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The Only Recent Real Advances in the Treatment of Tuberculosis
Dr. Irving Wilson Voorhees, the Distinguished
Surgeon, Summarizes the Effective Work Against
the Disease, and Points Out the Great Flaw in
the Friedmann Turtle Theory.
By IRVING WILSON VOORHEES. M. S. t M. D.,
Junior Surgeon in the Vanderbilt < lime .
I T wan the great Pasteur who said, "It Is
within the power of man to cause all para
sitlc diseases to disappear from the world."
Since this astounding but altogether reasona
ble postulate wag formulated, physicians and
scientists the world over have stood shoulder
to shoulder In the great tight against the rav
ages of illness and death caused by preventable
diseases.
Of all these tuberculosis stands out first and
foremost, because it is probably the greatest
single scourge of civilization at the present
day.
It is not surprising, therefore, that since the
great discovery by Koch of the tubercle bacil
lus, thousands of investigators in the labora
tories the world over have gone to work with
microscope and “retort” and chemical reagents
to study very intimately the characteristics of
this bacillus, both within and without the body
in the hope of ultimately conquering the great
destroyer.
Following out the worfc of the great blood
speolallsts on Infection and immunity, Dr.
Koch, after an exceedingly exhaustive study
on lower animals, produced a substance which
he called tuberculin. It was hoped and, in
certain quarters, loudly acclaimed that tubercu
lin was a specific remedy against tuberculosis,
and that by injecting it into the blood stream of
patients suffering from this disease an im
inanity would be obtained which would anni
hilate or render forever inert the hardy bacil
lus and its harmful products known as toxlnes.
Reasoning by analogy, the observers thought
that it should lie no more difficult to induce
immunity against tuberculosis than against •
diphtheria, which in these latter days is so
nearly under our absolute control. In tills
they were, however, mistaken, for it was soon
found that while the problem's at long distance
seemed much alike, they are at close range
absolutely and unqualitiedly different. For
instance, while diphtheria is an active disease
of short duration, lasting at the most only a
few days, tuberculosis Is a slow Insidious af
fection, coming on usually without stormy
symptoms, and passing on to the chronic stage
before Its true nature is ascertained.
It became apparent very shortly, therefore,
that the analogy would not bold. and. although
tuberculin was given a very thorough trial, it
did for the most part very little good, and In
some cases, at least, was actually harmful, be
cause of the very violent reactions which it
aroused when introduced Into the body. It
was consequently almost abandoned, but re
cently has been taken up again by a few
authorities who have been redoing and chang
ing it in order to do sway with its poisonous
and dangerous effects.
At tills point one may say a word about the
recent attempts of Dr. F. F. Friedmann, of
Berlin, to cure tuberculosis by the use of ac
tive living tubercle bacilli from the turtle. The
writer met Dr. Friedmann in New York, and
studied both his cases and Ills methods very
carefully. Of Dr. Frleumann’s aDsolute sincer
ity and belief 1 have no doubt.
It seems, however, that he has failed to take
into account all of the factors in liis problem:
Most important of these is that tuberculosis
is a localised and not- a blood disease. It
causes destruction of tissue at the site of its
'lose and Throat Department, New York,.
origin, and tends to remain there unless new
foci are formed by contact or by diseased tis
sue being swept along the lymph and blood
paths. The bacilli are not found in the blood
until the advanced stages of the disease are
reached, and very often not even then. The
fever, emaciation and general illness are not
due to the tubercle bacillus directly, but to the
poisons (toxines) which are thrown off as a
result of the life, multiplication and death of
these germs. Therefore, about all one can ex
pect from a tuberculosis anti toxin or serum
or vaccine is an improvement in the patients'
symptoms. The local process goes merrily on,
and finally produces death through weakness,
heart failure, pneumonia, etc.
It may farther be said without wishing to
throw cold water on Dr. Friedmann's splendid
efforts, that one of the highest authorities
holding an administrative office In the Berman
Government has written privately that “The
product Is viewed here (in Germany) with
skeptical eyes, and its real value Is probably
so Insignificant as to be ignored." He goss
on to say that in his own judgment be feels
compelled to express an urgent warning
against tlie use of the remedy in human beings.
However, we hi America should give Dr. Fried
mann every opportunity to prove the worth of
liis treatment, and we ought also to remember
that it will take at least one or two years be
fore Its uselessness or usefulness can be es
tablished as a scientific fact. It is impossible
and unreasonable to expect a cure in one or
two weeks.
