A Typhoid Carrier

In the Bulletin of the Kansas State Board of Health, October, 1912, S. J. Crumbine, secretary of the state board, reports the interesting case of Mrs. D., a typhoid carrier. At a luncheon served at the home of Mrs. D., pressed chicken sandwiches prepared by her were eaten by the guests. Of the twenty-six persons present all but one ate the sandwiches, and later developed what was diagnosed as food poisoning, and still later symptoms of typhoid presented in all these persons except those who had previously had that disease. Subsequently twelve secondary cases developed in the families of those affected. Mrs. D. had formerly been operated on for gall-stones and at the time of the luncheon had a permanent biliary fistula. It was suggested by the former physician of Mrs. D. that, as she had had typhoid nine years before, she was probably the source of the infection. A thorough investigation disclosed the fact that, during the period since the operation for gall-stones, members of the family of Mrs. D. and a number of her neighbors, who had visited her and had eaten at her house, had suffered attacks of typhoid. Samples of the bile secretion from the fistula of Mrs. D. were examined in various laboratories and definite determination made of the Bacillus typhosus. The fact was thereby established that Mrs. D. was a chronic typhoid carrier and the infection of the persons present at the luncheon could be directly, and the twelve secondary cases indirectly, attributed 'to this source. An operation for closing the fistula was successful and subsequent examinations of urine and stools proved negative as to the typhoid bacillus. Altogether it is estimated that seventy-six cases of typhoid originated either primarily or secondarily from this single carrier during the nine years since she had had typhoid.

The Spread of Infantile Paralysis

In an article by Mr. Charles T. Brues of the Bussey Institution of Harvard University, on insects as agents in the spread of disease, published in the last issue of the Monthly, a footnote was added to the effect that since the article had been written experiments with monkeys by the author and Dr. Rosenau showed that infantile paralysis, poliomyelitis, can be transmitted from one monkey to another by the stable fly, Stomoxys calcitrans. A brief account of the experiments was presented before the International Congress on Hygiene and Demography

in September and has been printed in the Monthly Bulletin of the Massachusetts State Board of Health.

Monkeys were infected by injecting virus from man into the central nervous system, and large numbers of stable flies were permitted to bite them. Twelve healthy monkeys were then exposed to the bites of the same flies. Six of them contracted the disease and of these three died from it. The authors state that they would like to emphasize the fact that this does not appear to be simply a mechanical transference, but rather a biological one, requiring a period of extrinsic incubation in the intermediate host. Details are, however, lacking concerning the period of incubation and the precautions used to avoid passive contamination. Dr. Flexner had in one case obtained infection by a filtrate from bedbugs which had fed on the blood of inoculated monkeys.

The preponderance of infantile paralysis in August, September and October, its prevalence in rural districts and its failure to spread in schools, asylums and the like, suggest an insect carrier, and the fact that the virus is a filterable parasite, invisible with the microscope, suggests an analogy with yellow fever and dengue known to be inoculated by mosquitoes. Dr. Flexner and his fellow workers at the Rockefeller Institute have, however, adduced strong experimental evidence that the mucous membrane of the nose is the site both of egress and ingress of the virus. While the problem in the case of infantile paralysis is not yet completely solved, we may take satisfaction in the progress made by experimental methods in discovering the causes and preventing the occurrence of many of the most terrible diseases.-The Popular Science Monthly, Jan., 1913. JOSEPH M. AIKIN (Omaha).

Double Bismuth Meal for X-Ray Diagnosis of Stomach

Lesions

Haudek advises the use of a bismuth meal six hours before the patient comes for examination. The distribution of this meal is first noted, then a second is given and the stomach watched to note the peristaltic action, size, position and form. By employing this technic Holzknecht has arranged a series of symptom complexes by which he is enabled to diagnose the various types of gastric ulcer, carcinoma in various stages and changes in the stomach produced by adhesions or pressure from without. TYLER (Omaha).

