Part 4

But Darwin was not the first to recognize the uselessness and danger of the appendix, since M. C. Martins, in “_Revue des Deux Mondes_,” which was published in 1862, mentioned the fact that this rudiment sometimes caused death. Indeed it is said the ancient Egyptians knew the appendix became inflamed and caused death, but for this we can not vouch.

In spite of these _hints_ of Martin and Darwin, physicians called the symptom syndrome of what is now known to be appendicitis, typhlitis or perityphlitis for years, although the cecum itself is seldom inflamed without some pathological change in the appendix. The latter structure, however, is often very badly diseased while the cecum is perfectly normal.

The first methodical operation for appendicitis was performed in 1886 by Reginald Fitz, and even today it is sometimes hard to persuade a patient to have this structure removed simply because recovery often occurs without operation.

EUGENICS.

The same author, Charles Darwin, in the same book, writes as follows: “Man scans with scrupulous care the character and pedigree of his horses, cattle, and dogs before he matches them; but when he comes to his own marriage he rarely, or never takes any such care. He is impelled by nearly the same motives as the lower animals, when they are left to their own free choice, though he is in so far superior to them that he highly values mental charms and virtues. On the other hand he is strongly attracted by mere wealth or rank. Yet he might, by selection, do something not only for the bodily constitution and frame of his offspring, but for their intellectual and moral qualities. Both sexes ought to refrain from marriage if they are in any marked degree inferior in body or mind; but such hopes are Utopian and will never be even partially realized until the laws of inheritance are thoroughly known. Everyone does good service who aids toward this end. When the principles of breeding and inheritance are better understood, we shall not hear ignorant members of our legislature rejecting with scorn a plan for ascertaining whether or not consanguineous marriages are injurious to man.”

Though the above was written thirty-five years ago, little real progress has been made in eugenics. It is true we have laws against miscegenation and against certain consanguineous marriages; some States have passed and other States have attempted to pass, laws making certificates of health necessary before marriage licenses can be issued; if we mistake not, in some States the habitual criminal is unsexed, and in many States this question has been discussed, but ignorance in regard to the laws of heredity is still the rule and not the exception.

Wealth and social position, rather than health and intellectuality, determine as many marriages today as when Darwin wrote, and America’s highest legislative body has not yet repealed the law against the dissemination of knowledge of means to prevent conception. Yet too many children in poor families not only means dire poverty and unhappiness instead of comfort and happiness, but oftentimes desertion, divorce, forced immorality or crime. It is just as necessary to be able to limit the number of children so that each will at least get a good start in life as it is to bring healthy children into the world, since healthy children can not remain healthy and develop as well under unfavorable as under favorable conditions.

Did the law affect rich and poor alike it would not be so pernicious, but such is not the case, since the largest families in this country are found among the poor and ignorant, the very ones who can least afford to have many dependents. Without being so intended, it is class legislation. The healthy, well nourished and well educated class escapes, the poor, ill-nourished, and ignorant class bears the burden until this burden is shifted on society in the form of beggar, defective, imbecile or criminal.

If all the members of Congress made a tour of the tenement districts of New York or other large cities, saw the overworked fathers and overbred mothers, the ragged, ill-nourished and oftentimes diseased children, inquired into the total earnings of the family and the necessary expenses, ate of their bread and breathed their air, if our congressmen did this, then the fate of the law as it now stands would be sealed. But our congressmen are not going to make any such tour, they are not even going to inform themselves by study of the actual conditions, but will do something far easier by voting an appropriation for the study of hog cholera, the foot and mouth disease of cattle, the Texas cattle tick or some other measure of more apparent benefit to the people—and the congressman. To vote on appropriations like the above can not weaken the legislator, to vote to repeal the present law might lose him a large following in some communities. Yet the repeal of the present law in regard to preventives is the first step in eugenics, and without the repeal the best efforts of the best men and women will accomplish but little.—_W. T. B._

PUBLIC HEALTH SERVICE HOSPITALS CURB TRACHOMA.

