April 5, 1889.] 



SCIENCE. 



257 



according to some writers, from one to seven per cent. It is a 

 clear and colorless fluid, highly volatile, and of an extremely pun- 

 gent, disagreeable odor, and strong, burning taste. It is rapidly 

 absorbed into the fluids of the body, and is one of the most deadly 

 poisons known. It is rendered volatile by burning the leaf, and is 

 present in the smoke of the tobacco. It is generally accepted that 

 the volatilized nicotine in the tobacco-smoke is more actively ab- 

 sorbed than is the case when the leaf is chewed ; but in either case 

 the nicotine absorption is the essential element in the production of 

 all of the evils which can be charged to the habit. Nicotine acts 

 on the heart, nervous system, stomach, and upper air-passages. 

 The prominent symptoms which may be caused by nicotine, with 

 reference to the heart, are intermission and palpitation ; that is, it 

 produces certain functional disturbances of the heart, which, for 

 the time, may be the source of more or less discomfort to the pa- 

 tient ; but the important point is, does this condition ever lead to 

 one of organic lesion ? 



Dr. Bosworth thinks that the action of nicotine on the nervous 

 system may be summed up by the statement that it produces dis- 

 turbance of brain, giddiness, muscular tremors with exhaustion, 

 sleeplessness, and depression of spirits. He does not advocate 

 the use of tobacco, but asks, " Are we not often liable to fall into a 

 mistake in universally condemning its use without sufficient 

 grounds, and is it not better when our advice, as physicians, is 

 asked, in this respect, to base our answers entirely on the evidences 

 of the effect of the drug upon each individual patient, and, further- 

 more, to recognize the fact that this effect is shown by well-marked 

 and easily recognized subjective symptoms ? I have frequently, 

 when asked this question, ' Does smoking hurt me ? ' frankly said 

 to my patients, ' You know better than I do ; no man uses tobacco 

 to his harm without being fully conscious of it.' As regards its 

 effect on the diseases of the upper air-passages, in a practice of 

 twenty years largely devoted to treatment of these affections, I recall 

 but exceedingly few cases wherein I have found it necessary to inter- 

 dict the use of tobacco as injuriously affecting in any way these 

 passages, or as interfering with the success of treatment." 



The object of this paper is not a plea for the use of tobacco, but 

 simply to suggest whether we had not best abandon the idea that 

 it is a drug whose use is pernicious in every way to body, mind, 

 and morals, and rather to take the view that it is one of God's 

 good gifts to man, — a " virtuous herb, divine, rare, superexcellent 

 tobacco " when properly used, but when taken " as tinkers do ale, 

 'tis hellish, devilish, and damned tobacco." 



Diphtheria. 



The subject of diphtheria is now attracting unusual attention on 

 the part of boards of health and physicians throughout the coun- 

 try. The Kings County Medical Association has spent the entire 

 winter in its discussion, and the medical profession of Boston has 

 recently devoted a great deal of time and thought to its causation 

 and methods of prevention. In the present number we give a 

 rdsujni of the discussions and reports as they have appeared in the 

 meetings of the Suffolk District Medical Society. There is no 

 question more important for sanitarians to consider than the means 

 of preventing the spread of this dread malady. From a recent 

 report we find that in a single week its victims were as follows : in 

 Brooklyn, 21 ; New York, 47 ; Philadelphia, 6 ; St. Louis, 11 ; Chi- 

 cago, 26 ; Boston, 1 1 : Cincinnati, 10 ; Paris, France, 37 ; and 

 London, 25. It has become a permanent resident in almost every 

 city of the world. In the treatment of this disease, but little prog- 

 ress has been made. If its ravages are ever to be lessened, it must 

 be done through its prevention. 



