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ORIGINAL COMMUNICATIONS

Short stories on the treatment of diseases and experience with new remedies are solicited from the profession for this department; also difficult cases for diagnosis and treat

ment.

Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors.

Copy must be received on or before the twelfth of the month for publication in the next month. Unused manuscript cannot be returned.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN. REFLECT. RECORD,

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Spelling Reform in Chemistry.

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BY HENRY LEFFMANN, M. D., PHILADELPHIA. Editor MEDICAL WORLD:-Our British ancestors wrote "tung," and it was not until the Norman clerks, who came over with the Conqueror, had bewitcht the language, that tongue became the approved spelling. English has never recovered from the mixing of languages, and to-day it stands as an object of derision among civilized nations for the eccentricities of spelling and pronunciation. With that bumptiousness that is apt to be born of success, many intelligent persons in the English-speaking countries glory in these peculiarities, and oppose or even abuse those who would simplify the system. It is true that the discordance between spelling and pronunciation is due in part to changes in the latter. Shakespearean scholars tell us that the first Hamlet pronounced the "1" in "would" and "could." The final "e," now generally silent, was once in full use.

It is not, however, spelling in general, but certain changes in the spelling of scientific terms that I wish to discuss. Chemistry is a science requiring a large number of special terms, and in the last quarter-century the demand has practically exceeded the supply. Moreover, the nomenclature dates from a very early period, when the prevailing theories were highly erroneous; in fact, from about a century ago, when the vast advances in the science were not foreseen. During the past twenty-five years, chemists have been trying, without success, to define with exactness such inherited terms as "acid," "base "and "metal," and to find systematic names for the legion of organic derivatives.

I deem it a fortunate circumstance that the spirit of reform stirred so deeply the

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members of the chemical section of the American Association for the Advancement of Science that they adopted a reform in spelling, which has brought many common terms out of the limbo of confusion. This was by the simple expedient of dropping the final "e" wherever phonetically useless; that is, when it does not render the preceding vowel long. This brings the pronunciation of "chlorin," "iodin," “ "chlorid" and "bromid " in accord with the spelling. It has been said by some that the omission of the final "e" is independent of the effect on the pronunciation, and that iodin would be so-spelled even if pronounced so as to rhyme with "confine." I regard this as a most objectionable view. Spelling-reform should be true reform; if it is merely a change from one bad system to another, it has no basis. The American and British Philologic Societies, which initiated these reforms, were actuated by a desire to reform the incongruities of English spelling and not simply to shorten words.

One of the fiercest contentions in regard to the reform in the spelling of chemic terms has been concerning the dropping of the final "e" in such names as "quinin" and strychnin." Some English chemists have almost shed tears over this change. It has been said that the final "e" is needed to show "basic" quality. There are several objections to this argument. In the first place, "basic" is a term no longer exact. It may serve as a mere adjective, but it cannot be defined with precision. Secondly, the so-called basic bodies show different degrees of activity, and it is difficult to say when the silent letter should be retained and when dropt. The most serious objection to the argument is, that the nomenclature in chemistry is not intended to show properties or qualities, but structure. In organic chemistry, the whole effort at present is to secure a nomenclature which shall indicate the structural relations of the bodies. In only one series is an exception made to this rule. The enzyms or non-organized ferments end in "ase." These bodies are, however, quite peculiar in their nature, and their structural relations are wholly unknown. It is permissible, therefore, to distinguish them by a termination indicating a special property. The importance of the dependence of pronunciation on spelling is shown by the fact that the final "e" is retained in one series of compounds, the hydrocarbons homologous with C,H. The body commonly

called acetylene is systematically termed ethine, and the last syllable rhymes with "vine." This method of spelling and pronunciation is part of a system which includes ethane and ethene, the change in the long vowel of the last syllable indicating a change in the amount of hydrogen by two atoms, ethane, CH,; ethene, C2H.; ethine, CH2. Unless we preserve the long vowel sound in each of these cases, the final "e" is phonetically useless and should be dropt. In the reformed system, the syllable "ine" will indicate a hydrocarbon of the ethine series, and it is just such exactness and suggestiveness of nomenclature that chemists are seeking.

In regard to the substitution of "f" for "ph," in sulfur, it may be said that those who think that etymology justifies the older spelling, are wrong. Our true "ph" comes from the Greek, but sulphur is not a Greek word. Neither it nor phantom deserves the "ph," but should etymologically have the letter "f."

