THE NEW ENGLAND MEDICAL GAZETTE. BOSTON, MARCH, 1879. SEVERAL weeks ago we received a fifty-six page pamphlet, the "Special Report of the Homœopathic Yellow Fever Commission," ordered by the American Institute of Homœopathy for presentation to Congress, printed at New Orleans, accompanied by a note from Dr. Holcombe, requesting us to abstain from noticing it just then, as it had not been presented to Congress. Now that this ban of impropriety has been removed, and a reprint of the pamphlet published for general circulation by Boericke & Tafel, we shall cull from it a few facts and observations, referring our readers to the original source if they desire more. We regret to learn that six homœopathic physicians of New Orleans got their backs up about some little personal matters, and disgraced themselves by refusing to report to the commission, being willing to sacrifice the public good to their private squabbles. There were 3914 cases reported by other homœopaths (of which 1945 were in New Orleans), with 261 deaths, — a percentage of 6. In New Orleans the fever was less severe than outside, the mortality in that city under homoeopathic treatment being in the ratio of 5% per cent to 7 in other places. It was much more severe in places where it had never been before than in those places which it had frequently scourged. It was far less fatal to the blacks than to the whites. The number of cases reported as occurring among negroes was exactly 900, with a loss of 27 patients, 3 per cent. Among children under fifteen the mortality was 4 per cent. The reports of about one half of the cases (2010) give not only cases and deaths, but the name, age, and address of every patient attended, so that with these documents every statement can be fully verified and comparison challenged. Of these 2010 patients, 129 died, 6 per cent. There were 64 recoveries after black vomit. Of 828 children under fifteen years of age, only 40 died, — 41 per cent. "Not at all," was the answer of the large majority of our physicians to the question asked in the circular sent them, "To what extent did you avail yourself of allopathic or eclectic measures?" Some acknowledged the occasional use of an anodyne to produce sleep in cases of extreme wakefulness; some gave a little sulpho-carbolate of soda for black vomit, or enemata of quinine in collapse, etc., but these interpolations were comparatively very infrequent. The remedies most often used were Aconite, Belladonna, and Bryonia for the first stage, and Arsenicum, Carbo vegetabilis, and Crotalus for the second. The homeopathists deny that blood-letting, purging, sweating, and other similar measures so often resorted to in the first stage even in this last epidemic by allopaths, can do more than simply weaken the patient. In mild cases they are not needed; in severe cases they entirely unfit the sufferer for the exigencies of the second stage, which is one of exhaustion. "The range of homœopathic loss, as between different physicians of the school, is very limited, say from five to ten per cent. The range of loss under the diverse and often opposite practices of the old school is very great, from five to twenty and thirty and even forty per cent. The heroic treatment, bleeding, emetics, purgatives, calomel, and quinine, to which may be added cold applications in the first stage of the fever, was uniformly the least successful. In proportion as milder and less medicine was given, the patient's prospects of recovery brightened; and the expectant physicians, those who gave little or nothing, approached nearest to the homœopathic success. "The yellow-fever germs for we accept provisionally the germ theory of the disease are indigenous to the West Indies and perhaps to the west coast of Africa, and have been thoroughly naturalized in many localities in the southern portion of the United States. They were imported into New Orleans during the last quarter of the eighteenth century, and have existed in the soil or atmosphere of that place ever since, either in a latent or an active condition. They may lie dormant for many years consecutively, and they require a concurrence of causes to develop them into a state of disease-producing activity. "The imported epidemic, whether from Havana to New Orleans or from New Orleans to Memphis, etc., etc., is always a more quickspreading and malignant disease than that arising from our naturalized germs. The comparative mildness of the late epidemic in New Orleans is one out of several reasons for believing that the disease was of local origin. "The yellow fever of domestic origin can only be prevented by local sanitary measures. So long as the public authorities ignore the crying evils at home, and watch only for the enemy at the seaside, we shall continue to be scourged with repeated epidemics of yellow fever. Quarantine may or may not keep out the tropical foe, but our utmost energies should be concentrated against the enemy which has been domiciliated in our households for nearly a century." THE report of the Yellow Fever Commission authorized by Congress (allopathic) contains seven or eight hundred pages, and is so bulky that very few will care to read it. The following abstract, however, furnished to the "Advertiser" by Dr. Samuel A. Green, City Physician of Boston and one of the members of the Commission, we know will prove of interest to those of our readers who have not already seen it: "All the cases of fever in the Southwest were traced to New Orleans, and were found to have originated there from two cases that arrived at that port in May from Havana. The disease is indigenous to the West Indies, but is always an exotic, never indigenous to this country. Yellow fever in the North is only prevented by our strict quarantine regulations. It is not contagious from one person to another, but is communicated by clothing. If a yellow-fever patient was thoroughly washed and cleansed, he could be put into any hospital without danger to the other patients, the infecting principle being carried by the clothes and not by the person. This infecting principle has been searched for in every possible way, microscopically and chemically, but has never been found. The theory most generally adopted is the "germ theory," because that hypothesis will explain more of the peculiarities of the disease than any other. The disease is believed to be propagated by invisible germs, which