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6. A poison is a substance which being in solution in or acting chemically upon the blood is capable of causing death or serious bodily harm. Example: Carbon monoxid, opium, nux vomica, arsenic trioxid, hydrocyanic acid.
7. IMPACTED STONE IN URETER. Symptoms: Colic pain shooting along ureter, tenderness over ureter, bematuria, anuria (if opposit kidney is blocked or diseased), abdominal tumor (persistent or intermittent). Urin contains crystals, blood, or pus. Prolapse of ureter into bladder. Skiagram shows stone. In the majority of cases the symptoms are simply those of renal calculus, and diagnosis is only complete on lumbar exploration and passing ureteral sound.
In some cases the stone can be felt per rectum or per vaginam.
From encysted vesical calculus: impossible clinically.
From cystitis. In this: Urin is alkaline; pus at beginning or end of micturition.
From ureteritis.-Difficult in absence of history of colic.
From vesical tuberculosis. In this: Tubercle in urin; polyuria; frequent micturition; slight hematuria; symptoms not relieved by rest.
From prolapsed inflamed ovary.—Ovary lies behind broad ligament and at greater distance from vaginal wall. Stone is felt in anterolateral fornix. ness and outline are more definit.
The skiagram shows a shadow in the course of the ureter, but this has to be distinguished from that of calcareous iliac glands or that of an appendix concretion (the latter very rarely throws a shadow).
Ureteral catheterization thru the cystoscope not only shows which side is affected, but the end of the catheter may touch the stone and a waxt tip receives a scratched impression.-(Graves' Synopsis of Surgery.)
8. Acetone and diacetic acid are found in the urin in diabetes mellitus.
Acetone may be found in the urin in typhoid, scarlet fever, pneumonia, high fevers generally, some digestiv disturbances, carcinoma, autointoxication, and chloroform narcosis.
Diacetic acid may be found in the urin in the same conditions as acetone.
9. Babinski's reflex: If the skin of the sole of the foot is irritated, extension of the toes occurs Instead of flexion; found in organic hemiplegia and lesions of the pyramidal tract.
Stellwag's sign: Absence or diminution in the frequency of the winking movements of the eyelids, and abnormal width of the palpebral fissure; seen in exophthalmic goiter.
Kernig's sign: If the patient lies on his back and his thigh is flext to a right angle with his body, he is unable to extend the leg on the thigh; found in meningitis.
Age. Young children and young adults. Cause. No local cause, but symptoms of tubercle elsewhere.
Course.-Longer than simple, especially the prodromal stage. Convulsions. Common, even during the compression stage; often precede death. Abdomen.-Markedly retracted.
1. Those associated with the presence of tubercle, and formation of peculiar greenish pus.
2. Attacks the base of brain. 3. Ventricles are distended, and hydrocephalus may follow. Lumbar puncture.-Fluid much less turbid or almost clear; lymphocy tosis.
-(Wheeler and Jack's Handbook of Medicin.)
The first volume took up twelve symptoms, this one nineteen. The plan is to select, analyze, and illustrate individual cases, giving the outcome. A valuable feature under each head is the diagrammatic table showing the relativ frequency of various diseases manifesting the symptom under consideration, thus giving the investigator a fair start as to the probabilities in the case. Exceedingly rare conditions are thus located at a glance, and one may take them up if extended examination and research fail to lead to a diagnosis of some of the commoner forms of ailment. plan is novel and attractiv to the earnest student, and savors much more of clinical instruction than does the average text on diagnosis. This volume covers the following: Abdominal and other Tumors; Vertigo; Diarrhea; Dyspepsia; Hematemesis; Glands; Blood in the Stools; Swelling of the Face; Hemoptysis; Edema of the Legs; Frequent Micturition and Polyuria; Fainting; Hoarseness; Pallor; Swelling of the Arm; Delirium; Palpitation and Arhythmia; Tremor; Ascites and Abdominal Enlargement. Each section has considerable space devoted to general considerations, and this prepares the reader for an intelligent survey of the case under consideration with reference to the cardinal symptom and the relativ frequency of the various diseases likely to be encountered. We are most favorably imprest with the plan, scope and method of execution.-A. L. R.
