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he never did he got another doctor.

THE MEDICAL FORTNIGHTLY Spas are all right when we must have them,

so is the country, and so are the mountains
and the seashore, but everybody cannot avail
himself of these therapeutic adjuvants, and
people want to get well at home; they MUST
do so, and if they cannot be told the way to
health by you they will eventually go else-
where, and their leaving you will have done
you no good!

Issued Tenth and Twenty-Fifth of Every Month.
THOMAS A. HOPKINS,
Managing Editor.

Editorial Staff:

O. E. LADEMANN, Internal Medicine.

JOHN MCHALE DEAN, Surgery.

F. P. NORBURY, Nervous and Mental Diseases.

R. B. H. GRADWOHL. Pathology and Bacteriology.
W. H. VOGT, Obstetrics and Gynecology.
WALDEMAR FISCHER, Ophthalmology.

A. LEVY, Pediatrics.

W. T. HIRSCHI, Therapeutics.

A. F. KOETTER, Otology.

HERMAN STOLTE, Laryngology and Rhinology.
T. A. HOPKINS, Genito-Urinary Diseases.

ROBERT H. DAVIS, Dermatology.
Editorial Rooms, Suite 319-321 Century Building, St. Louis.

EDITORIAL

As a general proposition it is the physician's duty to consider practicability in all his dealings with his clientele and his failure to do

so often results disastrously. Nowhere is discretion more needed than in prescribing remedial measures other than medicines, people want to be told what they must do to get well in the surroundings where they are living and are forced to continue to live, and with the means at their command, it is their right to receive the best. instruction applicable to the circumstances. To advise a couple of months at the seashore to a mother of several small children, in the family of a wage earner who has no income save his wage, is little short of cruel; to advise a man with a total income of sixty dollars a month and a family to support, to ride horseback a couple of hours each day, when you must know that he couldn't hire the horse for less than his entire income in St. Louis, is preposterous. Yet we keep hearing of just such impractical advice being given patients by physicians who should know better. The vast majority of the people whom we meet have to study ways and means, they have no endless leisure and no inexhaustible bank account, and the remedial means must be fitted to their situation. It was recently my privilege to hear the parents of a ten-year-old girl discussing the treatment advised by a physician, five years out of college, for the child who was suffering with a mild attack of chorea, The father stated that following this advice meant the breaking up of his family for a year, the exiling of the mother and child, leaving him to care for the three other children as best he could, and the devoting of his entire income to the two ab.

Impractical
Medicine.

Happily in the case of at least one disease treatment at home and under normal surroundings is having proper attention; we refer to pulmonary tuberculosis. There can no longer be question as to the efficacy of rationally conducted home treatment, and with this treatment has come hope to the many who found it impossible to seek more favored conditions. If you have a very wealthy clientele you may find it possible to South in the winter, you may use the massend your patients North in the summer and euse frequently, and your patients may be singing your praises at the various spas; but if you are meeting the people most of us meet you will preach open windows, proper clothing and food, sensible exercise and a host of other things which are at every man's command, and may be used without causing financial distress to the patient and his family. The man who will discover and apply these things will live in the love of his patients.

THE motives prompting argument for making of the Female Hospital a department of the City Hospital have been questioned in the present discussion ofthe subject, and make further comment justifiable. The institution is situated in one of the remote parts of the city, far from the offices of the Health Department, the City Dispensary and from the City Hospital with which institutions it is closely identified, its distance from the dispensary is especially to its disadvantage; the hospital building has reached an age of apologetic usefulness, and it is not at all suited to modern hospital demands. Presently this building must be razed and another erected in its place; wisdom would point to the erection of the new building as a pavilion of the City Hospital group. We believe that this union would present nothing but advantages over the continued independent conduct of the hospital, and the strongest argument in favor of the change is the fact that those officially interested in the institution express themselves as considering the change

The Female Hospital.

a desideratum. There may be legal tangles to be straightened out before this can be effected, there doubtless are, but the move is in the line of progress, and it is going to be.

The Female Hospital is the second hospital in point of importance conducted by the city, in spite of the fact of being housed in a building which has outlived its best usefulness; the work being done there is of a class and volume which is splendid; the old building holds an up-to-date hospital. Its present conduct is scientifically effective, but its usefulness would be increased were the institution housed in a modern pavilion and were the patients delivered to it with less of an ambulance ride as will be the case after the union is effected. The pleas ure of service will then be tremendously increased.

