The Cleveland Medical Journal CONTINUING THE CLEVELand MedicaL GAZETTE and MONTHLY The Official Organ of the Academy of Medicine of Cleveland Entered March 7, 1902, as Second-Class Matter, Post-Office at Cleveland, Ohio, under Act of Congress of March 3, 1879. EDITORIAL Plague Investigations in India Cursory examinations of the files of the Journal of The American Medical Association shows that plague is endemic in India, not a week passing without the record of a certain number of deaths from that disease. The conditions of native life, notably the objections on the part of certain of the sects to the taking of any form of life, make the problem of plague prophylaxis a serious one for the Government. In recognition of this they have appointed an Advisory Committee, whose results are published in the Journal of Hygiene. The last issue, of some 300 pages, deals especially with the epidemiology, and has many points of interest for us on account of the constant threatening of our Western ports. Most of the work has been done on the basis of the rat infections and their bearing on the human infections. There is a most interesting series of charts of certain of the best studied villages, showing the relation of the finding of plague infected rats to the subsequent development of the human cases, and a further series showing in curves the relation of the time incidence of the two series of cases. In general the Committee has observed that there are two main kinds of rats in Bombay, one the ordinary sewer rat, of more or less wandering habits, the other the house rat, almost a domestic pet and inclined to remain in the same place. They have noted that there are on the average twice as many fleas on the sewer rat as on the house rat, and in connection with this, that about twice as many sewer rats are found to have plague. The sewer rat epizoötic precedes the house rat epizootic by about ten days, and in this connection it has been found that experimental exposure to infected fleas gives an incubation period of about eight days. The human epidemic follows the house rat epizootic by about the same interval as that between the rat infections. From these observations they conclude that the prime mover in the infection is the sewer rat, and that this animal carries the infection over the less active periods; that the sewer rat is responsible for the infection of the house rat and that the latter is responsible for the human cases, though in some instances the transfer from the sewer rat to the human being may be direct, and also that the rat fleas are the carriers in practically all cases. The extirpation of all rats is a large problem, but so far as present knowledge goes, all treatment or other prophylaxis is only palliative as long as these active agents of infection are allowed to remain and multiply. Sewage Disposal in Cleveland It would seem that savages would scarcely pollute their drinking water with sewage. State Boards of Health recognize this elementary condition and apply it to the individual, but seem to be totally impotent when municipalities are concerned. The isolated farmer cannot turn his sewage into the stream or lake, but it seems to be quite beyond the power of State Boards of Health to prevent large cities from pouring the entire sewage of a city into a lake or river. When Cleveland proposed to build an intercepting sewer to gather up all the sewage and empty it into the lake at the eastern limits of the city, an effort was made by public-spirited citizens to prevent this pollution of the drinking water. Meetings were called and Colonel Waring was brought here from New York, and protested in a public address against such a method of sewage disposal. A commission of so-called experts was appointed, and they reported that there was a current of four miles in twenty-four hours down the lake, so that if sewage was emptied into the lake at the eastern limits of the city it would not pollute our drinking water, but would be passed on to Ashtabula, Erie and Buffalo. In order to demonstrate the truth of this proposition a great many sealed bottles were put into the lake at about the location of our present intake, and it was proposed to go down toward Buffalo and pick up these bottles later. Unfortunately, however, for the experiments, the bottles were nearly always picked up at Rocky River, showing that the current at that particular time was toward the west and not toward the east. As a matter of fact Cleveland is in a bay and there is no current, and if it were not that the prevailing winds are from the west our water would be much worse. The present agitation for a filtration plant by the City Council seems to be ill-timed; at present the drinking water is comparatively safe, though still somewhat polluted with sewage. It would seem to be a much more rational proceeding to devise a more effective method of disposing of sewage. If it were otherwise cared for the question of filtration might be indefinitely postponed. Even though water is filtered it must leave a bad taste in the mouth to know that it is only filtered sewage. Cities should not be permitted, any more than individuals, to menace public health by polluting sources of water supply, but as past experience has shown, local and State Boards of Health seem to be absolutely unable to control this matter; it would scem that the only solution is Federal regulation of public health as now so forcibly urged by the Committee of One Hundred of the American Association for the Advancement of Science in National Health. New Journals There is no better evidence of the advance in medicine than the addition to the literature of a number of new journals that are of a decidedly high character. Within a few months there have appeared the first issues of the Archives of Internal Medicine