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Medical Items.

BALTIMORE.

DR. HENRY M. HURD left Baltimore on November 17 and will spend two months at least in Cuba and Mexico and California. In February he will sail with his family for an extended European tour.

THE Hospital for Crippled and Deformed Children netted $1500 as the proceeds of a recent vaudeville entertainment at the Maryland Theater.

THE Southern Medical College Association met in Baltimore on December 10. The president, Dr. Christopher Tompkins of Richmond, Va., was re-elected for the coming year.

PROF. H. S. FRENKEL of Switzerland addressed the Section on Neurology and Psychiatry of the Medical and Chirurgical Faculty on December 5. His subject was "The Treatment of Locomotor Ataxia by Systematic Exercise."

THE Medical Examining Board has lodged information with the State's Attorney for Baltimore city against 13 illegal practitioners. The grand jury has found true bills against II of the number, and the other two have left the State.

THE Baltimore City Water Engineer has made another of his exhaustive investigations of typhoid fever in Baltimore. He concludes with the continuous conclusion that the Baltimore city water supply does not cause typhoid fever.

DR. WILLIAM OSLER, regius professor of medicine in Oxford University, made a brief visit in Baltimore recently. On December 10 Dr. and Mrs. Henry Cushing gave a reception in honor of Dr. and Mrs. Osler. From Baltimore Dr. Osler went to Canada to spend the holidays with his aged mother. He will visit Baltimore again before returning to England.

MR. WILLIAM A. MARBURG and Mr. Francis M. Jencks have presented to the library of Johns Hopkins Medical School two valuable collections of books, together numbering 1800 volumes. One of them is the old Warrington Dispensary collection of Liverpool, England; the other is the Friederich Ahlfeld Library of Marburg, Germany.

DR. SAMUEL T. DARLING, formerly pathologist to the Baltimore City Hospital, now pathologist to the Isthmian Canal Commission, was in Bal

timore on December 9, and on December 12 sailed for Europe. During his two years' service at the Isthmus Dr. Darling has been able to demonstrate a new pathogenic organism, the Histoplasina capsulata, which causes an obscure disease characterized by progress in emaciation, anemia and enlarged spleen.

IN the December JOURNAL we printed an item about some alleged legislation pending in Congress providing for the placarding of houses in the District of Columbia on account of tuberculosis. Some satirical remarks were made in this proposition. The source of our information concerning this legislation was the news columns of one of the best-known medical weeklies. It seems, however, that no such legislation has ever been proposed in the District of Columbia, and our comments were, therefore, misapplied. We are very glad to announce that the District presents no such phase of antituberculosis legislation, and hope we have not furnished any aid or comfort to those who oppose the legislation really needed and now being sought by the District authorities.

DR. ISAAC EDMONDSON ATKINSON died at his home, 609 Cathedral street, Baltimore, on November 24, after a brief illness of pneumonia. This removes the most distinguished general practitioner of his day in Maryland. Dr. Atkinson was born in Baltimore on January 23, 1846. His father was James Edmondson Atkinson of Easton, Talbot county, and later a prominent merchant in Baltimore. He graduated in medicine at the University of Maryland in 1865, being at that time under 20 years of age. He was a vaccine physician in 1873, and in 1883 during the great epidemic of smallpox he was made superintendent of vaccination. It is not generally remembered, and perhaps was not widely known at the time, that this office was brought into existence by the epidemic of smallpox. Indeed the office was created by the then Mayor, William Pinkney Whyte, now United States Senator, for the purpose of engaging Dr. Atkinson against the pestilence, which had for two years baffled the city Health Department. When the epidemic was subdued, Dr. Atkinson retired from the service of the city, and the office which he vacated was abandoned. For several years before that time Dr. Atkinson had been particularly interested in dermatology, and had been professor of that subject in the University of Maryland School of Medicine. He was, moreover, a remarkable clinician, and in 1881 began to give clinics in internal medicine at the University Hospital. The writer was

present at the first ward clinic ever given by Dr. Atkinson. From 1886 to 1900 he was professor of materia medica, and from 1890 to 1893 dean of the Medical School. He retired from the University in 1900, becoming professor emeritus. He was a consulting physician to Johns Hopkins Hospital from the time of its foundation until his death. Dr. Atkinson was always prominent and active in the affairs of the Medical and Chirurgical Faculty, having held many of the offices, including the presidency, vicepresidency and trusteeship. He was a leader in the movement which gave the Faculty its present fine library. He was president of the American Dermatological Society in 1888. He was the author of many important contributions to medical literature, though his activity in this line was much diminished in recent years. Dr. Atkinson was a remarkably effective lecturer and an inspiring teacher. It seems a pity that the demands of a great private practice should have deprived him of the great record he might have made as a teacher and writer.

