PREVENTIVE MEDICINE.
BY ELIAS H. BARTLEY, M.D.,
Professor of Chemistry and Toxicology, and Lecturer on Diseases of Children, Long Island College Hospital, Brooklyn.
THE GERM THEORY A CENTURY AGO.
Under this caption the British Med. Journal for February 11, 1888, contains an editorial review of a pamphlet of 87 pages, published in 1788, and entitled: “A Treatise on Fevers, wherein their Causes are exhibited in a new point of view, to prevent Contagion; and Putrid Sore Throat, Inflammatory Fluxes, Influenza, Consumptions, as well as the Low Nervous Fevers that terribly affect the Spirits, may be cured with ease.”
The most remarkable part of the book is the speculative or explanatory part, consisting of an exceedingly ingenious argument, based upon the analogy of admitted facts, to prove that the cause of contagious fevers is some invisible noxious matter in the air. Of the intimate nature of this matter he says: Some consider it to be a sulphurous exhalation from the earth; but this cannot be, for, if so, acrid and sulphurous fumes would increase it, instead of checking or annihilating it. Another theory is that it is due to the products of putrefaction; but how can dead putrid matter ever get such activity as to work such astonishing results? It must therefore be something endowed with a more powerful activity than anything belonging to the mineral kingdom or simply putrefying matter, and must, therefore, be something “actually living.” He further concludes that these living organisms must have an existence independent of the body in which they are found. For this view, surprising and novel enough at first, loses some of its singularity, if we search for resemblances elsewhere. Now, just as it was well known that itch is due to the presence of acari, insects visible by the aid of the microscope, so close attention to these matters in numberless cases during many years, has proved beyond a doubt that the gaol distemper, putrid fever, plague, and infectious epidemics generally, proceed not from matter putrid in itself, but from invisible insects also, that, floating in the air at times, are lodged in the skin in immense quantities; feeding here in clusters, they produce pimples, pustules, etc.; for instance, the eruption of small-pox. He overlooks, or fails to mention, the possibility of their entering by the air passages or digestive system. “Medicines,” he says, “which poison insects without injuring the constitution have always proved specific.” These insects, which constitute contagion, are communicated by air, the raiment, as by contact. He admits that vegetables as well as animals suffer from the ravages of these animalcules. He believed that they originated from eggs and not de novo. He advises fumigations with sulphur and frankincense to destroy contagion in rooms, and shows that many diseases in lower animals are cured or prevented by the use of certain agents known to kill insects.
In summing up his theory, he says that, generally speaking, there are two sources of these animalcules. First, from subterranean sources, which operate in all sorts of weather and are accompanied by electrical phenomena. Second, from the surface of the earth, swamps, filthy lakes, stagnant ponds, etc. The eggs left on the soil develop in summer, and “the multitudes effluviate into air.”
The essay is interesting to us because of the very clear foreshowing of a theory that we are apt to regard as the creation of recent years. It is a good example of the power of attentive observation and inductive reasoning, which is so seldom met with even in scientific medical men of the present day.
ALBUMINURIA A FREQUENT RESULT OF SEWAGE POISONING.
Dr. George Johnson, in Br. Med. Jour. for March 3d, gives the histories of four cases of albuminuria which he believes were the result of breathing sewer air. In addition to other diseases, the result of drain poison, the author has met with several cases of albuminuria which he believes can and does under continued exposure to the sewer poison, result in incurable disorganization of the kidneys. He thinks that, in the absence of other probable exciting causes of albuminuria, the possibility of sewer poisoning should be constantly borne in mind. It is needless to dilate upon the importance of discovering the exciting cause of a disease so serious in its consequences as nephritis. In each of the four cases cited, albuminuria and casts were found in the urine, and blood in two of them. In each case defective drainage was proven, and in two of the four an immediate improvement occurred on removing this cause. One proved fatal from suppression of the urine.
The author suggests as an interesting point, that amongst the various diseases resulting from drain poison, diphtheria is in a very large proportion of cases associated with albuminuria.
It would be interesting to know whether a large proportion of cases of diphtheria occurring in houses having defective plumbing suffer with albuminuria, than in houses where no such defect exists. If these observations are confirmed, we may learn from them something of the cause of the great fatality of scarlet fever and diphtheria in houses which contain defective drains.
SEWER-AIR POISONING.
The question of sewer-air poisoning has received no inconsiderable attention at the hands of sanitarians within the past few years, some claiming that it is a carrier of many of the contagious diseases, including malarial affections, while others have denied its harmful action in these respects.
