The disappearance of the reaction denotes favorable progress of the disease, and its reappearance an unfavorable turn, and it is, therefore, a valuable prognostic sign. To obtain the full value of the reaction, tri-daily tests should be made throughout the disease; the nurse in charge of the case being instructed how to make the test. In this way a record can be obtained, not only of value in confirming the diagnosis, but of great value as an index of the progress of the disease. Zomotherapy in Tuberculosis. L. Brown (Amer. Jour. Med. Sc., vol. 125, no. 6) has recently contributed a series of systematic investigation of the value of raw meat or its juice in the treatment of tuberculosis, as so favorably announced by Richet and Hericourt, of France, some months ago. Brown's experiments, carried out on dogs, were very thorough, and his conclusions, as here given, should be given due weight: 1. That raw meat has no perceptible effect on the duration of experimental tuberculosis in dogs if the bacilli are virulent and a sufficient number injected intravenously. 2. That raw meat has no effect on the prolongation of the duration of experimental tuberculosis in dogs, even if the bacilli are attenuated, provided a reasonable quantity be injected intravenously. 3. That under the same conditions dogs fed on a mixed diet with no raw meat may live a much longer time. Regarding the use of meat in pulmonary tuberculosis, it may be said: 1. That meat is highly essential in the dietetic treatment. 2. That much meat with a judicious admixture of carbobydrates, fats, etc., is essential to the treatment. 3. That rare meat is better than meat well cooked. 4. That meat-juice is of great value in suralimentation, as myosin albumin is easly digested by most patients—even the dyspeptic, and it affords a "maximum of nutrient for a minimum of effort." (In a few patients meat-juice causes diarrhea and meteorism.) 5. That meat-juice can be taken wher patients can take no other form of meat, i. e., when there exists a marked repugnance to all solids. 6. That the juice from raw meat seems slightly, if at all, more beneficial than the juice from meat slightly browned. 7. That the disadvantages of preparing and preserving raw meat-juice more than offset its advantages. (Patients who object to juice from raw meat will willingly take that from meat browned.) 8. That meat-juice is of value, as it can be administered in the form of jellies, ices, etc. SURGERY. UNDER CHARGE OF W. B. ROGERS, M.D. Professor of the Principles and Practice of Surgery and Clinical Surgery, Intestinal Resection. J. H. Dunn (Jour. Amer. Med. Assn., vol. 40, no. 22) says that during the past six years he has had occasion to resect the intestine 16 times, as follows: For strangulated hernia, 3; for fecal fistula, 3; for sarcoma of the small intestine, 2; for carcinoma of the cecum, 2; for carcinoma of the sigmoid, 2; for intussusception, 1; for gunshot wound, 1; for injury during operation, 2. In these the Murphy button was used 9 times, with 3 deaths; the suture 7 times with one death. As to the relative value of mechanical means versus the suture, he believes that neither shall have invariable preference, as there arise cases in which one method will serve better than the other. His views are well summed up in the following conclusions: 1. Suture is the most indispensable and generally applicable method of anastomosis in intestinal resection. 2. The Murphy button is equally useful, if not preferable, under certain conditions, but very inferior under others. For the end-to-end union of segments of normal small intestine, or the end-to-side anastomosis of healthy small and large bowel, it gives results unexcelled by any other method. In unions of the larger intestine it is so far inferior to suture as to be practically contraindicated. Pathologic changes in the small intestine or its mesentery which render the perfect ap plication of the button difficult or such as would probably disturb the course of healing, should be united by suture. 3. Of suture methods that of Gregory F. Connell is incomparably the best; is, in reality, the simplest; a single row of continuous suture, all within the gut, the most likely to be even, strong and tight, with the smallest and most even diaphragm, admits of the easiest and most perfect dealing with the mesenteric border and is capable of a simple invariable technic. 4. It is especially desirable to choose the fewest and simplest means compatible with the best work, because intestinal operations occur at rare and irregular intervals as emergencies in the hands of many surgeons, and the little conveniences which enter into highly specialized operations of repeated daily execution are for the most part worse than impracticable. The Present Status of the Treatment of Superficial Carcinoma and Tuberculosis by Means of the X-Rays. W. L. Rodman and G. E. Pfahler (Phila. Med. Jour., vol. 11, no. 24) interestingly detail the results of experiments conducted by them with the object of determining the value of X-rays in the treatment of superficial carcinoma and tuberculosis. Their conclusions are: 1. The length of time required for the cure of epitheliomata is longer than by surgical or caustic treatment, while the cosmetic results are better. The dangers are proportionate to the urgency of the treatment, as indicated by the degree of malignancy. It should only be recommended in cases that are inoperable either because of the extent of the growth or its location. 