EXECUTION OF MR CHAMBERLIN!

Star (Christchurch), Issue 5498, 25 February 1896, Page 4

EXECUTION OF MR CHAMBERLIN!

EXCITING SCENES ON THE SCAFFOLD. The Americans' can beat the Britishers all to pieces in newspaper headings, and you may generally gather all that the paper contains by carefully reading the elaborate headlines to the various items of news. But in the Old Country we have an institution which is far greater than sensational headlines ; we refer to the itinerant newsvendor. ■ - j The boys of this particular profession are wonderfully 'cuto in their adaptation of their " cry" to the particular "wants " of the passer-by. The parson, for instance, is never appealed to with " Special ! All the winners!" — that is reserved for more likely patrons. Tou may not only learn, as in the American headings, all the contents of the paper from their cries, but may gather a good deal that is not in the paper at all [ On dull days it is almost pathetic to see a "runner" appealing to a "hard case." "Scene in Parliament — Special!" No aitewer f rOm the old gent. ■" Horrible disaster at sea ! " No answer. "Jack the Ripper's latest!" Still frb answer. A pause, and then " Ruin of a hkdy of title. Awful details ! " Still silence. '- " Gam away. Yer ain't human ! " " And yet the modest announcements made from time to time have brought Indian Chief Cigarettes into the front rank and their quality wil keep them there. ■

_ _i_______n\aaVf , p—"-i-y.r"- , '' m - m — w — mmmm:mmma^™ x^* 9^ rally we can now face the question of its i recognition in the individual case. s THE DIAC.SO3I3 OF TUBERCULAR DISEASE ' is thus primarily bacillary, and not histo- . logical. Yet how few physicians— l. speak of English and Australian physicians, and ■ am careful to exempt our Continental ', brethren— ever (Search (for the bacillus, or 1 even make themselves competent to do so. Outside metropolitan hospitals it is the rare exception to find ..any such attempt made ; andyet certainly ardiagnosis, with all that depends thereon, is often only thus obtainable. The bacillary test, however, is defective. There may be no sputum, examination may give simply negative results, and the test itself gives no information as to the presence or extent of the constitutional factor. Hence it requires to be supplemented by clinical examination. Unfortunately neither constitutional weakness nor sbVht tubercular infection is necessarily recognisable even by the most skilled clinician. Examination is often suggestive rather than conclusive, and this in the very cases where certainty is most desirable. Who, for example, has not met cases in which he found himself unable to be. sure as to the tubercular infection of fibroid phthisis, apical consolidation, apical pleural adhesion, pleural effusion, pleuro-pneu-monia, chronic bronchitis, bronchitic asthma, or disease, of bones, skin, &c.P As an invaluable aid in such diagnosis, I venture strongly to recommend TUBERCULIN. With- Whittaker (" Sajon's Annual of the Medical Sciences," 1892) I hold it established that a local reaction following injections of tuber-ulin is proof of the existence of tubercle at.that point, and that a characteristic febrile reaction after injections of •005 or less may be taken, as practical proofthat tubercle is present somewhere in; the system. In dealing with this questib— we must remember the great frequency of unsuspected tubercle. After more than four years' continuous use of tuberculin, I may perhaps claim to speak with some weight upon this point, and I venture to tell this congress that I have always found tuberculin reliable diagnostically when used with discretion. (Applause.). I am aware that some experimenters have expressed different opinions, but in far the majority of such apparent failures there has, in my opinion, been something wrong with the expectoration, or the dosage, or the administration, or the sample. Its nse requires practised skill, and its interpretation needs discretion and experience. I have already quoted instances of this diagnostic value _ of tuberculin in papers before the Victorian branch of the British Medical Association (vide Australian Medical Journal, March 15, April 15, and Nov. 20, 1894). Thus I have been able,Jby the use of tuberculin, to diagnose cases of early phthisis as tubercular before there was any sputum, and whilst physical examination was inconclusive —to eliminate cases of anaemia, to distinguish between influenzal and tubercular consolidation of the apex, between apical pleurisy and early tubercle, between tubercular and non-tubercular pleural effusion, between fibroid phthisis complicated with tubercle and simple cerebosis of the lung, between lupus and tertiary syphilis, between