaker-drop" /> + +<div class="chapter"> +<div class="bbox"> +<h2 class="nobreak" id="BOOK_NOTICES">BOOK NOTICES</h2> +</div> +</div> + +<p class="hanging2"><span class="smcap">Manual of Obstetrics.</span> By Edward P. Davis, A. M., +M. D., Professor of Obstetrics in the Jefferson Medical +College, Philadelphia. 12mo of 463 pages, 171 illustrations. +Philadelphia and London: W. B. Saunders +Company, 1914. Cloth, $2.25 net.</p> + +<p>As indicated by the name this is a handy book. It is +well illustrated, the text is brief and well written, and +as complete as could be expected in a work of its size.</p> + +<p>It presents no features which are especially new, +though it takes up many of the most recent advances in +obstetrics.</p> + +<p>It is a work that aims to give those who wish it a +concise account of the status of obstetrics at the present +time.</p> + +<p class="right"> +—<span class="smcap">Adair.</span><br /> +</p> + +<p class="hanging2"><span class="smcap">Balneo-Gymnastic Treatment of Chronic Diseases +of the Heart.</span> By Prof. Dr. Theodor Schott, Bad-Nauheim. +Published by Blakiston, Philadelphia. +Price, $2.50.</p> + +<p>This brochure sets forth in the main, preceded by a +short chapter on medical treatment, the philosophy, +technic, and clinical results of balneogymnastic therapy +in chronic heart-conditions.</p> + +<p>It would appear, inasmuch as Prof. Schott admits the +non-establishment of the probable curative factors of +either the carbon dioxide or mineral constituents, that +possibly, as Dr. Anders in the foreword surmises, the +curative properties may reside in the “advantage of being +far removed from the cares and responsibilities growing +out of the practical affairs of life at home.”</p> + +<p>Relative to the more firmly established value of the +gymnastic element, it is quite evident that the “resistance +movements,” are an improvement over the Zander +mechanico-gymnastic, and of similar value to the so-called +“Terrain Kur,” with the added advantage of personal +application.</p> + +<p class="right"> +—<span class="smcap">Schneider.</span><br /> +</p> + +<p class="hanging2"><span class="smcap">Diseases of Bones and Joints.</span> By Leonard W. Ely. +M. D., 220 pages, 94 illustrations. Surgery Publishing +Co., N. Y. Price, cloth. $2.00.</p> + +<p>Few men are better fitted than Dr. Ely to write an +authoritative book on joint and bone diseases. He has +gone at his study from the only logical end; that is, +the study of the underlying pathology. The book +<span class="pagenum" id="Page_131">[Pg 131]</span> +throughout shows the result of much conscientious work +in the pathological and x-ray laboratories, carefully +checked up from the clinical aspect.</p> + +<p>The average specialist who writes a manual for the +use of the general practitioner seems to think he must +mention every theory which has ever been brought out +since the time of Hippocrates, together with a list of +every form of treatment ever proposed. The bewildered +family doctor gets about as much help as he would from +the perusal of a few pages of the Index Medicus. One +good theory, clearly stated, even if it is not universally +accepted, may form a practical working basis which will +be of great aid to the doctor in the understanding and +care of his cases. In this particular Dr. Ely is most +satisfactory. He has worked out the pathology of the +tubercular and other chronic joint diseases in a clear and +logical manner. While much may have to be altered +in the light of further research, at least one can feel +sure that Dr. Ely has convictions, and that his work +will form a useful basis for further investigations.</p> + +<p>The illustrations are taken almost entirely from photographs +or photomicrographs and are mostly original. So +many works on Orthopedic Surgery appear which are +filled with cuts handed down from one text-book to +another, cuts of impossible people wearing impossible +appliances, that it is hard to imagine that such a book, +illustrated with such quaint old prints, can represent the +latest word or offer anything new.</p> + +<p>Dr. Ely’s discussion of the pathology of joint tuberculosis +is perhaps the most interesting thing in the book. +His idea of the red bone marrow and the synovia being +the sole tissues to be primarily involved does not agree +with the recent work of Fraser, of Edinburgh. Evidently +more work must be done in order to harmonize +these findings.</p> + +<p>In general, while not much space is given to treatment, +what there is, is clear and is carefully selected by +the author, instead of leaving this important point to the +discretion of the reader.