A JOURNAL OF MEDICINE AND SURGERY

Published Monthly by Western Medical Review Company, 701 So. 13th Street, Omaha, Neb. Per Annum, $2.00, 20c per copy. The Western Medical Review is the journal of the Nebraska State Medical Association and is sent by order of the Association to each of its members. Entered as second-class matter at the Postoffice of Omaha, Nebraska, under the act of Congress of March 3, 1879. Telephone Douglas 1290.

The Scientific Sessions of the State Meeting: How To Accomplish the Most.

How to conduct the scientific sessions of the state meeting to the best advantage is a perennial problem. At intervals for more than a dozen years the association has met in two sections, only to again revert to the older method of one body the ensuing year. This argues that the dual section method is not universally satisfactory. The argument for separate sections has for its basis the assertion that the association has grown to such an extent that the fifty to seventy papers cannot be presented and properly discussed in one meeting place. In the working

Omaha Public Library

out of the matter it so happens that many members want to attend sessions in both sections, or are permeated by the spirit of unrest, so that there is a more or less constant surging back and forth from one meeting room to another, confusion, often small attendance at both places, and little good derived by any

one.

It is understood that the coming meeting is to be conducted as one body and the writer has been asked to suggest how it may be done to the best advantage, and for the greatest good to the greatest number.

It is self evident that the essayists (hailing from all parts of the state, and some coming long distances), have the first right to be heard. As a basis for argument it may be stated that the actual time given to scientific work is about eighteen hours during the three days of the meeting, and that if fifty essayists appear to present papers, about twenty-five minutes is the average time to which each paper is entitled both for reading and discussion.

It therefore becomes absolutely necessary that the sessions begin promptly at the appointed hour and minute, that essayists be limited to twenty minutes, and that no requests for additional time be allowed by the chair, and that motions to give an essayist more time be ruled out of order by the chair, that discussions, by any one person, be limited to the five minutes provided by the fundamental laws, and that no member be heard more than once.

Inasmuch as the scientific part of the program is collected in three sections, it is thought the courtesy of presiding over the work of a particular section belongs to the chairman of that section. In view of the fact that the work is all done in one body, this may well be doubted. The courtesy of presiding over a part of the section work may be given to the chairman thereof, but the president of the association is the responsible. head of the annual meeting, and he is the one to hold the reins and make matters go. The rights of many essayists tower above the rights of courtesy of the section heads.

It has been demonstrated that by conserving every minute,

beginning promptly, keeping busy, disallowing prolonged discussion, and allowing no one, however prominent, to speak twice on the same subject, not tolerating discussion foreign to the subject before the meeting, all papers presented can be read and discussed profitably, and the interest of the members be held to the end. F. A. LONG (Madison)

The Pathology of Competitive Athleticism.

This subject for notice in this journal is presented because of reports by the Surgeon-general of the Navy of the subsequent history: first of 265 former athletes of the Naval Academy, classes from 1891 to 1911. (J. A. M. A. Jan. 6th, 1912, P. 40) and of 580 non-athletic mid-shipmen, from 1892 to 1911, inclusive (J. A. M. A., Jan. 11th, 1913, P. 131) and, finally, by a very capable editorial in the J. A. M. A. for February 8th, 1913, pages 446 and 447.

We quote from the journal of the American Medical association the results of these investigations, which to the writer of these lines have been a foregone conclusion for many years; and not from statistics, such as those to be presently quoted, or the frequent reports of deaths and serious, often permanent injuries from so-called college athletics, but by reasonings based on scientific facts, long a property of medical men, but seldom heeded by pseudo-scientists, abounding in the ranks of college instructors.

"Any comparison between the two groups in this matter should of course result in favor of the athletes, for they are not only picked men, but as the surgeon-general says, twice selected picked men. They are the men who, it would reasonably be supposed, would be best able to resist the real effects of over training and overstraining and who should, other conditions being equal, possess a comparatively greater expectation of health and longevity. After a careful collation of the data, however, this has not proved to be the case. It has been found that from those diseases to which athletics have a possible or probable causative relation there has been but one death among