It Stands the Test The smallest actual fact is better than the most magnificent statements of impossibilities. TYREE'S ANTISEPTIC POWDER promises no more than it really does. IT T has been found extremely useful when applied to all mucous surfaces, external or internal:-Vaginal, Urethral, Rectal, Nasal, Oral, Pharyngeal, Intestinal, etc. Dilutions up to 1 part in 50 are still germicidal; that gives great value and makes it economic. Its range of utility in the large field of antiseptics is wider than that of any other preparation. FORMULA ON EVERY BOX Always insist upon getting original packages. Only the genuine TYREE'S POWDER reliable. Literature and Trial J. S. TYREE Chemist WASHINGTON, D. C. Tyree's Antiseptic Powder WAR DEPARTMENT, JANUARY 3, 1890. This is to certify that the exact antiseptic strength of Tyree's Pulv. Antiseptic Comp. is one part of the Powder to fifty of water (1:50). Test-tubes containing peptonized beef broth were charged with the powder (Tyree's Antiseptic Powder). The solutions were then inoculated with the Anthrax Bacillus and with the Straphylococci of Pus and the tubes placed in the incubator for 48 hours at a temperature of 39° C. On removing the tubes from the incubator it was found that in the solutions of one in ten to one in fifty there was no development of bacteria. W. M. GRAY, M.D., Microscopist, Army Medical Museum. Bedside Helps. SOME PERTINENT POINTS ON ANES THETIZATION. If a patient vomits early in anesthesia, and is otherwise doing well, push the anesthetic; in the later stage, or if lividity develop, stop anesthetic and turn the patient's head to one side, draw the tongue forward, clear the mouth and throat out, and wait till paroxysm is over before attempting to renew the administration of the anesthetic. During anesthetization, spasm of the diaphragm either denotes the onset of vomiting or release from anesthesia. The indication is to push the anesthetic; but if the patient's condition will not permit, wait till vomiting ceases, and renew administration cautiously till deep anesthesia is reached. If the jaws clamp early in anesthesia, increase the amount of anesthetic; if this occur in later stage, force jaws open by screw or gag, or push patient's jaw forward by thumbs under chin and fingers hooked back of angles of jaw. If emergency during anesthesia demands use of hypodermic needle, a touch of tincture of iodine will make site of puncture sterile instantly. If time permits the anesthetizer to follow the subjoined routine rules, it will be conducive to the comfort of himself and nurse, as well as to the safety of the patient : Empty the bladder by catheter, and rectum by enema. Examine heart, lungs, urine. See that there is no tightly fastened clothing anywhere about the body. Lavage the stomach through tube if undigested food rises. Never take your eyes away from the face of the patient longer than an instant; here danger is seen early. Watch pulse and respiration closely. Examine ciliary and pupillary reflexes frequently. Give the patient just as little anesthetic and as much air as is compatible with complete anesthesia. Never anesthetize a female unattended. Remember that ether is highly inflammable; chloroform but slightly so. (Ether is heavier than air, and hence at night keep light high.) Secure free ventilation when giving chloroform at night; there is an injurious chemic decomposition of the fumes caused by heat; even the electric light has caused this, and has also ignited the vapor of ether. Ether is the agent of choice if one must depend on an untrained anesthetizer, and it is also preferable in atheroma and organic heart disease. Select chloroform in brain and eye work, and in presence of lung and kidney disease. Nitrous oxide is contraindicated in atheroma or aneurism, but is the best to use if about to break up adhesions about an ankylosed joint, for very short operations, and as a preliminary introduction to other general anesthetics. Do not use A. C. E. mixture. You have no means of knowing how much chloroform you are giving.-Medical World. RESORT TREATMENT OF SYPHILIS. It must be borne in mind in the treatment of syphilis, especially in the graver types of the disease, that mercury is not alone a specific, and its action is comparatively useless unless combined with other measures, such as proper tonics, food, rest and climate, to combat disease. Upon this fact rests the rapid beneficial results produced at the various resorts, because at such places the patient is away from his business and social obligations, and the change of scene and air (which is always beneficial) comes to the aid of the local inunctions. Again, the patient attends such places for the purpose of getting well, and in most instances concentrates his energies and gives his whole time and attention to this object. These gentlemen do not claim any specific effect for their waters upon syphilitic diseases, and therefore their excellent dissertation is conservative, wise, and highly prac tical.