Part 4

Instead of sending to one hospital only, the sick coming from garrison and from government ships, several military hospitals ought to be established. Every barrack should have its infirmary, with medical service, and the sick should not have to cross the city to obtain treatment. There is no disease which develops contagious miasm more suddenly than yellow fever. A large accumulation of sick in the same place, is a certain source of disease and contagion.

On board of vessels, a good hygienic system would greatly diminish the number of the sick. In ordinary times, government vessels should not have full crews. The men will then have a sufficient quantity of air to breathe. They should not be drilled in the fierce heat of the sun, or in rain, and they should be required to go to the surgeon, for the least pain in the head.

We have observed, that the incubation of yellow fever, is from ten to twelve days. It will be prudent then, in the heated term, not to remain in port more than six days. English vessels have the habit of not remaining more than three days, but they cruise in the vicinity, or go to Jamaica, so that they are always exposed. The best plan would be to leave the waters of the Gulf, which is the true centre of infection. When, despite every precaution, there are sick men on board, and their condition inspires apprehension, they should be put ashore at once, the vessel whitewashed, and sail set for other latitudes to the north.

Commercial are not under the same conditions as government vessels. On the former all is sacrificed to speculation. The crew is lodged as closely as possible, and ten or twelve men are often seen in a space, where four men can scarcely lie down. The government should require the lodgment of the crew to be on deck, so as to allow free circulation of air. Their food should be wholesome, and well chosen, and instead of giving the crew fresh meat every day, it is better to continue giving them salt meat which is more wholesome, and more nourishing. Let us add, that the meat of the country, bought by merchantmen, is not of first quality.

There are some captains, who, to shun the invasion of the disease, engage blacks to load and unload their vessels, and during this time, leave their crews inactive. This plan is of no avail. The crew is generally composed of strong men, habituated to bodily exercise, which facilitates transpiration. They require, therefore, moderate labor.

The water of the country is bad, and it would be good to add to it a little brandy or rum. This drink is better than wine, or beer, which are adulterated and often give colic.

Prophylactic remedies have been much recommended. In latter times, chlorine on board ships was extolled, and has fallen into disuse, like others I have tried without satisfaction. I have seen a captain, who, convinced of possessing the universal panacea, neglected his sailors, and they became gravely sick. Prophylactics can not have any action on a disease which is in the air. Hygienic precautions and cleanliness, are worth more than these pretended preventives.

_Inoculation._—At one time, it was attempted at Havana to prevent yellow fever by inoculation of the poison of a snake, supposed to be the _crotalus horridus_. A German adventurer assumed the respectable name of Humboldt to sustain his theory. This man had observed that the Indian prisoners, lead from Mexico to Vera Cruz, exhibited, when they were bitten by a viper, symptoms analogous to those of yellow fever. He then made some experiments with the inoculation of this substance at Vera Cruz, and at New Orleans. He came afterwards to Havana, and obtained from General Concha, then Governor of the Island, permission to make some trials at the military hospital. He proceeded in this wise: He made, said he (no one saw it), the snake bite the liver of an animal, and kept it to putrefaction. He inoculated with this substance, and gave at the same time, internally, a syrup composed of _mikiana-guaco_ and rhubarb, with the addition of iodide of potassium and gutta-gamba.

