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lus so closely in appearance that it has often been mistaken for tubercle bacillus in genito-urinary microscopical work.

The preceding being an introduction, we will proceed to consider various diseases, or phases of the same and the relationship of microbe invasion to their manifestation.

The first we will consider is that abnormal condition or rather one phase of it-known as epidemic influenza, or “la grippe."

Asthmatus Ciliaris.

This is the name given to the forms we are about to describe. Kent, in his manual on "British Infusoria," describes them under this name. However, I do not find them described by Professor Liedy in his great work on "Rhizopods" for the United States government.

Professor Haller, in Zeitschrift für Para

Asthmatus Ciliaris. (Drawn by A. T. Cuzner, M.D.)

sitenkunde, Jena, Prussia, describes them as follows, and the writer can verify from his own experience and the testimony of Dr. J. H. Salsbury and that of Prof. John Phin, editor of American Journal of Microscopy, the accuracy of this description.

Infusorial catarrh is purely a parasitic disease arising from a peculiar organism armed upon one side or at the end, or all round, with cilia. This organism assumes a variety of shapes and sizes. By watching its development and metamorphosis under the microscope, it may be seen to transform itself into many different forms. The most usual shapes appear to be either spherical or oval. Each frequently sends out a proboscis, at the end of which is an elongated and dilated cilium. This proboscis may be in the center of the mass of cilia or at the side or end.

It may be drawn in, leaving a nipple-like elevation, or it may disappear entirely. These

forms have a rolling, rocking motion from side to side, their cilia being likewise in rapid vibratory motion.

This motion of the forms, and the vibration of their cilia, are extremely irritating to the afflicted person. These forms are to be found mostly in the thin, watery discharge from the nose. They may be discovered in the tears that flow from the eyes. In not all forms of influenza or "la grippe" do we find these organisms. Neither are they so common in the south as in the north.

However, the writer, while serving on the Bureau of Medical Relief, during the epidemic of yellow fever in Jacksonville, Fla., in 1888, had the opportunity of exhibiting under the microscope, using a one-fifth Gunlack objective, some of these forms as they appeared in the secretions obtained from a Cuban doctor suffering from influenza.


The most efficacious local application we have found for relief are sodium benzoate and thymol, both to be used as errhines.

We have also found menthol an excellent local application. Such internal remedies as tend to eliminate from the body the toxic material, the result of the life history of the asthmatus ciliaris, and tonics to take up the slack.

As a neutralizer of the poison we have found the application of calcium sulfid, gr. 1/6, three pellets to be given every hour, to be all that could be desired.

Gilmore, Fla. A. T. CUZNER, M.D.

Sanatoriums for Inebriety and Narcomania

EDITOR MEDICAL WORLD:-A good man writes me, what has become of all the inebriate asylums and hospitals in this country? That is a practical question.

From 1880 to 1890 there were over 150

gold cure and other specific hospitals, sanatoriums, homes and asylums for drinking men. That was the acme of that great charlatan movement, which claimed that it had discovered new and absolute remedies for the cure of spirit and drug neurosis.

From that time there has been a steady decline, and now, twenty or more years after, there are less than thirty institutions and homes, including the three-day cures, in operation.

Forty years ago there were eight or nine hospitals, both scientific and semi-scientific, at work in this field. To-day there is about the same number or less. Two are State

institutions or farm colonies. Three or more are semi-scientific, using religious means and methods, and promoting special ideas of cures. There are two or three more that are strictly scientific with no mysterious drugs or guaranteed cures.

On the other hand, there are 150 or more hospitals, surgical and medical, insane asylums, homes for mental diseases and sanatoriums for nervous cases that have distinct wards for inebriates and drug takers. Some of them are more or less crowded with this class of patients. All of them advertise and receive such persons, and it has become quite a feature of these various institutions to give aid and help to this class.

All practical men in charge of these institutions complain that these are very difficult cases to treat, unless kept by themselves. Their influence is bad on other patients. Inebriates feel that it is a sort of a stigma to go to hospitals for the insane, and that it implies that they are mentally disturbed, and both the families and friends find serious objections to this kind of treatment. The only feature of this is that such institutions can take these patients at lower rates than exclusively organized hospitals for drink and drug takers.

In the meantime, many men are selling specific drugs and remedies to physicians for home treatment. Others are advertising boldly the special remedies they use, and when tested the failure is attributed to lack of skill and appointments.

One thing is certain: the number of drink and drug takers is larger to-day than it ever has been before. There is no doubt that it extends into the thousands, and the problems of treatment have not attained the scientific prominence they deserve. What is needed to-day is special homes and small hospitals, practically houses of refuge, where active men and women can retire, have the alcohol and drugs removed, and the mind and body built up, and receive a species of education on how to take care of themselves in the future. Psychic treatment should also be applied in the most effectual way.