</p> + +<p>His discussion of the chronic arthritides is quite full +and very instructive. He points out particularly the resemblance +between the pathological conditions found in +various chronic infectious joints and in the various +stages of joint tuberculosis.</p> + +<p>This little book will certainly be of use to anyone who +has to treat bone and joint diseases.</p> + +<p> +—<span class="smcap">Reed.</span><br /> +</p> + +<hr class="chap x-ebookmaker-drop" /> + +<div class="chapter"> +<div class="bbox"> + <h2 class="nobreak" id="NEWS_ITEMS">NEWS ITEMS</h2> + </div> + </div> + +<p>Dr. Chas. Pierce, of Wadena, has moved +to Menahaga.</p> + +<p>Dr. J. L. Stewart, of Spearfish, S. D., has +located at Custer, S. D.</p> + +<p>Dr. Jas. Farrage, formerly of Deering, N. D., +has located at Park Rapids.</p> + +<p>Dr. Hugo Neukamp is leaving Fessenden, +N. D., to locate in Beulah, N. D.</p> + +<p>The Dell Rapids Hospital was completed and +opened the latter part of February.</p> + +<p>Dr. H. A. Gueffroy, of Chicago, has taken over +the practice of Dr. D. F. Sullivan, of Frankfort, +S. D.</p> + +<p>The new St. Alexius hospital, at Bismarck, +N. D., was formally opened to the public February +15th.</p> + +<p>The entire surplus of the old Homeopathic +Hospital Association, amounting to $1,000, was +voted to the support of the Maternity hospital, +of Minneapolis, at a recent meeting.</p> + +<p>The Physicians’ Hospital company has been +incorporated at Thief River Falls for the purpose +of building and maintaining a hospital at that +place. The company is capitalized at $25,000.</p> + +<p>In a previous issue we stated that Dr. G. P. +Shepard, of Chicago, had located at Jamestown, +N. D. Dr. Shepard is from Courtenay, N. D., +and not from Chicago, though he has been taking +postgraduate work in that city for the past +few weeks.</p> + +<p>The Medical Society of the State of New York +invites all physicians of the country to its hundred +and ninth annual meeting which is to be +held in Buffalo, April 27-29. This will probably +be the largest medical meeting of the year, except +perhaps that of the A. M. A. in San Francisco.</p> + +<p>Messrs. J. D. Edgar, Arnold Hamel, R. A. +Johnson, and H. A. Rudd, and Miss Olga Hansen, +all of the class of 1915, have been elected to +the Minnesota chapter of Alpha Omega Alpha, +the national honorary fraternity in medicine, the +membership of which is based solely upon +scholarship.</p> + +<p>Dr. James E. Moore, who has practised in +Minneapolis for thirty-two years, twenty-eight of +which have been devoted to the exclusive practice +of surgery, has given up his practice and will, +hereafter, give his entire time to the Medical +School of the University of Minnesota, except +for a limited amount of consultation work.</p> + +<p>In our last issue we made the statement that +the Ramsey County Medical Society would not +admit a physician to membership until he had +been a resident of the county for one year. This +should have been written so as to convey the +meaning that a physician must have been a resident +of some county for at least a year, not necessarily +Ramsey County.</p> + +<p>It is the desire of the publishers of the Journal-Lancet +to make this department of news as interesting +to its readers as possible. The items are +obtained from a number of sources, and, though +<span class="pagenum" id="Page_132">[Pg 132]</span> +a great deal of care is given to their preparation, +mistakes will necessarily occur. Will you not +help to keep up the interest of this column by +sending in anything which may be of interest to +the readers? Notify us of mistakes as they occur +that we may make a correction in the next issue.</p> + +<p>“The Mayo Foundation for Medical Education +and Research, Incorporated,” with an initial +endowment fund of $1,500,000, has recently been +incorporated. It has for its object the endowment +of the graduate medical instruction and research +work which has for years been a feature +of the Mayo Clinic, at Rochester. The founders +are: William J. Mayo, Charles H. Mayo, Henry +S. Plummer, Edward Starr Judd and Donald C. +Balfour. The board of temporary trustees having +in charge for the present the investment of +the fund is composed of Bert W. Eaton, George +W. Granger and Harry J. Harwick. The board +of scientific directors is composed of Louis B. +Wilson, William F. Braasch, E. Hessel Beckman, +A. H. Sanford, and Walter D. Sheldon. +For the present the expenses of the foundation +will be met by annual contributions from the +Mayo Clinic, the income from the endowment +being allowed to accumulate and increase the +principal.