We do not believe that any of our institutions will ever be able to do effective work with any smaller medical and nursing forces than they now have, and any argument claiming economy as a result of union must refer to the retinue of help which will doubtless be considerably decreased when the institutions are conducted as a single menage.

IN France there were eleven hundred less medical students in 1906 than there were in 1895, not counting foreign students whose numbers had diminished 46.8 per cent; that is, from 1137 in 1895 to 604 in 1906. In the

United States there was a decrease in 1906 of

about 25 per cent.

HUNTING FATALITIES FOR THE 1906 SEASON-Press reports give the following statistics of casualties of the hunting season in all the states of the fall season, 74 killed and 70 wounded. Northern Michigan and Wisconsin, where the open season for deer closed November 30, went ahead of the record for last year in deaths, 28 being reported this season, against 26 for the previous one, but in the number of persons injured this year's record falls far below that of the previous one, having only 20 serious accidents which did not result in death. The larger part of the deaths were the result of accidental discharges of shot-guns, many of them occurring while the owners were cleaning the weapons. Statistics for New England to midnight of November 30, when the close season on moose went into effect, show that 19 human lives were lost in the woods. Of these eight fatalities occurred in Maine, six in Massachusetts, six in New Hampshire,

and two in Vermont. Of the above total 13 were directly the result of accidents causing the death of the victims being mistaken for

game.

THE REVIEWER'S TABLE

Books, Reprints, and Instruments for this department, should be sent to the Managing Editor, Century Building, St. Louis

THE DISEASES OF INFANCY AND CHILDHOOD.Designed for the Use of Students and Practitioners of Medicine. By Henry Koplik, M. D., Attending Physician to the Mount Sinai Hospital: formerly Attending Physician to the Good Samaritan Dispensary. New York; Ex-President of the American Pediatric Society; member of the Association of American Physicians, and of the Academy of Medicine. Second edition, thoroughly revised and enlarged. New York and Philadelphia: Lea Brothers & Co., 1906. (Cloth, $5.00 net; Leather, $6.00 net.)

In its first edition this work has established for itself a firm place in the esteem and confidence of the profession, and the mere announcement of a revised, and somewhat enlarged edition must needs excite pleasurable anticipation. In revising Dr. Koplik has entirely rewritten some sections of the book, and has made changes wherever it has seemed that change would increase its usefulness. He has made some considerable additions to the text. There has been no radical change in his general presentation of the subject. The profession is at this time especially interested in anything relating to infant feeding, and it is a definite pleasure to note the careful attention and the clear presentation he has given the subject. His discussion of the treatment of diseases of the new-born is also an especially interesting department of the work.

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THE NEW THERAPEUTIC GAZETTE.-The publishers announce that after January 1st next the Therapeutic Gazette, Medical Age and Medicine will be incorporated in one journal, which will be known as The Therapeutic Gazette, and will be edited by Drs. · Hobart A. Hare and Edward Martin. The excellent practical qualities which have made each of the three journals among the foremost of American medical publications will be continued in the greater Therapeutic Gazette. While we may regret the discontinuance of the Age and Medicine deeply, we will expect the Gazette to more than make up to us for what we have lost.

GOVERNMENT MODEL FARMS.-James J. Hill, president of the Great Northern Railway, believes that model farms should be established in every agricultural county of the United States, under control of the several state governments, or of the national government, or of the two conjointly. Such farms, he argues, would radiate intelligence, activity, and reform in tillage, with the possibility of doubling the farm product of the country. The December Century will publish Mr. Hill's discussion of these "Government Model Farms" and his plea for their establishment. "Might it not be worth while, he argues, "to expend the sum that such a system would cost, even though it should be necessary to postpone for another year the building of a battleship or a couple of crusiers." A significant declaration by Mr. Hill is that such a scheme should be kept out of the clutches of the spoils system.

29

THE WISE MAN.-Once upon a time there was a poor, overworked Muck Raker who had become tired of his job. He was ambitious, and felt that his efforts were not appreciated. He had a long nose and wore magnifying glasses. One day while raking assiduously he was accosted by a stranger whose aspect was even worse than his own. This man was a Herald of Light. His mission was to seek out sweetness and virtue in a naughty world, and he was admirably equipped with a darklantern without any oil, and wore spectacles with smoked lenses. "What are virtue and onesty?" inquired the Muck Raker.