are probably taken in through the lungs. These organisms have the property of reproduction, and multiply very rapidly. They germinate out of the body, but there is no evidence that they multiply in the body in a way that will affect other people, although becoming a poison to the patient. The only way of meeting the disease is by strict quarantine, and upon this point the experts are very certain. In order to have a uniform system of quarantine at the South, it has got to be by the national authority. The South will undoubtedly be in favor of a national Quarantine Act. An interesting fact in connection with the epidemic of last summer is the way in which certain towns that quarantined themselves escaped the ravages of the disease. All through Mississippi, Alabama, and some portions of Florida, the town authorities, and sometimes the county authorities, established a rigid quarantine, which was sometimes called "shot-gun quarantine.', A few men would go out on the roads leading into a village and establish themselves as in days of the war, and challenge those who approached, shooting them if they attempted to run the blockade. The towns thus guarded almost invariably escaped. The city of Natchez, for example, on the river between Vicksburg and New Orleans, had a strict quarantine and was not visited by the disease. Texas was strictly quarantined against the east. No one was allowed to enter it from Louisiana, and even the mails were not received. The importance of these precautions is so deeply realized that, if a national Quarantine Act is not passed, and the epidemic should break out again, the people would very likely burn the railroad bridges to stop the trains from infected points. It is possible, assuming the correctness of the germ theory, that the fever will break out this season in houses where there were cases of it last summer, upon the supposition that the frost was not severe enough in protected places to kill all the germs. It is believed, however, that the fever springing from the winter germs is not so virulent as when it starts from the fresh imported germs, and, although there may be fever in New Orleans this year, it will not necessarily be epidemic. “Dr. Green speaks with much pleasure of the treatment the gentlemen from the North received from the Southerners. They were uniformly courteous and hospitable, and he did not see a single instance of animosity or ill-feeling on the part of anybody, high or low." CORRESPONDENCE. To the Editor of the New England Medical Gazette: In the January number of your journal you ask the question, Are we not doing too much for the poor in the way of free medical attendance? Two years ago the following letter was published in the "New York World," and may be of interest, as showing that medical charity can begin at home, and at the same time be dispensed without producing paupers or encouraging impostors. The fact that the small-fee system inaugurated by us has been adopted by many of the dispensaries located in New York (homœopathic and allopathic), and has proved successful in every instance, is sufficient recommendation for its further extension. Among the dispensaries in New York City which have adopted the small-fee system may be found the New York Dispensary (where, until lately, all treatment was free except at the venereal clinic), the Eastern Dispensary, the Demilt Dispensary, the Northeastern Dispensary, and the Out-Door Service of the New York Hospital. Thus more than one half the dispensary practice in New York has been made to come within the provisions of the small-fee system. As in no case has the adoption of this method been regretted, I think its universal acceptance is only a question of time, with the possible exception of college dispensaries. The fee at our dispensary is ten cents for medicine without examination, and twenty-five cents for medicine with examination. Respectfully, NEW YORK, Feb. 9, 1879. FREE DISPENSARIES. EMMA SCOTT-Wright. To the Editor of the World: Sir, - Allow me to state, in connection with the movement for establishing a provident dispensary system in this city, that the management of the " Homœopathic Dispensary for Women and Children" adopted the small-fee system last October. The plan so far has worked most successfully. This system was adopted after studying the main features of an English provident dispensary, the points being furnished by Dr. Clifton, of Northampton, England, he having had an extended experience in this direction. Comparing Dr. Clifton's report with the experience of the physicians in attendance at the "Homœopathic Dispensary for Women and Children," the conclusion was drawn that existing differences in the social condition precluded the successful engrafting of the English plan into the United States. Through the adoption of the small-fee system this dispensary has become self-sustaining, and a number of unworthy people who formerly applied for relief hvea ceased their attendance; "they preferred, if they had to pay, going to a doctor's office and paying the difference in prices." By the withdrawal of these impostors, some of them real-estate owners, the daily attendance at the clinic fell off, at first, about thirty per cent. This diminution is now made up by a deserving class of applicants. After an almost daily attendance of four years in a dispensary, I am convinced that the present system of free dispensaries tends to demoralize the poor, is an extortion from tax-payers, and an injustice to physicians. Respectfully, EMMA SCOTT-WRIGHT, M. D. Homœopathic Dispensary for Women and Children, SOCIETIES AND JNSTITUTIONS. ESSEX COUNTY HOMEOPATHIC MEDICAL SOCIETY. REPORTED BY N. R. MORSE, M. D., SECRETARY. THE annual meeting of this well-known society was held at the house of Dr. N. R. Morse, in Salem, on Tuesday, Dec. 24, 1878, at two P. M., the President, Dr. M. V. B. Morse, of Marblehead, in the chair. After the secretary had read the records of the November meeting, Charles Leeds, M. D., of Chelsea, was unanimously elected to membership, he having been proposed as a candidate at the November meeting in Lynn. The treasurer now presented his annual report, which was accepted, and the society proceeded to the election of officers with the following result: President, Augustus Thompson, M. D., Lowell; Vice-President, C. W. Scott, M. D., Lawrence; Secretary and Treasurer, Nathan R. Morse, M. D., Salem. |