The symptoms appeared in the following order: at the moment of inoculation, the subject was taken with a transient vertigo, at other times, with a nervous trembling, which lasted a longer time. Seven hours after, the pulse was modified in a permanent manner, more frequent or slower, stronger or weaker. Eleven hours after, he had febrile heat. At the end of fourteen hours, he had headache, inappetence, thirst; sixteen hours after, the face red, the conjunctiva injected. From the outset, the gums were swollen and the patient suffered from colic. Eighteen hours after, the gums were painful, and their borders became red, with pains in the salivary glands, and in the nerves of the face and teeth. Nineteen hours after, pain in the lower jaw, in the direction of the submaxillary nerve. At the twentieth hour, bad taste in the mouth, coryza, and œdema of the face; at the expiration of twenty-two hours, a sensation of contraction of the throat, without visible change. At the twenty-third hour, jaundice; at the twenty-fourth, gingival hemorrhage; at the twenty-eighth, conjunctiva injected, chills; at the twenty-ninth, tonsillary angina; at the thirtieth, pains in the loins; at the thirty-eighth, pain in the joints; at the seventy-second, swelling of the lower lip. During convalescence, prurience of the skin, with cutaneous eruptions. These symptoms are far from being those of yellow fever. They belong in part to those produced by the mixture of guaco and iodide of potassium, and in part to those, which putrifying substances produce, when they are absorbed.

M. Humboldt would not yield to the desire of the Commission, to try solely the inoculation and the syrup of guaco. The conclusions of the report were absolutely unfavorable to the experimentalist. The epidemic of yellow fever continuing its course, the proportion of mortality was the same among the inoculated, as among other subjects, and if the statistical tables, presented by M. Humboldt, disagree with the conclusions of the Commission, it is because he had among the inoculated, not only a great number of acclimated persons, but of individuals who had already had the disease. These ideas of inoculation, inspiring a false security, might produce the saddest results. I think, however, that this interesting question might deserve to be studied anew.

I here terminate my effort. I have proposed to make yellow fever known, as I have observed it at Havana for some twenty years. The reflections, which I have presented on the nature and the causes of this terrible disease, the details into which I have entered, in order that all that relates to its symptoms, its progress, and its treatment, may be clearly estimated, make this work a monograph, the utility and opportuneness of which, will, I hope, be appreciated by those medical men, who are called to practice in tropical regions.

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_The Elastic Bandage in the Treatment of Aneurisms._—It seems likely that Esmarch’s bandage will add very greatly to our means of treating aneurism. Dr. Weir has collected twenty-one cases of iliofemoral, femoral, and popliteal aneurisms, mostly the latter, treated in this way. Twelve of these were successful, while the others failed, owing chiefly to the fact that obstruction to the arterial current was not kept up after the removal of the elastic bandage. Upon this point Dr. Weir lays great stress, and states that in it is the gist of the treatment.

In connection with the study of this matter, the question of how long a limb can be kept desanguinated is of importance. In the lower animals the time is six or eight hours. In man the time is longer than has been heretofore supposed. Ischæmia has been enforced for four, five, and in one case fourteen hours without injury. During the compression it is important to remember that the arterial tension elsewhere is increased.

Autopsies have made it probable that coägulation begins in the tumor and extends up several inches into the artery. The arterial clot then becomes organized into fibrous tissue, and for this organization a healthy state of the wall is necessary. Aneurisms with large mouths are perhaps more easily cured by Esmarch’s bandage.

As the result of a study of the cases collected, including his own, Dr. Weir recommends a plan of treatment like the following: the limb should be bandaged up to the tumor and above it, but not over it. The patient should stand erect before the upper bandage is put on. Tubing should be applied in the usual manner. The elastic compression may be kept on for two hours, followed by the application of a tourniquet for two hours. If pulsation is still apparent, the elastic and mechanical compression should be repeated until pulsation has ceased. After consolidation of the tumor is secured it is well to moderate current above the tumor for twelve or twenty-four hours by a bag containing seven or ten pounds of shot.—_Amer. Jour. Med. Sciences_, Jan., 1879.

EDITORIAL.

NORTH CAROLINA MEDICAL JOURNAL.

A MONTHLY JOURNAL OF MEDICINE AND SURGERY, PUBLISHED IN WILMINGTON, N. C.