The establishing of small trachoma hospitals in localities where this contagious disease of the eyes is prevalent presents the best solution of the trachoma problem, according to the statement contained in the annual report of the Surgeon General of the United States Public Health Service. The Service now has five trachoma hospitals in the three States of Kentucky, Virginia, and West Virginia, and so great has been the number of applicants for treatment that a waiting list has been established. In the past fiscal year 12,000 cases of trachoma have been treated, the larger proportion of which were cured, while those in which a cure was not effected have been greatly improved and rendered harmless to their associates. The great majority of these trachoma patients were people who lived in remote sections far removed from medical assistance, and who, but for the hospital care and treatment provided would have remained victims of the disease practically the remainder of their lives.

“When it is considered,” the report of the Service states, “that thousands of persons suffering with trachoma, a dangerous contagious disease, would otherwise remain untreated, it is realized how farreaching results have been obtained through these trachoma hospitals and the other public health work done in this connection. It would be impossible to estimate with any degree of accuracy the number of people who have been saved from contracting this communicable disease by thus removing these thousands of foci of infection.”

In addition to treating persons with the disease the hospitals have been used for educational work. Doctors and nurses have visited the homes of the patients and have explained how to prevent the development and recurrence of the disease. One thousand three hundred and eight such visits were made during the year in Kentucky alone. “It has taken some time,” the report continues, “to educate the people afflicted with this disease to the importance of cleanliness and the use of simple hygienic measures in their daily life.” That results have been obtained is evidenced by the noticeably better observance of hygienic precautions by those among whom the work has been done.

In addition to the hospital work, surveys were made in sixteen counties in Kentucky, especially among school children. Eighteen thousand and sixteen people were examined, 7 per cent being found to have trachoma. Similar inspections in certain localities of Arizona, Alabama, and Florida resulted in finding the disease present in from three to six children out of every hundred. Periodic examination of school children for the disease and the exclusion of the afflicted from the public schools, are two of the recommendations the Public Health Service lays emphasis upon.

One of the special features of the trachoma work was the giving of lectures and clinics before medical societies in various counties where trachoma hospitals could not be established. Patients were operated upon in the presence of physicians and the most modern methods of treatment demonstrated. Throughout, the purpose has been to stimulate local interest in taking up the campaign to eradicate trachoma.

HOW THE GOVERNMENT IS MEETING THE MALARIA PROBLEM.

Four per cent of the inhabitants of certain sections of the South have malaria. This estimate, based on the reporting of 204,881 cases during 1914, has led the United States Public Health Service to give increased attention to the malaria problem, according to the annual report of the Surgeon General. Of 13,526 blood specimens examined by Government officers during the year, 1,797 showed malarial infection. The infection rate among white persons was above 8 per cent, and among colored persons 20 per cent. In two counties in the Yazoo Valley, forty out of every one hundred inhabitants presented evidence of the disease.

Striking as the above figures are they are not more remarkable than those relating to the reduction in the incidence of the disease following surveys of the Public Health Service at thirty-four places in nearly every State of the South. In some instances from an incidence of fifteen per cent, in 1914, a reduction has been accomplished to less than 4 or 5 per cent in 1915.

One of the important scientific discoveries made during the year was in regard to the continuance of the disease from season to season. Over 2,000 Anopheline mosquitoes in malarious districts were dissected, during the early spring months, without finding a single infected insect, and not until May 15, 1915, was the first parasite in the body of a mosquito discovered. The Public Health Service, therefore, concludes that mosquitoes in the latitude of the southern states ordinarily do not carry the infection through the winter. This discovery indicates that protection from malaria may be secured by treating human carriers with quinine previous to the middle of May, thus preventing any infection from chronic sufferers reaching the mosquitoes and being transmitted by them to other persons.

Although quinine remains the best means of treating malaria, and is also of marked benefit in preventing infection, the eradication of the disease as a whole rests upon the destruction of the breeding places of Anopheline mosquitoes. The Public Health Service, therefore, is urging a definite campaign of draining standing water, the filling of low places, and the regrading and training of streams where malarial mosquitoes breed. The oiling of breeding places, and the stocking of streams with top-feeding minnows, are further recommended. The Service also gives advice regarding screening, and other preventive measures as a part of the educational campaigns conducted in sections of infected territory.

