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to make it practically impossible for oysters at are preparing to invest $1,000,000 for the hosall subject to pollution to be taken and shipped. pitals and equipment to be used for the treatment All the oyster beds in the States mentioned have of cancer and other diseases. Two wealthy men been so charted that when certain beds are closed, are interested in the institute for philanthropic owing to pollution or other causes, it is easy to reasons, and five more will shortly be identified establish from these maps the definite area covered with the board of control. The board of manby these beds. In certain cases these restrictions agers includes prominent physicians. have compelled the transplanting of oysters for a The Weekly Bulletin of the Health Department time long enough to make them absolutely free

quotes from the summary of the Investigation from any danger of pollution, or have limited the

Concerning the Physiologic Aspects of the Liquor taking of oysters to the seasons when the beds are

Problem by Dr. John S. Billings, Jr., which was in absolutely clean condition. In this work all prepared for the Committee of Fifty, showing the States concerned have co-operated most ac- that the common idea that a large part of the tively and, what is regarded as of great impor- injury to health from the use of alcoholic drinks tance by the Federal authorities, the oyster men is caused by the injurious substances in the liquor, themselves are seeing to it that no oysters from such as fusel oil and furfurol, which have not the prohibited sources enter the local markets or been properly removed is erroneous as is also the are shipped inland.

notion that cheap liquors contain larger quantiA department entitled "Rational Organother- ties of such ingredients than others. The inapy” is being conducted by Dr. Henry R. Har- jurious effects of the fusel oil are trifling in comrower in American Medicine. It deals with the parison with those of the ethyl alcohol. The therapeutic uses of the various ductless glands. general conclusion is that fine old brandies and

Dr. C. W. Hunt, of Brevard, N. C., won a $250 whiskies are nearly as likely to produce ill effects prize offered by the Anheuser-Busch Brewing Co. as the cheaper varieties of the present time if for the most appropriate title to a picture sent to taken in the same quantities and the injurious many thousand doctors in all parts of the United effect is in proportion to the ethyl alcohol conStates last spring. The picture shows a cottage

tained. on a hill, lights ablaze in every room, with a The Rockefeller Foundation, in making public typical country doctor hurrying up a trail leading September 23d part one of its annual report, to the house, the moonlight throwing his shadow covering the period to the end of 1914, tells what upon the ground. The old doctor dressed in

has been accomplished by its International Health old-time garb, walking up the path with long Commission in mitigating the ravages of the hookstrides, his medical satchel in his left hand, his worm disease in tropical countries. The report right hand under his chin holding his eyeglasses, says that the relief and control of the disease is an his right elbow bent and extended, pointing from undertaking of enormous magnitude, as the inhis elbow is an old-time umbrella, with the posi- fection belts the globe in a zone on both sides tion of his body bent so as to form the shadow of the equator, 66 degrees wide and with a popuof a stork on the ground in the moonlight with lation of about 900,000,000 souls. Thus far plans bill extended toward the cottage on the hill. The have been adopted and work begun for the contitle to the picture was to be suggested by the trol of the disease in British Guiana, Antigua, doctors, the best suggestion to be selected by Trinidad, St. Lucia, Grenada and Egypt. In ada committee of eminent men. Dr. Hunt's sug

dition to the work undertaken in the British gestion was “On the Honeymoon Trail,” and out colonies, the commission has responded favorably of more than twelve thousand suggested titles to invitations from several Central American this was selected as the best, and accordingly he countries and work has been inaugurated in Panhas received a check for $250 in good and lawful ama, Nicaragua, Costa Rica and Guatemala, The money.

report shows that the percentage of population inThe first annual meeting of the National Com- fected is large in many countries. It shows that mittee for the Prevention of Blindness will be the southern two-thirds of the Chinese empire is held in the assembly room of the Russell Sage involved, the infection in many parts of the Foundation Building, corner of East 22d Street Yangtse Valley running as high as 70 to 76% and Lexington Avenue, New York City, at 4.30 among the farming population. The report makes P. m., November 4th. Ex-President William H. it clear that the International Health Commission Taft will be present and will speak, and Dr.

has not undertaken to eradicate the disease in any George E. de Schweinitz, of Philadelphia, will country. The accomplishment of this result, it make an address.

is stated, will require the operation of permanent The $600,000 George F. Geisinger Hospital, a

agencies, working over long periods, and this memorial from his widow to her townsmen of

should be the work of the governments interDanville, Pa., was opened September 19th, in

ested, time for a typhoid epidemic there.