THE TUBERCULOSIS NURSE. By Ellen N. La Motte, R.N. 316 pages. Publisht by G. P. Putnam's Sons,
6 W. 45th St., New York. Price, $1.50, net.
In the great problem before humanity of eradicating tuberculosis is the necessity to secure effectiv workers. The experience of one who has labored in this field since it has expanded sufficiently to require capable efficient nurses is here given and it includes all phases of the subject, from the executiv to the routine work of the nurse. All the little details that one would meet in this work seem to have been encountered and a satisfactory method of handling them is offered. This book gives the functions and qualifications of the nurse who would join the great work of eradicating tuberculosis and constitutes a handbook for practical workers-physicians and nurses in the tuberculosis campaign.J. C. R.
The first number of the Virginia Motorist has appeared, with Dr. C. A. Bryce, editor of the Southern Clinic, of Richmond, Va., as editor. It is the official organ of the Virginia Automobile Club, and publisht monthly at $1 per year. It is a very attractive and interesting magazine of 28 pages and cover.
“Talk” may be separated from THE WORLD by cutting this leaf on this line. Thus "Talk" without the medical part may be passed among lay friends, &
OUR MONTHLY TALK.
June 12, 1915.
One of our subscribers writes: "I am crazy to see what you will say about Bryan." I didn't expect to say anything about him; but I can say things about the State Department situation that I have not seen in any of the numerous and nauseating editorials that have appeared in the prominent papers. We all agree that John Hay and Philander Knox were great secretaries of state. But let us suppose that a great crisis in the State Department had occurred during the incumbency of either, that the president took the entire matter into his own hands, retired into seclusion for several days while studying the matter, then emerged with the "note" ready to submit to the entire cabinet, all this time ignoring the Secretary of State. Do you think the president would have found Mr. Hay or Mr. Knox still at the head of the State Department when he emerged from his seclusion? Up to this time I have always resented the charge that our President is carrying "school teacher" methods into his administration. I fear that this charge has a basis of fact, however, in his relations to the Department of State. I have not seen a single reference to this as a reasonable cause for Mr. Bryan's resignation, and I suppose Mr. Bryan was too patriotic to urge a personal reason for leaving the cabinet. The papers have for a long time carried news concerning the ignoring of the Secretary of State by the President. It is right and proper for a president to give his personal attention to any department when there is an important and unusual crisis that said department has to deal with. But official propriety and every other consideration demands that such attention be given in conjunction and in consultation with the head of the department involved. Else why have departments at all? Why not the president be the whole thing, with only irresponsible subordinates?
The above does not touch the issue between this country and Germany. Perhaps you want me to go into this, and Mr. Bryan's relation to it. I did not wish nor expect to do so, but of course I have opinions, and if partizans will only possess themselves in peace, I think I can give both sides something to think about. Will you agree-you who can see only one side (whatever side that is)? Are you big enough to listen to one who looks upon every side, without shouting "stop my paper"? Unless you can permit an editor to speak frankly what is in his heart, what's the use of having an
With this understanding I will go ahead. And first I will say that Mr. Bryan is only one man. He is not the question at issue, tho the newspapers see nothing else. In the following discussion I will speak of Mr. Bryan only incidentally.
Everything revolves around the Lusitania disaster; so we will come directly to that. It was a horrible and revolting crime that shocked the entire world; and it will stand in history as a blot upon twentieth century so-called civilization. Over a hundred of our citizens, largely women and children, perished-"drowned like rats." We all wondered what our Government would say or do. Our President ignored his Secretary of State, and emerged from his seclusion with an official note that will stand in history as a literary gem. The note was sent to Germany, and practically the entire nation rallied to the President's support.
The German reply was disappointing-"evasive." But it suggested investigation as to certain facts. Then came from many of our people the bombastic cry of "honor"; nothing to arbitrate, nor even to investigate! The cry of "honor" and unwillingness to arbitrate or investigate always indicates weakness of the side that does so. As beautiful a literary production as President Wilson's first note was, there were some important points that he left untouched. The same is true of his second note. I believe that Mr. Bryan could have done better, Iand would have done better if he had had the opportunity that should have belonged to one in his position. Thousands of my readers will be startled at what I have just said; but in a year from now you will be able to reread these lines without any shock.