Here in New York a great work Is being done
in the cure of tuberculosis by placing so-called
“camps" on tlie roofs of houses and hospitals.
At the Vanderbilt Clinic, Fifty-ninth street and
Amsterdam avenue, we have a day camp on
the roof which is open from 9 to 6. Here pu
tients are given steamer chairs, blankets, suit-
‘ able food and just the kind of nursing and doc
toring which they would receive in a famous
resort. They go home at night, and a visiting
nurse sees to it that the advantages gained by
tltfs open air day treatment is not negatived in
their own quarters *
The New York Nose, Throat and Dung Hos
pital, in West Fifty-seventh street, has estate
llshed a night camp for workers. Here patients
are made to sleep out of doors, and are obliged
to take baths, exercise, proper food and medi
cine. They are awakened at a definite morn
ing hour, and are sent away to work if they
are able to go. They are weighed, examined
and tested frequently by the staff physicians,
and a careful record is kept of the progress of
the disease toward healing or the contrary.
Thus fa rthe results have been^xcellent.
At the foot of Fast Twenty-sixth street, ad
joining tlie grounds of Bellevue Hospital, the
city of New York has maintained for a long
time an open air school for children. This is
located upon the old Southfield, a ferryboat,
long since doomed by the steamboat Inspectors,
but now serving an exceedingly useful pur
pose. Any child of school age may come to
this school. Most of the pupils are Horn ven
poor homes, and a large proportion are or
phans.
A great deal is being done for bone tubercu
losis in children at the Sea Breeze Hospital,
Coney Island.' One of the slow-going chronic
The Old “Hyper-Extension” Treatment for Little Sufferers from Bone Tuber
culosis—A Method Superseded by Dr. Albee’s Operation.
Diagram Illustrating Dr. Albee’s Treatment for Spinal Tuberculosis. The Diseased
Vertebra (A) Is Split and Then Appears as Shown in B. Into This Slit B Is
Placed the Splinter of Healthy Leg Bone C.
monary tuberculosis is that of "artificial pneu
mothorax.” Pneumothorax means simply in
troduction of air through the chest wall into
the space between the lung and the wall itself.
There is a membrane known as the pleura
which covers the entire lung surface like the
skin of an orange, save that instead of enclos
ing the entire organ, it is reflected over the
inner surface of the bony thorax, or chest
wall. There is, therefore, a chink between that
part of' the membrane covering the lung and
the reflected portion. Now, it was discovered
after an accident in which a tuberculosis pa
tient fractured a rib that air had entered this
chink, had separated the two layers of pleura
or lung covering described above, and had com
pressed the lung, causing it to collapse. It
takes some time for this air to be absorbed, so
that the lung can again expand, and during this
time it was seen that the patient in question
had greatly improved. His cough had stopped,
his expectoration was scantier, he began to
gain weight and to improve generally.
A bold surgeon, observing this fact, resolved
to bring about pneumothorax by operative
means, but it seemed better for several reasons
not to use ordinary air. Accordingly, he plunged
a fine needle into this so-called pleural cavity
or space an dintroduced nitrogen gas. He used
this for two chief reasons—because it is one
of the most harmless and inert gases in nature, *
and because it is slowly absorbed; therefore,
he found that he could keep the lung quiet as
if in a splint for a long time. This complete
disuse of the lung gave it the required rest, so
that the conservative forces of the body could
go to work to repair the destruction caused by
the tuberculous focus. One important condi
tion is, however, necessary, viz., that the un
treated lung shall be healthy, for if not the pa
tient cannot properly oxygenate the blood, and
will die ouickly of suffocation. There are some
special dangers to be guarded against in this
treatment, but it marks a very distinct advance
in the treatment of pulmonary tuberculosis,
especially so since it can be used in advanced
cases to the very great relidf of the general
symptoms.
In view <5f the very earnest study and ex
perimentation that tuberculosis is now receiv
ing, it is possible that we are just approaching
the dawn of a rational and thoroughly efficient
cure.
Tubercular Children Lying Naked in One
of the Swiss Outdoor Sanitariums.
forms of bone tuberculosis is I’ott’s disease of.
the spine, a condition which, when healed,
leaves the patient badly deformed, and in
popular language, a “hunchback.'' This type
of tuberculosis attacks the bodies of the vef :
lebrae, which makes up the spinal column
Usually tbe focus involves from one to four of
these, and, when extensive, causes knuckling
of the spinal column, with pressure on tho
spinal cord leading to paralysis and great
wasting of the body and limbs. Formerly
these little patients were treated in “hyper-
extension' 1 —that is, by bending the body far
backward oyer an iron frame, strapping It in
this position and holding it there for several
months.