The Second New England Tuberculosis ConThe National Red Cross has directed the re

ference was held October 22d-23d in Springfield

and Westfield, Mass. turn to the United States, not later than October 1st, of all Red Cross units except those in Bel

The $1,000,000 buildings of the University of gium and Serbia. The typhus section returned

Pennsylvania dental department, Philadelphia, from Serbia early in October, having fulfilled its

were opened in September for the current session. mission there.

A half million dollar fund for the new buildings Contracts signed at New York, October 5th,

of the Children's Hospital, Philadelphia, is now for the purchase of $120,000 worth of radium, being raised. the largest amount ever sold in this country for The Special Relief Society, thru its executive medical purposes, mark the beginning of the committee, is endeavoring to arouse the women Radium Institute of New York, whose projectors of America to a full realization of the importance of immediate preparedness. The work which the ORIGINAL COMMUNICATIONS women can do consists in the offering of summer homes for emergency hospitals in the event of war, the preparation of kits for the regular and

Short articles of practical help to the profession are

solicited for this department. volunteer army, the making of garments needed

Articles to be accepted must be contributed to this jour. in the field, the making of an auxiliary kit, con- nal only. The editors are not responsible for views valescent kit, hospital kit, the provision of extra

exprest by contributors. camp comforts for the soldiers, the organiza

Copy must be received on or before the twelfth of the

month for publication in the issue for the next tion of sewing clubs, contribution of materials

month. We decline responsibility for the safety of and funds, the preparation of a list of volunteer unused manuscript. It can usually be returned if nurses. The membership of the society consists request and postage for return are received with of the following classes : sustaining members, an

manuscript; but we cannot agree to always do so.

Certainly it is excellent discipline for an author to feel nual members, contributing members and life

that he must say all he has to say in the fewest pos. members.

sible words, or his reader is sure to skip them; and As a means of physical development and pro

in the plainest possible words, or his reader will cer.

tainly misunderstand them. Generally, also, a down. moter of public health, Dr. Maurice M. Seymour,

right fact may be told in a plain way; and we want Commissioner of Public Health in Saskatchewan

downright facts at present more than anything else.

RUSKIN. and president of the Canadian Public Health As

READ REFLECT COMPARE RECORD sociation, strongly advocated universal military training for all young Canadians at the annual meeting of the association in Toronto, September

Blood Transfusion Apparatus. 3d and 4th. Dr. Seymour also spoke of the

EDITOR MEDICAL WORLD:-Methods for necessity of caring for prospective mothers. He outlined the new law in Saskatchewan which gives transfer of whole blood, defibrinated blood, every mother $25 and pays a doctor a fee of $15 and blood serum, by both direct and indirect for medical attention.

methods, have occupied the attention of Criminal suits against various self-called os- many surgeons and therapeutists since the teopathic operators in that section show that the New Jersey College of Osteopathy is now simply have been devised for the purpose.

time of Harvey; and many instruments a diploma mill.

