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

WHAT TUBERCULOUS PATIENTS TO SEND AWAY AND WHERE TO SEND THEM.

THE benefit derived from a change to an appropriate climate for properly selected tuberculous patients is a fact too fully realized to be questioned by any one, but the haphazard practice of advising every patient afflicted with pulmonary tuberculosis to remove to the West or Southwest is one which should be discredited for reasons which we shall endeavor to present.

That removal from lower and damp altitudes to higher regions where respiration is increased in frequency and depth and oxygenation thus promoted, combined with a plenty of out-of-door exercise and nourishing food is conducive to the encysting of the tuberculous process and therefore arrest of its progress and recovery of the patient, is quite evident from. the numerous "cures" reported, but it has furthermore been shown that this process almost invariably reasserts itself if the patient return to his former place of abode. Thus is demonstrated the fact that "lungers" must content themselves with permanent residence in the more favorable climate. Time and again have we seen patients return to their old homes, thinking that they were fully restored, and after a short time the disease has vigorously reasserted itself, and they either speedily die or else beat a hasty retreat to the favoring clime. In the initial and early stages of pulmonary tuberculosis a change of climate is, in our opinion, the most desirable and promising form of treatment that we can offer, but where the disease has advanced to that point where physical examination shows a great loss of lung tissue, and emaciation is marked,

we regard it as highly inadvisable to urge a change of climate upon the patient. He must necessarily undergo a long and tiresome railway journey, he will probably be far removed from friends, the expense usually is quite a consideration, and very little benefit can be hoped for, and in many cases even harm results from the change. Such patients would be far better off at home surrounded by their family and friends, where they would receive proper attention and nourishment, and where they could spend their few remaining days in peace and comparative happiness. It is useless to hope for cure or even much retardation of the process in advanced tuberculosis, and the numerous cases of this condition which are advised to seek a change to the West or Southwest are being urged to undergo discomforts, privation, useless expense-many times borne where other members of the family are very needywhich is the result of the advice of the family physician who means well to the patient, but has not looked closely into the question of climatic influence. Towns and cities in the West and Southwest are constantly complaining of the great numbers of hopelessly afflicted consumptives who are being sent out to them, who many times become objects of charity on their poorly provided hands, and who die within a short while after their arrival, or else soon must return to their homes, perhaps in a worse state than that in which they left. Better, as we have urged, that these patients remain at home and take their chances in home surroundings than they should go to a strange and perhaps inhospitable land to spend their last few miserable days.

Now as to the locality or localities most favorable for consumptives, our experience has been that this depends largely upon the state of the patient's lungs, and also upon idiosyncrasy. Some incipient cases which have gone to Colorado have found the climate intolerable, claiming that the altitude was so high that they suffered from depression and frequently had hemorrhages from the nose. These patients have gone further south, into Arizona or southwestern Texas, and there have done finely. On the contrary, others have found the neighborhood of Denver and Colorado Springs to be more favorable to their cases. The majority of our patients, however,

have seemed to do better in southwestern Texas than in any other section of the country. Early cases of pulmonary tuberculosis should be sent to a section where they can remain out of doors practically the entire year, and should be told to seek the rural districts and keep away from the cities and large towns. They should be enjoined to find a location where they can secure an abundance of nourishing food, and where they can get horseback riding and other out-of-door exercise. To go to a city, where they live largely an indoor life, and are constantly thrown in contact and association with other consumptives, is ill advised, and improvement is slow in patients in such surroundings in comparison with those who seek the out-of-door life of the ranch. Again we would say, send only early cases away from home, and keep these in the country.

THE PREVALENCE OF DIPHTHERIA.