tubercular adenitis and lymphadenomata, between strumous and rheumatoid affections of bone, between tubercular ulceration of the larynx and malignant disease, and between tuberculosis and actinomycosis before examination of the tissues affected. (Applause.) In many instances the results were confirmed by the independent examination of other medical men, and commenting on some of them the editorial of the Australian Medical Journal for April, 1894, stated that they" Certainly show that in tuberculin we have a valuable adjunct to the means at our disposal for diagnosing obscure cases of tuberculosis." And yet I regret to find myself the only^ tnedical man in Australasia, so far as I can gather, who makes any use of this, I believe, invaluable aid. If after thisr experience of its value any ofi my professional brethren wish to add to their > diagnostic means I shall be happy to give all the information in my power as to dosage, administration, &c. (Applause.) Meantime I content myself with sending round the illustrative chart which accompanied my first paper. As the practical end of all the foregoing comes the great question of THE TREATMENT OF TUBERCULAR DIBEABE. It will be at once apparent that I place preventive treatment as incomparably before everything else. This requires, of course, to be dealt with both from the | bacillary and the constitutional points of view. The former includes the destruction of all approachable bacilli before their Contamination of environment, tho disinfection of infected environment, and the prevention of tubercular infection through air, food and milk. Some, at least, of these requirements demand State interference if they are to be satisfactorily performed; but it lies, in my opinion, at the door of bur profession to do infinitely more than is at present attempted. It is almost incredible — yet some years' continued inquiry have conclusively proved it to me — that scarcely a percentage of medical men give any instructions worthy the name for the destruction or disinfection of the sputum, and, still less, make any inquiry into the condition of the dairy from which the milk of their sick children is obtained, or direct that the unknown milk should be scalded before use. Who, again, pay attention to THE KILLING OF THE BACILLI that must have collected in rooms and dwellings frequented by . expectorating consumptives? And yet, (in the absence of these essential precautions, we claim to be treating the case- ! And, worse still, we permit of others — relatives, friends and strangers — running known risks .of infection without word of : warning or advice, with the frequent and unnecessary result of extension of infection to those who were previously free -therefrom. . Can we wonder that tubercular disease is so rife ? If, therefore, we are to sensibly lessen its ravages, the first essential, in my opinion, is the more general recognition that the' disease is to some extent infectious, and the spread of information as to the precautions which must be adopted if infection is to be prevented. Advice should be given to, patients and their friends by printed slips' as to the forbidding of infected milk, the danger of eating meat in' a partially cooked state, or drinking ordinary milk unboiled, the necessity of receiving the sputum in special

receptacles which are kept moist until scalded or burnt, the disinfection of infected rooms, public spitoons, conveyances and the lite. How this may be accomplished may be gathered from the printed slip, which I send round, which I drew up for. the Australian Health Society, a copy of which I have given to each of my consumptive patients or one of their friends for some eighteen months past. This individual information and effort must, of course, be supplemented t>y veterinary inspection of dairies and dairy rattle and of meat supply— (applause)— improved sanitation as regards the ventilation and dryness of dwelling-houses, and disinfection wherever necessary. And I am one of those who believe that the placing of tuberculosis amongst the infectious diseases and its compulsory notification will be necessary before some at least, of these requirements are properly fulfilled. Similarly from the constitutional point of view prevention is the. first thing to be aimed at. THE BEST SAFEGUARD IS PERSONAL HEALTH. But in-breeding, unhealthy ancestry, and the like, prevent, in many instances, such a birthright, and health is a something that has to be acquired. And where prevention is impossible, the parents should be informed that the constitutionally weak require special care. Thus the milk they drink must be above suspicion, their houses dry, their bedroom air pure, their specially treated, and occupation and climate