2. It is absolutely the best means at our command for the treatment of superficial tuberculosis, and it gives better cosmetic results. 3. It should follow all operations for malignant disease or tuberculosis, with the twofold object of stimulating the healing process and of preventing a recurrence. In some cases it may be of advantage to give a course of treatment before operation, to destroy the outlying portions of the growth and make such operation of a less formidable nature. Memphis Medical Monthly Memphis Medical Monthly, established as the Mississippi Valley Medical Monthly, 1880 Memphis Lancet, established 1898. LYCEUM BUILDING, MEMPHIS, TENN. Subscription Per Annum, One Dollar in Advance. Official Organ of the Tri-State Medical Association of Mississippi, Arkansas and Tennessee, Memphis Medical Society, and Yazoo Delta Medical Association. C. H. BRIGHT, BUSINESS MANAGER. RICHMOND MCKINNEY, M.D., EDITOR ELSEWHERE in this issue of the MONTHLY will be found an address by Dr. G. W. Penn, of Humboldt, Tennessee, a practitioner of more than ordinary attainments, who assumes as a topic for discussion the ever-increasing specialism in medicine. Dr. Penn takes a position that is held by many of the best posted practitioners in our smaller communities, that the general practitioner in the country and small towns, or, as he puts it, "country doctor," is doing himself and his patients an injustice by referring cases which are generally considered to belong to the field of special surgery to those who are engaged in special practice in the cities. Dr. Penn argues that many of the so-called "specialists" in the cities are no better prepared to do the work required than are many country practitioners. He claims that every up-to-date country practitioner has just as many opportunities to familiarize himself with operative technique as most of those in the cities who pose as specialists, and yet run around and prescribe for every other condition that they may meet. We do not care to attempt to controvert the statements made by Dr. Penn in his very able address, for we are painfully cognizant of the fact that the practice of special medicine appears so inviting to the majority of general practitioners that there is a great inclination for many of them to branch A out in some particular line. This has led to an immense output of practitioners in special fields who frequently are inadequate to meet the demands of such work. The making of a specialist is not accomplished by a six weeks' course in a post-graduate school, for the diagnostic skill and operative technique that justify claims to peculiar expertness in a particular line come only as the result of concentrated attention. in a given line and years of practical clinical experience. The tendency now-a-days for general practitioners to go to New York, Chicago or some other large medical center and take a few weeks' course in a special line, and then return to practice as a full-fledged specialist, is very much to be deprecated. few weeks or months spent in one of these clinical schools, during which time the student is perhaps not brought within a hundred feet of the operator, and the purchase of some instruments and a cautery battery, does not constitute a specialist in diseases of the eye or of the nose, throat and ear. Yet this most abused line of work has its devotees in almost every town of a few hundred inhabitants in the country, for painful and long is the list of cauterized and mutilated turbinated bodies to bear witness thereunto. And in other fields of medicine and surgery how many tombstones testify in silent protest to the ravages brought about by the ignorance of specialists"? 66 Yet the fact that specialism is so abused should not be taken as an argument for every one to attempt the same kind of work in which so many others who purport to be specialists fail. For the novice spurred on to such work by arguments against specialism is likewise frequently guilty of the greatest errors. It is absurd to argue that specialism is likely to drive the general practitioner out of business, for we believe that the future will witness the advent of a better equipped class of men to devote their entire attention to lines in which they have gained reputations for a degree of extraordinary skill, and the general practitioner's line of work instead of being narrowed will be widened by the fact that he will better understand his limitations, when to send his cases for special advice and to whom to send them. We believe with Dr. Penn |