M. J. DEROSSET, M. D., New York City, Editors. THOMAS F. WOOD, M. D., Wilmington, N. C.

☞ _Original communications are solicited from all parts of the country, and especially from the medical profession of The Carolinas. Articles requiring illustrations can be promptly supplied by previous arrangement with the Editors. Any subscriber can have a specimen number sent free of cost to a friend whose attention he desires to call to our_ JOURNAL, _by sending the address to this office. Prompt remittances from subscribers are absolutely necessary to enable us to maintain our work with vigor and acceptability. All remittances must be made payable to_ DEROSSET & WOOD, _P. O. Box 535, Wilmington, N. C._

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THE APPROACHING MAY MEETINGS.

We ask the attention of the members of the North Carolina Medical Society, at the request of Dr. Charles Duffy, Jr., President, to their obligation as Chairmen and members of Committees and Sections.

The sections as instituted at the last meeting of the Society are as follows:

_Surgery and Anatomy._—Dr. Charles J. O’Hagan, Greenville. _Obstetrics Gynæcology._—Dr. H. Otis Hyatt, Kinston. _Practice of Medicine._—Dr. W. A. B. Norcom, Edenton. _Materia Medica and Therapeutics._—Dr. G. G. Smith, Mill Hill. _Microscopy and Pathology._—Dr. G. G. Thomas, Wilmington.

It will be remembered that the resolution creating the Sections offered by Dr. Shaffner, of Salem, designed that all papers coming under the above heads should be presented to the Chairman of that section, and through him papers are to be presented to the Society. It is highly desirable, therefore, that papers intended to be presented should be sent forward to their proper chairman, that they may get early attention. The ultimate design of this method is to promote a systematic and orderly presentation of papers, and to induce every contributor to the literature of the Society to put his paper in a way to be properly shaped before being read to the Society. Sometimes papers are too long to be read during the session, and still are too important to be neglected. These papers should be passed upon by the Section to which they belong, and given to the publication committee.

As desirable as this plan is, it must not be understood to exclude papers prepared too late to be reviewed by the section, for literary laziness and procrastination is the prominent failing of members of our State Medical Society. (We are now speaking as editors).

With the additional work now devolving upon our State Society, every effort will have to be made to economize time. It is desirable that the Board of Medical Examiners meet a day in advance of the Society, in order that candidates passing the Board can at once enter into the duties of full membership, and enable the members of the Board also, to take active part in the proceedings. This we understand to be the plan agreed upon by the Board, and it may be officially announced in this JOURNAL.

All these matters should be thought over before the meeting is right upon us, if we intend to make the best use of the opportunities presented, and not embarrass the presiding officer by a jumble of ill-digested work, or bring disrepute upon the Society by presenting papers put together without due study.

Another matter of vital importance should be carefully considered by every member of the Society. It is the amendment proposed by Dr. T. D. Haigh, of Fayetteville. He proposes to amend the Constitution (Art. IV, Sec. 2,) so that the officers are elected by ballot. This is not a new feature. It has been tried before in the Society but was found to consume a great deal of time. This is the only objection we have heard against it, and this should not be considered insuperable, if the amendment corrects abuses of which we have heard complaints.

We would like to see the office of President filled for a longer term than one year. A good presiding officer is not so easy to get that we ought to be willing to let him go out of office as soon as he has shown his capacity, and this remark applies with peculiar force to the present incumbent. To affect this change though, there must be a further amendment of the Constitution.

YELLOW FEVER POISON SURVIVES A WINTER.

“The U. S. Steamer Plymouth, Captain Hanning, which left Boston March 15th, for a cruise to the West Indies, returned to Vineyard Sound on account of two cases of yellow fever occurring on board when about 80 miles south-east of Bermuda Islands.

“The ship had been in Boston during the winter, and as she had come from the West Indies last autumn with yellow fever on board she had been frozen out and fumigated. As she had not called into any port since leaving Boston, this development showed that the germs of yellow fever still existed in her, and she was headed north, being deemed, under the circumstances, unfit for cruising in the tropics. On the 31st of March, Peter Eagan, the boatswain’s mate, was buried, having died from yellow fever on the previous day.”—_Wilmington Sun’s_ associated press telegram.