-Interstate Medical Journal. DON'T GET TIRED! It's uncomfortable, enervating and distressing, this tiring overwork. But now two French savants arise to prove that the tired worker is more liable to accident than the one who is fresh or newly rested. This they establish from official reports of accidents in various trades and occupations, taking their basis of argument from the time of day at which the accident occurred. From this they argue for more and longer resting periods in all occupations. Fatigue is the inevitable consequence of all expenditure of energy, and, although we cannot do away with it without abolishing work itself, we can at least prevent it from reaching the degree at which its influence in the production of accidents is injurious.-Trained Nurse. MEDICAL JOURNAL A Journal of Medicine and Surgery Vol. XLVIII No. 2 BALTIMORE, FEBRUARY, 1905 Whole No. 1041 DYSENTERY, WITH SPECIAL REFERENCE TO ITS BACILLARY FORM. By Joseph J. Kinyoun, M.D., Glenolden, Pa. AN ADDRESS BEEORE THE ASSOCIATED HEALTH AUTHORITIES OF PENNSYLVANIA AT GETTYSBURG, MAY 27, 1904. DYSENTERY may be defined as an acute infectious inflammation of the mucous membrane of the intestine, chiefly affecting the colon and rectum, but very frequently invading the ileum as well. In the advanced stages there is a destruction of the mucous membrane and underlying tissues, with the formation of ulcers. It is one of the oldest diseases of which we have a record, a rather accurate description being found of it in one of Eber's papers, 1550 years B. C. Hippocrates described this disease quite at length in A. D. 481. Herodotus also mentions it, and Galen mentions it as one of the disordered conditions of the body juices, the principal attribute being that of the bile, the liver being considered the primary seat of the disease. The latter was the accepted view held by the medical profession until the beginning of the seventeenth century, when Morgagni made post-mortem examinations of cases dead of dysentery, and found that the lesions were in the large intestine. It was too early in the evolution of medicine to expect that they would attribute any specific cause to this disease, and it is more than probable that many diseases of the diarrheal nature were included under the terms of dysentery. We cannot, therefore, conjecture just how prevalent was this disease. Distribution.-Epidemics of dysentery were reported in the seventeenth century occurring in India, and shortly afterwards in the West Indies. Our present knowledge of the disease shows that it occurs in nearly all latitudes, prevailing endemically in the tropics, often becoming epidemic. It also occurs in temperate climates, sometimes even in the arctic regions. It is principally epidemic during the warm months. Sporadic cases, however, may occur at any and all times of the year. Its geographical distribution may be said to be about the same as that of malaria. It reaches the acme in epidemic form during the warm months from July to September in north temperate and from January to March in the south temperate zone. It is also intimately associated with camp life and a follower of nearly every campaign. It is also of frequent occurrence in eleemosynary institutions, especially in insane asylums; hence the term "institutional dysentery." Two forms of dysentery are recognized-one known as amebic and the other bacillary. The classification of the dysenteries into the acute, catarrhal, etc., really do not give anyone a clue as to their cause, as all the clinical manifestations and lesions are observed in both. One lesion, however, is observed in the dysentery caused by ameba which is unusual in the bacillary form-that is. abscess of the liver. Lambl1 observed certain ameboid cells in the discharges of dysentery. Lösch2 in 1875 was first to suggest a causal relation to exist between these ameboid cells and the disease; in fact, he suspected that it was the true cause, and went so far as to make animal inoculations with discharges from cases of dysentery with apparently successful results. Koch in 1883, and Kartulis a year later, made extensive researches on the dysenteries in Egypt, which were confirmatory of the contention of Losch. To Kartulis, however, belongs the credit of demonstrating that these ameba were specific. He found these bodies in the majority of cases of dysentery, but did not find them in the discharges of healthy