MARYLAND.

SMALLPOX has appeared during December in Frederick and Kent counties.

THE Board of Managers of the Maryland State Tuberculosis Hospital is examining sites for the proposed sanatorium. On December 27 Governor Warfield, with other members of the board, inspected sites on South Mountain, Washington county.

To the Medical Profession of Maryland:

The medical profession of San Francisco lost its medical library, the San Francisco County Medical Society Library, in the fire last spring. Most of the psysicians also lost whatever private libraries they had succeeded in collecting. A committee (named below) has been appointed by the American Medical Association and by the Association of American Physicians to collect and send books to San Francisco, both for the library and for private individuals when duplicate copies are sent on, as they are sure to be. Will you send to Dr. W. S. Thayer, 406 Cathedral street, Baltimore, Md., any medical books of value or bound volumes of journals which you can spare. Fairly recent editions of standard text-books, foreign text-books bound journals (French, German and Italian), hospital reports, monographs of all sorts, books on special subjects, old classics (e. g., Trousseau, Charcot) and the Sydenham Society publications are especially desired. Acknowledg

or

ment of all that is received will be made through the medical journals and the books will be packed and shipped as promptly as possible.

Signed: Charles L. Dana, chairman, New York city; Frank Billings, Chicago; E. Bates Block, Atlanta; J. A. Capps, Chicago; T. D. Coleman, Augusta, Ga.; George W. Crile, Cleveland; W. E. Fischel, St. Louis; F. Forchheimer, Cincinnati; Charles L. Greene, St. Paul; Arthur T. Holbrook, Milwaukee; George M. Kober, Washington; Lawrence Litchfield, Pittsburg; Rudolph Matas, New Orleans; H. C. Moffitt,. San Francisco; John H. Musser, Philadelphia; William Osler, Oxford, England; Henry Sewall, Denver; C. G. Stockton, Buffalo; W. S. Thayer, Baltimore; R. C. Cabot, Boston, secretary.

GENERAL.

THE American Association for the Advancement of Science opened its annual meeting at Columbia University, New York, on December 27. The president of the association is Dr. William H. Welch.

Ar a meeting of the trustees of the Carnegie Institution in Washington on December 11, Drs. William H. Welch of Baltimore, S. Weir Mitchell of Philadelphia and John S. Billings of New York were re-elected trustees.

DR. JOSEPH W. HEARN, clinical professor of surgery in Jefferson Medical College, is very ill as the result of a fall from his carriage on December 4. He was thrown to the pavement and sustained a fracture of the skull. He was unconscious for 24 hours, but at last accounts his recovery seemed possible.

THE studies of cholera in Manila have been checked by the death of 10 out of 25 prisoners in Bilibid jail, who were inoculated with anticholera serum. The Governor-General has appointed a special commission to investigate these deaths and has suspended the permission to make anti-cholera inoculations.

DR. ALONZO GARCELON of Lewiston, Maine, died recently at the age of 93 years. Dr. Garcelon has been said (and with reason) to have been known to more members of the medical profession than any other physician of these days. He was quite regular in his attendance at the meetings of the American Medical Association, where his venerable though striking appearance always attracted attention. He was an ex-president of the association, and had also been Governor of his State.

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By William Royal Stokes, M.D., and Wilbur P. Stubbs, M.D.,

Baltimore.

THE following communication is intended to show the results obtained by the use of formaldehyde gas in room disinfection after communicable diseases and to demonstrate the effect of this gas upon test cultures. The reinfection of houses following disinfection is also considered. Although disinfection alone is not depended upon to prevent the spread of the communicable diseases, yet we believe that in combination with other means it is useful in limiting their spread. Before stating our results, the methods of prevention in vogue other than disinfection will be mentioned. In order to make a succinct statement the various diseases will be considered seriatim.