from the press of The American Medical Association, the Quarterly Journal of Medicine in the production of which Dr Osler has been so actively engaged, The Proceedings of the Royal Society, an organization formed by the union of a number of different medical societies in England, and The Archives of Diagnosis published quarterly in New York. New Journals of State Associations are appearing from time to time, the most recent of which is the Journal of the Indiana State Medical Association. The statement has been made that there are already too many medical journals and that it would be a great blessing if many of the articles contained in them had never seen the light. To some slight extent this may be true and many articles are merely a compilation and add little or nothing new to our existing knowledge, but who is to judge the worth of any particular article or of what value it may prove in the future? It may on the one hand prompt someone else to contribute an article of great merit or it may give help to some practitioner in the management of a troublesome case and in any case it will necessitate helpful study on the part of the writer. The results of many researches may seem of little use at the time but the day may come when they will furnish a cog in the mechanism that will aid materially in the solution of other problems, hence the value of placing on record the outcome of such researches even if their practical value is not apparent at the time. Hydrotherapy In our February issue in referring to the subject of hydrotherapy and the means for carrying it out, we made this statement, "So far as this city is concerned, if suitable facilities for carrying out such treatment already existed, the fact was unknown to many of the profession." Exception to this statement has been taken by Christian Sihler, M. D., who points to the Windsor Hydriatic Institute with which he is connected, the good results obtained there and the physicians who have referred patients to it. No reflection upon this Institute or upon any one of several others in this city was intended and we regret exceedingly if that construction has been placed upon our remarks. The statement was intended simply to point out that the profession as a whole are more or less indifferent to the results of hydrotherapy and consequently to the existing facilities, inquiry made haphazard among them tends to support this contention. Department of Therapeutics Opium Habit: CONDUCTED BY J. B. McGEE, M. D. In reply to a request from one of our subscribers for notes on the treatment of the opium habit, H. H. Drysdale, of this city, writes as follows: In neurologic practice the most trying and perplexing patients encountered are those that seek escape from an invincible desire for opium or its alkaloid morphin. Individuals so affected are for the most part neuropathic, emotionally unstable and hypochondriacal. They are intolerant of pain, egocentric and irascible. When the drug has once provided transient relief accompanied by a significant degree of euphoria, it becomes to many an inseparable friend, a comforter of their existence, a deity to whom incense is offered by the enslaved mind. Not a few patients gradually become habituated to the vice through the suggestion of a medical prescription given to overcome some chronic painful state. From the continued use of morphin the physical economy grows accustomed to it and when the original dose ceases to excite that inebriation of the senses, combined with pleasurable sensations, it is steadily increased. Finally the patient takes on the symptom-complex of chronic opium poisoning. The somatic manifestations of this deplorable condition depend, of course, upon the individual idiosyncrasies and the length of time the narcotic has been taken. In all cases an aversion to food occurs and gastro-intestinal disorders follow. Flatulence and attacks of diarrhea alternating with constipation are common symptoms. The circulation fails and the heart action becomes accelerated and irregular. The patient rapidly loses flesh and he appears apathetic and listless. Persistent insomnia is always a troublesome feature. Furunculosis will be observed in many cases when the drug is used hypodermically. The mentality of the victim also suffers and his personality promptly deteriorates. He loses his moral and esthetic tone and indulges in deceit and fabrications of every scope and variety. A true psychosis may develop any time. The treatment of these unfortunates demands, in the first place, all the tact, patience and ingenuity the physician can devise. The mental status of the individual as much as the physical condition from which he suffers requires the best that is within us. In very mild cases the habitue may be treated at home, secluded from his family and friends, and the responsibility of his care placed in the hands of a reliable nurse who fully appreciates that these patients will resort to all manner of subterfuge to secure the drug. In the majority of cases absolute isolation is imperative and the proper place for treatment is in the hospital. In years gone by an attempt was made to cure these afflictions by substitution and various drugs were recommended to replace the morphin. Among such were cocain, hyoscin, paraidehyde, and spartein. This plan, however, has long ago passed into the depths of oblivion, unhonored and unsung, from the fact that the use of these agents converted the individual's condition into another equally dangerous, if not worse. Another mode of treatment sometimes advocated is the sudden withdrawal of the drug. This method fortunately has met with little favor except in very mild cases. Those who have witnessed the "phenomena of abstinence" and the frightful chain of symptoms they provoke will promptly discard it. To me it appears |