</p> + +<p class="center">PHYSICIAN WANTED</p> + +<p>To locate in a thriving North Dakota town. For full +information correspond with Andrew Erickson, Makote, +N. D.</p> + +<p class="center">OFFICE FURNITURE FOR SALE</p> + +<p>A good roll-top desk and other office furniture is +offered for sale at a reasonable price. 616 Syndicate +Bldg., Minneapolis.</p> + +<p class="center">PRACTICE FOR SALE</p> + +<p>An established practice in a town of 2,000 for sale +for the price of the office outfit. If you mean business, +write at once. Address 205, care of this office.</p> + +<p class="center">SANITARIUM FOR SALE</p> + +<p>A new, strictly modern, 50-bed sanitarium with three +acres of land on a beautiful lake, located near the Twin +Cities, for sale cheap. Address 206, care of this office.</p> + +<p class="center">WANTED</p> + +<p>An eye, ear, nose, and throat man who is willing to +work. Must be sober, competent man. State the salary +expected, and give credentials in the first letter. Address +the C. A. Hoffman Co., 814 Nicollet Ave., Minneapolis, +Minn.</p> + +<p class="center">PRACTICE WANTED</p> + +<p>In Minnesota or South Dakota town, with some future +and where English is spoken. This is wanted by physician +who has had several years’ experience in practice, +and has done laboratory and hospital work. Address +198, care of this office.</p> + +<p class="center">WANTED</p> + +<p>A physician and surgeon to locate at Judson, North +Dakota. No doctor located within seven miles on the +west and twenty-three miles or more in other directions. +One who could start small drug-store in connection +with his practice preferred. Address First State Bank, +Judson, N. D.</p> + +<p class="center">WANTED TO EXCHANGE</p> + +<p>Contract mining practice, on Iron Range, with modern +hospital, complete equipment, autos, good roads, drive +all the year, best contracts, $600 to $800 cash each +month; future very bright. Owner wishes to correspond +with an A 1 physician and surgeon with a good +stand in or very near the Twin Cities, with the view of +effecting an exchange for part of the year. Address, +204, care of this office.</p> + +<p class="center">FOR SALE</p> + +<p>To a man with surgical ability, one-half interest in +my private practice and well-equipped hospital, located +in a live up-to-date county-seat town in Minnesota; +population 2,500; two railroads; good schools and roads; +good fees. This is an excellent opportunity to get into +a place with a good future. Price, $5,000 for one-half +interest in hospital building, equipment, office fixtures, +and practice; $2,500 cash. Don’t write unless you mean +business and have the cash. Address 202 care of this +office.</p> + +<hr class="tb" /> + +<p>Doctor: If you want practical post-graduate work +during the fine season in the delightful city, write for +particulars. Twenty-eighth annual session opens September +28, 1914, and closes June 5, 1915. New Orleans +Polyclinic, P. O. Drawer 261, Post-graduate Medical +Dept., Tulane University of Louisiana.</p> + +<hr class="chap x-ebookmaker-drop" /> + +<div class="chapter"> +<p><span class="pagenum" id="Page_133">[Pg 133]</span></p> + +<div class="figcenter illowp100" id="i-battle-creek" style="max-width: 28em;"> + <img class="w100" src="images/i-battle-creek.png" alt="Text of advertisement transcribed below." /> +</div> +</div> + +<div class="chapter"> +<h2 class="nobreak">The Battle Creek Method in Diabetes</h2> +</div> + +<p>Diabetes, though not always curable, is controllable. Practically +all diabetics can be made sugar-free and the acidosis disappears +with the sugar. By a special regimen the reappearance of the +sugar and the acidosis may be prevented.</p> + +<p>The Battle Creek method is based upon experience gained in the treatment of many +hundreds of cases supplemented by the observations and discoveries of Von Noorden, +Falta, Guelpa, Benedict, Allen, and numerous other investigators. The essential +features of the method are—</p> + +<p>1. A thorough preliminary examination and repeated examinations comprising (a) +complete quantitative examination of the urine daily, (b) differential study of the blood, +(c) chemical, microscopic and bacteriological examination of the feces and study of the +pancreatic function, (d) X-ray examination of the stomach and intestine with special +reference to stasis.</p> + +<p>2. Study of the patient’s metabolism by the respiration apparatus to determine his +respiratory quotient, CO<sub>2</sub> tension and basal ratio.