Tuberculosis.-A State law of Maryland now requires that every case of tuberculosis shall be reported to the State Board of Health, and when this is done the physician receives a bottle of carbolic acid, sputum cups, Japanese napkins, two waterproof pockets, and a book of directions concerning prophylaxis and cure. In this way the physician becomes the intermediary between the State Board of Health and the patient, and thousands of cases are reached in this way that would otherwise be neglected. The physician is paid a small fee for this service. All tuberculous houses must be disinfected after the removal or death of the patient.

Diphtheria.-One of the most valuable adjuncts to disinfection in preventing the spread of diphtheria is the compulsory reporting of cases and placarding of houses. Although not always effectual, yet the warning card puts most people on their guard and diminishes the exposure to disease or to healthy persons harboring the bacilli in their throats. Every teacher in each public and parochial school receives a semiweekly list of all cases of diphtheria

reported, and no children from the infected house can attend school until after the disinfection of the house and the removal of the card from the door by the health officer. This card is not removed until the throat inspector has visited the house and taken cultures from all of the persons living therein, with the exception of the breadwinner. The throat inspector is especially enjoined to take cultures from both nose and throat of the patient and from the throat of the nurse or mother and of each child in the household. If any of these cultures are positive, the throat inspector visits the house every other day and takes cultures until the throats which contatined the diphtheria bacilli are found to be free from these germs.

It may be urged that this custom is not practicable, since it may keep the placard on the house for weeks. Even if such is the case this entails no very serious consequences. The breadwinners, unless harboring diphtheria bacilli, are allowed free egress and ingress, and the children, deprived of school attendance, no longer serve as sources of general infection to the community.

Occasionally we find that the diphtheria bacillus remains in the throat for several weeks or more after discovery or after convalescence. In a series of about 25 such cases we have found that these can be cleared up by the local application of antitoxin. This method was first proposed to us by Dr. C. Hampson Jones, Assistant Health Commissioner of Baltimore, Md. One thousand units of antitoxin are insufflated through each nostril, and the fluid is allowed to remain in contact with the posterior nares and fauces as long as possible before swallowing. In most of the cases thus treated the diphtheria bacilli have disappeared from the throat in from one to three days, although a small percentage of cases have still remained positive after this treatment. We have found that this method of throat inspection can be carried out in a city of over half a million inhabitants. Even if a few positive cultures follow the first negative culture, a system based upon this method is better than desuetude.

After all of the cultures are pronounced negative the infected room is disinfected by formaldehyde and the card is removed from the door. Permits are left at the house allowing the children to return to school, and the house is relieved of this mild form of quarantine.

The table which follows will show the results of disinfection for five years, and while all rooms were not rendered absolutely sterile as far as surface disinfection is concerned, yet the table shows that the majority of rooms were thoroughly disinfected. As far as the eruptive fevers are concerned, it must simply be assumed that the unknown causes of these diseases were destroyed. The percentage of reinfections from scarlet fever and diphtheria were about the same, and we cannot help but feel that disinfection may have helped to limit the spread of the various eruptive fevers. Steam disinfection of mattresses, pillows and

other bulky materials is a necessary adjunct to this surface disinfection.

Results of Disinfections Tested by Control Cultures.

Positive (growth)....

Negative (no growth).

..

1901. 1902. 1903. 1904. 1905.

288 224 336 438 284 832 1018 1733 1606 1508 136 302 323 185

Empty, broken or not returned.. 345

These figures show that many rooms in Baltimore receive a surface disinfection controlled by a test culture, and that such a method can be greatly improved if the interest of the householders can be further aroused.

The Eruptive Fevers.-In our city all cases of smallpox are removed to the Quarantine Hospital and the house is disinfected by formaldehyde. Cases of scarlet fever are placarded, and such

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cases, as well as measles, are reported to the Health Department and by this department to the schools.

After three weeks from convalescence, if desquamation has ceased, the scarlet-fever sign is removed and the houses are then disinfected.

Method of Disinfection and Control.-Formaldehyde gas is used for the surface disinfection of rooms, and the method is controlled by means of cultures prepared in the following way: It has been the custom to test each disinfection by placing a dry culture of the Staphylococcus pyogenes albus on linen in the room. These linen slips are put into small, sterile tin boxes which are placed in mailing cases, consisting of a perforated light board, in which the tin box can be placed. The tin box is opened just before the fumigation and closed and placed in the mailing case as soon

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