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pulmonary tuberculosis expresses itself through whole, and are poorly adapted to all patients the visceral nerves, emphasizes the importance of except those who will approach treatment with this line of study as an aid to diagnosis.
an intelligent understanding and cooperation. If Prognosis
only there were some specific medicine to give The prognosis in tuberculosis has greatly im- or some specific remedy to inject, then tubercuproved with our increased knowledge: (1) of the losis could be treated successfully by physicians disease, and (2) of the tuberculous patient. I de- generally; but until our scientists give us some sire to emphasize a fact that should be self evi- such measure, practitioners in general will condent but which seems to be generally overlooked; tinue to say that they are unable to cure tuberthat is, that these early tuberculous infections culosis by open air and food, and will continue do not always become quiescent, but without to feel pessimistic regarding its eradication; and producing a frank clinical disease, manifest them- its successful treatment will have to remain in selves as clinical entities in the way of interfer- the hands of those who give the disease special ing with the growth and development of the study. child. While they may not extend and produce There are two elements in the healing of tuactive open tuberculosis, yet the bacilli multiply berculosis: (1) the local stimulation of the focus and invade adjacent tissues and produce toxins of disease by the reaction which takes place bewhich prove particularly detrimental to the nerv tween the bacillary products and the antibodies ous system of the child, and often, sooner or formed by the patient's tissue cells; (2) the later, cause open clinical disease.
formation of defensive substance, both generali! These cases should be sought out and treated. and specific, by the body cells. They respond readily. I have found no type of The bacillary products which unite with the tuberculosis in which the prognosis is so good. antibodies and produce focal reaction may be Children, relieved of active infection before the furnished by the patient himself from the bacilli age of puberty, often go on to a normal develop- which cause his infection; or may be introduced ment.
from without in the form of products known as Early clinical tuberculosis should nearly al- tuberculins. The specific stimulation of the ways heal, under ideal conditions. It will heal focus of disease by this reaction is a very import- . in probably 20 per cent of cases by such simple ant factor in healing. Tuberculin when adminmeasures as change of occupation, rest and tonic istered intelligently will supplement the products measures. If only we knew what patients were furnished by the patient himself, and will hasten included in this 20 per cent, we would save them healing. My experience in its employment for time and expense, but we have no way of judg- many years leads me to believe that it will add ing; so it is our duty to treat every case of early at least 20 or 25 per cent to the average patient's clinical tuberculosis as serious, and provide those chances of cure; and in many will be the deterafflicted with the intelligent aggressive treat- mining factor in healing. ment which will restore health to nearly all. Whether tuberculins are used or not, the main This is all the more important and urgent because point in cure is the life that the patient lives. the prognosis rapidly decreases as the disease ex- ' Resistance must be kept high for a prolonged tends; whereas 80 to 90 per cent can secure an period of time, until healing takes place. How arrestment of their disease in early clinical tu- long this will be differs with the character and berculosis; the percentage drops to 50 to 70 in extent of the process; the underlying nervous, moderately advanced cases; and 30 to 40 in the psychic and physical reactibility of the patient; advanced. These figures apply to patients treated the ability of the physician to outline an intelliunder the best of conditions and with a whole gent and sufficient line of treatment; and the hearted cooperation. Treatment under less fa willingness and ability of the patient to give a vorable conditions without full cooperation will whole-hearted cooperation. It will be long produce results correspondingly less favorable. enough under the best conditions, and is much
prolonged under less favorable circumstances. Treatment
Early cases require from six months to a year It is impossible to give more than a few gen- of treatment and should be under observation for eral principles of treatment without making this a year longer; moderately advanced cases require paper far too long. While it is unfortunate that from two to six months longer for treatment, and we have not as yet found a remedy for tubercu- a correspondingly longer period of observation; losis which ranks with mercury and salvarsan in and far advanced cases can rarely be dismissed in syphilis, quinine in malaria, and antitoxin in less than ten or twelve months, some even being diphtheria, yet there is much room for encour- compelled to spend two or three years in obtainagement in treating this disease by present day ing an arrestment,, after which they must still methods. Unfortunately present methods re- be observed for a period of two years or more. quire much time devoted to treatment, are not The patient who desires to recover from tugenerally understood by the profession as a berculosis must be willing to accept disappoint
ents, practice self denial, and cooperate until · complishment because of the rapidity with which e disease heals. He must not have the attitude examinations must be made. Colonel Bushnell, at he is working for health to please his physi
who has long been a careful student of tubercuan; on the other hand, he must know that the hysician is the instructor who is teaching him
losis, set as the standard for exclusion, all applind helping him to play his own game. The
cants in whose chests are found "determinate" ame is worth it only because it offers hope of
rales. While this does not take into consideraeward.