selected for them. If this were systematically advised and generally practicable, how many more would be resistent against infection ! Then the ' possibility of becoming vulnerable, either as iSolis Cohen puts it, by want of what is necessary, by excess, of .expenditure , of . force over power of re-accumulation, _or by hindrance, of conversion of potential .energy into kinetic, must always be borne in mind! and translated into the understanding of the individual case. It should be dinned into the ears of all that the price of safety is the maintenance of the individual health. It is in this category that I would venture to place the still despised tuberculin. We are all aware how/; with reference to the value of tuberculin as a remedial agent, our profession has jumped from the one extreme of miraculous salvation, to the other extreme of unmeasured condemnation. But there have been some at least who, with Burney Yeo, felt that the latter was as hasty and unwise as the former was hasty and premature. And, whilst recognising that given in a certain way in certain cases it was dangerous and even injurious, it was still possible that given in another way and in other cases its potency might be utilised to advantage. It was for these reasons and in this anticipation that, with Whittaker, Coghill and others, I continued to make THERAPEUTIC USE OP TUBERCULIN, and it is owing to .what I have myself seen that I still continue such use. It was early evident that it contained toxin rather than anti r toxin (though both seem present to some extent), that good would follow rather along the lines of a progressive immunity than from a bactericide or anti-bacillary saturation. Small, graduallyincreasing doses, avoiding anything like serious reactions, thus superseded large rapidly-increasing doses given with the "intent of repeated reactions. Will those who decry tuberculin say they have given the remedy this trial? What has been the result of four and a half years' testing in this manner in my hands ? I have seen a case, of tubercular disease of the bones (Australian Medical 1 Journal, April, 1894, p. 181) given up by ; the profession in Tasmania,, practically i cured, and remaining well to this day. I have seen two cases of tubercular ulceration of the larynx heal completely, and their healing remain so far permanent (Dr Cox, specialist to the Alfred Hospital, having laryngeal charge of the cases). : I have seen a case of tubercular ulcer of the pharynx, practically abandoned by several medical men of repute, RAPIDLY AND COMPLETELY HEALED UNDER TtJBEBCULIN'. I have seen a case of lupus improve, according to the patients father, more than under the best London treatment, relapsing, however, afterwards, though still much better than before injection; very complete local measures being continued, and in my opinion a further course of tuberculin indicated, but not carried out. I have seen a case of strumous eye disease improve out of all recognition. And turn- ", ing to pulmonary cases, my general report ; to this Congress may be summarised as fol- j lows : — All my caßes of pulmonary phthisis in an early stage (with one exception) remain well, and some half-dozen are, in my opinion, cured, and free from any sign or symptom of the disease. The^one exception has twice got well, remained well for months, and only broken down (so lam informed) owing to very exceptional exposure and adverse surroundings. Coming to more advanced cases — softening affecting a large area, cases of cavity, cases with pronounced hectic, with complications in larynx, intestine and elsewhere — my experience is not encouraging save in one case. This failure is not surprising. We have here to deal with mixed infection and with the absorption of THB SOLUBLE PRODUCTS OP DIFFERENT PYSCOCCT. Against these tuberculin has no power, and large doses are probably generally injurious. But symptomatically, and not curatively, I believe very small doses are frequently of great though transient value. In these views of the therapeutic value of tuberculin Ido not standalone. I have received several letters from Dr Whittaker, one of the best American authorities, in which he. takes exactly the same stand, and in "Sajon's Annual" for 1892 and 1893 he publicly . maintains that it remains true, as Koch first declared, that tuberculin is the best remedy we have for pure tuberculosis, and that it radically addresses the products of tuberculosis, but not those of sepsis. Burney Yeo, again, in his " Clinical Therapeutics," agrees that tuberculin has been hastily and unwisely denounced. More recently Coghill, of Ventnor, has reported a number of cases successfully treated by injection, and recorded that Dr Armand Ruffer has just