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Editor MEDICAL WORLD:-During the last year my attention has been attracted to the use of two comparatively new remedies calcium sulfid and iodid. The former has been before the profession for a long time, but only recently have its remarkable properties begun to be appreciated. Ringer recommended it in doses of one-tenth grain. Brunton described it as a dangerous drug, sulfudric acid reducing hemoglobin and being with difficulty replaced by oxygen. Dyspnea is the evidence of its full or rather toxic action, and it causes death by asphyxia. How much would be required to produce this effect I do not know, but much larger doses than those mentioned may be given with impunity. It comes very near being It comes very near being a specific for gonorrhea, especially in such constitutional infections as gonorrheal rheumatism.

It won a reputation in diphtheria, even in the inefficient doses, but failed in malignant epidemics. Since these are invariably dependent upon gross defects in the hygienic conditions of the affected locality, it scarcely seems to be our duty to look for a remedy for a condition so easily obviated by well-known and accessible means. does not seem the part of common sense to hunt for specifics for such a condition, and let the poisoning go on by impure

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water, contaminated by sewage, or air reeking with the emanations from filth in the cellar, alleys, back-yard, gutter or cesspool. If these sources of malignancy are removed, the remedies ordinarily effective will prove so again. And of these, none is so efficient as calcium sulfid.

I have given it to adults in doses of one grain seven times a day, with no bad effect. Others have given this quantity and more to children two years of age, and pronounce it practically harmless in any doses. I would urge its use in the dose of half to one grain every hour, to children two years old, in diphtheria, continued until the danger is evidently past.

Besides this, the sequels of diphtheria, such as heart failure, other forms of paralysis, etc., would be much less frequent if strychnin were given thruout the attack as a preventive. I prefer the arseniate, in doses of half a milligram every one to three hours, to a child two to four years of age.

I have so frequently urged the importance of thoro local treatment, frequently and efficiently applied, that I shall assume that every reader of THE WORLD knows my views on this subject, and thus I will not repeat them.

Is membranous croup the same thing as laryngeal diphtheria? The trend of opinion has been in that direction for some years, since the strong presentation of the case by Morell Mackenzie. Very wisely, the health authorities of most cities direct that all cases of both shall be reported as diphtheria, to be on the safe side. clincical study and bacteriologic investigation alike point to the probability that some cases of croup are not diphtheritic. And in some of these typical croup cases, calcium sulfid has failed completely. However, it is in just these that the iodized calcium has succeeded best. This substance is not the chemical known as calcium iodid, but a product known commercially as brown iodid of lime. Given in doses of gr. every five minutes, it relieves the symptoms of croup and induces resolution in a way that seems little short of marvelous. But in ne diphtheria, it has no perceptible effect whatever.

It has been a year since I described in this journal a treatment of pulmonary consumption, from which I was obtaining such effects as warranted me in recommending it to my brethren. In brief, it consisted in the use of calcium sulfocarbolate as an intestinal antiseptic, iodoform

to relieve cough and keep the lymphatic circulation clear, possibly affecting the diseased lung-tissues favorably at the same time, and nuclein to create an artificial leukocytosis. I have employed this system now for another year, and have that much more reason to trust it. No tuberculous patient has died. Some have gained steadily, others have apparently recovered, the bacilli having disappeared from their sputa and the physical signs indicating cicatrization.

The only alteration the year has seen in my plan is that I have used the nuclein in much larger doses, giving ten minims once to three times daily. The reason for using nuclein constitutes one of the most interesting chapters of modern physiologic research. The white blood cell was an element of unknown importance, until Metschnikoft's celebrated observations were made public. Previous to this, our physiologies talked of the white cells changing into red cells, or vice versa. Following Metschnikoff's investigations came the study of leukocytosis, which was found to be present in nearly every disease of infectious nature, the most notable exception being tuberculosis. But tuberculosis is a notable exception, in that it alone of the infectious diseases is non-protective and not self-limited. Is the leukocytosis the cause of the self-limitation? If so, may we not utilize Vaughan and Aulde's no less remarkable discovery, that the administration of nucleinic acid increases the number and activity of the leukocytes?

This is the problem we are trying to work out. And as my contribution to it I have to say that the administration of nuclein in tuberculosis is followed by a surprising improvement, enough to explain the enthusiastic claim of a colleag, that nuclein is "the active principle of life."

Now this is all new, too new for any detailed statements as to results. I am giving you a glimpse into the laboratory, of a process not yet fully elaborated, but still inchoate. Try the idea if you will, but do not hold me too strictly to account if the completion of these studies leads us to widely different conclusions. If you succeed, you will have the satisfaction to be among the first to enter the field; if you fail, your consumptives will be no worse off, to say the least.