The above dispatch has since been verified and the minute details will no doubt be investigated most thoroughly. Notwithstanding this case is not without a parallel, it comes in uncomfortable collision with the theories we cherish of the killing power of low temperature on the yellow fever poison.

In the most dismal times of a ravaging epidemic the heart turned with anxious longings for the arrival of frost! This was the line of demarcation between the pestilence and recovery from it! But in this case we are informed that the Plymouth spent the winter in Boston harbor with open hatches, the cold being intense enough to freeze the water in the boilers. Every means for thorough disinfection had been applied that could suggest itself to the minds of the well educated medical officers in the service of a government lavish in its supplies. With all this, a short cruise develops the fever in a form intense enough to cause the death of one of the two seized with the disease.

We will await the detailed accounts of the investigation which is to follow with peculiar interest. It is a starting point for the National Board of Health, and a difficult one.

We append the following from the Surgeon-General of the Navy, received through the Bulletin of the Public Health, from Surgeon General Hamilton, U. S. M. H. S.:

“The Surgeon-General of the U. S. Navy has furnished the following facts in regard to the recent outbreak of yellow fever on the U. S. Steamer ‘Plymouth:’ On November 7th last, four cases of yellow fever occurred on board the vessel while lying in the harbor of Santa Cruz; these were removed to hospital on shore and the ship sailed for Norfolk. Three mild cases occurred during the voyage and the ‘Plymouth’ was ordered to Portsmouth, N. H., thence to Boston. At the latter port everything was removed from the ship and all parts of the interior freely exposed to a temperature which frequently fell below zero, the exposure continuing for more than a month. During this time the water in the tanks, bilges, and in vessels placed in the store rooms was frozen, 100 pounds of sulphur was burned below decks, this fumigation continuing for two days, and the berth-decks, holds and store rooms were thoroughly whitewashed. On March 15th, the ship sailed from Boston southward; on the 19th, during a severe gale, the hatches had to be battened down, and the berth deck became very close and damp. On the 23d two men showed decided symptoms of yellow fever, and on the recommendation of the Surgeon, the vessel headed northward. The sick men were isolated, and measures adopted for improving the hygienic condition of the vessel and crew. The surgeon reported that he believed the infection to be confined to the hull of the ship, especially to the unsound wood about the berth deck, all the cases but one having occurred within a limited area, and that while the ‘Plymouth’ is in good sanitary condition for service in temperate climates, should she be sent to a tropical station, probably no precautionary measures whatever, would avail to prevent an outbreak of yellow fever.”

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_Charcoal for Burns._—A retired foundryman claims that powdered pine charcoal thickly dusted over a burn is a never-failing and speedy remedy.

THE NATIONAL BOARD OF HEALTH.

This body as now composed includes fairly representative men. As far as we can learn it is as follows:

Dr. James L. Cabell, University of Virginia, President. Dr. John S. Billings, U. S. A., Washington, Vice-President. Dr. Henry J. Bowditch, Boston, Mass. Dr. Henry A. Johnson, Chicago, Illinois. Solicitor-General, Samuel Phillips, North Carolina. Dr. S. M. Bemiss, New Orleans. Dr. Th. Turner, Surgeon U. S. N., Washington, Secretary. Dr. P. H. Bailhache, U. S. Marine Hospital. Dr. Robert W. Mitchell, Memphis, Tenn.

A committee of experts has been sent to Havana to study the disease where it is endemic, and where it can be seen for many months in the year.