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"I

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can't tell you, answered his companion sadly. "I have never seen any.' While thus conversing, they were joined by a wise man who proved to be real reformer disguised as an oculist, and who, perceiving their error, presuaded them to exchange glasses. The remedy was simple but effectual. The Muck Raker is now working union hours and is happy and contented, while the other has already made some most astonishshine, if welcomed and encouraged, will often ing discoveries. Moral: A small ray of sundestroy an army of offending microbes.-December Lippincott's.

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THE ABSURDITY OF FRETTING.-There is one absurdity which it seems to us is everywhere and by everybody underestimated, and too much overlooked in valuation of character. It is the absurdity of fretting. It is common as air, as speech-so common that unless it rises above its usual monotone, we do not even observe it. Watch any ordinary coming together of people, and see how many minutes it will be before somebody fretsthat is, makes more or less complaining ably every one in the room, or in the train, statements of something or other, which probor at the street corner, it may be, knew before, and probably nobody can help. Why say anything about it? It is cold, it is hot, it is dry, somebody has broken an appointment, ill-cooked a meal; stupidity or bad faith somewhere has resulted in discomfort. about.-Health. There are plenty of things to fret

THE HEALTH OF THE AMERICANS IN THE CANAL ZONE.-According to the report of the Department of Health of the Isthmian Canal Commission for the month of September, 1906, seven white men out of a total of 5,000 died, two of disease and five from violence. Both of the white men died of pneumonia; one was a Greek and the other a Jamaican, and both had been on the Isthmus for eight months. There are about 4,800 Americans on the Isthmus, and Dr. Gorgas says: "I think it is worthy of remark that 5,000 Americans recently from a temperate zone should have been able to pass two months during the height of the rainy season, their work extending forty miles through a tropical jungle, without a single death from disease of any kind. The figures with regard to employees are absolute. We get the actual number of employees from our pay rolls, and the deaths from the hospital reports and the cemetery reports." There are about 1,000 women and children, wives and families of the American employees on the Isthmus, and none of these died of disease during August and September.

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The Hospitals of New St. Louis

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THE ALEXIAN BROTHERS' HOSPITAL.

THE ALEXIAN BROTHERS' HOSPITAL was founded in 1869, the erection of its building was begun early in 1870 on ground acquired at 3933 South Broadway, and the beautiful structure was completed in 1900. The cost of the ground and building has been about $250,000. The building contains 250 beds, and the institution cares for about 1900 patients each year, of whom fully one-sixth are charity cases. The institution is conducted by the Alexian Brotherhood of the Roman Catholic Church. A training school for nurses, which is open only for members of the brotherhood, is an important feature of the work of the institution. The medical staff includes the following physicians: Frank J. Lutz, J. P. Hennerich, Ernst Mueller, D. F. Hochdoerfer, Hy. Muetze, and L. R. Padberg.

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DR Y. E. COLVILLE, of Chattanooga, Tenn., has become half owner and editor of the Oklahoma Medical News-Journal; he will hereafter have complete editorial control of the journal, Dr Phelan devoting his attention to its business management. The journal is keeping pace with the rapid progress of Oklahoma; its field of usefulness is constantly

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WARFARE WAR ARC Wh

widening and its management is fully awake to the situation.

NEW MEMBERS OF THE ST. LOUIS MEDICAL SOCIETY-During November the following were elected to membership in the St. Louis Medical Society: R. Lilburn Byrd, 1000 Bitner; Theo. F. Fienup, 3218 Lafayette; Carl J. Koontz, 4551 Delmar; J. W. Marchildon, 2254 S. Vandeventer; George M. Park, 5744 Cates; Edward Schulz, 3869 Cottage; Selden Spencer, 2723 Washington; Benjamin G. Benson, 2136 Benton; W. Antoine Hall, 1556 Tower Grove; Frederick C. Simon, 1835 Cass; Nathan N. Yahlem, 1816 Franklin; Guthrie McConnell, 4421 Berlin; Charles S. Rehfeldt, 2255 S. Jefferson; Walter B. Yost, 1119 Union.

"I give you this, you understand, as hush money," the Senator whispered.

And, handing the druggist a quarter, he took up the bottle of soothing syrup and tiptoed out.