Recently Dr, Fred H. Albee, of New York
City, an exceedingly clever orthopedic surgeon,
lias devised an operation which shortens the
treatment to six weeks or even less. Dr. Albee
studies the exact condition of the patient’s
spine with the X-Ray. He then cuts through
the muscles of the back directly in the middle
line of the body, exposes the tips or spinous
processes of the vertebrae, and splits them
longitudinally with a chisel. This done, ,the
operative field is protected temporarily, and a
piece of bone about one-half inch in thickness
and as long as the diseased area required is
'removed from the shinbone of the leg. This
is then inserted into tbe groove made by the
splitting of the vertebrae, and Is sewed in posi
tion by means of kangaroo tendon. In a few
days the patient is allowed to get up and walk
around without any heavy plaster cast or sup
port, and recovery usually takes place within
a few months. The results from this treatment
have been excellent. Dr. Albee has also dp-
vised a bdne-grafting method for tuberculous
joints, which has been successful in several
cases.
How a Diseased Lung Is Made to Collapse and Absorb Nitrogen Gas m the
“Artificial Pneumothorax” Treatment.
The advantages of uir and sunlight have al- Quite recently high frequency currents of
ways been known and used in the treatment of electricity have been used with success. This
tuberculosis, but at the Tuberculosis Congress Is especially so if the trouble is on the exterior
in Rome last year a Swiss physician described of the body or in a limb. In the lung, however,
a sunlight treatment which has produced re
markable results. The sanatorium where this
work is done is located at Daysin, a village
hidden away tn the rugged slopes of the pic
turesque mountains of Switzerland. The ele
vation here is from 4,100'to 4,500 feet, and the
climate more than' 30 degrees Fahrenheit at
the snow level. There is ample protection from
the north and west by the natural configuration
of the place. Children are purposely provided
with very little clothing, and romp and play
in the snow to their heart’s content. During
the first eight days the patient is not exposed
to direct sunlight, because o’f the danger of
severe burns and inflammation of _the skin.
The feet are first exposed, then the legs, knees
and gradually the entire body, save the eyes,
which must be protected. The skin takes on a
peculiar brownish color, which increases its
elasticity and resistance, and the child’s condi
tion speedily improves. Blondes do not stand
the rays as well as brunettes, and if the sun
light ceases for a few days before healing is
complete there is a marked return of bad symp
toms. Healing is due to a predominance of
ultra-violet rays.
it is difficult to secure good results, because of
the danger of severe burns to the skin and
chest wall, which are very difficult to heal. If
the chest could be opened and the lung treated
directly this treatment might help, but it is
well known that if the chest is opened, the at
mospheric pressure causes the lung to collapse,
and consequently the patient is likely to die
from suffocation. This obstacle has been par
tially overcome by so-called “positive pressure”
apparatus, by means of which air is forced
constantly through a tube inserted into the
mouth and down-the windpipe. Thus the lungs
are kept expanded.
We may, therefore, soon have a very valua
ble aid from high frequency currents in lung
tuberculosis. This high frequency method was
originated by De Keating Hart, of Paris, is
known as "fulguration,” and is being extensive
ly used in the treatment of cancer by Dr. W.
S. Bainbridge, at the New York Skin and Can
cer Hospital. A voltage of 500,000 units is
used, and tbe spark played upon the diseased
area must be 10 or 12 centimetres long.
One of the latest methods of treating pul
How the Business Men of America Can Save Two Millions a Day
| Editor’s Note.—The author of this article is
president of the Business Bourse, editor of the
Efficiency Magazine, an active member of the
Efficiency Society, and is retained as advising
expert by many ot the leading concerns as coun-
stl upon questions relating to office and execu
tive efficiency.
Mr. McCormack s the inventor of the original
typewriter tabulator, the unit voucher system,
etc.; In fact, he has possibly invented more
labor-saving devices and systems for the office
than any other man.
He is well known throughout the country as
a lecturer on office efficiency, having given
Illustrated lectures upon the subject in all the
leading cities, and ia an ,-icknowledged authority
upon all aubjects relatb.g to office management
and office efficiency.)
By H. S. Me Cormack.
president of the Business Bourse.
F you raise pigs, the United States Government
pfhees at your disposal an elaborate staff of
specialists who are backed by n very com
prehensive system of experimental stations, and
these experts will supply you with pamphlets and
booklets of instructions and will otherwise help
you along scientific lines.