tion the finer diagnostic work which has de
veloped during the past few years, it does elimIf only the difficulties which are attendant inate most of the frankly tuberculous at the bepon obtaining a favorable result in this disease ginning. If sufficient help were obtainable to t any time after it has become a clinical entity, inquire into the clinical history with reference nd the comparatively greater difficulty of doing to such symptoms as blood spitting, pleurisy,
when the disease has become advanced, could frequent and protracted colds, cough, and general e impressed upon both laymen and the members nerve instability and loss of strength, examinaf our profession, so that physicians would be tions would be made more accurate. A point onsulted early and early diagnosis would be that could well be considered in determining nade, then the time and money spent in the whether a suspicious case should be taken into reatment of tuberculosis would be reduced by the army or not, is whether he is going to better one-half; the percentage of favorable results his condition by entering the army. If so, he vould be increased three-fold; and invalidism could be taken with little risk; if not, he should vould be immeasurably reduced. This can be be rejected. A farmer boy in question should accomplished even with our present imperfect be eliminated; on the other hand, the city dweller method of treatment, which, as previously men who will be put on healthful outside exercise, cioned, amounts to making the patient live so that should profit by it. his resisting power may be maintained at a high level in order that his body cells may respond
The effect of caring for the rejected draft vith large quantities of defensive bodies and to
men and the soldiers who return, should have an keeping him so living until the diseases has time
important influence on the amount of tubercuto heal.
losis found in civil life. The problem of the re- •
turned tuberculous soldier has several important Factors which aid in keeping resistance high,
angles: 1, immediate efficient sanatorium care are such as open air. good food in sufficient for all who can be helped ; 2, infirmary treatment quantities, properly regulated rest and exercise, for those severely ill; S; proper care after disheliotherapy, hydrotherapy, various medicinal charge from the sanatorium. tonics, procedures which relieve symptoms and
Realizing that tuberculosis heals slowly, treatcomplications, among which must be mentioned
ment should not be for a set period; but for the artificial pneumothorax, and carefully applied
attainment of a definite result. After this result psychotherapy. Each of these will, when prop
has been attained, then suitable light work with erly applied, add its five, ten or twenty per cent
compensation should be provided, so as to turn to the patient's chances of cure. None of them
the soldiers back into society capable of self supshould be considered as a "cure” for tubercu
port. If those who have secured a favorable losis in itself. All are aids when properly em
result were given some light employment at ployed, and many even can do harm when em
which they could work part time and remain ployed in a wrong manner. I do not hesitate to
within their strength over a sufficient period of assert that what seems so simple a measure as
time to permit the disease to fully heal, relapses “exercise,” wrongly applied, has been responsible
would be reduced to a minimum. The period of for more deaths in tuberculosis than any other
time would vary from one year to several years, single measure.
according to the individual concerned. Tuberculosis and the Soldier
The war should have a beneficial effect upon
the tuberculosis problem in the United States. The world war brings several important prob- While the disease must be expected to increase in lems as far as tuberculosis is concerned: 1, the
the European states in which the war has lowered
the European, states in problem of excluding active tuberculosis from
the status of living and at the same time brought the army; 2, the care of soldiers who become
such overwhelming nerve depression, in America actively tuberculous; 3, the influence of the war
it should decrease because of our added opporon the problem as found in civil life.
tunity of determining those who are infected be
tween the ages of 18 and 46, and because of the The exclusion of tuberculosis from the army care which is being given to rejected applicants is greatly to be desired and yet difficult of ac- and which will be given to returned soldiers.