This study is typical of the scientific investigations which are being carried out by the Public Health Service, all of which have a direct bearing on eradicating the disease. The malaria work now includes the collection of morbidity data, malaria surveys, demonstration work, scientific field and laboratory studies, educational campaigns, and special studies of impounded water and drainage projects.

Reviews and Book Notices

“Pellagra.” By George M. Niles, M.D., Gastro-enterologist to the Georgia Baptist Hospital, Wesley Memorial Hospital and Atlanta Hospital, Atlanta, Ga. Octavo of 261 pages, illustrated. Philadelphia and London. W. B. Saunders Co., 1916. Cloth, $3 net. W. B. Saunders Co., Philadelphia. London.

We are in receipt of the second edition of this work upon a subject that has of late attracted a great deal of attention from the profession. Pellagra has in recent years sprang up in an unaccountable manner, especially in the southern section of the United States, and it behooves every practicing physician to equip himself with such knowledge as will enable him to recognize the disease when encountered in his practice and to handle it in a scientific manner. This work in its second edition, although following the appearance of the first edition so closely has undergone many changes and had numerous additions so that it has been brought fully up with the present state of knowledge. The chapter on etiology contains the results of the recent investigations of Dr. Joseph Goldberger, Special U. S. Agent for the study of the disease, and Thompson-McFadden Commission on Pellagra. The work is that of a southern physician and should receive the warm support of southern physicians everywhere.

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“A Practical Treatise on Infant Feeding and Allied Topics.” For Physicians and Students. By Harry Lowenberg, A.M., M.D., Assistant Professor of Pediatrics, Medico-Chirurgical College of Philadelphia; Pediatrist to the Mt. Sinai Hospital; Pediatrist to the Jewish Hospital; Assistant Pediatrist to the Medico-Chirurgical Hospital and to the Philadelphia General Hospital; Formerly Instructor of Pediatrics, Jefferson Medical College. Illustrated with Sixty-four Text Engravings and Thirty Original Full Page Plates, Eleven of which are in color. Philadelphia. F. A. Davis Co., Publishers. English Depot. Stanley Phillips, London. 1916.

Our thanks are due the obliging publishers for a copy of this exceedingly valuable book. The author’s long experience and intimate acquaintance with the subjects treated of eminently qualify him to present a work that will prove of most valuable assistance to physician and students. The work is eminently practical and presents throughout the subject matter in an easily accessible form. The arrangement of the text is systematically perfect and only such material is used as may render the work available for the needs of practitioners and students. The importance of breast-feeding is emphasized and artificial alimentation discussed thoroughly so as to furnish the best schemes for obtaining the best results. The article upon “Surgical Treatment of Infantile Pyloric Obstruction” is by the celebrated surgeon, Dr. John B. Deaver, a chapter that adds much to the value of the work. A feature of the work is the presentation of a number of plates showing in colors the appearance of stools in various conditions of alimentary disturbances. We are greatly pleased with this work and can conscientiously recommend it to students and practitioners.

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“Annual Report of the Surgeon General of the Public Health Service of the United States.” For the Fiscal Year 1911. Washington. Government Printing Office. 1914.

This is the forty-third annual report of the operations of the Public Health Service, in the one hundred and sixteenth year of its existence, issued by the Surgeon General of the Public Health Service of the United States. This treats of the seven divisions of the bureau under the following heads, viz. (1) Scientific Research and Sanitation; (2) Foreign and Insular Quarantine and Immigration; (3) Domestic (Interstate) Quarantine; (4) Sanitary Reports and Statistics; (5) Marine Hospitals and Relief; (6) Personnel and Accounts; (7) Miscellaneous. The report contains a great deal of interest to the general reader, especially to those interested in sanitary matters, and shows the methodical and systematic manner in which the affairs of the bureau are administered.

Publisher’s Department

“IN PARTICULAR CASES.”