If you are troubled or perplexed upon a ques
tion which relates to forestry, mining, navigation
or. In fact, almost any subject, the Government
is back of you and you are forced to appreciate
that you are living in an age full of wonderful
opportunities.
But if, on the other band, you are trying to
esiabllsh a business of any kind, don't expect to
receive any assistance from Uncle Sam.
' It Is the business of I be country that gives cm
ployment to the millions that makes the Govern
ment possible. Wnen business is good, t uele Sam
is well; but when business is poor, be is very,
very slcfl. And yet this most important part of
the country s activities is ignored by Uncle Sam
Business men are left to blaze their own trails.
No lecturers are sent through the country to show
them bow business can be made more scientific;
no special trains with data and with Instructors
are despatched about the country—such neces
sities are denied to business men, although they
pay the greatest revenues to the country.
The waste through Inefficient business manage
ment and failures (a large percentage of widen
can be avoided) lias been terrific, for there is an
enormous waste volume of office business done.
Every business has at least one office; many
businesses have dozens of offices. There are
3,948,013 separate business offices in Ilia country
(as shown by offices having telephones), or an
office to each 27 inhabitants.
Two million dollars a day is my conservative
estimate, based on detailed personal knowledge
of the situation, of the amount of money need
lessly expended in offices throughout tbe country.
Eliminate one-third of throe million offices as
being too small to be efficient, and eliminate an
other million, for tbe sake of argument, as being
100 pec cent efficient, and it is only necessary to
save $1 a day per office to conserve two million
dollars a day.
This estimate of $1 saving does not represent
each person, but instead represents an entire
office force; and, for the purpose of being conser
vative to a fault, but one-third of the efficiency
that might be a sited for Is to be considered.
Even to those who have made but a limited
study of office work, the estimate of only $1 a
day will appear ridiculous, because the simplest
analysis shows, for instance, that tbe average
cost of business loiters is from 7c. to 11c. apiece,
and that it is only the highly efficient offices
which handle correspondence ut a cost of 6c. or
5)^c. per letter.
Eliminate one-third of tilt' unnecessary work
that is performed daily in business offices
throughout tbe country, and tbe saving will be
nine times greater than the saving proposed
through tbe revision of the turiff.
Capitalize the energy lost through waste ef
fort or tbe needless work performed in business
offices, and there is enough energy available to
turn over tbe Panama Canal without expense to
the nation.
1 be number of useless needless letters written
daily cannot easily be computed, but tbe actual
loss in this direction runs Into the hundreds ot
thousands.
Business men who would not, fill their pockets
with silver dimes each morning and scatter them
right and left through tile streets do countenance
and encourage tile employment of clerks who
thoughtlessly and needlessly write letters wliicb
bring no return whatever to the senders.
Business men borrow money and pay 5 or 6
per cent per annum for Its use, and then day by
day destroy the earning power of those dollars
by negligence, carelessness and thoughtlessness.
A hundred dollars Is invested in a business
which is supposed to earn 6 per cent, or $6.00, iu
365 days; and the man who makes the Invest
ment engages an extra clerk to do unnecessary
detail work and pays the clerk $12 a week, thus
destroying every week the annual earning power
of $200. This means that the earning power of
$800 is lost every month, or the earning power of
approximately $10,000 every year.
Make an analysis of tbe simplest office routine,
and it ts astounding to ascertain liow much work
is done over and over. Writing and rewriting ap
pear to be tbe order of the day.
The fact that a man says he has a system does
not make it so—if a man believes himself or his
office efficient. It does not reduce his expenses,
and no one is fooled but himself, while he is busy
making preparations for tbe receiver to step in.
When u man starts to analyze what is going on
in his own office it is a healthy sign. If he begins
with tbe operation of making checks, he may find
that his bookkeeper does tbe following:
(1) . Writes the check.
(2) . Copies the same information upon the stub.
(3) . Makes nn entry on bills or on voucher
cover of distribution.
(4) . Prepares some acknowledgment or receipt
or enters details in distribution record.
Tbe various forms for making payments by
checks vary to such an extent that no set rule
governs Ibe handling of these transactions; but
repented investigations prove that from 3 to 7 op
erations are usually performed in connection
with every bill and in some offices these op
erations are repeated day after day in tbe hand
ling of hundreds of bills passed for payment.
A set of unit forms will, without repetition of
qny kind, eliminate two-thirds of the work now
performed in the payment of bills, by combining
the following operations into one:
(II. Writing of check.
(2). Writing of receipt.
f3). Writing of voucher cover.
(4l. Writing of register.