lectic Medical University: Director Johnson's Pathological
THE COMPLEXION IN CANCER ditions for the very purpose of preventing thi
ant irritation of the chemical rays of the sur Professor of Preventive and Tropical Medicine in EcLaboratory for Cancer Research, Kansas City, Missouri.
in the incidence of cancer. In the incidence o In introducing the novel title of this paper cancer, in the prevention of cancer, one of th it is the purpose of the writer to emphasize the most important facts is complexion. Despite th value of clinical observation in the study of can- great weight of authority to the contrary, ski cer. It is recognized that the experimental and cancers above the collar and below the wrist ban not the clinical method is the vogue in all the on blond men who lead an outdoor life exceed al great endowed, recognized and approved labora- other cancers put together. tories. So firmly have the experimental methods This statement is true for the United State become intrenched, that to do or even suggest and for all countries where a people of ligh the clinical study of cancer, is to call down upon complexion is subjected to bright sunlight. Th the head of the investigator all the opprobrium only regions of the earth having a blond popula of a so-called scientific and medical press which tion are those regions having a large proportio is controlled by organized medicine. In face of fog and moisture-laden atmosphere, the Britisi of all this, we are bold enough to state that a Isles, Scandinavia, North Germany. The indi clinical study of cancer not only brings out many genous populations of the rest of the world havi important truths, but overthrows many of the accommodated themselves to their sunlight by hypotheses of the experimental research labora- varying degrees of pigmentation of the skin tories.
Among these peoples the incidence of cancer o Cancer is a chronic alkaline autointoxication. the skin is very low. White peoples who have When we first studied chemistry, we were taught colonized countries of much uninterrupted sun that there were three states of matter : gaseous, shine are the principal victims of cancer of th liquid and solid. Now we know that there are at skin. This is especially true of the United State least four states of matter: gaseous, liquid, col- and the Australian Commonwealth. The aborig lodial and solid. Nature looks with such favor ines accommodated to the sunshine of the upon the collodial state that she has chosen it United States have the brownish copper colored · exclusively for the presentation of all organic skin of the American Indian; the native negritos
forms. With a few exceptions, organic colloids of Australia are almost black. may be defined as protoplasm in combination A moist atmosphere absorbs the rays of the with ionized water. The youth of every organism infra-spectrum and up to the red in the spectrum is characterized by an abundance of ionized and becomes heated thereby. The light rays are water and a corresponding scarcity of solid mat- not absorbed by a moist atmosphere, but may be ter. As the organism grows older, the tissues greatly diffused. The rays of the ultra-spectrum give up water and become more dense and solid. from the violet on through the rays too shor As alkalinity is the condition of all growth, the to be seen are absorbed by a moist atmosphere alkalinity increases with the concentration. All The rays of the ultra-spectrum are the ray colloidal reactions are necessarily slow. The which tan and burn. They are of the same nature alkaline concentration of the tissues is slow. It as X-rays and the rays of electric light. The is retarded by all conditions which hinder drying. rays of the ultra-spectrum in tropical countries It is accelerated by all conditions which facili- greatly exceed the rays of the same character in tate evaporation. This evaporation of water England and Scandinavia. They are in much from colloidal tissues is called deaquification. It greater proportion at high altitudes. Persons is the process and mechanism of senility. The of white skin become sunburned on going up trajectory of life is indigenous and specific to from humid plains to the tops of high mountains every organism at its inception. Time is of the Tyndall states that he became markedly tanned essence of the process. The time necessary to ac- by working under an electric light. complish senility is a specific attribute of every The first essential in the etiology of cancer tissue, be it vegetable or animal. Hence the age of the skin is the production of the systemic conof ripening and of senility is past the middle life ditions of hyperalkalinity. As already indicated. of the organism.
