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to make it practically impossible for oysters at all subject to pollution to be taken and shipped. All the oyster beds in the States mentioned have been so charted that when certain beds are closed, owing to pollution or other causes, it is easy to establish from these maps the definite area covered by these beds. In certain cases these restrictions have compelled the transplanting of oysters for a time long enough to make them absolutely free from any danger of pollution, or have limited the taking of oysters to the seasons when the beds are in absolutely clean condition. In this work all the States concerned have co-operated most actively and, what is regarded as of great importance by the Federal authorities, the oyster men themselves are seeing to it that no oysters from the prohibited sources enter the local markets or are shipped inland.
A department entitled "Rational Organotherapy" is being conducted by Dr. Henry R. Harrower in American Medicine. It deals with the therapeutic uses of the various ductless glands.
Dr. C. W. Hunt, of Brevard, N. C., won a $250 prize offered by the Anheuser-Busch Brewing Co. for the most appropriate title to a picture sent to many thousand doctors in all parts of the United States last spring. The picture shows a cottage on a hill, lights ablaze in every room, with a typical country doctor hurrying up a trail leading to the house, the moonlight throwing his shadow upon the ground. The old doctor dressed in old-time garb, walking up the path with long strides, his medical satchel in his left hand, his right hand under his chin holding his eyeglasses, his right elbow bent and extended, pointing from his elbow is an old-time umbrella, with the position of his body bent so as to form the shadow of a stork on the ground in the moonlight with bill extended toward the cottage on the hill. The title to the picture was to be suggested by the doctors, the best suggestion to be selected by a committee of eminent men. Dr. Hunt's suggestion was "On the Honeymoon Trail," and out of more than twelve thousand suggested titles this was selected as the best, and accordingly he has received a check for $250 in good and lawful money.
The first annual meeting of the National Committee for the Prevention of Blindness will be held in the assembly room of the Russell_Sage Foundation Building, corner of East 22d Street and Lexington Avenue, New York City, at 4.30 p. m., November 4th. Ex-President William H. Taft will be present and will speak, and Dr. George E. de Schweinitz, of Philadelphia, will make an address.
The $600,000 George F. Geisinger Hospital, a memorial from his widow to her townsmen of Danville, Pa., was opened September 19th, in time for a typhoid epidemic there.
The National Red Cross has directed the return to the United States, not later than October 1st, of all Red Cross units except those in Belgium and Serbia. The typhus section returned from Serbia early in October, having fulfilled its mission there.
Contracts signed at New York, October 5th, for the purchase of $120,000 worth of radium, the largest amount ever sold in this country for medical purposes, mark the beginning of the Radium Institute of New York, whose projectors
are preparing to invest $1,000,000 for the hospitals and equipment to be used for the treatment of cancer and other diseases. Two wealthy men are interested in the institute for philanthropic reasons, and five more will shortly be identified with the board of control. The board of managers includes prominent physicians.
The Weekly Bulletin of the Health Department quotes from the summary of the Investigation Concerning the Physiologic Aspects of the Liquor Problem by Dr. John S. Billings, Jr., which was prepared for the Committee of Fifty, showing that the common idea that a large part of the injury to health from the use of alcoholic drinks is caused by the injurious substances in the liquor, such as fusel oil and furfurol, which have not been properly removed is erroneous as is also the notion that cheap liquors contain larger quantities of such ingredients than others. The injurious effects of the fusel oil are trifling in comparison with those of the ethyl alcohol. general conclusion is that fine old brandies and whiskies are nearly as likely to produce ill effects as the cheaper varieties of the present time if taken in the same quantities and the injurious effect is in proportion to the ethyl alcohol contained.
The Rockefeller Foundation, in making public September 23d part one of its annual report, covering the period to the end of 1914, tells what has been accomplished by its International Health Commission in mitigating the ravages of the hookworm disease in tropical countries. The report says that the relief and control of the disease is an undertaking of enormous magnitude, as the infection belts the globe in a zone on both sides of the equator, 66 degrees wide and with a population of about 900,000,000 souls. Thus far plans have been adopted and work begun for the control of the disease in British Guiana, Antigua, Trinidad, St. Lucia, Grenada and Egypt. In addition to the work undertaken in the British colonies, the commission has responded favorably to invitations from several Central American countries and work has been inaugurated in Panama, Nicaragua, Costa Rica and Guatemala. The report shows that the percentage of population infected is large in many countries. It shows that the southern two-thirds of the Chinese empire is involved, the infection in many parts of the Yangtse Valley running as high as 70 to 76% among the farming population. The report makes it clear that the International Health Commission has not undertaken to eradicate the disease in any country. The accomplishment of this result, it is stated, will require the operation of permanent agencies, working over long periods, and this should be the work of the governments interested.
