John Ritter

A Short Sad Clinical Note

To the Editor.— The medical facts are as common as cornbread. A 70-year-old man came to my office in the middle of December. He was healthy except for a small hydrocele that he wanted me to fix. I told him that surgery was not necessary and he left without protest. The human facts are less clear. I knew that he was old and lonely and poor. I saw no depression and he was certainly not out of contact with reality. Somehow he must have had a desperate need, because on Christmas day in a tar-paper shack in an abandoned coal camp he blew out his brains with a shotgun. Perhaps I should have put him in a warm hospital full of Christmas decorations and young nurses happy with holiday plans. Perhaps I should have accepted the sacrifice of his small hydrocele in exchange for a good meal and a kind

TRANSMISSION OF TUBERCULOSIS

To the Editor: —InThe Journal, August 1, page 316, Dr. J. A. Myers offers a pathetic picture which may create unrest in the minds of prospective medical students and tuberculosis nurses as well. The teaching of tuberculosis as a clinical entity in medical schools had its inception about twenty years ago. Previous to that time tuberculosis was not considered of sufficient importance to be offered space in the curriculum of any medical school in our country. I can well recall my first attempt at the organization of a class for the teaching of clinical tuberculosis. At that time all medical students considered the examination of an active tuberculous person as extremely hazardous, and it was not until many years later, when the student body became convinced that there was actually no danger in the physical examination of the tuberculous patient, that classes became enrolled for intensive study of tuberculosis

PULMONARY TUBERCULOSIS ASSOCIATED WITH BRONCHIAL OBSTRUCTION

To the Editor: —A clinical note on this subject inThe Journal, April 21, concerns a 3 year old child, who became suddenly ill and after ten months developed meningitis and died. A diagnosis of miliary tuberculosis was made. The most striking feature is the frequent negative Pirquet tests. These tests were from the beginning positive signs of a disseminated tuberculosis. Even a tuberculin test made some months before the sudden onset would in all probability have been negative. The infant from the onset was tuberculotoxic and in that state it is impossible for the body, with added tuberculin, to produce an allergic reaction, and the negative reaction pointed definitely to an active tuberculous condition. In the tuberculously infected, in the patient suffering from localized disease and in pulmonary tuberculosis, not too progressive or too far advanced, the tuberculin test is always positive and the test remains positive only as

IODINE IN TUBERCULOSIS

To the Editor: —To one who has administered tincture of iodine in tuberculosis for a number of years, the reading of material on this subject in recent issues ofThe Journalhas been of deep interest. Concerning the work done by H. W. Butler on guinea-pigs, to which Dr. Edwards (The Journal, August 14, p. 509) refers, particularly the one pig that received a single dose of tincture of iodine for fourteen days, it is questionable whether one-fifteenth grain (4 mg.) of iodine in a drop of tincture of iodine U. S. P., or the drop of pure alcohol, killed the pig. Every one who has done experimental work on guinea-pigs knows quite well that tincture of iodine cannot be given to guinea-pigs satisfactorily. The guinea-pig is extremely sensitive to the most minute quantities of alcohol, and alcohol administered to the animal in any form is highly and quickly toxic.

The Official Responsibility of the State in the Tuberculosis Problem

To the Editor: —InThe Journal(Aug. 7, 1915, p. 512) appears a most interesting paper by Dr. William Charles White of Pittsburgh, which was read at the recent meeting of the National Association for the Study and Prevention of Tuberculosis, at Seattle. All those who are vitally interested in the tuberculosis problem are of the opinion that only by united and concerted action between city, county and state authorities with the federal government can mitigation and control of tuberculosis be accomplished. Dr. White, in the beginning of his paper, refers to the unsatisfactory demonstrations made for the control of the disease, and expresses the opinion that if a unit in a community ever so small could demonstrate a feasible plan for the control of the disease, such a plan could be adapted by any community, as a whole, as a practical working plan. In 1911 Dr. Petruschky of Danzig

AN ANOMALOUS TEMPERATURE-CURVE IN THE MODERATELY ADVANCED TUBERCULOUS

The variability of the temperature-curve and the pulse-wave as usually observed in the tuberculous is so well known to all physicians that a reference to it at this time may appear to be somewhat superfluous, if not preposterous. A correct picture with the proper interpretation of the ordinary temperature-curve and pulsewave in a suspected tuberculous person often strengthens our diagnosis, and such a picture as we usually see in moderately advanced, not very active, tuberculous cases, with a subnormal temperature in the early morning, normal toward noon, hypernormal in the late afternoon, and again slightly below normal in the evening, is generally described in every text-book treating on tuberculosis. An anomaly in the temperature-curve and pulse-wave, not described in any text-book consulted, and very little mention of which is made in the literature treating on the subject of phthisis as far as I was able to learn, came to my

EARLY RECOGNITION OF PULMONARY TUBERCULOSIS BY STUDY OF LYMPHOCYTIC PICTURE AND ALBUMIN CONTENTS OF SPUTUM

Since the discovery of the tubercle bacillus by Robert Koch in 1882, the examination of the sputum of a suspected tuberculous individual has rested chiefly in demonstrating either the presence or absence of the bacillus. In many cases a diagnosis has been based entirely on these findings, more particularly in cases of doubtful physical signs. It is now well known that a sputum negative as to Kochs bacillus does not exclude pulmonary tuberculosis even in the presence of either negative or positive physical findings. In recent years much work has been done to aid the diagnostician in arriving earlier at more definite conclusions, and this labor has demonstrated that much can be learned from a study of the various components of the sputum both chemically and microscopically, particularly at a time when the sputum is supposed to be still free from the bacillus and the tuberculous process is yet in

CORN OIL IN THE TREATMENT OF PULMONARY TUBERCULOSIS.

The medical profession is fully conversant with the fact that, in the treatment of pulmonary tuberculosis, the oils and fats take foremost rank. All tissue waste, in excess of that in health, which always takes place during the active tuberculous process, must be met by an abundance of aliment to restore the metabolic equilibrium. Our chief reliance usually is placed on the ingestion of easily assimilable and readily digestible food. As food values the fats and oils are of the most importance. If the tuberculous patient refuses to take, or does not well tolerate, fats and oils which form part of the daily diet, such as butter, yolk of eggs, bacon, etc., then recourse must be had to some animal or vegetable fat given as a medicine. Of animal oils, that obtained from the liver of the cod fish has for years been given the preference. Of late, the use

SOME PARASITES INFESTING THE HUMAN INTESTINE.DESCRIPTION, DIAGNOSIS AND TREATMENT.

Parasites which inhabit the human alimentary canal are usually described as entozoa or intestinal worms. There are about 20 different known species of the entozoa, all of which infest the alimentary canal of vertebrate animals or man. Entozoa of the order of Cestoda are commonly known as tapeworms, and of this particular worm about 10 different varieties have been observed and studied. They inhabit either the intestines of some vertebrate animal or man, but it is the parasite infesting the alimentary canal of man with which the physician is chiefly concerned. DESCRIPTION AND VARIETIES. Three species of tapeworm are of special interest to the medical practitioner and all are usually found in the upper third of the small intestines. 1. Taenia Solium (Pork Tapeworm). —This is an armed parasite, the head of which is provided with a circle of minute hooklets for the better attachment of the worm to the