Page images
PDF
EPUB
[merged small][merged small][graphic]

FIG. 4.

Radiogram showing condition of humerus, groove in soft parts near the upper

end of the humerus and the shadows of three needles in the forearm.

the result of infection from some of her numerous wounds. At the time of the operation a lymph node was excised from the axillary region and was reported "mixed cell sarcoma," a diagnosis which Dr. Haines looked upon askance. The patient made an uneventful recovery and her general health has remained good ever since. On examining her, however, I found several large cicatrices on the left half of her trunk, two in the left mammary region, one in the posterior axillary line and in addition a large ulcerated granulating surface in the left upper abdomen. (See Fig. 3). This wound had a peculiar gelatinous appearance and made upon me the impression that some irritating substance had been frequently applied. In my conversation with Dr. Haines he mentioned that the radiograph of the arm had disclosed the presence of three shadows in the forearm which indicated apparently pieces of needle, the eye being near the point, evidently sewing machine needles, and our conclusion was that the patient must have inserted. these herself. In this radiogram (see Fig. 4) the groove in the soft tissues near the upper part of the limb can clearly be made out and I doubt not that the patient had again resorted to the rubber adhesive strip before presenting herself at the Harlem Hospital. The osteomyelitis of the humerus had been diagnosticated by the X

ray.

This form of self injury is fortunately uncommon. The writer has met with but one previous case in which an amputation resulted. This was in a girl about 18 years of age, who was a patient in the surgical ward of Mt. Sinai Hospital, service of Dr. A. G. Gerster, when I was on the House Staff in 1888. She persistently infected the skin over the left knee cap

producing a painful ulcer, and she would put her fingers under the dressings and rub pieces of hardened plaster of Paris into the part. Yet she shrieked with pain at each dressing. Finally, under a plaster of Paris bandage of the entire limb so applied that she could not disarrange it the wounds healed and the patient went home. She later returned with the story that she had accidently broken a needle off in her knee and Dr. Gerster explored the joint; it was before the days of Roentgen's discovery. The patient managed to infect this wound and eventually she lost the extremity, above the knee, the amputation being done by Dr. Gerster. Still she was not satisfied and reentered the hospital with a badly infected stump for which I did a reamputation in the midthigh. Later still she went to another hospital where a hip disarticulation was performed and she then appeared satisfied. I followed the case for a few years after the last operation and then lost sight of the patient.

The writer believes that cases of this sort when clearly diagnosed are not suitable for general hospital treatment. Such patients should be committed for care in institutions for the treatment of mental disorders.

Thyroid Disease and Septic Tonsils.Thyroid disturbances, including typical Basedow's disease, are associated with septic tonsils so often, says Wm. S. Tomlin in the Indianapolis Medical Journal, and show in some cases such marked improvetonsillectomy and adenectomy that the relament in all the symptomatic conditions after tion of cause and effect is proved as more than a suspicion. And persistent thymus with status lymphaticus has been demonstrated in so many instances as associated with the need of tonsillectomy that coincidence does not satisfactorily explain it.

BY

SANATORIA FOR CONSUMPTIVES. it he recognizes the direct, primary cause of the transmission of the disease. Koch's judgment in this matter has been widely disseminated and almost universally accepted. Like all great truths, however, there are facts which controvert its too ab

BEVERLEY ROBINSON, M. D.,

New York City.

No problem before the medical profession, today, is of greater interest than that of the proper disposal of our consumptive patients. There are many reasons for this. First, and above all, is the undeniable fact that consumption, or phthisis pulmonalis, is the direst cause of death of a larger proportion of the human race in almost all countries and climates, as compared with acute contagious or infectious diseases, like smallpox, scarlatina, measles, typhoid fever, diphtheria, etc.-it destroys far more human beings than all these in their aggregate.

Again, it is a disease which incapacitates those affected for a much longer period, with respect to their ability of selfsupport. It becomes, therefore, a constant menace to the health of those who are inevitably brought into contact with persons who are thus attacked. Besides, it is well known that by judicious preventive measures the danger of individuals affected with tuberculosis to the well may be greatly diminished. It is only right, therefore, that proper government of the diseased patients should be instituted so as to protect the community in which they live. This becomes a more evident obligation as it is also recognized we are thus directly useful to those who are diseased.

It has been appreciated for a long while by well-informed medical men that there was a contagious element in phthisical patients. In what this existed precisely, was not known, until Koch made his famous discovery of the bacillus tuberculosis. In

solute acceptance, and even admitting its immense value and possibly literal truth, we must still recognize modifying conditions which limit its universal acceptance, unless we emphasize these in very strong terms. Admitting that without the bacillus there is no tuberculosis, yet even with the bacillus we must have the soil ready or prepared for its growth, development and all the evil consequences of its presence. In a healthy individual it is more than probable that the bacillus tuberculosis will be innocuous; it meets here with a barren soil, takes no root, breeds no disease. Susceptibility, hereditary or acquired, must exist, or the attack of the microbe remains without effect-literally, does little or no harm to the well.

Now, what should be our preventive measures to carry out those which protect the few, the very few, by isolation and separation from their fellows? Or rather the much broader, more humane standpoint, institute such regulations as will benefit the race and cure the consumptives themselves as far as can reasonably be done?