</p> + +<p>3. Establishment, by the aid of metabolism studies of each case, of a regimen adapted +to the individual by determining the proper proportion of protein, fats and carbohydrates +to keep the urine free from sugar. The kind of protein, fat and carbohydrate +is considered important, as well as the amount.</p> + +<p>4. The patient’s metabolism is regulated by baths, voluntary and automatic exercise, +photo- and thermotherapy and other physiologic means.</p> + +<p>5. The results of the regimen and treatment are accurately controlled by a “Metabolism +Graphic” which shows the daily variations in the amount of urine, amount of sugar, +acidosis, coefficient of sugar utilization, coefficient of carbohydrate utilization, nitrogen +balance, glucose nitrogen ratio, weight balance and energy balance. These factors +are all worked out by expert chemists and dietitians and with this data before +him, and a great variety of special foods of known energy value suited +to diabetics at ready command, and the assistance of a strong corps of +specially trained dietitians, the physician is able easily to arrange a dietary adapted +to each case and to note each patient’s progress with the most careful scrutiny.</p> + +<p>Under this comprehensive management the sugar usually disappears from the +urine in two or three days, and does not return so long as the prescribed +regimen is followed.</p> + +<p>A few weeks’ treatment usually suffices to train the patient to a suitable +dietary which he may safely follow under the guidance of his home +physician.</p> + +<p>We will be glad to send full information concerning the Battle +Creek Method in Diabetes to any physician who will mail +to us the attached coupon.</p> + +<hr class="dotted" /> + +<p>The Battle Creek Sanitarium, Battle Creek, Mich.</p> + +<p> +Box 350<br /> +The SANITARIUM,<br /> +Battle Creek,<br /> +Michigan<br /> +</p> + +<p>Please send to the undersigned +full information concerning +the Battle Creek method +of treating diabetes.</p> + +<p>Dr..............................</p> + +<p>Street..........................</p> + +<p>City............................</p> + +<p>State...........................</p> + +<hr class="chap x-ebookmaker-drop" /> + +<div class="chapter"> +<p><span class="pagenum" id="Page_134">[Pg 134]</span></p> +<div class="bbox"> +<h2 class="nobreak" id="PUBLISHERS_DEPARTMENT">PUBLISHER’S DEPARTMENT</h2> +</div> +</div> + +<h3>QUAKER OATS</h3> + +<p>Doctors all over the country are advising the use of +oat foods for the old as well as the very young child. +It is for young folks developing, for grown-ups, who are +hard workers, and for the old folks who wish to keep +young. You can safely use Quaker Oats. It costs no +extra price, and when you use it you are certainly getting +the very best in oat foods. Physicians should read +their page announcement in this paper.</p> + +<h3>ELECTRO-THERAPY</h3> + +<p>The Scheidel-Western X-Ray Coil Co. announce on +another page that they have the latest appliance in +electro-therapeutics, namely, the Columbia Treatment +Transformer No. 9.</p> + +<p>The apparatus is illustrated and described on another +page, and more fully in the Company’s new catalog.</p> + +<p>As the Company is the largest manufacturer of x-ray +apparatus in the world, their catalog should be in +the hands of every man using this line of treatment.</p> + +<h3>BOREMETINE—A NEW EMETINE PREPARATION +FOR PYORRHEA</h3> + +<p>Every doctor and dentist in the United States should +know about this new preparation for the local treatment +of pyorrhea alveolaris. Boremetine is a 1-2 per +cent solution of emetine hydrochloride, together with +boric acid, zinc sulphocarbolate, and aromatics.</p> + +<p>The emetine is amebicidal, the boric acid bactericidal, +and the zinc sulphocarbolate astringent. These three +drugs meet the three essential factors necessary for the +successful treatment of pyorrhea. Boremetine should +be used in every case, either alone, or (in some severe +cases) in association with the subcutaneous injection of +Emetine Hydrochloride (Abbott).</p> + +<p>A special free booklet on “Pyorrhea Alveolaris: How +to treat it successfully with Emetine” will be sent on +request. Send for it today. The Abbott Alkaloidal +Company, Chicago.</p> + +<h3>OCONOMOWOC HEALTH RESORT</h3> + +<p>The State of Wisconsin has an enviable reputation for +not a few things in which it excels all the other western +or middle-western states. One of these is its sanatoriums, +or health resorts. The climate, the beautiful +scenery, the pure water, the proximity to the large cities +of Milwaukee and Chicago, and the high-grade medical +specialists made it possible to found such institutions +in southern Wisconsin long before other parts of the +middle west had the population or transportation facilities +to make success in this line either probable or possible.