The last class, in substantiation of their claim, point to the assumed fact that plumbers and those who work in sewers are not, as a rule, especially subject to the diseases generally attributed to sewer air. That plumbers are not exempt from troubles of this kind is attested by numerous examples. According to Science, an inquest was recently held in Liverpool, Eng., on the body of a plumber’s apprentice who had been engaged in repairing pipes which connected with the sewer. Quantities of gas came through these pipes, and at the time the young man complained of pain and sickness, and died forty hours afterward. The jury rendered a verdict of poisoning by sewer air.
According to the Sanitary News, Dr. Vaughn, of the Michigan State Laboratory of Hygiene, claims to have found the specific germ of typhoid fever in the air of a soil pipe from the prison at Jackson, in that State, during an outbreak of typhoid fever.
The Sanitary Inspector for February and March, reproduces from the Medical News an article by Dr. Henry Hun upon this subject. Dr. Hun cites twenty-nine cases in support of his statements. The histories are those of non-contagious diseases, and therefore were probably cases of illness produced by non-infected sewers. He says: “In all of these twenty-nine cases there was an escape of a large amount of sewer gas into the air which the patients breathed; and at the time that the case was observed, it seemed extremely probable that the sewer gas was the cause of the disease.
“From the consideration of these twenty-nine cases, we may conclude that it is probable that the following conditions may result from sewer-air poisoning:
“1. Vomiting and purging, either separately or combined.
“2. A form of nephritis.
“3. General debility, in some cases of which the heart is especially involved.
“4. Fever, which is frequently accompanied by chills.
“5. Sore throat, which is frequently of a diphtheritic character.
“6. Neuralgia.
“These conditions may occur separately, but are frequently combined, and it is especially common for the fever to be associated with other symptoms of sewer-gas poisoning. Finally, in cases of sewer-gas poisoning, there is one group of symptoms which is almost always prominent, and these symptoms are: loss of appetite, drowsiness, extreme prostration, and a dull, unpleasant feeling in the head; and whenever this group of symptoms occurs, not as the result of an attack of acute disease, but as a chronic condition, we are justified in suspecting that the patient is exposed to sewer-gas infection.”
EFFECTS OF FOOD PRESERVATIVES ON THE ACTION OF DIASTASE, PANCREATIC EXTRACT AND PEPSINE.
This subject has recently received experimental study at the hands of Dr. Henry Leffman and William Beam, the results being published in the Analyst for June, 1888.
The antiseptics selected were those which have been known to be used to preserve articles of food and drink. They were salicylic acid, boric acid, sodium acid sulphite (sodium bisulphite), saccharine, beta-naphthol and alcohol.
In the following experiments a solution of arrow root starch, 30 grains to the litre, was used.
To 100 c.c. of this solution was added 0.5 c.c. of maltine diluted to 50 c.c. with water.
The figures give the proportion of antiseptic to the whole volume of liquid.
Experiments with Maltine.
| Antiseptic used. | Amount. | Fehling’s Solution reduced by the Maltose formed. |
|---|---|---|
| None. | None. | 245 cc. |
| Salicylic acid. | 1 to 500. | No sugar formed. |
| Salicylic acid. | 1 to 1,000. | No sugar formed. |
| Salicylic acid. | 1 to 20,000. | 245 cc. |
| Boric acid. | 1 to 1,000. | 245 cc. |
| Sodium bisulphite. | 1 to 1,000. | 245 cc. |
| Saccharine. | 1 to 1,000. | 18.5 cc. |
| Saccharine. | 1 to 500. | 5.6 cc. |
| Beta-Naphthol. | 1 to 1,000. | 204 cc. |
| Beta-Naphthol. | 1 to 500. | 174 cc. |
| Alcohol. | 1 to 25. | 245 cc. |
Experiments with varying amounts of diastase showed that one part of salicylic acid to 1,000 of liquid prevented the diastasic action completely. Saccharine in the proportion of 1 to 1,000 prevented the formation of sugar when the proportion of diastase was 1 to 1,000 of liquid. When the proportion of diastase was reduced to 1 in 2,000, salicylic in the proportion of 1 to 3,000 prevented the formation of sugar. It seems, then, that the weaker the diastasic solution, the more is its action hindered by salicylic acid, saccharine, etc. Sodium bisulphite has little if any power of hindering diastasic power.
Experiments with Fairchild’s Pancreatic Extract.
| Antiseptic. | Amount. | Fehling’s Solution required. |
|---|---|---|
| None. | None. | 78 cc. |
| Salicylic acid. | 1 to 1,000. | No sugar formed. |
| Saccharine. | 1 to 1,000. | No sugar formed. |
| Beta-Naphthol. | 1 to 1,000. | 78 cc. |
| Boric acid. | 1 to 1,000. | 78 cc. |
| Sodium bisulphite. | 1 to 1,000. | 80 cc. |
The tests were made with 0.2 grams of the extract.
