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theria; Antitoxin is only a “holy hypoth- therefore all our wisdom is only pieceesis" (?)
meal; all our knowledge is only a "holy The virus we use for vaccination is a hypothesis,'' and it can never be an exact blood poison-the inoculation of one blood science. poison to prohibit, forestall or to hinder Why do we rather give morphin by hythe ravages of another blood poison or podermic injections than by the mouth? germ of disease, is, to say the least, a It is easier, quicker and more certain
holy hypothesis," a fraud-not sustained in its action. Let us give all our remby facts—(only a Yankee trick to gull the edies, especially the alkaloids and spemasses.
cific tinctures by electrical transfusion into Is the process of vaccination purifying the system and you will then know their to the blood or tissues, so that the small- true physiologic effect, unaffected by mouth, pox germ cannot develop in such soil? gastric or intestinal secretions ! Then it would be a benefit to everybody; Any weak galvanic battery will accombut the wiseheads of the profession say, plish this, and the practice of medicine do not vaccinate scrofulous children, or will be a pleasure and the certainty of those with tainted blood dyscrasia! action of the remedies given will soon for
Dr. Cooper says:-“If one has been liv- ward our hypothesis into an exact science. ing grossly and the blood is in a bad con
A. OPPERMANN, M. D. dition, vaccinia will go hard with him ; it Auburn, Nebraska. might furnish a partial excuse for the loss of an arm, or for a result even worse than
Answer to a Criticism. that. The prudent physician will not Editor MEDICAL WORLD: - From the vaccinate such a patient till he has criticism of my article in the December cleansed up his system.
World entitled “A protest against sweepThe more depraved the blood the more ing classification of diseases— Treatment of susceptible to disease, is it not ?—then the pneumonia"-I evidently failed to make worse the arm after vaccination the better myself understood, or was misrepresented the system has been purified and made in several particulars, thereby creating a the least susceptible for the smallpox false impression of my intention in writing poison. How is it with such persons the article. where the vaccinia does not take at I was not composing an article especially all? “Holy hypothesis" helps us to find on pneumonia. The remedies I mentioned the reason—why or if vaccination does were only a few suggestions and not inprevent smallpox.
tended to cover the whole treatment of the What is a physiologic effect of a reme- different pathologic conditions on the dy? You would have to experiment upon various forms and stages of that disease. a standard, normally healthy person, to Dr. Waugh asks several questions, and find out such physiologic effect. Has any- altho somewhat doubtful of the sincerity one ever found such a person? Who is of his desire for information, I will enauthority on such physiologic effects of a deavor to answer as tho he really wished remedy—especially on the plant-extracts, to be enlightened. I have a great regard which contain from ten to twenty different for his ability as a therapist, and I do not principles, belonging to organic chemistry? think I can " teach him anything." I can -is it not also a "holy hypothesis?" only relate my experience with certain
Even Prof. J. U. Lloyd, W. C. Abbott, remedies and make an application of the W. F. Waugh or F. Ellingwood could not knowledge obtained in that way. He asks vouch for the effect of any remedy. Even 66 What is an alterative ?" It is a term strychnin will not kill always! Even the which perhaps is somewhat indefinite, but grand theory of dosimetry, an alkaloidal no more so than many others in our nomethod of administration of remedies is menclature. The word has filtered down only a “holy hypothesis,” for nobody can thru all our medical literature for years, foretell what chemic combination or de- and has become incorporated in all our composition will ensue, while the granule, text-books as signifying special pathologic so given per mouth, will dissolve and en- changes produced in the blood by the adcounter the quasi chemic contents of ministration of certain remedies. Your esophagus, stomach or intestines !
alkaloidal text-books use the term, then All our failures are based upon this un- why question its propriety? known change that may ensue-while our For fear, however, that any definition I remedies are in process of assimilation- may give will not be acceptable, I will let the eminent Dr. Headly answer the ques- hepatization is fully establisht, aconitin, tion. He says: “Where shall we place veratrin, digitalin or strychnin were valuesuch remedies as mercury, arsenic, iodin? less in relieving the exudation existing in In an arrangement founded on ultimate the lungs either immediately or remotely. effect they should be grouped in a class as If this is so, what would naturally sugalteratives, as medicines which result in al- gest itself to our minds? If it cannot be tering for the better the condition of the done quickly, would it not be by the system in disease. It cannot be that med- administration of such remedies as would icines should be able to affect the nerves gradually act upon these diseased and and to influence the glands in divers ways, engorged tissues-remedies which we beand none should exert any action on the lieve have the power to counteract thru blood. Such remedies would seem to me to the blood morbid conditions existing in be more important than any others.” The the system, and thus restore them to their author does not attempt to explain the ex- normal functions ? act method of the operation of these reme- If by these means we are able to raise the dies in the blood, but says “ They seem to blood to a healthful standard of nutrition, counteract certain morbid poisons existing can we not ultimately expect to promote there."
