The Cleveland

Medical Journal

CONTINUING THE CLEVELAND JOURNAL OF MEDICINE

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

Serum Treatment of Epidemic Cerebrospinal Meningitis

The wide spread epidemics of the last few years have stimulated a number of observers to attempt the preparation of an antiserum analogous to that against diphtheria. In this country the work has been taken up by the Rockefeller Institute and the first publication of results is found in the January number of the Journal of Experimental Medicine. Flexner and Jobling have been working on the problem for some time, and it is interesting that the first cases on which the serum was tried occurred in the Castalia epidemic, and that the actual injections were made by a Cleveland physician.

The serum is prepared by inoculation of horses, and is bactericidal rather than antitoxic, having its effect rather on the bodies of the diplococci than on their products, though it is probable that there is at least a small amount of antitoxin also present. Intravenous injections were found to be unsatisfactory, and at present the serum is introduced through lumbar puncture after removal of some of the excess fluid. This brings the bactericidal

serum directly in contact with the bacteria, while subcutaneous injection is notably slow of absorption into the spinal canal. Microscopic and cultural examination of the fluid drawn at subsequent lumbar punctures shows a decrease in the number of the organisms, and especially in their ability to grow on media. Phagocytosis also appears to be markedly increased. Fortyseven cases were treated in all and 31 recovered. In four of the fatal cases the injection of the serum was so late that death occurred in a few hours, and with the omission of these the death 1ate was 20%, much smaller than that among the untreated cases. Results, in general similar to these, with sera prepared in about the same way have been reported from abroad and, although the total number of cases is too small for any wide generalizations, it would seem that there is marked promise in the treatment, and that careful observation of such cases as fall under the notice of each physician will soon give a body of information which will allow authoritative comments on the subject. Serum will be supplied to physicians under certain restrictions to aid in bringing about this desirable result.

Facilities for Hydrotherapeutic Work

The physicians of Cleveland were invited to visit the new Y. W. C. A. building on Saturday, January 12, in order to inspect the splendid new gymnasium and baths with which the establishment is equipped. Hydrotherapeutic and gymnastic measures, for the relief and cure of disease, have not, perhaps, received the attention they deserve, and this may be partly explained by the fact that, until recently, due stress has not been paid to them in the medical college curriculum. In the Medical Record for January 18, 1908, Simon Baruch emphasizes the neglect of instruction upon hydrotherapy in the medical colleges of this country. Columbia University was the first to institute a regular course in it by creating a special chair of hydrotherapy. He points out that only for the past decade has the subject received due attention in Europe and it was taken up there only when it was found how valuable these measures had proved in the hands of irregular practitioners. The regular profession today are attacked by such irregulars as the osteopaths because they are "drug doctors" and it is perfectly true that we often fail to take full advantage of other means of treatment than the administration of medicines. 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.

It is hoped, by those in charge of these departments at the Y. W. C. A., that physicians will avail themselves of the opportunities offered by the Association and that if hydrotherapy or gymnastics are considered, advisable for any female patient, she may be referred to the Y. W. C. A. and suitable instructions for carrying out the treatment conveyed to those in charge of these departments.

The gymnasium is most thoroughly equipped with the latest apparatus and a regular instructor is in charge to direct the exercises so that no harm may result. The baths include Turkish, Russian, shower and needle baths, an electric-light bath and every facility for hydrotherapeutic work. An experienced nurse is in attendance to see that the instructions of the physician are accurately carried out.

The good work accomplished in a great many directions by the Y. W. C. A. deserves the highest praise and the support of everyone and we sincerely trust that the departments referred to may prove especially successful and that the profession will bear in mind the fact that they may avail themselves of the facilities offered by the Association.

The Passing of the Board of Health

A recent ordinance of the Cleveland City Council abolished the Board of Health and created a new Department of Health under the supervision of the Board of Public Service. The members of the Health Board accordingly handed in their resignations. Under the new arrangement Mr. Starr Cadwallader has been appointed Director of Health and has already taken steps to familiarize himself with the details of his work. What futher changes are to be made in the personnel or conduct of the departinent are at this moment unannounced, but its organization and work will be watched with the keenest interest by those most vitally concerned in its efficiency,-the medical profession.

