probably know the causal germ. As in the case of typhoid fever it may prove possible to produce an active immunity by the means of vaccines. An Armenian investigator has used goat serum to produce this protection. Protective sera have been used in scarlet fever. Here the serum of convalescent patients was used until other observers found that normal human serum had the same effect. In closing, I should like to emphasize one point with regard to measles, that is if we are going to expose these children we should do it at a time when the danger of lighting up a tubercular process in a lymph gland is least. I may remind you that the outlook of children who are infected with tuberculosis before they are two years old is bad and on the other hand that the infection tends to undergo a normal retrogression by the time they are seven or eight. So therefore on these grounds I should urge that if we intend to only consider the possibility of the exposure that is hinted at by the doctor, it should be done late in childhood. I may repeat, however, that I will consider it far more desirable to make an attempt to find out a means of producing the disease in a milder form or at least to use a serum. Either one of these two methods is far to be preferred to the indiscriminate exposure of non-infected children. MARY STRONG (closing): I don't think the doctor discussed the paper in such a way as to disagree with any of my statements. I said children had better have measles after they got over babyhood. I said from two; he thinks they ought to be a little bit older than that. Perhaps that is so, but a good, stout two-year-old will convalesce in plenty of fresh air, without some fool grandmother shuts the air off. He referred to one thing which I know about but did not put in the paper. I was moderately familiar from my reading at intervals in the medical journals from mumps and other things; but my paper did not enable me to discuss mumps, with immunization plague, scarlet fever, etc. I do not see that anything Dr. Beifield says militates in the slightest degree against my belief that immunity under present conditions ought to be acquired in childhood. SINUSITIS, A SOURCE OF SYSTEMIC THADDEUS A. MINASSIAN, M. S., 1 M. D. During the past two years a number of cases have come under my observation, a brief account of which I wish to give before discussing my subject. They were cases of chronic sinus infection, associated with such general infections as acute articular rheumatism, arthritis deformans, chronic endocarditis with valvular lesions and other systemic complications. Mrs. P. entered the eye, ear, nose and throat service of the Iowa State University Hospital, September 13, 1913, complaining of headaches and crust formation in nose. Diagnosis atrophic rhinitis with double pansinusitis. Physical examination by the internist was made and diagnosis of rheumatic endocarditis with mitral stenosis was made. *Read before the Medical Society of the Missouri Valley at Des Moines, Ia., September 23, 1915. Mr. C. was admitted in the same service Diof the State Hospital January 1, 1914. agnosis-chronic pansinusitis right. Internist's report of his general condition stated chronic endocarditis with mitral stenosis, and also acute articular rheumatism. Three other cases of various forms of sinus infection with either acute articular rheumatism, or chronic arthritis were treated about this time at the Mercy Hospital at Iowa City, where joint affections had resisted all forms of treatments, until the sinuses were drained and the foci of infection were gotten rid of; then under proper systemic and local treatments of the joints, great improvement resulted. Of these three cases, one especially made a remarkable recovery from the rheumatic trouble. Sister M., of Clinton, had for years been suffering from attacks of acute articular rheumatism, which did not improve materially under any kind of treatment. Examination of her sinuses revealed empyemia of right antrum of Highmore, and right chronic ethmoiditis. Drainage of her sinuses was followed by immediate recovery from her rheumatic attacks. A great deal of research work, both clinical and laboratory, has been done in recent years in tracing general infections to tonsillar, or alveolar origin. While very little attention has been given to like pathologic processes of nasal origin. The average general practitioner seems to be well informed on the subject of visceral complications of infection of the palatine or pharangeal tonsils; on the other hand, he knows but little of localizing the infecting agent following the diseases of the nose, or its accessory sinuses. It is probable, not to say certain, that The posthe complications are the same. sibility of complications involving the serous membranes, especially the endocardium and lining of the joints, in the course of acute infections of the nose is no longer denied by any one, although perhaps these complications appear less frequently here than following tonsillitis. In discussing the etiology of the so-called idiopathic arthritis and nephritis, Billings gives nine sources as sites of original infection. He considers faucial and pharangeal tonsils as the most common and prolific source, abscess of the gums with pyorrhea alveolaris second, and chronic sinus suppuration as third in importance. From the earliest times, the relation between certain forms of infectious, angina and rheumatism has been recognized, but it has been only of late we have come to real ize that chronic infections of the nose and sinuses as well may the cause of various forms of arthritis; and why not? Since chronic ethmoiditis is just as common as chronic tonsillitis, and the lymphatic drainage of both is into the