Guaiamar is one of the newest creasote derivatives. I have given it to one tuberculous girl for one month. The bacilli were notably decreast in number at the end of

the month. The remedy was well borne by the stomach. In doses of 60 grains a day the urine blackened, and it was found expedient to drop the drug for a few days and then resume in doses of 30 grains daily. That patient is now taking creosote carbonate for a month, for comparison.

It has been a long time since I wrote in my WORLD articles anything about the morphin habit, but I still receive letters referring to those I wrote a year or more ago. Experience brings a certain improvement in methods, or in the application of them, and this is seen in the lessening of the patient's suffering. In a case just discharged, the patient ceased to take morphin in less than a week, took no other narcotic as a substitute, never missed a meal, slept at least four hours every night, and did not suffer a particle of pain, aching, burning or other distress. It was a youth who evidently had been persuaded by his friends to undertake the treatment, and he had very little if any real desire to quit the use of the drug. Those who have treated these cases know how difficult they are. He had no need for the drug, but yet he wanted it, not to relieve suffering, but to make him feel good. Nevertheless, in ten days he was so well over it that he was allowed to go out alone, and did not abuse his liberty.

Will the cure be permanent? It will depend on the happenings of the next six months. If his neuralgia returns, and the doctor into whose hands he falls uses morphin to relieve it, he will probably relapse, as he has no idea of suffering pain. But he goes for six months' rest to Colorado, where the climate will restore his red blood cells and the hygienic conditions will be nearly ideal.

Dr. L. S. Cooms, on page 77, asks some rather singular questions. No, it is not a mixture of anything but simply the result of experience. Some cases of morning diarrhea are benefited by these minute doses; others are not. Metrorrhagia is also benefited by the alkaloid hydrastin, (not the resin), in small doses, and it is good practice to give just enough to accomplish your object, and stop at that. Otherwise you miss your object by your clumsiness in handling your weapons. Take pilocarpin in the treatment of the night-sweats of phthisis, for instance. If you give just enough to restore the normal tenacity of the skin, the leakage, which is passive, will be checkt. If you give an overdose you will cause a warm, active

perspiration. Five grains of zinc sulfocarbolate is a very moderate dose, if the salt is pure. If it disagrees with a few persons they have abnormally sensitive stomachs. If it disagrees with every one you have a poor specimen of the drug, possibly with some free carbolic acid in it. I have often given ten and sometimes twenty-grain doses with impunity, and so have many others. It is sometimes worth while to try a new idea before concluding that because it has not occurred in one's own experience it must be a mistake.

But these questions are after all unimportant. I offer a solution of Dr. Richards' problem: Why do dogs howl? I would suggest that it is because they have not enough fleas to keep them properly employed. WILLIAM F. WAUGH, M. D. Ravenswood, Chicago.

Tuberculosis.

Altho for

Editor MEDICAL WORLD: years a reader of THE WORLD, I have not until now sought access to its columns. And now I ask for space to put before the reader, whoever he may be, a few thoughts upon that thread bare subject:-Pulmonary Tuberculosis. The views herein expresst are the ultimate product of years of close study, observation and experiment.

The greatest minds do not always enunciate the greatest truths; for some important things are withheld sometimes from the great and wise, and given to those who occupy a more modest position. As conclusions arrived at depend somewhat upon the nature of experiments made, the place and surroundings, as well as the mental peculiarities of the experimenter, it is well not to accept too readily the dogma of one or two, while the accumulated testimony of the rank and file has not yet been given. We should be receptive toward the truth; but he who would know the truth must find it for himself. For to receive and adopt that which is given out by another is not receiving truth until it has been tested and proven by the recipient himself. So long as wide. differences of opinion exist between authorities of equal eminence touching any one thing the essential truth is not establisht. And the field is still open for even far lesser lights to put in a word.

In regard to tuberculosis there seems to be a wide divergence of opinion upon some important points. Some regard all cases of phthisis as tuberculous; some do not. Some declare that the breath of the patient

does not contain the germ; others assert that it does. Some claim that the disease is directly transmissible to healthy persons by contact; others assert that certain preparatory conditions are essential. It cannot, therefore, be out of place for another to enter testimony derived thru the legitimate channels of observation and experiment. Assuming the right and privilege to be heard, I shall proceed as briefly as possible to put down the conclusions formed from personal observation and experiment and designate whatever is quoted from others.

In the first place let me ask: Can we recognize a tuberculosis without the "bacillus tuberculosus" of Koch? There certainly are cases of phthisis in which the bacilli are entirely wanting. They cannot be distinguisht from cases of the true tuberculous type, except that they are usually attended by more intense symp. toms and run a rapid course to a fatal end. I have met with a goodly number of cases in which no bacilli could be found in any excreta from the body, from the very beginning of the disease to its fatal end. Every possible method to find them failed. Therefore I must record myself as a believer in the existence of a non-tuberculous phthisis.