persons. Cunningham and Lewis denied the specificity of the ameba, as they were unable to find this organism in all cases of dysentery, and, moreover, this same organism was claimed to have been observed by them in cases of cholera and in the discharges of healthy persons. Grassi at one time held the same view as did Cunningham and Lewis, but on further investigation abandoned it. Notwithstanding these adverse opinions, the preponderance of evidence seemed to lean to the side of the ameba being the specific agent in tropical dysentery. The comprehensive and painstaking researches of Councilman and Lafleur' and those of Kruse and Pasquales left little remaining to be said regarding the etiological rôle of the "ameba dysenteriae." The clinical picture of amebic dysentery is rather diverse. It runs a very erratic course, sometimes occurring as an acute malady and followed by exacerbations, and more often assumes a chronic form. A considerable number of cases of amebic dysentery are complicated with abscesses of the liver, which may or may not be caused by the ameba. Ameba have been found in many of these cases, oftentimes in the pus from these liver abscesses. In others, according to Councilman and Lafleur, abscesses of the liver are in all probability due to a secondary infection of the pyogenic cocci. Strong's researches on tropical dysentery seem to indicate that the ameba found in his cases were specific, and were not ameba coli, as has been claimed by some writers. Schaudinn10 has recently demonstrated the life-history of the ameba dysenteriae, and shows that its life-cycle is quite different from the ameba coli. In contrast with the amebic dysentery, epidemics of dysentery have been observed wherein the ameba was absent. The clinical manifestation of this form is somewhat different from that of the tropical, as it usually is ushered by a chill, the attack being sudden, the stools rapidly assuming a true dysenteric character. The dis-' ease may then run a rapid course, ending either in death or recovery. It has been stated by some that it rarely assumes a chronic form. This, however, is not in accordance with the writer's own observations on a group of cases of bacillary dysentery occurring in Manila. In these there were many which had assumed a chronic form. It has long been suspected by many observers that many cases of dysentery were of bacterial origin, and from time to time there. have been published accounts of the discovery of a number of bacteria which were claimed as being the specific cause. Chantemese and Widal" reported in 1880 an organism which they had isolated in a number of cases of dysentery which they termed the bacillus coli dysenteriae. Unfortunately, the cultural and other tests employed at that time were not sufficiently comprehensive as to remove all doubts as to its specific nature. Celli and Fiocca12 later made a similar claim for a bacillus which thye found in cases of dysentery occurring in Rome. It remained, however, for Shiga13 in 1898 to positively identify a bacillus as the cause of acute epidemic dysentery of Japan. He reported a case of dysentery occurring in Tokio during the summer of 1897, from which he isolated an organism by special cultural and agglutinating tests which left no doubt as to its being intimately connected with the disease. He found that when this organism was isolated in pure culture and mixed with a quantity of serum from a convalescent case it would agglutinate in the same manner as has been observed in the Gruber-Durham test (Widal) for typhoid fever. Animal inoculations demonstrated that the organism was quite pathogenic, causing an acute septicemia in the smaller animals. Monkeys inoculated with this organism by feeding caused the typical lesions of dysentery. Since Shiga's announcement the investigation has been undertaken again with renewed interest, and with the result of adding considerable to our knowledge both as to its pathology and its distribution. It has been identified in Japan by Shiga, in Manila by Flexner and Strong, in Italy by Celli, in France by Valliard. and Dopter, in Germany by Kruse; also in cases returning from Indo-China, India and Porto Rico, and a few cases have been reported from Central America and the West Indies. Vedder and Duval1 have made an extensive study of this disease in the United States, and they conclude that it has a wide distribution. There can be now but little doubt that the epidemics of dysentery occurring during the late Civil War were of the bacillary form. It is more than probable that nearly all these cases were of the bacillary origin, because the records of the post-mortem examinations made of cases of soldiers dying of dysentery |