same region. That we may appreciate this fact as we should, I shall briefly describe the lymphatic drainage of the accessory sinuses. The lymphatic reticulum of the antrum of Highmore is composed of a series of small canals, which form large and irregular meshes and finally converge towards the opening of the antrum like the spokes of a wheel, where they surround the free edge of the ostium, to then unite with the central nasal lymphatic vessel. A fine network of lymphatic vessels are said to line the ethmoidal sinuses. These vessels are said to communicate with each other by means of small canaliculi, which perforate the cell walls, and then unite to form a few larger vessels which join those of the nose. Very little is known concerning the existence of any lymphatic reticulum, in the frontal, or sphenoidal sinuses, but Poli considers it most probable that such a network exists, connected with that of the nose. Thus, the terminal lymph vessels of the accessory sinuses join those of the nasal fossae proper, which in turn anastomose with those of the nasopharynx and tonsils, then drain into the lateral retro-pharangeal and superior deep cervical glands. They in turn empty into the inferior deep cervical glands, these being the last substation, so to speak, the efferent vessels from which form a common lymphatic jugular trunk, which opens on the right side into the veins at the junction of the jugular and subclavian, and on the left side into the terminal bend of the thoracic duct. From the above description, it is evident that systemic infection of nasal origin is as probable, though perhaps not as frequent, as infection of tonsillar origin, since the lymphatics of the former as well as those of the latter region drain through the inferior deep cervical glands directly into the venous circulation. Some will probably ask why is it that only a few cases with chronic sinus suppuration show symptoms of systemic infection. The probable explanation is that during and following acute stage of sinus infection, we have a partial immunization on the part of the patient, a reduced virulence on the part of the infecting organisms, and an attempt on the part of the surrounding tissues to isolate or encapsulate the infected focus; so that in many cases the process remains localized. However, in some cases, often before this encapsulation is complete or even afterward, there are leaks, so that the organisms escape into the general cir culation and produce lesions in other organs. Again, some may ask why systemic infections following sinusitis are not as frequent as those following chronic tonsillitis? Two reasons may be stated: First, for anatomical and histological reasons, there is very little attempt, probably none, on the part of the tissues at encapsulation of the infecting focus in case of chronic tonsillitis, as we have just described in cases of chronic sinusitis, so that in the case of the former the organisms have much freer passage into the circulation, in fact they meet no barriers until they reach the first chain of lymphatic glands. Second, the diagnosis of chronic sinusitis is much more difficult to make so that many cases causing systemic infections are probably often overlooked. As Dean says, "when the diagnosis is better understood and the frequency of this condition is recognized and its presence more often detected, the sinuses will rival the tonsils as sources of systemic infection." In conclusion, I wish to quote Broeckart, who says: "We have no reason to be astonished over the determination of the cause of the disease at a distance, and the explanation of it is very simple. After having crossed the first barriers which the lym phatic ganglia oppose to them, the germs reach the afferent vessels of the inferior glands of the deep cervical chain, and these pass directly into the systemic circulation; from them they are capable of producing the gravest and most varied visceral disorders according to their own virulence, and according to the morbid aptitude of the subject, or the condition of resistance of each of the organs at the moment of invasion." 308 Bank Building. For inflamed joints, from sprains or injuries, and inflamed bunions, the veratrum ointment-8 grains to the ounce of vaseline, is a good general anti-pain unguent. Topical application of equal parts iodine and glycerin (weaker if painful) will abort and quickly cure many acute inflammations about the nose and throat. Useful also in chronic forms. The thyroid treatment of obesity is still the subject of discussion. In obesity due to over-eating, belladonna has been found to take the edge off the patient's appetite. Address all communications to the Managing Editor, 613 Lathrop Building, Kansas City, Mo. Vol. XXXIV DECEMBER, 1915 Editorial PELLAGRA INVESTIGATED, CURED, ERADICATED BY UNCLE SAM (?) Among the most recently issued pamphlets of the U. S. Public Health Service is one of Nov. 12th to the effect that pellagra has been thoroughly investigated, that its origin is due to insufficient proteid food and its cure is full feeding of this class of foodstuffs. Also it has been produced clinically, at will, among convicts, by overfeeding of carbohydrates and withholding proteids, and that a reversal of this regimen cures it at once. The work has been done at the Mississippi State Penitentiary at Jackson under the supervision of surgeons Joseph Goldberger and G. A. Wheeler. There is a suggestion of haste about the report and a possibility of it being classified with the "half baked" philosophies we are learning to avoid. We have been accustomed to accept government reports upon medicine as reliable gospel truth, but this one fails to "measure up" to the standard. In the first place the