absorption and elimination in the affected We judge of the effect of medicines by lungs when the crisis of the disease comes ? their results. It is not really essential in Perhaps we all err in considering pneuour use of them that we should understand monia too much as a local disease. their exact process of attaining those re- The theory has been advanced that sults, however desirable such knowledge the pneumococci in the lungs produce a might be. Dr. Waugh says “Aconitin poisonous material which is immediately relaxes the vasomotor spasm of the skin." absorbed into the circulation and this in He does not tell us how it does this, turn forms an antitoxin in the blood, and whether by paralysis of the afferent nerves when the process is completed this antiof the vasomotor system, or simply by its dotal substance neutralizes the toxic subvirtue of being sedative to the circulation, stances as they are produced by the pneumothereby lessening the blood-pressure. I cocci. It is at this period in the process believe it is a disputed question. By the that the crisis comes and resolution takes administration of the remedy, however, he place. sees the result and that is enuf for him In the admirable article of Dr. Russell as it would be for me.
“At the present time our treatIn cases of pneumonia coming under our ment is aimed at the effects of these poisobservation I believe fully one-half of those ons. How shall we prevent their formwe are called upon to treat have passt the ation ?" We may not be able to prevent stage where aconitin can be of any value their formation by the administration of whatever except in controlling the heart remedies acting in the blood where toxin action and allaying the fever. In the exists, we may be able to assist the blood initiatory stages when the congestion is in hastening the formation of the antitoxin active and the blood flows freely thru the —if the theory I have mentioned above is capillaries I believe that aconitin does true. Dr. Russell suggests that I call my tend to relieve the engorgement of the treatment antiseptic instead of alterative. lungs by action on the vasomotor nerves
That would perhaps be carrying out my of the cutaneous system. This condition, ideas of the action of the remedies I have however, usually lasts only a few hours mentioned, but the remedies themselves, and if we can see our patient at the very iodin and bromin — are usually classt beginning of the attack the remedies sug- under the head of alteratives. gested by Dr. Waugh are certainly indi- Dr. Waugh asks me, “What is the cated.
exact pathologic condition at which you In the second stage, that of red hepati- aim your singular combination of iodin, zation, what effect can the administration bromin, phosphorus and fir balsams ? » of aconitin have in drawing the blood When I tell him that I expect the iodin from the capillaries, or strychnin in forc- and bromin to act as alteratives in the ing it out? Their effect would only be blood, and by such action correct the apparent, I should think, outside of the poisons existing in such a condition as area of hepatization.
pneumonia, I am stating a process which, I have always thought after tissue- from our knowledge of the actions of those changes have taken place in the lungs and remedies, would be likely to occur. If by this means we are able to present to the results with the ineffectual remedies I diseased lungs a condition of the blood as have used, “ for which all thanks.(?)" near its normal standard in health as The sentence in Dr. Waugh's article to possible, are we not assisting those organs which I particularly objected was this: so far on the road to healthful action ? "There should practically bé no deaths
Dr. Periera says, “The preparations of from pneumonia with this treatment." iodin exert in the blood some special action Didn't you mean theoretically, doctor, inof a catalytic nature by virtue of which stead of practically? We admit that the they are enabled to counteract morbid con- theory is all right, but when the results of ditions existing there in disease." By the our best efforts are reviewed, how often do administration therefor of those remedies, we find our theories fail of achieving all I should expect just that result, and thru that we had a right to expect. Look at this change in the blood I should antici- the hundreds of cases of pneumonia which pate a favorable action on the diseased prove fatal every year among the high and tissues of the lungs by increast absorption the low. Do not those in affluent circumand elimination.
stances employ the best medical talent the Why have we not reason to suppose that country affords to save their lives? Yet, iodin has a special action also on the with all the skill of the most eminent phymucous membrane ? In cases of poison- sicians, how many succumb to the disease? ing, its specific manifestations are always If your treatment is so far superior to first observed in the mucous membranes all these, that “you practically lose no paof the mouth and nasal passages, acting as tients," I am glad of it. an irritant. If it has this effect in large I owe Dr. Waugh an apology, however, doses, why does it not have an effect in for seeming to include him among those small doses to stimulate excretion and who make a wrong diagnosis. I did not restore the engorged membrane to health- mean that for him,--altho he had a right ful action in a condition like pneumonia. to infer s0,-but was thinking of many I do not state this as a fact, but give writers for medical journals who claim so it as a suggestion-hang it up, as it often for their methods of treatment that were,-as something to be shot at by my they “had not lost a case in 10 years,' critics.