this is the physiological result of the natural proIn all organisms, the appearance of ripening cess of senility or growing old. This condition or senility can be hastened by deaquification can be hastened by constipation and defective This is a matter of common knowledge and com- elimination. As the tissues are all colloidal, the mon observation in the ripening of grain. Agri- process of deaquification is necessarily slow. culture is not hedged about by the prejudices of Deaquification is hindered by all agencies which medicine. It is equally true of human tissue. It retard evaporation. Among civilized blond races is so true, that for untold ages, our human or- the chief agency retarding the process of deaquiganism has sought to adapt itself to climatic con- fication is clothing. The skin under the clothing
in the thin skinned blond is very soft and pliable, death of cells. Hence we do not know the workeven when he has cancers on the face and hands. ing field of the x-ray and radium as we do know The exposed parts of the body, that is, the face the working field of heat after the criteria of and neck above the collar, and the wrists and Doyen. But we do know that x-rays and radium hands below the wrist band, are subject to the rays are rays of the ultra-spectrum and that they drying processes of air and heat. These tissues irritate tissue. The x-ray specialist knows that become dry, harsh and locally increased in alka- blonds are more subject to x-ray burns than are linity because the chemical changes in the col- people of dark complexion. Pigmentation of loids are slow and cannot be equalized as rap- the skin is a protection against the rays of the idly as evaporation removes the water. In the ultra-spectrum artificially produced, just as it is brunetts and in the darker races, this evaporation a protection against the rays of the ultra-specis not nearly so rapid, and as a result, the ex- trum of sunlight. posed surfaces of their bodies are not subject to In the regions of the earth having the maxithe drying experienced by the blonds.
mum amount of uninterrupted sunlight, the The second essential in the etiology of cancer aborigines are dark skinned. In the regions of of the skin is chronic irritation. This can be fog and clouds which interrupt the rays of the supplied by the rubbing of the collar, by the ultra-spectrum, the aborigines are blonds. When bridge or bow of glasses, by the irritation of pro- these blond peoples migrate to countries having jections of the skin such as warts and moles, and the maximum amount of uninterrupted sunlight by the rays of the ultra-spectrum. The cancers and live out of doors or engage in the outdoor of the skin in blond persons who lead an outdoor occupations, they become the victims of skin life owe their location to irritation by the rays cancer. The skin, after middle life becomes dry of the ultra-spectrum. This has been demon- and harsh. Senile keratoses and verruca senilis strated clinically and experimentally by the pro appear. These develop into epithelomas. Since duction of epitheliomas by the use of the x-ray. the clothing protects the skin of the body, these The rays of the ultra-spectrum are the rays
growths appear above the collar and below the
g which cause the irritation called sunburn. The wrist band. natural protection against sunburn is called tan Only recently I examined a tall thin blond ning. Persons of light complexion tan and sun- man who had a mass of epitheliomas on the back burn readily. Races long accustomed to the of his neck and none on his face. On asking his higher degrees and longer duration of sunlight occupation he stated that he was a sexton in a are of dark skin. This dark skin, of all shades cemetery and for many years had been stooping from yellow to black, is the protection of these over digging graves and burning the back of his races from the irritation of the rays of the ultra- neck. A clinical study of many thousands of spectrum. Heretofore it has been the approved cases leads to the inevitable conclusion that skin custom for sociologists to regard pigment in cancers prevail upon blond persons who lead an the skin as an evidence of racial inferiority. Only outdoor life. In America, this means the men. a few savants have studied the physiology of I have seen a few skin cancers upon blond women skin pigmentation. Since the field of scientific who worked in the fields bareheaded. Blond men endeavor was preempted by the sociologist, the who work indoors are seldom the victims of skin scientist did not receive a hearing in America. cancer. In the clinical observation of many thouThe negro was black, and therefore was of in- sands of cases, I have found that the external ferior race. The fact that he did not have skin epitheliomas in blonds are to the same tumors cancers had no relation to the etiology of the in brunetts as at least 500 to one. The propormalady in blond Caucasians.
