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he does not know; but of this he feels reasonably certain
that it is not due
simply to the difference of primary syphilis among them. To say that it is due to a racial and sexual difference in the power of resistance of the nervous system, does little more than restate the facts. Virchow has lately raised his voice against the methods of study which have led to the all but universal belief that tabes is always directly dependent upon preceding syphilis.
The time between the syphilitic infection and the first symptoms of tabes varies a good deal; this point was determined in 47 cases. Tabes developed after the venereal sore in 47 cases: In the first 5 years, 6 times; in the second 5 years, 10 times; in the third 5 years, 13 times; in the fourth 5 years, 10 times; in the fifth 5 years, 4 times; after 25 years, 4 times. The shortest interval was 2 years, and the longest intervals were 26, 27, 30 and 42. It occurred about equally in the second, third and fourth 5 years.
As to the other causes of tabes, Thomas' histories show nothing important.
CLIMATOLOGY AND PHTHISIOLOGY.
UNDER CHARGE OF LLEWELLYN P. BARBOUR, M.D., BOULDER, Colorado.
The Declension of Phthisis in England and Wales.
For several decades there has been a steady decline in the number of deaths from pulmonary tuberculosis in England and Wales. In an oration before the Hunterian Society, Sir Hugh Beevor, Bart., M.D., discusses the subject very thoroughly (The Lancet, London, April 15, 1899).
The oration begins with some quotations from John Hunter, showing that this great man taught, in advance of his day, that the tubercle of the lungs depended upon the same constitutional disease as scrofula, and that tubercles were the cause of consumption; that consumption is a specific disease, to which animals are liable as well as man, probably from the same cause; that it was only the readiness to fall into this peculiar action when properly irritated, only the susceptibility, which was hereditary. Hunter stated that consumption was most frequent in those countries where little else but a vegetable diet was eaten.
Coming to his subject (The Declension of Phthisis), Sir Hugh first discusses the value of the vital statistics relating to consumption. They deal with large numbers, they are the subject of ever fuller inquiry and correction, and they have in every decade been analyzed and criticised by competent statisticians. These critics and investigators agree that the apparent declension of phthisis is not due to the transference of deaths from phthisis into any other class. No disease is so readily diagnosed as phthisis in its advanced stage, and it is certainly less likely to be wrongfully certified to than most causes of death. The statistics are unquestionably reliable, and there can be no doubt whatever that there has been a steady reduction in the death rate from consumption in England and Wales from the year 1851 to the year 1895. There has been not only a reduction in the number of deaths from phthisis, but also the proportion of deaths from phthisis to deaths from all other causes.
The death rate per 10,000 living is now about one-half what it was when the earlier statistics were taken, up to the age of 35; after that age is passed the
declension is continually less as we approach old age. the number of deaths from phthisis in old age being about the same now as then. The greatest death rate then was between the ages of 25 and 35; now it is greatest between 35 and 45. The death rate of phthisis of children is about one-half what it was at the earlier period, but the declension of the death rate of children from other tubercular diseases has been very slight. The declension is decidedly more marked among females up to middle age; afterward the difference is continually less. That is to say, while in the earlier statistics the death rate from phthisis was greater among females than males until after the age of 35, it is now greater only until the age of 20, and a comparatively slight difference up to that age; while after 20 the death rate from phthisis is decidedly greater among males, and remains so through life, but the difference growing less toward old age.
Dr. Beevor, among other tables of statistics, gives one showing an increase of ten per cent. per capita in the amount of food consumed in England and Wales during one year now compared with the earlier years of the statistics, and the increase was rather more in meats than in breadstuffs. Space limit forbids following Dr. Beevor in his analysis of tables of vital statistics, of wage, of food, of clothing, etc., etc. His conclusions are briefly as follow:
The declension of the phthisis death rate is due to the better feeding, clothing and housing of the British laboring classes.
The principal cause of declension is the increased nutrition consequent upon the improved wages.
The declension of phthisis is most marked in those places where the increased consumption of meats is most marked.
The declension is most marked at those ages when phthisis is most prevalent-that is, during early life.
The effect of improved feeding is most marked in early life.
The declension of phthisis is more marked in female than in male.
Males are more liable to all forms of lung disease than females.
Males are more and more taking up indoor occupations.
The improvement in the condition of females among laboring classes is more decided than the improvement of male conditions, the females being less confined than formerly, and more out of doors.