work has been carried on in a district where the disease is prevalent, so that other factors of etiological value have not been eliminated nor considered. Placing twelve convicts upon a diet deprived of all nitrogen practically, thereby No. 12 lowering their vitality may permit the true factor-whatever it may be to assert itself, and the disease exhibit itself; then restore full diet whereby resistance is elevated to normal limits and the disease disappears. The experience is a very debatable one. Why have not cases recovered elsewhere in institutions or families where full well-rounded diet has been exhibited? Such a restricted diet as outlined, has been followed by the writer's patients for weeks at a time without any suggestion of pellagra. There are institutions in this country where a purely carbohydrate diet is prescribed for long periods, without ill results. To be sure, in these cases sanitation and hygiene are considered; they do not live in squalor nor filth. It is admitted by the investigators the disease prevails among the poor, the rich do not become victims; therefore a factor must be found which comports with squalor and filth, indefinable as it may be, to which the insufficient diet when added turns the scales. It is unfortunate for the profession that articles from accredited institutions or the government, of such revolutionary optimism should be permitted to reach the pub lic. It results in disappointment to the patient and chargin to the profession. It is hoped the experiments of the Public Health Service surgeons are on the right track, and the problem is to be solved, but the report as it stands today is hardly convincing, nor is it entitled to full consideration, if from no other shortcoming, the time limit and the limited field of experimentation. J.M.B. charge from the eye or eyes of such infant inde pendent of the nature of the infection, occurring any time within two weeks after the birth of such infant, shall be known as 'inflammation of the eyes of the new born."" Sec. 2. It shall be the duty of any physician, surgeon, obstetrician, midwife, nurse, maternity home or hospital and any person in attendance at childbirth, knowing the condition above defined to exist, within six hours thereafter to report such fact to the local board of health of city, village or political subdivision thereof. Sec. 3. The local health officer must keep on file a record of all such cases and report the results of his investigation to the State Board in conformity with the regulations issued by them. Sec. 4. The State Board shall enforce the provisions of this act; shall issue rules and regula tions; provide for the gratuitous distribution of a scientific prophylactic; to provide, if necessary, daily inspection and prompt and gratuitous treatment to any infant whose eyes are infected. To keep a record of any and all cases filed in the office of the State Board of Health to become a PREVENTION OF BLINDNESS. Prevention is the watchword of the present. Much careful thought and scientific study is given to the cause of diseases and the most effective measures for its prevention. The Missouri State Medical Society has a standing committee on the "Prevention of Blindness," whose duty it is to give part of the annual report to the governor. To If publicity to the causes of those diseases which lead to blindness, and by lectures, stereopticon views before various interested societies explain the most effective measures for the conservation of vision. it can be shown, then that blindness to any large extent exists which under, more favorable conditions should have been avoided, it manifestly becomes the duty of physicians to initiate such measures as may be necessary for the public safety, because others neither know that eyes are lost which should be saved, nor are they informed as to what should be done to prevent such disasters. More than one-half of blindness is preventable, and about onethird of the blindness is due to ophthalmia neonatorum. Industrial accidents are responsible for the production of cases of blindness which by proper protection could be prevented. Wood alcohol claims some victims. The following has been issued by the Cincinnati Department of Health, and is herewith reproduced on account of the great importance of the subject: The attention of the medical profession is herewith drawn to House Bill No. 470, introduced by Mr. Deaton, known as a bill for the prevention of blindness from inflammation of the eyes of the new born. This bill passed both houses, was signed by the governor and will become a law in ninety days. The designation ophthalmia neonatorum has by design been omitted from this bill, since it is now a well-recognized fact that many other micro-organisms in addition to the gonococcus may lead to inflammation, suppuration and total destruction of the cornea and subsequent blind ness. report any and all violations of this act to the State Medical Board of Examination and Registration, local police and county prosecutor wherein said misdemeanor may have been committed. Sec. 5. It shall be the duty of physicians, midwives, or other persons in attendance upon a case of childbirth in a maternity home, hospital, public or charitable institution, in every infant immediately after birth, to use some prophylactic against inflammation of the eyes of the new-born and to make record of the prophylactic used. Sec. 6. It shall be the duty of every midwife, in every case of childbirth, to use some prophylactic. Sec. 7. The failure of any physician, midwife, etc., as herein before set forth, to comply with any of the provisions of this act, shall constitute a misdemeanor under this act, and the offender shall on conviction thereof be fined