You indignantly say: "Wasn't the boat sunk without warning and were not our people destroyed? Is there any doubt about this? What is there to investigate?'
Too true. But why were they there, in a belligerent's ship, in waters which had been, months previously, declared to be a dangerous zonewar zone," in a ship built partly by British Government funds with view to using it as an auxiliary British cruiser, and was then carrying ammunition to be used against the German soldiers in the field? Elaborate warnings by the German embassy had been given, both publicly and individually, to the passengers, particularly to the American passengers, warnings to the effect that it would be dangerous to sail on that ship, particularly on that trip, as special efforts would be made to destroy it.
Have these facts anything to do with the case? Some say not, claiming that our people have a right to take passage on an unarmed passenger ship, under the protection of "international law." And what is international law? Nobody knows. All the nations now at war have riddled it so thoroly that there is scarcely a shred of it left. New and exceedingly destructive agencies have entered into this war, upsetting old rules and demanding new ones, which cannot be made and agreed to until this war is over.
Another question of right may well arise: Has any citizen of the United States a right to tempt fate by deliberately taking a passage on a belligerent's ship, which can readily be changed into a naval vessel, and which is then carrying munitions of war to be used on the European battlefields as soon as it can be transported, when that particular ship (conspicuous in any sea by its size) has been specially threatened, and when there are plenty of opportunities for sailing on neutral ships? any United States citizen a right thus to put our country to the risk of serious complications? You may answer, "Yes, a legal right." Perhaps. But it is a legal right that may be pushed dangerously near to the line of treason.
The next day after the disaster, Dr. Dernburg said: "Screening munitions with American passengers!" Then the feeling ran so high thruout the country that he wisely said no more, went into seclusion, and left the country to-day (June 12th). He and the other German partizans think that we should not sell munitions to the Allies. Here I think that the German partizans are absolutely wrong. Our manufacturers will sell as readily to the Germans as to the Allies, but the Germans cannot transport them. That is not our fault. If it is a sin for private firms in a country to sell war
materials to foreign countries, what firm in the world has been as great and as persistent a sinner in this respect as the famous Krupp works at Essen, Germany? This firm has corrupted individuals connected with purchasing departments of foreign governments, it has gotten up fake war scares, and has used every possible method, honest and dishonest, to sell its goods. Now the complaint that we sell war materials on the open market comes with poor grace from Germany.
But, of course, Germany will oppose the delivery of such goods to her enemies with every means in her power. This is but natural, and it is a part of the war. This is no concern of ours after the goods have left our shores. But we should recognize the fact that it is a very deep concern of the German Government, and that is the chief motive that led to the destruction of the Lusitania. Germany claims the right (in war) to prevent such deliveries by every means in her power. The submarine is her only means. It is a new instrument in naval warfare. Such ships as the Lusitania depend upon their speed to avoid the comparatively slow submarines. Hence such a ship must necessarily be taken by surprise if the effort to destroy it is to have any chance of success. Hence the old rules of "visit and search" and then provide for safety of passengers in case of destruction-the things that President Wilson is insisting upon, are absolutely impossible with a submarine.
Then, insists our President, stop the submarine warfare on unarmed merchant ships. As strongly anti-German as I am in this war, I hold that, as long as war is the hell that it is, it is unreasonable to expect Germany to deliberately put aside her only means of preventing or limiting the delivery of war materials to her enemies. And if the carrying of a few American passengers is to be an effective shield to such a cargo, all that England or France would need to do would be to hire a few Americans to take passage on every ship carrying munitions. It must occur to all who think that passengers and munitions should be separated.
I do not think anybody expected the Lusitania to go down so quickly, whatever might happen to her. We have heard so much about those wonderful safety compartments, that maybe the passengers expected to be saved in any event. We used to hear that it would be almost impossible to sink a modern passenger ship; that if the ship were cut in two, the two parts would remain afloat, owing to the water-tight compartments. Perhaps the Germans who fired the torpedo thought that the ship would not actually sink until plenty of time had elapsed for the escape of the passengers. On the day following the disaster, the captain of the Lusitania said that only one torpedo struck the boat; but that soon after there was a second, internal, explosion. This suggests the presence of war explosives, and accounts for the sudden destruction and sinking of the ship. I think the captain tells a different story now. If you will examine the papers which appeared the first few days after the disaster you will find his statement as I give it above. I remember it very well. It made a strong impression on my mind. However, this is my only evidence concerning the above.