returned from Berlin favourably impressed with recent results ; whilst Adams, of Montreal, has reported a post mortem of one of Koch's' own cases, in which tuberculin seems to have permanently ARRESTED AN EXTENSIVE AND ADVANCING TUBERCULAR INFECTION. Ihave the more confidence, therefore, in recommending its further study to patients and careful physicians. My exceptional case is so suggestive that I quote it at some length. He is No. 13 in my second progressreport(.4us£ralian.Medical Journal, February, 1892). He had acute mischief, implicating the upper half of the right lung, and was so bad that, even in October, 1891, I declined to inject him. At his earnest wish he was injected and progressively improved. He has been injected ever since, in all some hundreds of times, for the last two years irregularly, "02 once a week or so. He has never missed a day from work since his discharge from hospital ; still brings up sputum containing a few bacilli, and has a gradually descending cavity at the apex, with the lung below at times clear, at times invaded by sounds. His general health is excellent ; his left lung abso-. lutely clear ; his weight maintained at a good standard, though he lives in poor surroundings ; has had n> holiday ; and

undergone a number of influenza attacks Of course he has taken such general ■ tonics as I have considered advisable. , I am of opinion that tuberculin has « arrested his disease, and I think _it probable he has acquired an immunity against tubercular infection. With M. de Bavay I propose to try his blood serum in the treatment of other tubercular cases, and need hardly say that I look forward to the result with very great interest — (Applause.) It thus seems possible that tuberculin may prove of great sprvice even in acute cases, under circumstances which require to be tested before they can be.determined, and from my experience I can add that in experienced hands testing is not necessarily attended with any risk. The generality of such cases, however, need j something different from tuberculin — a mixed anti-toxin peculiar to the individual case ; and it will be another of M. de Bavay's and my attempts, during the year to manufacture such a mixed anti-toxin (upon lines that we have agreed upon but do not feel at present justified in proclaiming), and to use it in suitable cases. Next to attempts after progressive immunity and suitable anti-toxins comes the influence of climate and diet. As regards climate, I have time but to refer with approval to Theodore Williams's and Weber's work, and to express my opinion that in the majority of cases at present climatic treatment must be placed before any other therapeutic procedure. (Hear, hear.) It would be a great gain if some competent authority would prepare a handbook for the profession upon the important question of Australasian climatology, and if this congress would forward to the Home medical Press a resolution pointing out the cruelty of dumping down on tliese shores advanced and often friendless cases of phthisis— -(loud applause) —and of the tjnstjitability of the coastal regions for phthisis in any stage whatever. (Applause.) Upon the question of diet, the only point upon Which I would now lay stress is the advisability of every physician providing himself with a printed slip of diet scales, or articles suitable to cases of consumption, and marking thereon the requirements general and particular, advisable in the given case. As regards drugs, I think a lecturer on therapeutics has little to add. We all know the place filled by cod oil, hypophosphites, arsenic, quinine, strychnine, iron, the mineral acids, &c. Few probably will deny that we have no specific, that creosote and its allies are of value against sepis rather than the bacillus, and that the different symptoms which may arise during the course of the disease require from day to day, as well as from year to year, all the ' . DIFFERENT COMBINATIONS OF REMEDIEB that the greatest experience and the wisest" skill can suggest. Symptomatic treatment is not what we should aim at, but in a disease such as tuberculosis is at present it is often our only resort, and, from the palliative point of view, it is gratifying to know that we can so frequently relieve, even though cure is out of the question. But it would be impossible, even if it were appropriate, in such a paper as this to attempt any particularisation in such matters. Let me end where. I began. It is by our preventive measures rather than by our remedial that we shall check this fell disease, which is so widespread that, according to Lord Playfair, it is the only one above the horizon from which we may anticipate the extinction of our race. (Loud and prolonged applause.)