“The system [adopted by the new National Health bill] contemplates a national sanitary supervision of all vessels engaged in the transportation of goods or persons from any foreign port where any contagious or infectious disease exists, to any port of the United States. All such vessels shall be required to obtain from the consul, vice-consul, or other consular officer of the United States at the port of departure, a certificate in duplicate, setting forth that said vessel has complied with all the necessary regulations and possesses a clean bill of health. This provision applies with particular and special force to vessels from Havana, a clause in the bill defining in detail the duties of the medical officer in charge of the port. The said inspector must issue a certificate setting forth ‘that he has personally inspected said vessel, her cargo, crew, and passengers; that the rules and regulations prescribed by the National Board of Health in respect thereto have been fully complied with, and that in his opinion the said vessel may be allowed to enter any port of the United States and land its cargo and passengers without danger to the health thereof on account of any contagious or infectious disease.’ Any vessels from such port entering any port of the United States without such certificate shall in each instance forfeit the sum of five hundred dollars. The execution of these provisions is entrusted to the National Board of Health. The latter is also charged with the duty of obtaining information of the sanitary condition of foreign ports and places from which contagious diseases are or may be imported into the United States, and also similar information from home ports. It is also provided that the National Board of Health ‘shall correspond with similar local officers, boards and authorities acting under laws of the States in sanitary matters, to prevent the introduction and spread of contagious and infectious diseases from foreign countries into the United States and from one State into any other State by means of commercial intercourse, or upon and along the lines of inter-State trade and travel.’ To such an end it shall be lawful in times of emergency for said board of health to confer upon any such local officer or board within or near the locality where his provisions of this act, and any rules or regulations made in pursuance thereof.”—_Medical Record._

SYMES ON THYMOL AND THYMOL-CAMPHOR.

Dr. Symes, in the _Pharmaceutical Journal_ of January 10, publishes the results of his researches on the combination of thymol, chloral-hydrate, and camphor, acting as an antiseptic. The two former drugs are rubbed together in a mortar, and an equal quantity of camphor added, which liquefies the whole, and produces a powerful antiseptic. Its virtues were immediately tested on some urine containing pus, and which was already beginning to decompose. Two drops of the compound being added to it, the putrefaction was arrested. If thymol and camphor alone are rubbed together, they also become liquid, and this a convenient form from which to prepare the ointment. Thymol-camphor can be mixed in almost any proportion with vaseline, _ung. petrolei_, or ozokerine, and the thymol will not separate, as in crystals, when thymol alone is used. A solution of thymol in water (1 in 1000) is sufficiently strong for the spray in surgical operations. If used for the throat, milk and glacial acetic acid will be found to be good solvents for it.—_London Medical Record._

REVIEWS AND BOOK NOTICES.

MODERN SURGICAL THERAPEUTICS: A Compendium of Current Formulæ, Approved Dressings, and Specific Methods for the Treatment of Surgical Diseases and Injuries. By George H. Napheys, A. M., M. D., etc. Sixth Edition. Revised to the most recent date. Philadelphia: D. G. Brinton, 115 South Seventh Street. 1879. Pp. 605. Price $4.00, in cloth.

This is a companion volume to Napheys’ Medical Therapeutics which we noticed in our January issue.

The design of this work is to give a careful digest of surgical therapeutics up to the latest date, and the author has succeeded in carrying it out. As a work of ready reference it may be compared favorably with any of a similar character. Discrimination in selections, however, does not seem to be the aim of the author, but rather to bring all matters under their heads, leaving the reader to select those best suited to his needs.

In divesting surgery of its operative procedures, it leaves a comparatively indifferent number of resources, but the therapeutical branch is by no means at a stand still.

We are pleased to see that under the head of anæsthetics, chloroform has been allowed its proper place at the head of the list.

Chloroform “is the most potent of all anæsthetics,” he says, “and its use is still advocated by many eminent surgeons. Only the alleged dangers attending it, prevent its exclusive employment. Many of these arise from its ignorant or heedless administration.” The directions for its use are given, as also the means of combatting dangers arising from it. Dr. Napheys might have added with a great deal of truth, that chloroform should not be administered by any surgeon who is not habitually on his guard as to the dangers of the anæsthetic state.