Take the poor in our large cities and towns; are they not the ones most frequently affected, and for whose welfare we should be most concerned, since they are in much larger number? Let our legislatures, then, see to it that in the tenements the air supply is sufficient and good, let sunlight penetrate dark, ill-smelling rooms, let let cleanliness be be obligatory. Enforce proper oversight of food and water supply,

and soon, very soon, tuberculosis will intelligence and leads to sad departures from common sense and logical deduc

diminish very greatly.

Of course, tuberculosis patients should not be permitted to expectorate on sidewalks, or floors or carpets, either in their homes or in places of public resort, but neither should healthy people be permitted to indulge in an unseemly, barbarous habit of that sort. It is opposed to decency, it shocks the senses of all refined persons that is enough. Let it be interdicted on this ground, but not because contagion may be rife in every sputum that becomes dried and wafted in the air. It seems to me that the former idea makes an appeal to everyone who desires progress in refinement and civilization; the latter idea merely raises questions and antagonisms, and why? Because when thoroly sifted the proof is often lacking to make it absolutely demonstrable.

Now, then, should we build sanatorial thruout our land, equip them with every modern improvement, make a large outlay of private or public funds, only after a shorter or longer period of rest, nursing, medical care, to send back these same persons either cured, improved, stationary or worse, to conditions and surroundings which are the source and origin, in my judgment, far more of the widespread pest of humanity than the microbe whose inoffensiveness is demonstrable when the causes which breed it and make it important, cease to exist?

The microbic theory of disease is very well as a working basis for our sanitary corps, for our practitioners and even our surgeons, because everywhere it is recognized it makes purity thru cleanliness. But when we lose sight of other great and important facts of medicine-old, and older than our civilization, it dwarfs the

tions.

Let our laboratories do their work, let the microscope show us all it can, let chemical research go hand in hand with bacteriological culture; but never allow the practitioner with broad mind and lofty aims. seek the lower level, which may belong to others, but which never can and never will be his due birthright.

THE RELATION OF THE EPILEPTIC SYNDROME TO INTESTINAL TOXEMIA.

BY

HAROLD BARCLAY, M. D.,
New York City.

The relationship of epileptic or epileptiform convulsions to intestinal toxemia is necessarily a difficult subject, as the term epilepsy and epileptiform convulsion covers a wide field, and it does not seem as if epilepsy could be considered a specific clinical entity; for under this generic term are included many symptom groups, which differ widely in their pathology and origin.

Intestinal toxemia is a term equally vague and only partially understood, yet, as we know, there are recorded cases where one undoubtedly finds a connection between them; and in my own practice I have had several such specific cases.

In epilepsy the convulsion represents a cortical explosion, induced by some superimposed motor sensory or toxic irritation, in individuals who have already suffered a primary basic impairment of their germ plasm. There are many conditions which have been regarded as etiologic factors in

the production of epilepsy; yet on analysis we are sceptical, that any one of them can logically be regarded as capable of causing the so-called epileptic syndrome; for as Spratling puts it "They are only effective in co-existence with an irritable nervous organization, one predisposed to convulsive manifestations."

It would seem that heredity, syphilis, alcohol and tuberculosis play prominent parts in damage to germ plasm and predispose to a nervous organization.

This would not appear theoretical, but real as shown by signs of morphologic arrest and deviations from the normal; to witness, the size and shape of the skull, the high and narrow palate, the analamous dentation of the ears, the digits and the general development. These are surface indications of other and more fundamental changes present throughout the organism.

The complications arising from intestinal toxemia are extremely complex and by no means entirely understood, and it not infrequently happens with the control of constipation, many of the toxic symptoms of the patient entirely disappear; there is an improvement of nutrition; they lose the greyish discoloration of the skin, the neurasthenia clears up and there is a change in the blood picture. Toxemia must be conceded as capable of causing general constitutional symptoms often of an extreme degree.

Food traverses the small intestine, which is relatively sterile, just as readily in constipated subjects as in normal ones; but in the former the normal delay in the terminal ileum may be greatly increased and subjected to prolonged action of the rich flora of that region, thus favoring the production of the toxic intermediate bodies.

Altho our knowledge of the bacterio

chemistry of the caudal ileum and the large bowel are still in their infancy, nevertheless there is much evidence at hand to establish very conclusively that the prolonged bacterial action on the simple products of digestion may convert them. into bases of extreme toxicity.

Mutch has shown that the different strains of the coli bacilli initiate different chemical actions; altho they, in themselves are indistinguishable in form; while Mallenby and Twort were able to obtain cultures of the colon bacilli which were capable of changing histidin, one of the simple end products of digestion into Biminazo, a potent poison, and one which when injected in animals in small quantities, causes a marked fall in the blood pressure and symptoms of anaphylactic shock. Eyre examined the terminal ileum in sixteen constipated persons, and in only one case failed to cultivate pathogenic bacteria.

The colon bacilli have been regarded as the guardians of the bowel. Under normal conditions they inhibit the action of the anaerobes, generating substances which have a powerful anti-bacterial action, not only on alien groups, but on themselves.

The stools of normal individuals are much richer in colon bacili than those suffering from constipation; the cause of this is ascribed to the increased opportunities to create bactericidal substances, thus inhibiting their own growth.

Moreover we know that under normal conditions, many substances formed in the intestines are excreted by the organs of elimination, the liver, kidneys, bowels and the skin.

Thru damage of function of any of these organs, we may have a storing up of metabolic products, of the effects of which, with the exception of urea, uric acid and the

« PreviousContinue »