The Second New England Tuberculosis Conference was held October 22d-23d in Springfield and Westfield, Mass.
The $1,000,000 buildings of the University of Pennsylvania dental department, Philadelphia, were opened in September for the current session.
A half million dollar fund for the new buildings of the Children's Hospital, Philadelphia, is now being raised.
The Special Relief Society, thru its executive committee, is endeavoring to arouse the women of America to a full realization of the importance
of immediate preparedness. The work which the 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 volunteer army, the making of garments needed in the field, the making of an auxiliary kit, convalescent kit, hospital kit, the provision of extra camp comforts for the soldiers, the organization of sewing clubs, contribution of materials and funds, the preparation of a list of volunteer nurses. The membership of the society consists of the following classes: sustaining members, annual members, contributing members and life members.
As a means of physical development and promoter of public health, Dr. Maurice M. Seymour, Commissioner of Public Health in Saskatchewan and president of the Canadian Public Health Association, strongly advocated universal military training for all young Canadians at the annual meeting of the association in Toronto, September 3d and 4th. Dr. Seymour also spoke of the necessity of caring for prospective mothers. He outlined the new law in Saskatchewan which gives every mother $25 and pays a doctor a fee of $15 for medical attention.
Criminal suits against various self-called osteopathic operators in that section show that the New Jersey College of Osteopathy is now simply a diploma mill.
Dr. Robert N. Willson is continuing his Friday afternoon postgraduate lectures on the heart in the amphitheatre of the Philadelphia General Hospital from 5 to 6 p. m.
He extends a cordial invitation to all physicians and medical students to be present. There are no fees and no obligations connected with attendance upon the course. The schedule is :
November: 5. Etiology and treatment of aortic aneurism. 12. Etiology of heart disease, congenital and acquired. 19. Symptoms of primary and secondary heart disease. 26. The pulse and the blood pressures in cardiac disease.
December: 3. Heartblock and other arhythmias. Treatment. 10. Nervous and mental phenomena of heart disease. 17. Etiology and treatment of angina pectoris. 24. Diseases of the pericardium; etiology and treatment. 31. The micro-organismal nature of myocarditis; its treatment.
January, 1916: 7. Myocardial degenerations and their treatment. 14. Hypertrophy and dilatation. Decompensation. Treatment. 21. Acute endocarditis; etiology and treatment. 28. Subacute and malignant endocarditis.
February: 4. Mitral insufficiency; etiology and treatment. 11. Mitral stenosis; etiology and treatment. 18. Aortic valve disease; etiology and treatment. 25. Congenital heart disease: tricuspid and pulmonary valve lesions.
March: 3. Stokes-Adams' syndrome, paroxysmal tachycardia, hyperthyroidism. 10. The heart in pregnancy, the menses, the menopause. 17. The heart in tuberculosis; tuberculosis in heart disease. 24. The heart in syphilis; syphilis in heart disease. 31. The heart in the pneumonias, influenza and diphtheria.
April: 7. The heart and exercise, athletic and therapeutic. 14. The non-medicinal treatment of heart disease. 21. When to use drugs in heart disease, and what to employ. 28. The prognosis of primary and secondary heart disease.
Short articles of practical help to the profession are selicited for this department.
Articles to be accepted must be contributed to this journal only. The editors are not responsible for views exprest by contributors.
Copy must be received on or before the twelfth of the month for publication in the issue for the next month. We decline responsibility for the safety of unused manuscript. It can usually be returned if request and postage for return are received with manuscript; but we cannot agree to always do so. Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will cer tainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.— RUSKIN.
EDITOR MEDICAL WORLD:-Methods for transfer of whole blood, defibrinated blood, and blood serum, by both direct and indirect methods, have occupied the attention of many surgeons and therapeutists since the have been devised for the purpose. time of Harvey; and many instruments
Some of them are elaborate, expensive and difficult to use. Scarcely any one of them, however, which has been proposed and gained even passing consideration and use, but has its one or more good points, and some of them have a number of points to recommend them.