The fact that such cases are not at all uncommon, necessitates the adoption of one of two opinions: We must either recognize a non-tuberculous phthisis, or we must cease to recognize the bacillus of Koch as a pathogenic organism. The former proposition will promptly appeal to any close observer.

But in the present light the bacillus cannot fail to hold its etiologic place. The relation of the bacillus to tuberculous disease is unquestionable, and if evidence were necessary, the one fact that the gradual destruction of the bacillus is invariably attended by a gradual return of health would be sufficient.

The bacillus tuberculosis, like anything and everything else in Nature, possesses an individuality which renders it a separate and distinct entity. It is a true parasite, therefore its home is within a living organism. When expelled from its selective abode its life is very brief, unless it is quickly provided with an artificial medium which will furnish the conditions necessary to its existence-warmth, moisture and protection from light. Its distribution embraces the human race and certain species of lower animals. In its

selective abode it manifests remarkable vitality. Taken into the systems of healthy persons with food, the bacilli may pass thru the alimentary canal and out of the body with the excreta without producing any lesion whatever.

Some able authorities deny the possibility of the germ passing thru the stomach owing to the hydrochloric acid of the gastric juice. It is doubtful if the acid in the stomach is in sufficient strength to have any effect upon a germ of such great vitality. Furthermore the transit might be made at a time when the gastric fluids were temporarily deficient in acid.

However they get there, they linger in the colon. I have found them in the contents of the colons of several robust, healthy men. This shows that we take them in with food. It is not probable that any person is at all times free from them. But altho commonly present in the digestive tract, they are perfectly innocuous except under conditions to be mentioned later.

When favorable conditions arise, the system is invaded by way of the digestive tract, in a very large majority of cases. The mesenteric glands and the liver are the seat of the primary lesion. Recent writers state that "tuberculosis of the liver is always secondary to tuberculosis in other organs." In this I do not concur. The intractable gastric catarrh, which so commonly precedes the pulmonary symp. toms, is very probably due to the invasion of abdominal organs. Postmortem appearances may not indicate an early invasion of the liver; yet we should remember the migratory character of the parasite, and also the fact that disease in one organ may become stationary when a more vital one has become involved.

Therefore, when the patient dies of pulmonary disease, one, two, or perhaps five years from the inception, the fact that the recent lesions obscure the early ones, gives the impression that the disease had but recently invaded that organ, while, in reality, it was first invaded, becoming latent as the lung disease advanced, and probably aroused again late in the disease when the entire glandular system was becoming rapidly involved.

If we consider the high percentage of deaths from tuberculous diseases among artificially-fed infants, we will recognize food as the medium, and the digestive tract as the channel of invasion.

Invasion by inhalation is extremely

doubtful. Possibly it may occur under exceptionally favorable conditions, but in all of my observations there has not been a case that could be so regarded. Recent writers express opposing of views on this point. Some, while supporting the inhalation theory, state clearly that the bacillus is rapidly destroyed by exposure to daylight.

Sternberg, quoting the words of Koch, at Berlin, in 1892, said that the sputum of a consumptive expectorated upon the ground or sidewalk, and exposed to direct sunlight, is disinfected in from a few minutes to several hours, according to the thickness of the layer; that diffuse daylight destroys the bacillus in seven hours; that sputa exposed to daylight is disinfected long before it is dry enuf to be pickt up by the wind as dust.

This statement has not been disproven, and if it be true, the expectorations of a consumptive when out of doors are entirely harmless.

Experiments made to determine the presence of bacilli in the air have not been successful; only a very few were found in the air of a consumptive ward of a hospital. Sweeping down the walls of a consumptive ward is charged with giving the disease to one of the workers; but this cannot be verified. One experimenter sprays pure culture into a cage of dogs, and one of the men engaged at the work afterward developt the disease. These cases are put down as inhalation infection. There is not a particle of evidence that either of these cases were infected at that time and place.

Some cases are recorded as transmitted from husband to wife, or wife to husband, but there is nothing to support the statement. If these were a transmission of the disease of a direct nature, what are we to say of the thousands of cases in which one partner dies of the disease and the remaining one never contracts it? What of the fond mother, who hovers lovingly over a son or daughter dying of consumption, ministers to every want, denying herself the much-needed rest, staying with the sick night and day, often, in the fervency of affection, pressing a warm kiss to the lips of the loved one, often after death? And did that mother contract the disease? No! Do you say such cases are rare? I answer, "No! They are as common as the day."

The theory of tuberculous infection, after exhausting the consecutive skill and

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