and this too in the treatment of cases, a In regard to the phosphorus, I think no portion of which must prove fatal, with one will deny that it is a nerve-stimulant, the best skill attainable. How many of and that we produce by its administration those who write articles for the press, and thru the nerve centers, a decidedly bene- claim such great results, think you, resort ficial effect on the peripheral nerves in the to bacteriologic examination to prove their capillaries-not by producing contractil. diagnosis? Probably not five per cent. ity in the capillaries, like strychnia- It is just this negligent habit of calling but by its furnishing nutrition to the nerve a disease what it is not and then claiming tissues.
such remarkable success, at which I aimed I would prefer strychnia where there my criticism. was a tendency to heart-failure or great It is hard for any of us to give up that prostration, but to produce a continued which we have learned to be valuable thru healthful action of the whole nerve-tissue, our own experience, but we are rather inI prefer phosphorus.
clined to exclaim, in the language of ScriptThe fir balsams I expect (like all the ure, “Prove all things, hold fast that balsamic preparations containing a vola- which is good.” We should not be too tile oil) to be excreted by the glands of the ready to accept new doctrines, entirely mucous membrane and by their stimulat- discarding the old, neither should we be ing effect to aid in expectoration. They so hedged-about by prejudice as to be unpossess an advantage over other expector willing to accept the opinions of those ants, such as ipecac, lobelia and equills, qualified by experience to advance new because they do not disarrange the theories. If we are, we certainly will be stomach.
left far behind in our professional career. Dr. Waugh entirely ignores the fact that Now, I hope my position is thoroly unI admitted the value of the medicines he derstood, but for fear it is not, I will rementioned. I stated they were of use, capitulate. bat added “I would not depend on these 1. In the initiatory or congestive stage alone." The doctor says I must be a of pneumonia, I would begin the adminispretty good doctor to obtain such good tration of remedies to control the few
support the heart if necessary,
to the human system in the cure of disease. lieve the congested capillaries so far as Who knows?
FORDYCE H. BENEDICT, M. D. 2. I would continue their use as long as Weedsport, N. Y. demanded by this condition. 3. I would use aconite, liquor ammonia
An Outline of Treatment for Pneumonia, acetatis, digitalis, strychnia or similar Editor MEDICAL WORLD:—When I find remedies, to meet these indications as the I have a case of pneumonia to contend
symptoms might require ; but, at the same with I generally open the bowels with caltime, if I was satisfied that I had a case omel in four to eight grain-doses every four of pneumonia, I would not depend upon those or six hours from four to six doses, folalone.
lowed with a seidlitz powder (better get 4. I would commence the use of some altera Abbott's seidlitz salt) until I get a sure Give remedies looking to the ultimate results of evacuation of the “Primae viae.” This
the disease, so that when the crisis came, the treatment is followed up by two-grain blood, the glandular system and all the emunc- doses of quinin and twenty to thirty drops Stories of the body might be in as active a condi- of aconite in three ounces of water, and
tion as possible to rid the system of the morbific Norwood's tincture of veratrum viride material existing there.
same amount in three ounces of water, a 5. To accomplish this last result, I would teaspoonful alternately every half-hour or use the preparation I have mentioned, con- every hour according to condition of the sisting of iodin, bromin and phosphorus, heart-beat. I have more recently adopted combined with the fir balsams; or, if I the defervescent granule (Abbott) in place thought preferable in certain conditions, of the aconite and veratrum, and so far calomel of ammonia muriate or biniodid of they have proved very satisfactory. mercury.
If the above procedure does not jugulate I do not mean that the above treatment the attack, and if the fever does not decline --- should invariably be followed, as there are after the bowels have moved copiously, say
many conditions in which they might be in the next 12 hours, but keeps up and the contraindicated. What I do mean is, that soreness is not relieved and the cough the line indicated would form the basis of continues with the characteristic expectomy treatment in any ordinary case of ration, red-streaked sputum, you may conpneumonia.
clude that your patient will have a run of I have not mentioned suitable nourish- so-called "lung-fever." ment, external applications, ventilation, Nourish your patient. Liebig's extract etc., as they would necessarily form part of beef is my preference, concentrated or of the treatment in any case.