The instrument devised by Dr. Bernard F. McGrath,' is a very complete and clever device for blood transfusion, and I have no doubt is a valuable adjunct in a wellequipped hospital with plenty of trained assistants. In the hands of an experienced operator with faultless technic and where time is not a factor it should work admirably, and I have no doubt does; and makes, besides, a transfusion look like a major operation. This may have an influence for good in certain cases, but in many instances is decidedly harmful. The employment of Dr. McGrath's instrument necessitates the permanent obliteration of an artery of the donor and a vein of the recipient both of which can be obviated by other methods, some of which do not even require an incision; and the avoidance of this latter is often of considerable importance and makes the operation less formidable to both donor and recipient.
No anesthetic, local or general, is required, no pain experienced (both of which have to be given due consideration in many
'Jour. Amer. Med. Assoc., Jan. 3, 1914.
method and pass it into the recipient's ve is certainly not very remote.
cases, since transfusion is often a last resort), no danger from infection, and no 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 effe required. 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 instrument on section, displaying the even caliber of the channel of the tube. (Courtesy of "International Clinics," J. B. Lippincott Company.)
FIG. 2.-The Steel Instrument for Blood Transfusion in Use. (Courtesy of "International Clinics,"
the Bernheim instrument is that the amount of blood transfused can be definitely measured, but the liability to form a clot in the use of either the McGrath or Bernheim
stop the transfusion. If a large amount of blood is required from the donor or an amount sufficient in any way to deplete him, the sphygmomanometer can be used and the transfusion stopped when the donor's pressure approaches 100 mm. It would be well
not to accept a donor with a pressure less than 120 mm. or above 140 mm.
The instrument designed by Dr. William A. Steel, Professor of Clinical Surgery in the Medical Department of Temple University, Philadelphia, for cost, simplicity and adaptability in any case and under all conditions and surroundings seems to be the last word in trans fusion instruments. (The Steel instruments are being used by the American Ambulance and Hospital service in Europe now.) The writer has had blood transfusion into his own veins and speaks from personal experience. Safety first and simplicity second should be the order in transfusion instruments and methods.
J. C. ATTIX, M.S., D.D.S., M.D., P.D.
2355 N. 13th St., Phila., Pa.
Reminiscences of a Laboratory Specialist.
IV. THE URIN AND BACTERIA. EDITOR MEDICAL WORLD:-What was said concerning urinary microscopy holds equally well for the bacteriologic examination: viz., the examination is usually a farce as carried out, and the report valueless. In some cases the blame should not be placed upon the laboratory worker, but rather upon the physician who submits the specimen, the latter not understanding the possibilities and circumscriptions of bacteriologic urinalyses. The points which I am about to emphasize appeal to me as intensely practical, and I give them hoping that the readers of THE WORLD will treasure them, for many will not be found in the literature.
The Bacteriurias in General.
1. Bacteria in the urin may be classified. as pathogenic, semipathogenic (those microorganisms causing fermentation in the urin before it has been voided), and harmless. Another classification which I would propose is as follows: (a) Bacteria causing trouble in the urinary tract. (b) Bacteria not causing trouble. This latter classification is important and must be kept in mind. We have good reason to believe that typhoid bacilli, colon bacilli, staphylococci and perhaps even tubercle bacilli may at times leave the body via the urin and yet cause no disease of the urinary organs.
2. No conclusions can be made concerning the significance of bacteria in the speci
"International Clinics," 1914, pages 259 to 262.
men as collected for the routine tests, or these conclusions must be conservative to say the least. The specimen for bacteriologic examination should be collected under special conditions, the container must be steril and the tests made as quickly as possible.
3. In females where the question of vaginal contamination is to be reckoned with, we must resort to catheterization as the best method. It must be remembered, however, that the catheter may carry up some contaminating bacteria, and in the male we have a much better method to fall back upon. Wash the glans penis and the meatus thoroly with soap and water, after which a very dilute alcohol (under 50% or the patient will object) may be used. Reject the greater portion of the sample and collect only the latter part of the voiding in a bottle which has been boiled then cooled. Cork with a steril cork, and send to the laboratory at once.
4. The examination of a hanging drop is not without value, but final conclusions are not justified upon this examination alone.
5. A hanging drop preparation in a case of suspected renal phthisis where pus cells are found, but in which bacteria appear to be entirely absent, argues rather strongly for an early tuberculosis. The bacillus of Koch is a selfish germ, seeking not the company of other bacteria and is known to actively destroy them. Later in the disease they may gain a foothold as secondary invaders. In any case of pyuria which may be tuberculous, where a hanging drop fails to reveal the presence of bacteria, a very close search must be made for the tubercle bacillus, not only by spreads, but by cavy inoculations.