IN Memphis and the surrounding country diphtheria is just now prevailing in unusual abundance. It is being seen in both its faucial and laryngeal types, and the mortality attending it, especially in the laryngeal form, commonly known as membranous croup, is almost as frightfully large as it ever has been. This may be attributed in great degree to the fact that an early diagnosis, particularly where it is primary in the larynx and so likely to be regarded as purely catarrhal in form, is overlooked, and prompt treatment with antitoxin. neglected. As we endeavored to impress editorially recently,* good results in the treatment of these cases with antitoxin are to be obtained in the majority of instances only by early injection of this agent and in large doses. Antitoxin is perfectly harmless, and the practitioner should not hesitate to inject a large dose even where there is only the faintest suspicion of the disease being diphtheria, and should secure a microscopic diagnosis after he has taken this precautionary measure.

If we had any one conclusion to offer as to the cause of the present wide prevalence of diphtheria, we should be inclined to ascribe it to the unusually dry fall which has characterized this section of the country. There has been very little rain, * Memphis Medical Monthly, October, 1904, p. 550. Vol. 24-48

and the temperature has reached the frost line only two or three times so far. The lack of moisture occasions a great amount of dust, and no doubt the morbific agent of diphtheria is whirled about by every gust of wind which rises. It is true of diphtheria, as it is of all other contagious diseases, that it seems to prevail some years much more generally than others. Last fall and winter there was very little diphtheria in this section, while the same period of the previous year was marked by its rather general prevalence, and this year it is developing in great abundance.

Antitoxin, it is true, has reduced the general mortality from diphtheria, but we are afraid that statistical computation of the mortality in the laryngeal form of the disease in this section would not be very flattering as to the results from the use of this remedy. It seems to us that almost as many die among those children who are attacked with the primary laryngeal form as in the preantitoxin days, but this, as we repeatedly have stated, quite likely is due to the fact that the early administration of antitoxin and prompt performance of intubation are not resorted to. Membranous croup, which is a very rapid form of diphtheria, asserts itself so quickly, and it is so fearfully virulent in its effects on the system, that in many instances the antitoxin is injected too late to give any beneficial results. Every suspicious sore throat or hoarseness in children should be regarded as probably diphtheritic, and unless immediate favorable symptoms supervene, the patient should receive the benefit of the doubt and be injected with antitoxin. Thus is the little patient given an advantage in the fight for life against the most fearful devastator known to infancy, and the practitioner is borne out in his action by the weight of authority and his own personal experience as to the futility of delay.

THE TRI-STATE MEETING.

CERTAINLY the recent meeting of the Tri-State Medical Association of Mississippi, Arkansas and Tennessee, held in Memphis on the 15th, 16th and 17th of last month, takes the palm for the best meeting that this association has ever held. With an attendance of upward of four hundred representa

tive physicians, and a program of thirty-five splendid papers actually read, undoubtedly this meeting deserved every word of praise which it received from the visiting physicians. Particularly notable was the high intellectual standard of the physicians in attendance, and the impartial observer would have at once concluded from the appearance of these men and the quality of their attainments as represented by the papers and discussions that the physical destinies of the several communities in which they practiced were in exceptionally good hands.

We would not risk the charge of invidious criticism by singling out any one or more papers read at this meeting as deserving of special commendation, for it would be hard to decide just what papers to thus distinguish, as the general excellence and scientific worth of the papers presented were such as to naturally give rise to a great deal of diversity of opinion as to which papers in particular were better than others. The papers on surgical topics, on the various specialties, and on the perennial subject of malaria all evoked full discussion, and were greatly appreciated by their hearers. Conservatism as to views in medicine and surgery was a marked characteristic of the tone of this meeting, and the few radical opinions expressed on this occasion were not received very favorably by the association as a whole. It is a characteristic of the Tri-State Medical Association that it does not pursue medical vagaries or chimeras, but rather inclines to opinions. which are the result of prolonged observation and tried clinical experience.

The importance of the Tri-State Medical Association in the professional lives of the physicians of Memphis and surrounding territory has long since passed from the stage of doubtif this ever existed-and its individuality as a hard-working, practical and useful medical society has become firmly stamped upon the profession of this section. The eligible physician who does not belong to the association and regularly attend its meetings misses the very best medical society meeting of which we have knowledge, and the one of the greatest value to the practitioner of our locality.