So far as we can learn, the declension of phthisis among the wealthier classes is much less than among the laboring classes.
The death rate from other tuberculous diseases is much greater under five years of age than the death rate from phthisis.
After five years the death rate from other tuberculous diseases is insignificant. Other tuberculous diseases do not often lead to lung infection—to phthisis. Hereditary susceptibility plays an unimportant part in the causation of phthisis. Acquired susceptibility is a very potent cause.
Discussion of Tuberculosis before the Chelsea Clinical Society.
A special meeting of the Chelsea Clinical Society, held April 18, 1899, for the discussion of tuberculosis, is reported in the Lancet of April 22, 1899. The president, J. Foster Palmer, in his introductory remarks, touched upon several aspects of the question. He thought surgery would yet play an important part
in the treatment of phthisis; he thought we should soon excise the lung for tubercular affection as certainly as we now extract teeth for toothache.
Prof. G. Sims Woodhead discussed the pathology of pulmonary tuberculosis. He pointed out the relation of consolidated patches and cavities to the glands. at the root of the lungs. He gave examples of extension of tubercle to the lungs: (1) from the glands; (2) from the abdominal cavity, especially when the base of the lung was adherent to the diaphragm and the diaphragm to the liver; (3) from the thickened pleura on the wall of the chest and in connection with thickened pleura at the apex. He also showed how, in cases of acute pleurisy, tuberculosis often appeared to come in as a purely secondary condition. He then described the results of feeding experiments on the pig, showing how the bacillus of tubercle could enter by the tonsil, which it might or might not attack directly, but having made its way to this point it followed the course of the glands of the neck down to the apex and then to the root of the lung. He thought this channel of invasion was only now coming to be recognized at its true value. He spoke of the necessity of absolutely cutting off tuberculous cattle from a dairy supply. He looked upon tuberculosis as an exceedingly curable disease. He thought tuberculin, in some form or other, would still prove useful in the treatment, especially when, as the president had indicated, we could cut out or expose thoroughly tuberculous lesions.
Dr. Sidney Martin and Mr. Watson Cheyne continued the discussion along the same lines. Dr. Martin pointed out that in experiments by feeding, by inhalation, or by inoculation, there might be direct local infection and infection at a distance. In feeding experiments, for instance, one animal would have a local lesion in the intestinal tract, while in another there would be none but a lesion in one or more of the mesenteric glands. This showed that the tubercle bacillus could pass through the intestinal mucous membrane without producing a local lesion. This could occur in the respiratory tract also. Mr. Cheyne sustained this point, and showed that even deep-seated lesions, as those of the joints, might be primary. Such lesions were perhaps not often primary, but that they were sometimes so he thought well established.
Analysis of Fifty Autopsies on Tuberculous Subjects.
Dr. A. S. Warthin (Medical News, April 15, 1899), in an analysis of forty-one autopsies on subjects dying of phthisis, found in one hundred per cent. the larynx, bronchial glands, liver, spleen and kidneys involved, as well as the lungs and pleura. In ninety-five per cent. of the cases the small intestines and mesenteric glands were involved as well. He thinks that these metastases and secondary infections play a much more important part in phthisis than is commonly believed. Nine autopsies are reported on cases of acute miliary tuberculosis, tubercular meningitis, etc. [A death caused by pulmonary tuberculosis directly and only is doubtless very rare. The writer does not recall in his experience a single case where an autopsy on a phthisic subject has not shown serious involvement of other important organs.—L. P. B.]
Congress of Tuberculosis.
A congress, having for its subject tuberculosis, met in Berlin May 24 to May 27. The business of the congress was conducted in five sections, viz.: (1) distribution, (2) etiology, (3) prophylaxis, (4) therapeutics, (5) sanatorium treatment. Abstracts of the more important papers will appear in this department as rapidly as we can get them.
