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One could go on and on showing the great importance of this subject, but time will not allow.

II. THE OPPORTUNITY FOR THEIR STUDY IN TEXAS.

I have not named quite a number of tropical diseases, waiting to discuss them under this heading.

Malarial Fever is found in this State in almost every community. The parasite can be gotten for study at any time. The malarial-bearing mosquito is here and is awaiting some one interested in working out its habits, distribution, etc.

The amaba and its relation to dysentery has been studied carefully by many observers. They are abundant here. Dr. George Dock, of Michigan University, while in Texas, contributed much to our knowledge of this parasite.

We have the bacillic form of dysentery, to which Dr. Simon Flexner has given much study, and with such brilliant and farreaching results.

Beri beri probably could be found in this State, were it more fully recognized and searched for. I reported four cases on shipboard in 1899 (Univ. Medical, Vol. IV, No. 6).

The extensive rice plantations of our coast region must arouse our interest in the theory of rice carrying the source of infection. It should be worked out here in this and adjoining States.

Malta fever has been found in this State. We are honored with a paper on this subject by Dr. Chas. F. Mason, U. S. A., to be read before this Section. Curry (Journal Medical Research, Vol. VI, No. 1) reports eight cases from Hot Springs, Ark. We probably have it in our midst many times and not recognized.

Dengue. There have been several epidemics in this State. Dr. J. W. McLaughlin, University of Texas, thinks it due to a micrococcus, while Harris Graham (Medical Record, February 8, 1902) thinks it due to a protozoan, much like the protozoan of malaria.

Intestinal Parasites.-These exist, I am sure, in as great a variety probably as in any place in the world. Dr. Charlotte Schaeffer reported the first case of anchylostoma here (Medical

News, 1901). Dr. C. W. Stiles has shown how widely distributed it is in Georgia, Alabama, Florida and other States. Dr. A. J. Smith reports eight cases (out of 80 persons examined) found in medical students from different portions of the State. (Paper to be read before American Medical Association, May, 1903, at New Orleans.

I have reported a case of strongloides intestinalis (American Medicine, May 30, 1903), found in Galveston. I have two other cases to report. I shall present to this Association, in the Section of Pathology, the first or second case of Tania nana found in North America, so far as I know.

(A preliminary note has been published on the Occurrence of Tania nana in Texas, University Medical, April, 1903.)

Dr. Stiles writes me that since I reported my case to him, he has found four cases in Georgia and one in Washington. I have no doubt that many others will be rapidly added as we systematically examine the fœces of our patients.

Filaria probably exists here. They are common in the West Indies; why not here?

Trypanosoma, a new parasite of the blood, is found in similar climates. Our communication with Africa is close enough to make it necessary that we know something of it.

Leprosy is also found quite frequently in this State and is, no doubt, quite often overlooked. I know of several cases in Galveston.

IV.

THE OBLIGATION TO PROVIDE FACILITIES FOR THEIR STUDY.

Opportunity and obligation are indissolubly bound together. No one would for a moment deny that these are questions of great importance and great moment to be worked out in the prevention of the spread of these tropical diseases that are already here, and others that will likely be introduced, unless prevented.

What is the remedy? I think medical men ought to be especially trained in the study of tropical diseases, so that they may be prepared to handle the great problems for preventive tropi

cal medicine that have been thrust upon us by our location within the warm belt, and by our contiguity with tropical countries with which we are establishing such close commercial relationships.

Then again, we have added to our possessions tropical countries, and our soldiers and people are passing hither and thither, unconsciously making our disease fauna and flora more cosmopolitan.

The State should not only contribute bountifully toward the equipment by training medical men to teach what is known of these diseases, but she should go further; there is badly needed in this State, and right now, too, men who could devote their entire time in research work along the lines spoken of but briefly above.

Would it not be wise for our State, through the regents of the University, to not only make it possible for men who desire to work along these lines of research to do so, but to make it the duty of those connected with her institutions of learning?

For one to do this character of work, money is needed, and routine work must be removed from him, so that he is given an opportunity to work. Then again, assistants are needed. They must be secured. These should be provided and placed under the direction of those conducting the work of investigation. The State would soon then become a producer instead of a middleman, handing out knowledge of things worked out by others.

Then, from an economical point of view, it would pay. Unless we work these problems out for ourselves, we must necessarily wait a long time. These opportunities are here; shall we embrace them?

I wish to conclude this address with a quotation from Dean Allan J. Smith's report to the regents of the Medical Department, University of Texas:

"It must be acknowledged, no matter how efficient the school is proving itself as an institution for undergraduate instruction, that in part it is far behind even less pretentious medical colleges of the country. This refers to the amount and character of

original scientific work done by the teaching staff and the advanced students. In one sense this is immaterial as long as the fundamental medical educational work, for which the school primarily exists, is being done; but in other senses it is a serious failure. Science has been making great strides in the past generation; even when it is acknowledged that the term science has been burdened with much that is unworthy of the name. It is clearly the part of every scientific institution to do a part of the advance. This is particularly true when in its relations such an institution is surrounded by special problems. The medical school at Galveston, the furtherest Southern medical institution in the United States and closely related by trade with the tropical regions, is in exceptional position for the study of tropical and subtropical diseases; and with the material for observation now possessed there, frequent opportunity for observation in these lines which can, in the existing conditions, have but little attention paid to them. The questions concerning malaria and its transmission, dengue, yellow fever, tropical hepatic abscess, a number of parasites of man and their transmission through lower life, occur time and again; but the full attention necessary for their solution fails because of lack of time for such work at the hands of the individuals here who are interested and for lack of special facilities.

Such work should be done as a matter of practice for the existence of the school and in its performance it would undoubtedly redound to the greater credit of the institution. The great obstruction is the lack of time after the routine work of class instruction has been performed.

DIPHTHERITIC PARALYSIS.

J. S. LANKFORD, M. D.,

SAN ANTONIO, TEXAS.

Three fatal cases of diphtheritic paralysis occurring in my own practice in rapid succession has so profoundly impressed me with the importance of the subject that I have concluded to report them in the hope of eliciting discussion, and gaining valuable information.

CASE 1. Miss H., age 14, had a trifling sore throat and consulted a physician. He saw nothing in the case that seemed important and prescribed a simple gargle. The young lady went away to school in a neighboring town in a day or two, though not feeling very well. She entered school, was dull, lacking in energy, made no progress, and was repeatedly chided by her teacher for indifference. After three weeks of useless effort in school it was discovered that her sight was defective, and she was brought to the city to see an oculist. He found beginning atrophy of the optic nerves, and some paralysis of the ocular muscles. Two days later she had difficulty in swallowing and was referred to a throat specialist, who found extensive paresis of the muscles of deglutition. A day or two later irregular heart action was noticed, and complaint was made of numbness in the legs, and two general practitioners were called. On the following day breathing was irregular and marked general weakness was noticeable with various abnormal sensations in different parts. General partial paralysis rapidly followed, the pneumogastric and the phrenics showing most disturbance, extreme irregularity of the pulse and sighing respiration being especially marked. Death occurred the sixth day after reaching the city, the heart continuing to beat for some time after breathing stopped. The physicians all agreed that the case was diphtheritic paralysis. Other cases occurred afterwards in the community.

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