6. A hanging drop preparation in a case of suspected colipyelitis where many short, scarcely motile bacilli are seen, argues rather strongly for that diagnosis. The urin must be collected as recommended above, or the finding should be ignored. The presence of pus cells even in small numbers along with this bacilluria, and especially when the sample is acid, is very strong evidence of colipyelitis. The final proof rests, not on the hanging drop, but cultures. The chief differentiation to be made is typhoid bacilluria, for in many cases colipyelitis complicates typhoid. The findings by the hanging drop are so suggestive that cases of colipyelitis should rarely be mistaken for
7. A hanging drop preparation of a urin of acid reaction, and which has been collected under the above conditions, showing cocci, and especially where pus is present and the two above conditions may be ruled out, proves rather conclusively that such cocci are pathogenic and active. DifferenDifferentiate gonococci, staphylococci and so on by other tests.
There are a number of conditions to the above conclusion, and I must warn the reader that cocci are not usually the pathogenic germs in kidney disease. Cocci found in the sample as ordinarily collected are to be ignored. Certain cocci are often associated with the alkalin fermentations, and may be semipathogenic in the mechanical types of cystitis.
8. This leads me to a very important caution. In forming opinions as to the value of the hanging drop picture, the reaction of the urin must be kept in mind. I will venture that it is invariably quite a waste of time to examin a hanging drop where the urin is alkalin.
9. What of urinary preservatives where bacteriologic examinations are are desired? They cannot be employed where cultural methods are to be carried out; in other cases they may be added, as they do not interfere with smear examinations. Use thymol or gum camphor as advised in the first of these articles. If the urin must be planted for colon bacilli, cocci, and so on, merely cool it and send to the laboratory in a vacuum bottle. If you are prepared to do the work yourself, do not cool it, but examin at once, not an hour or so later. If you must delay the planting, ice it invariably.
The Pus Cell.
We cannot go very far into a discussion of bacteria without gossiping about our little friend the pus cell, sworn enemy of the criminal micro-organisms. He is almost always present, just as cops are concentrated in the red-light district. The following considerations are most important:
1. Pus cells invariably accompany pathogenic bacteria when the latter are up to mischief. I have witnessed colipyelitis without pyuria. Colon bacilli have been present in large numbers, but within a few hours pus was certain to appear. Pus cells may be present in the urin when the pathogenic bacteria are apparently absent. This is the case in renal tuberculosis. As a matter of fact, the specific bacteria are present, but in
relatively small numbers and elude the microscopist; and here is where the pig inoculations are of use. The presence of pus cells does not necessarily mean true infection, for in the mechanical types of cystitis they have been dared out by semipathogenic bacteria. Any factor destroying or inhibiting the normal germicidal properties of the mucosa is taken as sufficient excuse for a visit by these little policemen.
2. Do not centrifuge purulent urins, but permit them to sediment, or else you will mass the sticky pus cells and they will cohere and microscopy will be almost impossible. The texts will tell you to centrifuge, because sedimentation takes time and favors bacterial changes. Correct, but the portion which is to be examined by microscope may be preserved or iced while standing, if sedimentation is tardy.
3. Pus cells in large numbers tend to obscure other important microscopic finds, and, where feasible, it is best to delay examination until there is less pus. This does not mean that the worker should wait until there is an actual decrease in the pus. It must be remembered that the amount of pus in a given urinary specimen varies directly with the concentration of that specimen, whereas the number of casts or cylindroids varies inversely. Give plenty of water and some mild diuretics for a few hours. Coincident with the increased dilution, there is a diminution in the relative number of cells. But, upon the other hand, many casts which have been resting in the upper tubules (where the current had been sluggish) are floated out and appear in large numbers. Flushing the kidneys with water in any case of nephritis is likely to result in a cylinder shower. In this way we will have a fairer chance of finding the occasional cast than in the concentrated sample. At this point I wish to call the attention of the reader to an observation. you ever note that purulent urins are, as a rule, light in color? There appears to be less pigment per c. c., and I gain the impression that there is an attempt at physiologic flushing in order that the infection may be diluted or washed away. As a matter of fact, pyuria and polyuria seem to go hand in hand, and Nature teaches us a therapeutic lesson. Perhaps, after all, some of the excellent results of urinary antiseptics may be explained by their diuretic action.
4. The reaction of the urin is rarely normal in pyuria. When the pus comes from