(5). Writing of bookkeeper’s distribution
record.
It is, indeed, rare to find a firm with an effici
ent telegram system. The customary method Is
to write the telegram and retain a duplicate for
the files; then write a letter and repeat therein
the contents of the telegram, which is but a
repetition of the work just done.
At the end of the month that becomes one
of the great factors in increasing the cost of
clerical work necessary to check up the bills from
the telegraph office to find out who sent the
various telegrams.
A system of form duplicate copies will at one
writing take care of the following operations:
(1) . Telegram.
(2) . Office cepy.
(3) . Confirmation.
(4) . Office register.
For many years business concerns could not get
away from tbe old custom of filling orders from
original orders. So much delay and confusion
were caused through this method that finally the
more progressive firms saw the advantage of tak
ing two copies. The results secured were so sat
isfactory that the plan was extended to three and
four copies, and many concerns are now making
from five to twelve copies, so that no rewriting of
orders is necessary.
While the agitation has beeh going on about
shop management, and efficiency engineers have
been lowering the cost of production, the execu
tive office expenses and the selling expenses have
been mounting higher and higher, until now it is
a well-known fact that it costs 66 cents to sell
and distribute articles which cost only 33 cents
to manufacture.
A sale can be made in an office—it may be a
doctor's office, a broker’s office, or a real estate
office. It is immaterial whether the sale amounts
to 10 cents, $10 or $10,000; the custom is to make
a charge slip* of some kind, according to the
transaction. The charge slip goes to the book
keeping department, where the juggling process
really starts. The amount is entered, possibly in
a sales book, then becomes a journal entry, gets
into the ledger, is carried to some distribution
record, gets upon a bill and goes down the line,
is accumulated iu a sales report; and, it may be
that the same amount is placed to the credit of
some department. With every juggle of this item,
it is hoped that when the totals of the various
combinations of figures are added together the
correct grand total will be secured. If not, then
it means the old story of going back and taking
trial balances, then checking off until the dis
crepancy is shown and all of the various ac
counts show uniform balance.
During the past fifteen or twenty years, un
fortunately, there has been a tendency toward
cumbrous systems which entail a lot of book
keeping and furnish a multiplicity of records, and
while these various reports and statistics are
all used in some cases, little thought has been
given to hnving the various operations combined
so as to be accomplished at one writing or with
one transaction.
A machine has been introduced Into the Gov
ernment Census Office which dispenses with hun
dreds of clerks; the work that formerly took ten
years to accomplish is now performed at less ex
pense In ten months.
What has been done by the Government In the
matter of handling the census can be done in
business houses. It will be possible to have little
punching machines, so that the 10 cent, $10 or
$10,000 item can be punched Into a card, which
card can be fed into an automatic machine, and.
without transcriptions of any kind, these little
punched holes in a card will take care of the
seven or nine operations, which some firms con
sider so necessary and which entail so much work
in re-writing and re-copying for the purpose of
securing their various records.
From the time the raw material is ordereS
there Is little else but office work—executive;
buying goods, salesmen selling them, clerks writ
ing orders, others writing letters about the goods,
attending to the billing and keeping the books.
The railroads furnish office help to write many
bills for raw material, the refined material, the
finished material; and the goods, from their raw-
state to the time they are ready for delivery to
the consumer, are subjected to re-wrlting and are
paid for by cheek possibly ten times, because
goods in their different stages must be paid for,
as well as transportation charges on them.
When the Government investigated the express
companies, they found that there were eleven
transcriptions, in part or in whole, that took place
from the time Jones delivered a package to the
company until it was received and receipted for
by Smith. The Government regulations have
eliminated a lot of that red tape aud tile public
are getting better service.
One of the leading textile concerns recently
conducted a test to ascertain the cost of writing
each bill. It was found to be 7 cents, and this
amount was Independent of all selling costs,
telegrams, salesmen, bookkeeping, etc.
President Wilson took a big step in the right
direction a few days ago, when he placed the
stamp of approval upon the work of the Efficiency
and Economy Commission.
The reports of this commission covered the
various departments in Washington which had
undergone an inspection. The investigations have
already resulted in the saving of hundreds of
thousands of dollars in Government offices
through the elimination of needless work.
There should be established a Government effl
ciency bureau to gather data and statistics for
the business man to use in his office—there must
be time studies, tests and experiments along the
same scientific lines as are conducted in any
other Government department which has been
established along economic lines.
Retailers must be shown how inefficient man
agement and inefficient distribution are one of
the great factors in increasing the cost of living.