I know what the feeling of safety is on a big ship. Since the Titanic and Lusitania, it is well to realize that this feeling may be misleading. And in time of war, no ship is safe. During August, 1914, many mines were strewn in the North Sea by the Germans. I sailed from Copenhagen Sep
tember 3d on a neutral (Danish) ship. Our course lay across the North Sea. We were anxious about those mines-it should be a crime to put floating mines in the open sea, endangering every kind of shipping wherever the mines may be carried by varying currents. Our captain skirted the Norwegian coast about as far north as Iceland, then cut across west for the open Atlantic, calculating that he could thus go around the mines. reached the Atlantic, and finally America, in safety, but we were anxious all the time we were in the North Sea. I would not have sailed on any sea at that time (nor since) if it had not been important that I should come home. I wonder at so many passengers going abroad in these times, and in belligerent ships, when they could as well go on neutral ships, tho it is a risk now to go abroad in any kind of ships. I think it the height of folly to permit a few hundred who persist in tempting fate by traveling in the most dangerous way, during these dangerous times, to jeopard the peace of our country, threatening the loss of hundreds of thousands of our best lives and billions of treasure in war.
Here the bully will come forward with the question, "Haven't our people got a right to travel if they want to?" I would reply, "Yes, of course; but at their risk, not ours." Then the rejoinder will come: "Of what account is a government that cannot or will not protect its citizens on the high seas?" Well, our Government has many and serious things to do. If you insist that the protection of our flag should go with you wherever you go, it is your duty to be somewhat discreet as to where you go. If you go among the lions of Africa, Uncle Sam will not agree to protect you. War is as savage and as relentless as lions. If you go where war is, you must expect to take the consequences, and we deny your right to drag us into war. This is rather new doctrine, but is it not sound?
We have a complaint against Great Britain for interfering with our foreign trade. This is also against the rules of so-called "international law," but this war has proved that there is no such thing as international law. To be consistent, President Wilson should send one of his "notes" to the British Government, also. Mr. Bryan wanted to do so. But I don't think it would do any good, and it would embarrass us just as, in my humble opinion, the attitude that our Government has assumed toward Germany will lead us to embarrassment.
We find the rules of war to be, keep out or take the consequences. You say, "This is not according to the rules of civilization—not according to international law." True. But war is not civilized. You can no more civilize it than you can civilize a rattlesnake. Belligerents know no international law. They are out to defeat their enemies, and if you get in the way you are going to get hurt. If your commerce with one side strengthens that side, the other side will stop it if it can. That is natural in a fight. It seems to me absurd for us to expect normal conditions on the sea during this greatest war in history.
We hear much of the freedom of the sea-the neutrality of the ocean. But who is going to maintain the neutrality of such a vast domain? I saw the reserves called out in Sweden during the first month of the war, to guard the coast; and in Denmark I saw trenches constructed, trees felled in parks so (Continued over next leaf.)
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that artillery might better defend a certain point, etc. All this to defend the neutrality of these little countries. And I understand that Switzerland and Holland have been very busy from the beginning with nearly every available man at the colors, ready at a moment at every point to defend their neutrality. Who will defend the neutrality of the vast expanses of the watery wastes on the globe? Wherever belligerents can get together they are going to fight. And why shouldn't they, as long as war exists? It is my humble opinion that no power will "rule the wave" with greater justice, consideration and restraint than Britannia has, during peace and war, until there shall be an international navy to render this service for the peace of the world. At present every nation is supposed to be responsible for the ocean out to an imaginary line three miles from its coast; beyond this line being "no-man's-land" or water. The fact is, force will always rule here as it always has everywhere. Let us make it intelligent force, and govern it in the spirit of justice in the interest of all. Query: What if the Lusitania had been destroyed just within three miles of the Irish coast, instead of ten miles out? The loss of life, etc., would have been probably about the same. Would being within the three-mile limit have made any difference in international relations?