tion may be 1000 to one. The phenomena of life are the expression of These clinical findings support in an incontrovibrations. The vibrations of all individuals vertible manner the finding of hyperalkalinity as differ. As yet, we are only beginning to measure the true constitutional condition in the etiology their rapidity and their wave length. The vibra- of cancer, and the further secondary requisite, tions of living things have not been standard- chronic irritation at the locus of tumor growth. ized. We know that the rays of the infra-spec- They further indicate means of prevention and trum up to red are stimulating to the physio- give a clinical history which should encourage logical or functional action of organs. We know early diagnosis and radical treatment of these that blue is sedative, and that the rays of the lesions of the skin. ultra-spectrum are irritating even to the point of 1320 Main St. destroying the life of tissue. We have not learned the vibration death point of tissue as we have the thermal death point. We do not know Dr. A. B. McGlothlan, of St. Joseph, was the difference between the intensity of vibrations elected president of the Buchanan County Medicausing irritation and of vibrations causing the cal Society at its annual meeting, Dec. 4.
The Medical Herald
rather than that of any particular group of men.
Laws will be amended, wage scales adjusted, Incorporating the kansas City Dedical Inder-Lancet
business methods altered, business and profes
sional relations of classes and masses rearranged, Vol. XXXVII
DECEMBER, 1918 No. 12 and this all to be adjusted to the newer views CHAS. WOOD FASSETT, Managing Editor
and altered temperament of our returning two
million fighting men with their larger and 713 Lathrop Building, Kansas City, Mo.
broader estimate of life. One factor helpful
toward realizing the new order of affairs will be ASSOCIATE EDITORS
the well balanced, orderly respect of our soldiers P. I. LEONARD, St. Joseph.
for discipline and the Central Government. DocJ. M. BELL, St. Joseph. JNO. E. SUMMERS, Omaha.
tors as citizens, will have a part to play in re
construction, they will add balance to the disCONTRIBUTING EDITORS H. ELLIOTT BATES, New York.
turbed era of civil affairs with a power equal to JOE BECTON, Greenville, Texas.
the force they exerted in winning the war. May HERMAN J. BOLDT. New York.
we as a profession realize our influence and with
due regard for men and for our grand govern-
J. M. B.
From the present outlook it would appear that
in the demobilization of the army, officers can, HUGH H. YOUNG, Baltimore.
if qualified, join the Regular Corps or the Medical Reserve Corps, or they may be honorably discharged. The medical officers of the army and navy constitute a splendid body of some
35,000 physicians, well trained and well equipped. The Editors' Forum
It would be a mistake-in fact, almost a crimeto permit these men to be completely detached from the army and navy and to be absorbed in
civilian life. Hence it is to be hoped that the The Reconstruction
third group—those requesting honorable disPeriod
charge—will be comparatively small. The reconstruction period upon which we are entering is an era of greater possibilities than the man in the street realizes, and the demand for
Lay Press men of great intellect, wisdom, firmness and tact
Sarcasm is apparent as never before in centuries. Should
The health board blames the doctors for the anarchy or lawless socialism gain the ascend
new outbreak of flu, charging that they have ency in European states and from there spread
failed to report cases for quarantine. Well, when to our shores--and it is a possibility—civilization
a doctor's practice depends upon his ability to may be well nigh annihilated, and a period of
please his patients, giving them operations, quarconditions similar to those of the French Revo
antines, etc., when they want them and postponlution become universal. Anarchists under what- ing them when they don't. what's the doctor to ever name they rally, represent a movement hav. do? Surely the doctors on the health board | ing no regard for God nor law. Present world
ought to understand that.-K. C. Star, wide conditions must be met by a broad spirit of charity, liberality, christian forbearance, firmness and wisdom. In our own land, problems
No More Physicians to Be Comsimilar to those met by our continental forefath
missioned in the Medical Corps ers, directed by Washington and later by Lincoln a half century ago, are to be faced, and the At 10 o'clock on the morning of Nov. 11th, integrity and patriotism of the citizens may be the War Department discontinued the commistried as by fire. Personal preferences must give sioning of physicians in the Medical Corps. way to the good of the community, the state, the This condition, in all probability, is permanigovernment. Classes, unions, organizations, if ent and no further consideration will be given they be made up of true American citizens, will applicants for a commission in the Medical Corps consider the general welfare of our country until further notice.