A number of large cities are already preparing to establish, or have started farm colonies for the special care of the indigent, giving them scientific treatment according to the conditions. New York has such a colony in operation. Cleveland has a similar project, and wherever these have been tried in a small way they have proved most ef

fectual. All such patients want institutional and then home treatment. Then the possibility of cure will be the rule and not the exception. A very few places now in operation have proved this fact beyond question.

The great central fact which every physician should impress upon drink and drug takers is, that they must go away and secure first-aid treatment at once. Then they can come back and continue under the charge of the family physician, and restoration will be sure. There is nothing mysterious about this but common-sense use of the means and measures, but they must be associated with radical change of living and surroundings at the beginning.

There are more institutions to-day than ever before in the world, and a greater demand, and yet they are unspecialized and the old theories that vice and wickedness enter into the causation still pervades the minds of many persons. In all this there is evolution and growth, and the direction is unmistakably in favor of small hospitals and scientific sanatoriums for the exclusive care of these poor neurotics.

Hartford, Conn.


Symposium on Circumcision.

In discussing the subject circumcision we may not all be discussing the same operation. As foreskins differ, so will the operations differ. Let us all get a proper foundation for our discussion, each one of us stating exactly what we mean by the word "circumcision." Strictly speaking, it means "cutting around." That might mean cutting. the foreskin loose by a circular incision where it is merely adherent to the glans, and in this case little or none of the foreskin may be removed. Where the foreskin is so constricted at the extremity that it leaves only a very small ostium, probably a half inch of skin and a half inch of mucous membrane is removed by the operation. Perhaps in many other cases, for various reasons, much more dermal tissue is removed.

It is quite possible that surgeons get into the habit of removing too much of the prepuce in their surgical operation. Only so much should be removed as is necessary to meet the indication. It may be that it is much more easy to remove a large section of the foreskin than a small one. It may be less difficult to secure a good cosmetic and surgical result by removing nearly all the

foreskin than by removing only the portion indicated in each case. But that does not constitute a sufficient reason for an extensive operation. The operation should be made to fit the condition, not the condition to fit the operation. As to the ritual operation, we do not know the extent of the tissue removed. Please state, in succeeding communications, to what sort of an operation you refer. This, we think, will clarify the situation and permit all our readers to get a thoro comprehension of your views and avoid all misunderstanding.-ED.

Benefits of Circumcision.

EDITOR MEDICAL WORLD:-You explain in a note to Dr. E. W. Feige's article in the September WORLD that Dr. Reed, in his essay on "Circumcision Should be Abolished," only meant circumcision done by rabbis and such like. I would take it that meant any circumcision done without proper antiseptic precautions. Possibly Possibly that is what he did mean, but Dr. Reed surely made it appear in his article in the August issue as if he meant that circumcision of any kind should be stopped from a humane standpoint.

I fully agree with Dr. Feige. The result of circumcision is usually wonderful. It not only reduces the irritability of the child's penis, but also the so-called passion of which so many married men are so extremely proud, to the detriment of their wives and their married life. Many youthful rapes could be prevented, many separations and divorces also, and many an unhappy marriage improved if this unnatural passion was cut down by a timely circumcision.

As a man's brain is excited by an erection, whether timely or untimely, a little child's brain, with its unstable nervous system, should and surely does undergo similar and more lasting reactions. I am certain that many a maniac, epileptic, or pervert could be prevented if circumcised in earliest youth, because it is the sympathetic reaction on the undeveloped brain-cells of the infant that does the harm-a great deal more than a little masturbation during adolescence. Circumcision will not prevent a boy altogether from masturbating.

Bedwetting can always be cured by a circumcision. Of course, the usual measures have to be employed in conjunction, such as forbidding the use of large quantities of water before going to bed, and looking

after constipation, etc. It is well to remember that the same condition is to be found with girls, and the loosening of the foreskin over the clitoris will usually reveal a number of hard concretions.

Why is it that the percentage of gonorrhea is a great deal smaller amongst the Jews? The reason is that many a Gentile seeking satisfaction among prostitutes for his imaginary excess of passion carries home under his foreskin enough germs, even after the usual unsatisfactory prophylactic measures used in such places, to give him a good start in venereal diseases.

If the physician would examine some of the babies that are nervous and not thriving well, he would find most of the boys had a long foreskin with a very small opening, while the girls had an adherent clitoris with solid concretions underneath. The circumcision of such children would save the doctor much annoyance, the mother a great deal of worry, and the child a great deal of suffering now and in after years. If a doctor has such a tender heart that he cannot hurt a child in order to benefit him, let him refer the mother to some one else; but he should not denounce and ridicule a treatment that has saved thousands of individuals from the most terrible suffering, physically, mentally and morally, and that has saved and would save thousands of unhappy wives from separation and the divorce.