for a first offense not to exceed fifty dollars, for a second offense not to exceed one hundred dollars, for a third offense and thereafter not to exceed two hundred dollars, for each violation. It shall be the duty of the local police or county prosecutor to prosecute for all misdemeanors as herein P.I.L. stated. CALLAWAY COUNTY (MO.) MEDICAL SOCIETY. At the regular meeting of the Callaway County Medical Society, November 11th, the session was held at the State Hospital, Fulton, Mo. Dr. R. N. Crews, president, and Dr. M. Yates, secretary, are to be congratulated in their successful arrangement of an all-day program. Dr. G. D. McCall, vice-president, gave a medical clinic in the surgical hospital operating-room, demonstrating the correctness of a provisional diagnosis of empyema. Drs. W. W. Duke, S. Grover Burnett, Howard Hill and L. S. Milne, of Kansas City, each gave illustrated lectures. Dr. M. O. Biggs, superintendent State Hospital, and his staff, Drs. Hermon S. Major, Floyd A. Martin and E. E. Evans, contributed through the wealth of clinical material at their command. Close inspection showed the wards to be clean as pink, regardless of the full quota of unclean, irresponsible patients belonging to every institution for the insane. The working service records, the history records, the exact detail of careful examinations on admissions, the recorded diagnoses made by exclusion, the segregation of patients according to the classified diagnosis, materially aiding in their treatment and the individual case treatment, including the proper application of the continuous bath in delirious manias with temperature-all these indicate the practice of medicine along scientific lines. These demonstrations pointed out by Dr. Major are just what should be done in all hospitals for the insane, but its the first time we have seen it done in any public institution for the insane in the State of Missouri. Its evident that our governor has inade a wise selection in the medical staff of Hospital No. 1. With this assistance the Callaway Medical Society has rare opportunities. AMERICAN MEDICAL EDITORS' ASSOCIATION. For over a quarter of a century the American Medical Editors' Association has been the most virile, independent and original of all the societies that have met in this country. This body usually holds its annual meetings at the same time and place as the American Medical Association, generally the day before, ending their one or two days session, with a banquet, which for a long time has been the most brilliant and unconventional social occasion of the year. 1 Eminent physicians, other than editors, I were always guests; clergymen, lawyers and others who participated in these events were astonished at the sharp repartee indulged in by the editors. These gatherings were by no means "mutual admiration" events. Every man's weakness came to the light, often in a merciless form, but so humorous and good natured the criticisms as to create the highSest kind of merriment. Editors as a class are very familiar with the pomposity and weakness of the profession and are very quick to discern motives and purposes in schemes and plans that ostensibly are used to promote the profession. While they do not often express themselves on the printed page, when they come to the annual meetings, their views and opinions are aired with astonishing familiarity, and with an intuition that is not unfrequently surprising. The last annual meeting which took place in New York was no exception to the rule. In many respects it was more brilliant and interesting than the others. Dr. H. E. Lewis was president, and wielded the gavel at the annual banquet, with a true editorial spirit. Dr. Jos. MacDonald, Jr., the well-known secretary, who for years has directed the interests of the association, always manages to have some epoch-making papers prominent. A dozen different papers were read, and Dr. E. C. Register, editor of the Charlotte Medical Journal, was elected president, and Dr. W. A. Jones of Minneapolis, vice-president. Both are very able men, of large experience in journalism and fully alive to the great interests which the society has sought to promote. The banquet which followed was just a trifle more classy than any that has ever been held, and showed clearly that the medical editors are keenly alive to the great interests of medical literature. Several years ago this association was considered too critical and sharp and some of the members who had been "laughed down" for their weaknesses withdrew and now has a rival society comprising the editors of the state journals, but unfortunately their meetings are held behind closed doors, and however brilliant and startling the proceedings may be, one never hears on the outside. This association is thoroughly independent. Each editor carries out his own poli- · cies and this is more nearly democratic than any other association in this country. The new president, Dr. Register, is a highly cultivated physician and the best interests of the association will be upheld during his presidency. Of the genius of Dr. MacDonald, the secretary, and his wide acquaintance with both editors and journals, too much cannot be said. This association represents a distinct branch in medicine and every editor who wishes to keep in touch with the highest range of American medicine should join it. Physicians who would know the medical editors in this country, should attend its meetings and banquets and get new perspectives of journalism, medical events and society work, above all prestige, theories and suppressive organizations. T.D.C. You can't judge a man's wisdom by the length of his whiskers, but years will ripen a man's judgment ef he's got any t' begin with. |