in fluid form. It is easily assimilated and If we would imitate Nature, I should takes up but little space in the stomach. think the administration of nuclein would Give little and often and force the feeding be indicated. At the seat of the disease if necessary. It should be remembered in the lungs the leukocytes marshal their that concentrated fluid foods are preferable hosts as if in defiance of the attack. Why for an undilated stomach, allows the diawould not the adminstration of remedies, phragm to recede deeply into the abdomwhich tend to increase the white cor- inal region in the respiratory efforts, puscles, aid in warding off the ravages thereby assisting the intercostal expansion which this disease creates in the system? of the chest, so needful in all cases of
In Osler's 66 Practice of Medicine" OC- pneumonia. curs this remarkable sentence: “Pneu- If your patient is a child from one to ten monia is a self-limited disease, which can years, or even older, there will be no exneither be aborted nor cut short by any pectoration, for the patient will not spit known means at our command."
out the mucus. It is raised to the pbarPerhaps we are all wrong in this quest ynx and is swallowed. This may accumfor remedies. Shall we say," Throw physic ulate in the stomach of the child until to the dogs," or " dum vivimus vivamus ? vomiting ensues and it is thrown up. by Nature's own remedies, proper nourish- It will be seen to have the rusty color and ment, pure air and the observation of all tenacity of the sputum of the adult. Its known sanitary laws? Perhaps that time bulky presence in the stomach obstructs will come, and we shall then see the ap- the abdominal expansion and does not alproach of the dawn which shall usher in low the pleural surfaces to rest. When the " vis medicatrix Natura," as applied once ejected from the stomach you will see
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your patient relax into a repose that will ing spells, the premonitory symptoms of be of benefit to the sufferer and satisfaction heart failure. Fortify against it with to the attendant.
nitro-glycerin (Abbott's granules preferDouble croupous pneumonia " is a holy ably). Leave the remedy with the nurse terror" so far as the sufferings of the pa- and explain the appearances indicating its tient are concerned. The diffused conges- use, also have the attendant instructed in tion of the lungs, the patient gasping for regard to the pulse-beat (don't be afraid breath at every inspiration, the depression that the attendants will learn something resulting from the scant aeration of the of your art, as none but conceited charlablood as it is forced thru the almost her- tans need be afraid of imparting a few inmetically-sealed air-cells, the temperature structions to the laity) and how to use over 104°, pulse 120, and as hard as a the remedy in case sinking-spells should wire under the fingers—such is the clinical come on. picture. Your hair stands on end, but Look to the renal secretions. See that don't lose your head! If the patient is of the urine is normal or as near normal in full habit, strong and muscular, tho an old quantity and quality as it can be put by and unpopular procedure, I bleed. Raise medication. My choice of renal eliminathe patient to a sitting posture, cord the tors is : arm and draw blood from the vein that R shows the best in the fold of the arm. I Fld. ext. hydrangea have taken until the patient showed signs Spt. aetheris nitrosi of faintness or complained of being sick. Acidi salicylic .
q. s. 3xij
“old rut” remedies. I use it for ago, immediately after the "wah," I used almost everything, even ingrowing toesantimonials, but substituted the aconite nails. Brace up the flagging energies with and veratrum mixture later on in my ex- tonics, and I especially commend strychperiences.
nin arseniate or Fellows' syrup hypophosDo not think your case has passt the phites. Study your cases, visit them crisis. Don't relax your vigilance, nor regularly at stated intervals, note temperdon't allow your anxiety to consume your
ature and heart-beat. Pneumonia and judgment, but watch the case closely and typhoid fever are two diseases that need meet the indications as they present them- close attention and deliberate thought. selves. This may sound like symptomatic I haven't used opiates for the last twenty treatment to some, and I don't care if it years, except once in a great while. I does. I am a pretty good homeopathist so am afraid of the vitiation that results, far as book-lore is concerned.
obscuring many symptoms that would be I have found by experience that gelsem- noted if not used. I rely on gelseminum to inum, specific tincture, is one of the best quiet and allay irritation, as before menagents for that peculiar nervousness char- tioned. acteristic of pneumonia, caused by the In conclusion I wish to say, don't think scant aeration of the blood when the that I have bled in every case of this maldyspnea seems the worst.
ady, but only in a few desperate ones that Dilute the specific tincture of gelsem- would not yield to medication ; it was inum by putting 20 or 30 drops in 3 ounces the last resort. Some of my cases, 3 of water and give a teaspoonful every ten that I can recollect, that were bled, died ; minutes in adult cases for four doses. many lived; some 14 or 15 cases recovered; Lengthen the time as the distress subsides. but whether it was luck or judgment you Give children in proportion to their age. may form your own opinion. Nor do I Try this and you will find it all right. It recommend that every general practitioner takes the place of the opiates in many should start out with calomel and the cases completely. I have almost discarded lancet, as in days of yore. These two opium in its many forms in this disease. agents in the hands of a novice would be
As the fever subsides look out for sink- more deadly than 13-inch shells and
premonitory ay ng