Some of them are elaborate, expensive Dr. Robert N. Willson is continuing his Friday afternoon postgraduate lectures on the heart

and difficult to use. Scarcely any one of in the amphitheatre of the Philadelphia General them, however, which has been proposed Hospital from 5 to 6 p. m. He extends a cordial and gained even passing consideration and invitation to all physicians and medical students to be present. There are no fees and no obliga- and some of them have a number of points

use, but has its one or more good points, tions connected with attendance upon the course. The schedule is :

to recommend them. November: 5. Etiology and treatment of aortic The instrument devised by Dr. Bernard aneurism. 12. Etiology of heart disease, con- F. McGrath," is a very complete and clever genital and acquired. 19. Symptoms of primary and secondary heart disease. 26. The pulse and

device for blood transfusion, and I have the blood pressures in cardiac disease.

no doubt is a valuable adjunct in a wellDecember: 3. Heartblock and other arhythmias. equipped hospital with plenty of trained asTreatment. 10. Nervous and mental phenomena sistants. In the hands of an experienced of heart disease. 17. Etiology and treatment of angina pectoris

. 24. Diseases of the pericardium; operator with faultless technic and where etiology and treatment. 31. The micro-organismal time is not a factor it should work adminature of myocarditis ; its treatment.

rably, and I have no doubt does; and makes, January, 1916: 7. Myocardial degenerations and besides, a transfusion look like a major their treatment. 14. Hypertrophy and dilatation. Decompensation. Treatment. 21. Acute endo: operation. This may have an influence for carditis; etiology and treatment. 28. Subacute good in certain cases, but in many instances and malignant endocarditis.

is decidedly harmful. The employment of February: 4. Mitral insufficiency; etiology and Dr. McGrath's instrument necessitates the treatment. 11. Mitral stenosis; etiology and treatment. 18. Aortic valve disease; etiology and treat

permanent obliteration of an artery of the ment. 25. Congenital heart disease: tricuspid and

donor and a vein of the recipient both of pulmonary valve lesions.

which can be obviated by other methods, March: 3. Stokes-Adams' syndrome, paroxys- some of which do not even require an inmal tachycardia, hyperthyroidism. 10. The heart in pregnancy, the menses, the menopause. 17. The cision; and the avoidance of this latter is heart in tuberculosis; tuberculosis in heart dis- often of considerable importance and makes ease. 24. The heart in syphilis; syphilis in heart the operation less formidable to both donor disease. 31. The heart in the pneumonias, in- and recipient. fluenza and diphtheria. April: 7. The heart and exercise, athletic and

No anesthetic, local or general, is retherapeutic. 14. The non-medicinal treatment of quired, no pain experienced (both of which heart disease. 21. When to use drugs in heart have to be given due consideration in many disease, and what to employ. 28. The prognosis of primary and secondary heart disease.

"Jour. Amer. Med. Assoc., Jan. 3, 1914.

cases, since transfusion is often a last re- method and pass it into the recipient's ve sort), no danger from infection, and no is certainly not very remote. after treatment of wounds nor remaining A much safer plan than measuring t scars. Five to ten minutes is all the time blood transfused is to measure its efferequired.

upon the recipient. This can be done t The apparatus described by Dr. Bertram taking the blood pressure on the oppos


Fig. 1.—The Steel Instrument for Blood Transfusion. The lower figure on this illustration shows the instrume: on section, displaying the even caliber of the channel of the tube. (Courtesy of "International Clinics,"

J. B. Lippincott Company.)

M. Bernheim, of Johns Hopkins, seems in arm and leaving the sphygmomanometer is many respects superior to the McGrath in- situ during the transfusion, and when the strument for reasons enumerated above pressure reaches 100 or 110 mm., either (tho probably much more expensive and from the amount of blood transferred or cumbersome). The one redeeming feature of the effects on the sensory nervous system.