A primary tumor of the lateral abdominal regioh in infants and young children is usu ally a sarcoma of the kidney.

REPORTS ON PROGRESS

Comprising the Regular Contributions of the Fortnightly Department Staff.

INTERNAL MEDICINE.

O. E. LADEMANN, M. D.

The Value of a Study of the Apical Outline in the Diagnosis of Incipient Pulmonary Tuberculosis.-Minor's (Am. Jour. Med. Sci., Oct., 1906) paper presents his impressions of the diagnostic value of outlining the apices of the lung in pulmonary tuberculosis, based on the marking of such outlines for the past six or more years in all cases. He proposes the term "apical outline" in preference to the designation "Kroenig's sign," as being more applicable and is self-explanatory. The pathological fact on which the value of this diagnostic method depends is the well-known tendency to shrinkage of the apex of the lung when a tuberculous process develops in itnot alone from fibroid formation with conse

quent contraction, but even before such fibrosis occurs, through lessened function in the apex. The technique requires great accuracy. It is best to use the little finger as a plessimeter; the percussion stroke needs to be very carefully and correctly made, the most vertical elastic stroke possible, generally very lightly made, alone giving accurate results. The patient should sit erect or stand directly facing or backing the examiner, according to marking of either anterior or posterior outlines. The head is to be held exactly in an anteroposterior plane in order to have muscular tension on both sides of the neck equal. Percussion for the inner anterior line should start well up the side of the neck, above the lung, and come slowly downward until pulmonary resonance is found, when the inner border of the plessimeter finger should be indicated by a dot of the blue pencil. Repeating this from behind forward we get a series of dots, which we unite with a line. The outer border should be approached from the shoulder and marked off in the same manner. In percussing out the posterior lines it is advisable not to have the upper ends of the anterior lines visible, as if they are it will inevitably affect our judgment, while the fact that the upper end of the posterior outline coincides accurately at the trapezius bilaterally with the anterior line, when run independently, adds to our assurance of the correctness of our results. The author found that in early tuberculosis, especially of the apex, but also of the lower portion of the lung, careful percussion will generally demonstrate a dislocation of the inner line out

ward, and that the inner line, both anteriorly and posteriorly, is likely to be the earliest affected. The posterior inner line changes chiefly or only in its upper twothirds. The dislocation inward of the outer border generally occurs later, and a change of both inner and outer lines is naturally less common than of the inner or outer alone. In early cases the lines do not approximate at the top, but join their fellows from the rear; in old cases with marked fibroid shrinkage they often run together to an apex before they reach the trapezius border. Minor found the diagnostic value of these outlines in earlier cases and to some extent their prognostic value later, to be considerable, not, of course, when taken alone, for no sign unsupported by others has great value; but combination with others, such as dislocation occurring in a dubious case, with other signs in themselves not final, may serve to clinch a diagnosis. A slight inward alteration of a border anteriorly and posteriorly carefully verified, will raise to a far higher value ambiguous auscultatory signs. Outward dislocation is neither so early nor quite so easy to determine, but if certainly demonstrated has equal value. Dislocation without marked flattening or hollowing of the supraclavicular fossa would seem to depend on lessening of volume from lessened function, while that accompanied by such hollowing or flattening would point to the existence of fibrosis, though only postmortem evidence could verify this assumption.

The Roentgen Ray in the Early Diagnosis of Pulmonary Tuberculosis.-Lehmann and Voorsanger (Am. Jour. of the Med. Scs., Oct., 1906) remark that the early diagnosis of pulmonary tuberculosis is so important, and so far reaching in its ultimate result and benefit to the patient, that every aid at our command should be employed to assure certainty in its incipiency. They plead for the use of the X-ray as a means of diagnosis in pulmonary tuberculosis. The four points most important in beginning tuberculosis often escaping clinical detection, and if discovered by the X-rays, speak most conclusively for a beginning process in the lungs are: (1) Williams' diaphragmatic sign-the lessening expansion of the diaphragm on the side where there is a beginning tuberculous process; (2) the finding of more or less centrally located affections, especially small or more pronounced shadows along the bronchi, which have been explained as, and by autopsy proved to be, peribronchitic tuberculosis; centrally located cavities, which may escape clinical detection, are also brought to light by the Roentgen rays; (3) haziness of the

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