</p> + +<p>The Oconomowoc Health Resort is one of the best +equipped and best managed of these institutions. It +accepts only nervous and mild mental cases. It is under +the management of Dr. Arthur W. Rogers as resident +physician. Dr. Rogers has both the professional equipment +and the personality that are necessary in the treatment +and care of persons suffering from nervous and +mental disorders.</p> + +<h3>BATTLE CREEK SANITARIUM</h3> + +<p>Fifty years ago examination was largely a matter of +pulse finding; now it is possible to weigh and measure +the organic functions of the body with as much accuracy +as is possible in the testing of an intricate mechanism. +This becomes possible through a series of tests in many +of which elaborate equipment is required. Perhaps no +other institution has a more complete organization for +diagnosis than the Battle Creek Sanitarium.</p> + +<p>The physical inventory possible there is a very thorough +and accurate stock taking of the vital functions. +Many business and professional men visit the sanitarium +each year in order to take full advantage of the diagnostic +facilities.</p> + +<p>An interesting booklet, “The Measure of a Man,” is +offered free by the sanitarium to those who care to know +more regarding the system of examination.</p> + +<h3>ARMOUR & COMPANY</h3> + +<p>Why Pituitary Liquid should be specified:</p> + +<p>It is a pure preparation.</p> + +<p>It is free from objectionable chemicals.</p> + +<p>It is made from absolutely fresh raw glands. It does +not require preservatives.</p> + +<p>It is standardized physiologically.</p> + +<p>It is sold in dated packages, permitting the physician +to discard old goods.</p> + +<p>Pituitary Liquid is required in such particular classes +of cases that the practitioner can afford to use the best +only.</p> + +<p>The use of Pituitary Liquid obviates the necessity of +forceps in a great many cases.</p> + +<p>Pituitary Liquid is of great service in parturition +uterine inertia—peristalic paralysis.</p> + +<p>We shall be pleased to send you a sample of Pituitary +Liquid with literature.</p> + +<p>Note the name of the perfect pituitary preparation—<i>Pituitary +Liquid (Armour)</i>.</p> + +<h3>THE DELICATE SCHOOL GIRL</h3> + +<p>Even the most robust and generally healthy children +show the deleterious results of the modern system of +educational “forcing” that prevails in most of our larger +cities. The child that starts the school year in excellent +physical condition, after the freedom and fresh air +of the summer vacation, in many instances, becomes +nervous, fidgety, and more or less anemic, as the term +progresses, as the combined result of mental strain and +physical confinement in overheated, poorly ventilated +school-rooms. How much more likely is such a result +in the case of the delicate, high-strung, sensitively +organized, adolescent girl? It is certainly a great mistake +to allow such a girl to continue under high mental +pressure, at the expense of her physical health and well-being, +and every available means should be resorted to +to conserve the vitality and prevent a nervous breakdown. +Regularity of meals, plenty of sleep, out-of-door +exercise without fatigue, open windows at night and +plenty of nutritious food, should all be supplied. Just +as soon as an anemic pallor is noticeable, it is a good +plan to order Pepto-Mangan (Gude) for a week or two, +or as long as necessary to bring about an improvement +in the blood state, and a restoration of color to the +skin and visible mucous membranes. This efficient +hematinic is especially serviceable in such cases, because +it does not in the least interfere with the digestion nor +induce a constipated habit.</p> + +<hr class="chap x-ebookmaker-drop" /> + +<div class="chapter"> +<div class="transnote"> +<p>Transcriber’s Notes:</p> +<p>A number of typographical errors have been corrected silently.</p> +<p>The cover image was created by the transcriber and is placed in the public +domain.</p> +<p>References to other pages noted in the Publisher's Department section +were not available for transcription</p> + +<p>The two lines below were swapped from the original:<br /> + by a chronic hypertrophic conjunctivitis. The<br /> + canthotomy necessary; and no case was followed<br /> + </p> +</div> +</div> + +<div>*** END OF THE PROJECT GUTENBERG EBOOK 65823 ***</div> +</body> +</html> |