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Fig. 2.—The Steel Instrument for Blood Transfusion in Use. (Courtesy of "International Clinics,"

J. B. Lippincott Company.)

the Bernheim instrument is that the amount stop the transfusion. If a large amount of blood transfused can be definitely meas- of blood is required from the donor or an ured, but the liability to form a clot in the amount sufficient in any way to deplete him, use of either the McGrath or Bernheim the sphygmomanometer can be used and the

transfusion stopped when the donor's pres'Jour. Amer. Med. Assoc., Oct. 9, page 1278. sure approaches 100 mm. It would be well

not to accept a donor with a pressure less men as collected for the routine tests, or than 120 mm. or above 140 mm.

these conclusions must be conservative to The instrument designed by Dr. William say the least. The specimen for bacteriA. Steel, Professor of Clinical Surgery in ologic examination should be collected unthe Medical Department of Temple Üniver- der special conditions, the container must be sity,3 Philadelphia, for cost, simplicity and steril and the tests made as quickly as posadaptability in any case and under all condi- sible. tions and surroundings seems to be the last 3. In females where the question of word in transfusion instruments. (The Steel vaginal contamination is to be reckoned instruments are being used by the American with, we must resort to catheterization as the Ambulance and Hospital service in Europe best method. It must be remembered, hownow.) The writer has had blood transfu- ever, that the catheter may carry up some sion into his own veins and speaks from contaminating bacteria, and in the male we personal experience. Safety first and sim- have a much better method to fall back plicity second should be the order in trans- upon. Wash the glans penis and the meatus fusion instruments and methods.

thoroly with soap and water, after which J. C. ATTIX, M.S., D.D.S., M.D., P.D. a very dilute alcohol (under 50% or the Chemist, Pathologist and Bacteriologist to the patient will object) may be used. Reject National Stomach Hospital.

the greater portion of the sample and col2355 N. 13th St., Phila., Pa.

lect only the latter part of the voiding in a

bottle which has been boiled then cooled. Reminiscences of a Laboratory Specialist. Cork with a steril cork, and send to the IV. THE URIN AND BACTERIA.

laboratory at once. EDITOR MEDICAL WORLD :—What was

4. The examination of a hanging drop is

not without value, but final conclusions are said concerning urinary microscopy holds equally well for the bacteriologic examina

not justified upon this examination alone. tion : viz., the examination is usually a farce

5. A hanging drop preparation in a case as carried out, and the report valueless.

of suspected renal phthisis where pus cells

are found, but in which bacteria appear to In some cases the blame should not be

be entirely absent, argues rather strongly placed upon the laboratory worker, but

for an early tuberculosis. The bacillus of rather upon the physician who submits the specimen, the latter not understanding the

Koch is a selfish germ, seeking not the compossibilities and circumscriptions of bacteri

pany of other bacteria and is known to acologic urinalyses. The points which I am

tively destroy them. Later in the disease about to emphasize appeal to me as intensely vaders. In any case of pyuria which may

they may gain a foothold as secondary inpractical, and I give them hoping that the

be tuberculous, where a hanging drop fails readers of The WORLD will treasure them,

to reveal the presence of bacteria, a very for many will not be found in the literature.

close search must be made for the tubercle The Bacteriurias in General.

bacillus, not only by spreads, but by cavy

inoculations. 1. Bacteria in the urin. may be classified

6. A hanging drop preparation in a case as pathogenic, semipathogenic (those microorganisms causing fermentation in the urin

of suspected colipyelitis where many short, before it has been voided), and harmless. scarcely motile bacilli are seen, argues Another classification which I would pro

rather strongly for that diagnosis. The urin

must be collected as recommended above, pose is as follows: (a) Bacteria causing

or the finding should be ignored. The prestrouble in the urinary tract. (b) Bacteria

ence of pus cells even in small numbers not causing trouble. This latter classifica

along with this bacilluria, and especially tion is important and must be kept in mind.

when the sample is acid, is very strong eviWe have good reason to believe that typhoid dence of colipyelitis

. The final proof rests, bacilli, colon bacilli, staphylococci and perhaps even tubercle bacilli may at times leave

not on the hanging drop, but cultures. The

chief differentiation to be made is typhoid the body via the urin and yet cause no disease of the urinary organs.

bacilluria, for in many cases colipyelitis com2. No conclusions can be made concern

plicates typhoid. The findings by the hanging the significance of bacteria in the speci- colipyelitis should rarely be mistaken for

ing drop are so suggestive that cases of "International Clinics,” 1914, pages 259 to 262.