It seems from these experiments that salicylic acid and saccharine, in the proportions used, entirely prevent the action of pancreatic ferment upon starch.
In similar experiments with saccharated pepsine with hydrochloric acid, except that the temperature was kept at 105° F., sodium bisulphite and boric acid were without effect.
Saccharine and salicylic acid had a slightly retarding action. Beta-naphthol almost entirely prevented the action.
With pancreatic digestion of albumen the results were practically the same, but the retarding action of the salicylic acid and saccharine was not quite so well marked.
From these experiments it will be seen that salicylic acid prevents the conversion of starch into sugar under the influence of either diastase or pancreatic extract, but does not seriously interfere with peptic or pancreatic digestion of albumen. Saccharine holds about the same relation as salicylic acid.
Sodium bisulphite and boric acid are practically without retarding effect.
Beta-naphthol decidedly interferes with the formation of sugar by diastase, but not with the action of pancreatic extract on starch.
It almost entirely prevents both peptic and pancreatic digestion of albumen.
The bearing of these experiments upon the sanitary question of permitting the use of these preservatives in foods, is self-evident. Prof. Leffman says: “Their use is scarcely allowable under any circumstances, and certainly only when the nature of the preservative and the amount is distinctly stated.” The use of saccharine as a sweetening agent must be looked upon as deleterious to health, and ought to be forbidden by sanitary authorities.
MILK AND SCARLATINA.
In a recent number of the Journal, we published an abstract of the reported investigations of Mr. Power, Dr. Cameron and Dr. Klein of a disease among cows, which they believed had caused scarlatina among persons using the milk. The conclusions reached by these gentlemen seemed so startling that the Agricultural Department of the Privy Council began an investigation of the disease. The investigation was given into the hands of Dr. Cruikshank, whose reports are published in the British Medical Journal of December 17, 1887, and January 21, 1888.
We have only space here to reproduce the conclusions reached by Dr. Cruikshank, which are as follows:
1. The nature of the contagium of scarlet fever is unknown.
2. The micro-organism regarded by Dr. Klein as this contagium is the streptococcus pyogenes.
3. Streptococcus pyogenes is found sometimes in company with staphylococcus pyogenes aureus, as a secondary result in scarlet fever and many other diseases.
4. A streptococcus was first observed in scarlet fever by Crooke, later by Löffler, Huebner and Bahrdt; but its exact relation to scarlatina, and its undoubted identity with the streptococcus from pus and puerperal fever, was definitely established in 1885 by Frankel and Freudenberg.
5. Both the Wiltshire and Hendon cow diseases were called cow-pox by the people on the farms.
6. Both diseases correspond in their clinical history.
7. The ulcers on the teats correspond in naked eye and microscopical appearances, and the latter vividly recall the appearances of cow-pox.
8. Calves inoculated from the discharges of the ulcers are similarly affected.
9. Post-mortem examination of such calves, or of calves inoculated with streptococci isolated from scarlet fever cases, show similar appearances.
10. The post-mortem appearances in such inoculated calves are the result of septicæmia.
11. There are no specific visceral changes in cow-pox, apart from complications or coincident affections.
To the above criticism of Dr. Klein’s investigation of the Hendon cow disease, this gentleman claims that Dr. Cruikshank studied a different affection, and that the organisms were not the same. It is insisted upon by Dr. Klein, that Dr. Cruikshank’s conclusions were the result of studying cow-pox and not the peculiar disease he described as the Hendon cow disease.
THE CAUSE OF DEATH IN PHTHISIS.
Dr. R. W. Philip has made an experimental study to determine the cause of death in phthisis. The results of his study are published in the Brit. Med. Jour. of Jan. 28th, 1888.
His experiments were conducted with an extract prepared from fresh sputum from phthisical patients, as follows:
The sputum was treated with alcohol, put in a sterilizer, and heated to 37 to 40° C. for some time, filtered clear, and evaporated at a low temperature until the alcohol was expelled. This extract was used for subcutaneous injections in frogs, mice, and rabbits.
This extract was found to possess very marked toxic properties upon these animals, which manifested themselves by a depression of the higher nerve centres and of the heart. The depressant action upon the heart seemed to be exerted through the cardio-inhibitory mechanism, and is more or less completely antagonized by atropine.
The toxic principle he believes to be the result of the growth of the tubercular bacilli, and allied to the ptomaines. He found the quantity of the substance to be extracted from the sputum to be proportional to the abundance of the bacilli present in it. These observations are in accordance with the observations of various experimenters with other pathogenic organisms, and with the theory that seems to be gaining ground that immunity is the result of such by-products of the growth of these organisms.