Elgin, Neb. L. W. WUESTHOFF, M.D.

[The above writer misconstrues our note to which he refers. We distinctly stated in that note (page 352 of September WORLD) that Dr. Pass referred to the operation performed by rabbis.-ED.]

Circumcision Must be Encouraged.

EDITOR MEDICAL WORLD:-I should like to say that Dr. A. P. Reed, of Boston, Mass., is not a bit right in his decision in abolishing circumcision. The causes upon which he built his decision are not at all convincing.

Dr. Reed says, in August WORLD, that some people confessed to him of having discomfort from clothing friction; others have a feeling of wanting to pull the prepuce forward and unconsciously do it to relieve exposure of glans. But what should Dr. Reed say of the 300,000,000 of circumcised Moslems and the other millions of circumcised Israelites? Perhaps they are not human. Do they all suffer? I have ten

brothers besides myself, and never heard a complaint of any of them. Yes, it is a religious rite, but it was made to be a religious rite after a good sanitary thought—that of cleanliness and comfort. As a doctor in medicin, I should like to say that prepuces are merely pouches of filthy microbes. But perhaps Dr. Reed will say prepuces should be left alone as Nature made them. We will answer him, so beards, nails, hair, and moustaches should be left alone as Nature made them. In my opinion, "they" are "all" dirty.

A case or two, or even ten in a doctor's clinic, are not a sufficient proof of the unusefulness of an operation.

What Dr. Reed should have said and would have settled the question, is that circumcision ought to be made early in childhood, so when children grow they would get accustomed to clothing friction.


Sinbellawain, Egypt.

Circumcision and Masturbation. EDITOR MEDICAL WORLD:-In his letter on "Circumcision and Masturbation" in the October WORLD, Dr. Wm. J. Robinson says he is convinced "that the prepuce is one of the great factors in causing masturbation in boys." Now, as it happens, my observation and experience would show to the contrary; that an exposed glans, thru the uncovering of a sensitive part, subjecting it to direct friction from the clothing, is quite as much a cause of masturbation as any prepuce can be. In the case of some masturbators the act itself, long continued, seems to practically circumcise the person inasmuch as the glans thus becomes more or less exposed permanently, and with me, these cases are very obstinate as far as curing or stopping the masturbation is concerned, a fact I attribute to this very thing of glans exposure. In these instances there seems a congestion that gives a constant condition of erotomania or eroticism. Boston, Mass. A. P. REED, M.D.

Circumcision Useful in Selected Cases. EDITOR MEDICAL WORLD:-There has been a number of articles publisht in THE MEDICAL WORLD from time to time upon the subject of circumcision. There is an old saying that truth, or, in other words, the right thing, is between two extremes. I do not pretend to say that circumcision is unnecessary in all cases, but I do not be

lieve it should be resorted to except in cases where nature has been too lavish and there is a decided superabundance of foreskin. In the large majority of cases merely dilating the prepuce is all that is required.

I would like to ask why was the male sex provided with such an appendage? As a general rule, nature does not make many mistakes. Everything is created for some purpose. Take, for instance, the clitoris in the female. Why did nature protect it with a partial covering or hood? Because it is a highly sensitive organ and needed a covering to prevent friction from clothing, etc.

The prepuce is intended to act as a protector to the delicate and sensitive glans penis. The argument that it allows shall I say filth to accumulate beneath it in the form of smegma, etc., is not sufficient reason for its removal. Any person who has not sense enough to keep the parts clean, which can be so easily done, should be sent to a reformatory. The penis is something that is not hid away and forgotten, but is handled more or less every day; so there is no excuse for uncleanness.

It is one of the strange things so far as my observation goes, and I have practised medicin nearly fifty years, that the elongated prepuce has been much more common during the last twenty years than previous to that time. There are ailments or diseases, also, that have become far more common during the last decade, such as appendicitis and ovaritis. Has the modern way of living brought about these changed conditions? Sciatica.

I was much interested in Dr. J. C. Dreher's article in October WORLD on cupping for sciatica. That is a method of treatment that I think has fallen too much into disuse. I remember relieving the pain in a case of pleurisy before the cup was removed and without a return. It has been many years since I have made use of cupping. A. NOXON, M.D.

Toronto, Canada.

C. F. Taylor, M.D., Editor of the Medical
World, Philadelphia, U. S. A.

DEAR DOCTOR :-Of course, I received your letter, including bill, and the journals in time. I am now enjoying reading the journals; and am just feeling that I am in U. S. A. discussing matters of the profession with the American doctors. Many thanks for THE WORLD.

You were asking if I were an American for my easy writing, or an Egyptian for my strange name. Yes, as you last mentioned, an Egyptian; obtained my medical education in America.

Sinbellawain, Egypt. ABDUL-AZIZ RAMZY, M.D.

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