7. A hanging drop preparation of a urin relatively small numbers and elude the miof acid reaction, and which has been col- croscopist; and here is where the pig inlected under the above conditions, showing oculations are of use. The presence of pus cocci, and especially where pus is present cells does not necessarily mean true infecand the two above conditions may be ruled tion, for in the mechanical types of cystitis out, proves rather conclusively that such they have been dared out by semipathogenic cocci are pathogenic and active. Differen- bacteria. Any factor destroying or inhibittiate gonococci, staphylococci and so on by ing the normal germicidal properties of the other tests.

mucosa is taken as sufficient excuse for a There are a number of conditions to the visit by these little policemen. above conclusion, and I must warn the 2. Do not centrifuge purulent urins, but reader that cocci are not usually the patho- permit them to sediment, or else you will genic germs in kidney disease. Cocci found mass the sticky pus cells and they will coin the sample as ordinarily collected are to here and microscopy will be almost imposbe ignored. Certain cocci are often asso- sible. The texts will tell you to centrifuge, ciated with the alkalin fermentations, and because sedimentation takes time and favors may be semipathogenic in the mechanical bacterial changes. Correct, but the portion types of cystitis.

which is to be examined by microscope may 8. This leads me to a very important be preserved or iced while standing, if sedicaution. In forming opinions as to the mentation is tardy. value of the hanging drop picture, the re- 3. Pus cells in large numbers tend to obaction of the urin must be kept in mind. I scure other important microscopic finds, will venture that it is invariably quite a and, where feasible, it is best to delay exwaste of time to examin a hanging drop amination until there is less pus. This does where the urin is alkalin.

not mean that the worker should wait until 9. What of urinary preservatives where there is an actual decrease in the pus. bacteriologic examinations are desired ? must be remembered that the amount of They cannot be employed where cultural pus in a given urinary specimen varies dimethods are to be carried out; in other cases rectly with the concentration of that specithey may be added, as they do not interfere men, whereas the number of casts or cylinwith smear examinations. Use thymol or droids varies inversely. Give plenty of gum camphor as advised in the first of these water and some mild diuretics for a few articles. If the urin must be planted for hours. Coincident with the increased dilucolon bacilli, cocci, and so on, merely cool tion, there is a diminution in the relative it and send to the laboratory in a vacuum

number of cells. But, upon the other hand, bottle. If you are prepared to do the work many casts which have been resting in the yourself, do not cool it, but examin at once, upper tubules (where the current had been not an hour or so later. If you must delay sluggish) are floated out and appear in the planting, ice it invariably.

large numbers. Flushing the kidneys with The Pus Cell.

water in any case of nephritis is likely to re

sult in a cylinder shower. In this way we We cannot go very far into a discussion will have a fairer chance of finding the ocof bacteria without gossiping about our lit- casional cast than in the concentrated samtle friend the pus cell, sworn enemy of the ple. At this point I wish to call the attencriminal micro-organisms. He is almost al- tion of the reader to an observation. Did ways present, just as cops are concentrated you ever note that purulent urins are, as a in the red-light district. The following con- rule, light in color? There appears to be siderations are most important:

less pigment per c. c., and I gain the im1. Pus cells invariably accompany patho- pression that there is an attempt at physiogenic bacteria when the latter are up to logic flushing in order that the infection may mischief. I have witnessed colipyelitis with- be diluted or washed away. As a matter of out pyuria. Colon bacilli have been present fact, pyuria and polyuria seem to go hand in large numbers, but within a few hours pus in hand, and Nature teaches us a therawas certain to appear. Pus cells may be peutic lesson. Perhaps, after all, some of present in the urin when the pathogenic the excellent results of urinary antiseptics bacteria are apparently absent. This is the may be explained by their diuretic action. case in renal tuberculosis. As a matter of 4. The reaction of the urin is rarely norfact, the specific bacteria are present, but in mal in pyuria. When the pus comes from

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