Therapeutic efficiency in the use of the bromides is often as dependent on the avoidance of untoward effects as on the attainments of maximum physiologic activity. For this reason Peacock’s Bromides offer the most satisfactory bromide therapy, for not only does this happy combination of carefully selected bromide salts insure all the benefits of the most active bromide preparation, but it does so with the great advantage that gastric disturbance and all tendencies to bromism are reduced to a minimum. This is why in “particular cases” so many physicians are in the habit of insisting on the use of Peacock’s Bromides.

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Notwithstanding the large number of Hypophosphites on the market, it is quite difficult to obtain a uniform and reliable syrup. “Robinson’s” is a highly elegant preparation, and possesses an advantage over some others, in that it holds the various salts, including iron, quinine, and strychnine, etc., in perfect solution, and is not liable to the formation of fungus growths. (See advertisement in this issue.)

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“Many cases of acute coryza and naso-pharyngeal irritation are often due primarily to the streptococcus rheumaticus and respond to the usual rheumatic therapy.”

In these cases commonly called “colds,” generally deep-seated, painful and exhausting, Tongaline mitigates the congestion and by rapid elimination of the poison or germs, promptly relieves a condition often very obstinate and if not corrected within a reasonable time, attended with serious results and always with a tendency to become chronic.

For special stimulation to the kidneys, Tongaline and Lithia Tablets; if malaria is indicated, Tongaline and Quinine Tablets.

NOT A DIGESTIVE SUBSTITUTE.

The amount of actual harm done with the best intention, by continually supplying the digestive organs with digestants, or ferments, instead of encouraging them to generate their own, is doubtless greater than we realize. It is not very often that one need order predigested food for a patient, although occasions may and do present themselves when this is advisable. But the indiscriminate use of pepsins and similar substances from the vegetable kingdom, in the management of many patients with weakened digestive powers, is scarcely to be justified. A much more useful remedy, because of its being a true stimulator to the digestive functions, gastric and intestinal, is Seng. This well known preparation contains the active principles of Panax (Ginseng), and is especially useful because it stimulates the physiologic activity of the digestive glands and thus “helps them to help themselves”—obviously the most desirable therapeutics in all functional cases. It should be remembered, therefore, that Seng is not a ferment to digest food which weakened organs can not care for in their natural manner. Instead, its action is to restore tone and vigor to the secretory structures so that they are able to evolve and supply their own ferments. Seng is a very agreeable remedy to take, and its benefits are manifested in surprisingly short order. In convalescence from fevers or diseases impairing the digestive functions it is unquestionably one of the most efficient remedies being used by medical men today.

INTEROL.

The world is full of fallacies—It is fed upon half truths. It drinks in sophistry and then wonder is expressed that the millenium is so long deferred.

Take for instance the unfortunate use of the terms “expensive” and “high-priced” or of “costly” and “cheap.”

Price—be it high or low, is what one pays.

It has nothing to do with what is received.

Quality on the other hand, is what one gets, or fails to get. Service ditto.

A useless, or inferior article or service, even when bought for a low price, is expensive and costly!

On the other hand, the better or higher the Quality or the Service that is obtainable, the higher the price—which is a great natural law. Hence, high-priced should, and usually does men, high quality or service.

In fact, a moment’s reflection will show that the impression created in the mind of a person of average intelligence, by the word “cheap” applied to a person or a thing, suggests inferiority.

A cheap person or thing is apt to prove the most expensive. A high-priced person or thing usually turns out to be the most economical.

And, it is a most important fact that this applies with especial force to therapeutic agents of any kind intended for use by the physician, and with fulminant emphasis to drugs or agents that have to be put into the human body.

The physician who hesitates or is influenced by “high price”, provided he knows the reputation and standing of the parties marketing the product, is false to his obligation to himself and to his patient.

All of which applies with especial force to mineral oil and particularly to Interol.

TRANSCRIBER’S NOTES

1. Silently corrected typographical errors and variations in spelling. 2. Retained anachronistic, non-standard, and uncertain spellings as printed. 3. Enclosed italics font in _underscores_.