It is a matter of congratulation that a gentleman of such attainments as Mr. Cadwallader should receive this appointment and we look forward with satisfaction to the fact that he will at all times co-operate with the profession in all things that pertain to public health. There will undoubtedly be questions arise in the administration of the department that will require the opinion of a trained sanitarian. We trust that the services of such an expert will be rendered available in the near future.

Vivisection

There are many well-intentioned people in this world, actuated by the most humane motives, who are not sufficiently broad-minded to look beyond immediate details to see the ultimate results that are aimed at, such are the opponents of vivisection. The infliction of pain on the lower animals, in itself, and with no other object than mere curiosity, is most brutal and reprehensible; unfortunately this is apparently the construction that is too often placed upon the actions of those engaged in experimental work on animals. The antivivisectionists fail to grasp the point that many of the triumphs of modern medicine and surgery, which have saved untold suffering and innumerable lives in human beings, would have been utterly impossible without such means. It is said of the great Pasteur, a most tender-hearted man, that nothing gave him greater distress than the suffering he had to inflict in carrying out his animal experiments which, in the end, conferred such a wonderful boon upon humanity.

A recent sensational article in one of the Cleveland papers directed the notice of the public to this matter. The attention of the Humane Society had been drawn to the fact that animal experiments were being carried out in one of the hospitals in this city and that the dogs which were used were allowed to recover from the anesthetic; as a result of this investigation of the Society, the dogs were ordered killed.

In devising any new operative procedure or in acquiring facility in the technic of a difficult or dangerous operation, before employing it upon human beings, it is not only the immediate results that count but the ultimate outcome is often the essential point and this necessitates the recovery of the animal from the anesthetic.

Not only operative procedures but inoculation experiments upon animals must fall under the ban of the antivivisectionists. Thus would the production of immunizing sera, which have proved of incalculable value, be rendered impossible. Experiments upon transfusion, anastomosis of blood-vessels, transplantation of organs and a host of other investigations of the utmost importance to mankind would be out of the question if the opponents of vivisection had the full sway they desired.

The regulation of vivisection is right and proper and fortunately many of the antivivisectionists are willing to concede that a certain amount of such work is inevitable and justifiable, but the

decision as to what is and what is not permissible should be left in the hands of those who are competent to form an intelligent opinion in the matter.

Editorial Change

With the December issue of our contemporary, the Columbus Medical Journal, Dr J. J. Barnhill retires from the active editorship. That this will be a great loss to the Journal and the profession at large goes without saying. Dr Barnhill has been actively connected with the editorial work for the last 14 years, during eight and one-half of which he has been the editor. Not only has this occupied his time, but he has been engaged in teaching as Professor of Surgery in the Starling-Ohio Medical College, and he has also done much hospital work. The editorship of a medical publication involves far more labor than would be supposed and it is bound to encroach upon the time that the editor should devote to his practice and other duties, for the financial recompense of such a position is usually nothing or very little. It is to be hoped that Dr Barnhill's influence will still be felt in the conduct of the Journal and surely it will be impossible for him to maintain other than a very active interest in its welfare. We regret that circumstances have been such that he has felt it necessary to resign the position of editor which he so satisfactorily filled.

Since the above was written the appearance of the first number of the Columbus Medical Journal, under the management of Dr C. S. Carr, the new editor throws much light upon the subject. The character of the Journal is now completely changed, it is no longer one for the physician but for the laity, so that we are not surprised at Dr Barnhill's resignation. His connection with it under the present circumstances would be out of the question. The Journal has found it financially impossible to continue under its former character and it is deplorable that enough support could not be secured to maintain its ethical standard. At the present time there are so many publications supported by the great medical organizations, that those of a local character find it a matter of increasing difficulty to make both ends meet. It is unfortunate that with the change in management the title of the Journal was not changed to be more in keeping with its new character.