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West Tennessee Medical and Surgical Association met at Jackson, Tenn., May 25, 1899, and was called to order at 10 A. M., President Wm. Krauss, M.D., in the chair; I. A. McSwain, M.D., Paris, Secretary. Registered as present: Dr. Asa Bell, Bethel Springs, first Vice-President; Dr. Wm. M. Mason, Hazel, second Vice-President. Members: Drs. J. M. Lemond, J. D. Hopper, T. J. Happel, R. A. Jones, M. M Moody, M. M. Smith, Jere L. Crook, J. T. Barbee, W. G. Snipes, E. C. Ellett, A. E. Cox, J. M. Arnold, J. T. Jones, J. T. Warford, J. W. McDonald, R. Wood Tate, Jno. A. Blackmon, Jno. R. Fowlkes, J. T. Herron, B. F. Baird, W. S. A. Castles, G. R. Thomas, J. C. Douglass, J. R. Carroll, P. B. Lusk, R. L. Greer, W. F. Rochelle, M. J. Siler, R. McKinney, J. S. Rawlings, Jr., T. J. Crofford, L. L. Webb, C. H. Johnston, W. T. Watson. The following new names, duly recommended by the Committee on Credentials, were elected to membership: Drs. J. C. Stinson, Centre Point; A. P. Smyth, Ridgely; L. G. Bouton, Greenfield; B. G. Adamson, Jackson; Alfred Moore, Memphis; E. K. McNeill, Jackson; Jno. H. Harris, Gadsden; I. W. Perkins, Henderson; Jno. Arnold, Middle Fork; F. D. Smythe, Memphis; E. M. Holder, Memphis; Geo. M. Dorris, Dorris; C. C. Drake, Jackson; J. E. Atkinson, Juno.
The following subjects were discussed:
The Financial Aspect of Medical Practice, by W. T. Watson, M.D., Lexington. Reports of Cases of Osteomyelitis, with Operations, by Jere L. Crook, M.D., Jackson.
Operation for Bullet near the Medulla, by W. F. Rochelle, M.D. Jackson. Ludwig's Angina, by R. Wood Tate, M.D., Bolivar.
Reports of Operations, viz.: Amputation of Breast and Urethrotomy, by T. J. Happel, M.D., Trenton.
Report of Cases of Abdominal Surgery, by T. J. Crofford, M.D., Memphis.
Different Phases of Life-Diagram, by J. D. Hopper, M.D., Andrew Chapel.
Traumatic Hematuria of the Vagina, by J. C. Stinson, M.D., Centre Point. Intubation of the Larynx in Laryngeal Diphtheria, by Richmond McKinney, M.D., Memphis.
Some Remarks on Mastoid Operations, with Reports of Cases and Illustrations, by E. C. Ellett, M.D., Memphis.
The Nuclein Preparations in the Prevention and Treatment of Certain Diseases, by W. M. Mason, M.D., Hazel.
Intestinal Antisepsis, by T. J. Crofford, M.D., Memphis.
Dark Iodide of Lime in Croup, by Geo. M. Dorris, M.D., Dorris.
The President's Annual Address, subject, Medical Legislation, by Wm. Krauss, M.D., of Memphis, was delivered at the Baptist church on the evening of the first day of the meeting. The address was public, and will appear in an early number of the MEMPHIS MEDICAL MONTHLY.
Rev. Dr. Powell also delivered a twenty-minute oral address on Tuberculosis, which was highly entertaining and instructive.
The following resolution was unanimously adopted:
Resolved, That a committee of seven members be appointed and instructed to prepare a circular letter, or letters, containing such information as the public needs in regard to contagious and infectious diseases, and indicating the necessity of wise and judicious legislation relative to the preservation of public health, as well as wholesome laws regulating medical practice.
The President appointed the following committee: Drs. I. A. McSwain, M. M. Smith, J. A. Crook, T. J. Happel, Wm. Krauss, W. S. A. Castles, J. P. Douglass.
The publication of such literature as should be agreed upon by the committee should be referred to the newspapers as a medium through which the public could be reached and benefited.
The following officers were elected: President, Dr. W. M. Mason, Hazel; first Vice-President, Dr. Jere L. Crook, Jackson; second Vice-President, Dr. A. E. Cox, Milan; Secretary and Treasurer, Dr. I. A. McSwain, Paris.
The following were nominated and elected delegates to the State Medical Society Drs. Jno. R. Fowlkes, C. C. Drake, G. M. Dorris, J. A. Blackmon, J. H. McSwain, A. P. Smyth, A. E. Cox.
To the American Medical Association: Drs. M. M. Smith, J. T. Herron, Wm. Krauss, G. R. Thomas, Jos. A. Crook, I. A. McSwain.
Milan was chosen for the place of the semi-annual meeting in November, 1899. The following committees were appointed:
On Arrangements for the Meeting at Milan, November, 1899: Drs. A. E. Cox, J. J. Richardson, J. A. Blackmon, Jno. R. Fowlkes, Geo. W. Penn.