Also, considering the danger to the Lusitania, her value, her cargo both human and munitions of war, could not our Government reasonably make a complaint of the failure of the British Government to give a convoy for safety thru the danger zone? There seems to have been a total lack of precautions of all kinds, giving the enemies to this ship every opportunity to do just what they said they would try to do. Now who is to answer for the consequences?
I believe that Germany began this war. believe that it wanted the war, tho not on such a large scale. I believe that it was prepared for the war, and perceiving that its neighbors were not prepared, it determined that then was an opportune time for "der Tag" (the day). Its plans were ambitious. It seized on the Serbian incident as a pretext. It rather counted on the adherence of Italy, and expected England to stay out. expected Belgium to submit as Luxemburg did. We see now, even with Italy out, with England neutral, Germany and Austria could have had France and Russia by the throat long ago. That accomplished, England could not then have made effective resistance even if she wanted to. Germany would then dominate Europe. Possibly the German Eagle would have been a wise and generous dominating power, but I very seriously doubt it.
This is my view, and I have studied the situation to my own satisfaction from many points of view. But this is my point: As thoroly anti-German as I am in this war, I will not allow my opinions to degenerate into prejudice, and thus become blinded to the German side (and there is a German side) of the Lusitania incident and the submarine, munitions, etc., situation. President Wilson has not dealt with these matters adequately, and the indications are that Mr. Bryan would have dealt with them more adequately; I do not believe that the course outlined by President Wilson's two notes will lead to a satisfactory nor permanent settlement of the points at issue. Mr. Bryan was disposed to recognize the important facts in the case, which is a necessary basis for a satisfactory settlement. He was also in favor of protesting to England against interference with our foreign
commerce. This for consistency, at least; and for making an effort to have the old "international laws" observed. But it may as well be recognized that in time of war, particularly such a war as is now raging in Europe, these "international laws become "scraps of paper" as soon as they get in the way of the fighting. It will always be so until an international government is established, with sufficient power to maintain its laws. All efficient government must rest finally upon force. Sentiment immediately gives way to force, if sentiment is on one side and force on the other. We should put force behind the best sentiment, and the force should be superior to any other force, else it cannot stand. That means that hereafter no nation can rely upon itself alone. As powerful and as "prepared" as Germany is, she will have to succumb in this contest. Civilization cannot permit Germany's selfish ambitions to be realized. However, German civilization, minus the militarism, must and will be preserved.
If Germany had, during the past 25 years, spent 10% of the time and treasure she has to build her fighting machine, in cultivating international amity instead of selfishness, she would have friends instead of "enemies.' The same truth can be applied to other nations, but to most of them in less degree. But if all had devoted only 1% of their military expense during the last 25 years to developing an international goverment, of which all would be a part, as each of our states is a part of our national government, this war would have been prevented. All would gain by such a program, as each one of our states gains by being in the Union. The German Government has led its people to the shambles for the glory of the Government, but it will be in vain. When the German people are led in the paths of peace, so that their sterling qualities may have an opportunity to win their proper reward, it will not be in vain. May all the nations learn that in war, all lose; but in peace, all win.
Later: It is a great pleasure to me to be able to state that the newspaper reports above mentioned concerning the ignoring of Mr. Bryan as secretary of state by the president are entirely erroneous. In the newspapers of Saturday, June 19th, and in a personal letter to me of same date, Mr. Bryan states that "not a single statement has been issued by the president, or prepared by him, about which I have not had the privilege of conferring with him beforehand, and the opportunity to offer suggestions after it was prepared."
Observations of An American Surgeon. The inhabitants of the warring nations to-day are divided into two classes, those who are killing man and those who are saving man. There is no other occupation. Railways are hauling food, ammunition and men to the battle line, and hauling back the wounded. Factories are turning out uniforms and guns, powder and shot. Telegraphs and telephones speak only of war. The printing press describes battles and records the names of the dead. Hotels and schools are hospitals and parks are drilling grounds. Iron and steel, copper and lead, are implements of injury and death, while the universities and scientific laboratories are deserted sanctuaries. Wealth and station, titles and honors, are lost; man is stripped of his trappings of civilization and has reverted to a common brute level. DR. G. W. CRILE, in The Nation, June 3, 1915.