Dr. J. H. McCollom has presented to the Suffolk District Medi- 

 cal Society some observations on diphtheria in Boston during the 

 year 1888. Of this disease, 1,411 cases occurred during that period, 

 of which 470, or 33.3 per cent were fatal. After a thorough study 

 of the facts, he comes to the conclusion that the theory advanced 

 by some recent observers, that diphtheria prevails more extensively 

 in the vicinity of old water-courses and dry river-beds, certainly is 

 not tenable so far as that district is concerned. Neither does the 

 theory of defective drainage explain the prevalence of the disease : 

 for, in the first instance, there are no old water-courses or dry river- 

 beds in that locality ; and, in the second place, the drainage the 



past year, when there has been a large number of cases, has been 

 much better than in 1887, when there were very few cases. Con- 

 tagion is, therefore, the only possible explanation for this condition- 

 From the opinion of the observers cited, from the fact that the dis- 

 ease has invaded districts where the sanitary conditions were re- 

 markably good, from the fact that out of 1,117 examinations in 

 only 596 instances was defective drainage found, from the fact that 

 the source of contagion could only be traced in 276 instanqes out 

 of 1,383 reported cases, and from the fact that there has been a 

 marked increase in the disease when children were brought together 

 in large numbers, it would seem that the general extension of the 

 disease must be attributed to contagion ; not from the recognized, 

 but from the unknown and mild cases. 



At a recent meeting of the same society a committee was ap- 

 pointed to confer with the board of health as to the necessity and 

 feasibility of further measures to limit the spread of diphtheria. 

 The committee, at the last meeting, reported that under the exist- 

 ing laws the board has authority to isolate cases of diphtheria 

 which are reported to them, or in any way fall under their observa- 

 tion, but that this power is not in all cases available, for lack of 

 proper financial means. They may, for instance, send cases to the 

 City Hospital or other institutions willing to receive them, and 

 having proper facilities for isolation and treatment ; but, once there, 

 the authority of the board ceases, and they cannot prevent the re- 

 moval of the case at any time by its parents, guardians, or friends, 

 nor can the hospital authorities compel their patients to remain. 

 The board can also compel proper disinfection where cases are 

 made known to them. They can enforce the legal penalities for 

 non-report on the part of physicians, but are here met with the 

 well-known fact that in many cases it is impossible for the most 

 skilful diagnostician to differentiate for the first twenty-four or 

 even forty-eight hours between non-contagious, tonsillar, pharyn- 

 geal, and nasal diseases and genuine diphtheria. There is a be- 

 lief among those not well informed, of the community, that this 

 disease is neither infectious nor contagious, and may therefore be 

 safely and more conveniently treated in their own houses. It is 

 believed by the committee that very much may be done in this 

 direction through the influence of this society by creating more 

 correct views in the public at large as to the contagiousness of the 

 disease, the absolute necessity of isolation, and a more earnest co- 

 operation with the board of health. The public has now become 

 so fully enlightened as to the dangers from small-pox, that the 

 board meet with comparatively little opposition in the most strin- 

 gent and arbitrary enforcement of isolation, so far as that disease is 

 concerned ; and it is believed that the same enlightenment with 

 regard to diphtheria would do very much towards diminishing its 

 spread by inducing a more ready compliance with the necessary 

 measures of isolation and disinfection. The committee recommends 

 that this society, both collectively and individually, should foster, 

 so far as they can, a proper sentiment in the community as to the 

 contagiousness of this disease, and more especially should en- 

 courage its earliest possible recognition and report to the board of 

 health in each individual case. By these methods a public senti- 

 ment will sooner or later be created, justifying and requiring from 

 the proper authorities a suitable separate hospital for the treatment 

 of infectious and contagious diseases, such, for instance, as is re- 

 quired by law in England, with ample means for its support, 

 and over which there shall be as absolute authority as already 

 exists over the hospital for small-pox. In the absence of these 

 necessary facilities for thorough isolation, it is impossible to exer- 

 cise an efficient control over the various dangerous diseases that 

 from time to time become epidemics in our cities, or which have 

 gained a permanent foothold in Boston. 



The Boston Board of Health has issued a circular for the pur- 

 pose of more widely extending the knowledge of a few well-attested 

 facts concerning diphtheria, and reminding all persons that greater 

 care should be exercised to prevent the spread of this much- 

 dreaded disease. The circular states that diphtheria is contagious 

 and infectious, and may be easily communicated, either directly or 

 indirectly, from person to person. It may be conveyed directly in 

 the act of kissing, coughing, spitting, sneezing ; or indirectly by in- 

 fected articles used, as towels, napkins, handkerchiefs, etc. The 

 poison clings with great tenacity to rooms, houses, articles of furni- 



