REPORT ON PROGRESS OF MEDICINE.

S. M. GARLICK, M.D.,

BEIDGEPOrt.

It is quite impossible for the average practitioner to keep up with, as oftentimes it is above and beyond him to epitomize the progressive movements in medicine. The good which men do lives after them, and one must really look backward from some point of vantage to know the progress which has been made; and in our labor for progress, as indeed in our attempts for review, results ofttimes do not bear evidence of the cost. It is said that Newton wrote his chronology fifteen times before it satisfied him; and Gibbon his memoirs nine times. Humboldt sent the outlines of his Cosmos just sixty-six years before he forwarded its last sheets to the printer. Thus we do labor and toil in our calling and often it seems "Love's Labor Lost"; that which we advocate as a most important truth to-day may be set aside to-morrow as of but little merit.

Over fourteen hundred physicians of the "regular school" have died in the United States since our last annual meeting.

In reviewing the long list of our fellow-workers who have passed to the other side in the short space of twelve months, one is struck with sadness and can but ery with Cicero. "There are countless roads on all sides to the grave."

Among our own countrymen we mention Bartholow, whose work has made light to shine in two hemispheres by his treatise on Therapeutics and Materia Medica.

Of foreigners I would name Sir Henry Thompson, Artist, Physician, Scientist; and Samuel Smiles, Sur

geon, Journalist and man of affairs, whose Scottish courage was helpful, not only to himself, but to thousands of young men through his books, "Self Help," "Duty," "Thrift." Of the multitude of others only less known, but no less useful and beloved in their humble spheres, we will only say of each: "The Eternal Master found his talent well employed."

PNEUMONIA.

I would emphasize the importance of the increasing prevalence of pneumonia and its startling fatality.

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A. R. Reynolds, shows that deaths from this disease have increased since the middle of the last century 346.6 per centum, and that in Chicago during the last three years pneumonia has caused one-eighth of all the deaths. Meanwhile the deaths from phthisis have in fifty years diminished 39.5 per centum. Since an early diagnosis is important I would refer to a paper by L. A. Connor and G. A. Dodge, which is an interesting study of the physical signs of pneumonia. The most frequent of the early signs is a weak respiratory murmur over the affected area; next is a circumscribed impairment of resonance; next the crepitant râle and third a slight increase in the clearness and intensity of the vocal resonance. These authors believe that "central pneumonia" is not a condition beginning in the depths of the lung and discoverable only when it has progressed to the surface, but that it is really a consolidation progressing slowly to completion. My own observation leads me to concur in this opinion.

PNEUMOCOCUS SEPTICEMIA.

Reports and personal observations demonstrate that Pneumococcus Septicemia or infection with Diplococcus pneumonia, in other than the respiratory organs, is more widespread and frequent than has been suspected until recently.

In the Bridgeport Hospital we had during the past

year a case in illustration of this point. A young man aged twenty-three years admitted November 1st, 1903, temperature 102, respiration 40, pulse 160; consolidation of both lobes of the left lung, crepitant râles, and pleuritic friction. The right shoulder was red, swollen and painful. Widal's reaction negative. On the twentyeighth of November, the swelling was incised, and about sixteen ounces of pus obtained; a specimen being sent to the laboratory Dr. Ives, of the house-staff, made bacteriological test and culture which showed pure culture of pneumococcus; at the same time examination of the sputum showed pneumococcus and no tubercule bacillus. Acute symptoms have gradually subsided though resolution has not yet occurred and he has yet a persistent cough. February seventh the shoulder was again incised and necrotic bone curetted, and at time of writing the bone is still bare. Repeated examinations of sputum have failed to show tubercule bacilli.

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G. Parker, 1 reports an autopsy, in the case of a child dying from pneumonia, which showed mediastinitis, resolving pneumonia and pericarditis, while, from various organs, cultures were made and pneumococci developed. My own observation notes a large variety of forms of disease, developing in a single family, or group of individuals, when the pneumococcus is present.

It is to be regretted that late years have developed no new or decided improvements in the treatment of acute lobar pneumonia; while the supporting treatment and careful sustenance of an embarrassed heart is to be employed the free use of alcohol is less resorted to than formerly.

Anti-pneumococci serum has awakened but little enthusiasm and the treatment by creosote carbonate, has not sustained the claims of the early advocates.

MALARIA.

Further and increasing evidence is obtained concerning the transmission of malaria by the mosquito. Mr. Luz

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zato, reports that he found malarial hemoglobinuria in several members of one family. He believes this complication due to hereditary predisposition. Man 2 describes a case in which there was a coincidence of malarial hemoglobinuria and uncinariasis. Considering this case to support Koch's belief that "Blackwater fever" occurs only when some other influence than malaria has already damaged the red corpuscles, his (Koch's) assertion that it, black-water fever, is only another name for quinine poisoning, seems to be as far from the truth as were his two great assertions regarding tuberculin and bovine tuberculosis. T. D. Delaney earnestly calls attention to the importance of the increase in the large mononuclears in the diagnosis of malaria. A percentage above twelve is, in suspicious cases, he believes, very important. Nothing else has been found yet which equals quinine in the treatment of, or as a prophylactic against malaria; in children euquinine may be used. It costs twice as much as quinine and is less than half as active, but has the advantage of being tasteless. Methylene blue, so much lauded by the Eclectics a few years ago, still holds its own as a substitute or succedaneum for quinine; or where, owing to some idiosyncrasy, the latter cannot be taken. It is probably of most value in chronic cases; on account of its diuretic action, it should be of especial value in hematuric and hemoglobinuric cases. Therapeutically, it is less certain than quinine and its effects are ordinarily more unpleas ant.

TUBERCULOSIS.

The "great white plague" still commands the earnest attention of our profession, and the year in review before us has brought forth a number of important articles. It may be stated that the active and widespread work, excited by Koch's paper at the London Congress, has demonstrated that his position was untenable.

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V. Behring reports that he has determined that al

buminous bodies pass the intestinal mucous membranes of newly born animals unchanged: That tubercle bacilli pass the intestinal mucous membrane of young guineapigs without producing any local lesions. The first lesion noted by him was tuberculesis of the cervical glands; later there were the appearances that are commonly considered to be characteristic of inhalation-tuberculosis in guinea-pigs. Thus he is led to believe that intestinal infection may and does ultimately produce lesions which are commonly thought to be characteristic of respiratory infection, and that in the young, at least, the digestive tract is the main source of infecton. Macfayden, and A. MacConkey, describe some remarkable results corroborating the above, obtained by investigations on independent lines. They examined the mesenteric glands from a series of twenty-eight cases in which there were no gross evidence of tuburcular disease of the intestines. All of the subjects were children and all but two under five years of age. Virulent tubercular bacilli were present in ten, and, most striking of all, in five of those who were supposed to have been entirely free from tuberculosis (or in twenty-five per centum of the non-tuberculosis persons examined) virulent bacilli were present. One of the positive cases mentioned was a still-born child. I need not emphasize the importance of such observations. I will repeat, the wide-spread and active work excited by Koch's statements at the London Congress has sufficed to demonstrate that his statements were unjustified. The pendulum has now swung the other way and the best evidence indicates that bovine tuberculosis is of much importance, even more than was formerly supposed, and instead of now relaxing our efforts for its suppression, we should even more earnestly seek to control possible infection from cattle. The year does not seem to have developed any certain improvements in the treatment of tuberculosis. Where there is mixed infection, in which the streptococci are