Imagini ale paginilor
PDF
ePub

He becomes so intent in trying to discover a specific for pneumonia, or "in relieving the extraneous deposit" that he fails to relieve the patient. He is somewhat like the surgeon who saved the tumor but lost the patient.

If it were possible to so forcibly impress one fact upon the minds of all physicians that they would at once accept it and utilize it as a guide n the treatment of disease, thousands of precious lives would be spared which otherwise will be sacrificed because of slavery to time honored authority. It is this: - There are no specifics for diseases as ordina ly classified, but there are specifics for pathologic conditions; symptoms and signs are the recognizable manifestations of pathologic conditions, and should be accepted as the principal guide in the selection of remedies.

Seldom should two cases of pneumonia or typhoid fever receive identical treatment. It should not be forgotten that under any treatment or with no treatment at all, a certain percentage of almost any disease will recover. If some prominent man comes forward with statistics to show that a larger percentage of cases of pneumonia recover when they have been packt in ice than when their vital centers are more or less paralyzed with morphin, veratrum or coal tar antipyretics, do not at once jump to the conclusion that there is no better treatment and abuse those who publish higher percentages of recoveries under other methods.

Dr. B. considers alteratives as of first value in treating pneumonia. Brunton says that an alterative medicine is one that improves the nutrition of the body without exerting any very perceptible action on individual organs. Dunglison says that an alterative is an agent capable of producing a salutary change in disease, but without exciting any sensible evacuation.

Here is a patient who will either be dead or on the highway to recovery within ten days. There is engorgement of the pulmonary vessels due to profound depression of the vaso-motor centers which should control their caliber. He is breathing rapidly, his lips are livid, his skin is hot and dry. The pulse is rapid, bowels constipated, urine scanty; digestion, nutrition and elimination almost at a standstill and the circulatory and respiratory organs struggling under the depressing influence of the virus of disease in addition to the accumulating products of tissue metamorphosis.

Here, according to argument made, the remedy of "first value" is one which acts on no particular organ and excites no visible excretions, but which in some mysterious way improves the nutrition of the body! Add to this a febrifuge mixture, and there you are- snug as a bug in a rug." No" mere routine" about that!

I am convinced that, as a general rule, causes of disease produce pathologic effects primarily thru their influence on ganglionic nerve centers, either directly or indirectly (reflexly); either as simple irritants producing spasmodic symptoms; or, acting more profoundly, they depress the functional activity of organs presided over by ganglionic centers. I must differ with Dr. B. when he says we want remedies which act on the peripheral nerves in the lungs. We want remedies which act on nerve-centers, to counteract the influences of causes of disease.

Fortunately, we have remedies which, with unfailing regularity, produce their most markt effect upon local areas, which are presided over by distinct ganglionic centers. In addition to their local action, many of them also produce a greater or less general effect thru their influence on the general vaso-motor centers.

In treating pneumonia or any other disease, the condition of important vital organs should never be overlookt. Examine the tongue. This is dry and contracted (manifesting irritation of sympathetic centers) warns us not to burden the stomach with drugs which increase the irritation, like quinin, morphin, strychnin, etc.; if it is broad and flabby, showing want of innervation, it tells as plainly as words can tell that active nerve stimulants, before contraindicated, are now demanded. Let us observe the general condition of the pneumonia patient.

Here we have a person whose system is charged with extraneous matter, germs, ptomains, urea, etc.; his skin and other excretory organs have ceased to perform their wonted function. The cardiac and vaso-motor centers are so depresst that local engorgements and inflammations en

Is it not possible that in this time of extremity we can find remedies more important than those which act on no particular organs and produce no visible excretions? The remedies to be employed in pneumonia should be mainly those which have a gentle stimulating or sedative effect. (If you strengthen the heart's action, you quiet it.) Depressants are

contraindicated. Very few persons are burdened with a surplus of vital energy.

A few words concerning the use of aconite and veratrum: There is a right and a wrong way to use them. Whisky is generally regarded as a stimulant, but you can paralyze (temporarily) the strongest man with it. Nitroglycerin is recommended as a heart stimulant, but it does not require much of it to quiet the heart for all time.

In small doses, five drops of Lloyd's specific medicine to four ounces of water, teaspoonful every fifteen minutes to one or two hours, depending on the urgency of the case, aconite is a most reliable cardiac stimulant tonic, at the same time toning up the capillaries, and exercising a kindly influence on the digestive and excretory organs when the tongue and skin are dry and secretion and excretion diminished; restoring the functional activity of the circulatory digestive and excretory organs. In summing up, I will say, that the remedy or remedies indicated by the symptoms should be given, regardless of the name of the disease. If the tongue is dry and contracted, quinin, strychnin, etc., will do harm, rather than good. If the patient's head is hot, face flusht, etc, opiates will place his life in greater danger.

In the stage of engorgement, some of the following remedies will be indicated: Aconite, veratrum, gelsemium, jaborandi, asclepias, bryonia, ipecac, lobelia. In the stage of hepatization, potash bichromate ammonia muriate, ipecac, lobelia, tartar emetic, etc.

Specific diagnosis and specific medication afford the most rational guides in the treatment of pneumonia or any other disease. O. C. MASTIN, M. D. Ewing, Neb.

Treatment of the Average Case of Pneumonia. Editor MEDICAL WORLD:-As the treatment of pneumonia is under discussion in THE MEDICAL WORLD, I desire to give, in part, my treatment for nearly all cases, croupous or bronchial. If the attack is very violent, bleed at once, taking blood enough to cause a soft pulse. Then give calomel in quarter-grain doses every hour until the bowels are emptied. If patient can tolerate it, apply spirits of turpentine and alcohol, equal parts, every hour, to nearly the whole of the chest, front, sides and back, until the skin reddens, and then often enough to keep it red, increasing, if need be, the proportion of turpentine,

even to using it pure. I also pin a napkin moistened with turpentine near the chin, that the patient may inhale its odor with every breath. Raw cotton should be tackt to a cloth and kept applied to the whole chest surface.

Strict attention must be paid to the comfort of the patient, and to the heart and kidneys. Give one-half to two grains of quinin every four to six hours, after suitable nourishment. I cannot emphasize too strongly the vast importance of sufficient rest. The patient should sleep at least eight hours of each twenty-four. With this treatment fully carried out, I believe there will be but few fatalities in pneumonia. EDWIN L. SWIFT, M. D.

Hamden, Conn.

Comments on Colds, Fevers, etc. Editor MEDICAL WORLD:-Apropos the treatment of colds, why not give the cold plunge bath a trial, if the patient's vital powers justify it? In baptismal immersions many people go into the water at almost freezing temperature, regardless of the fact that they may be suffering from colds, sore throats, etc. The ever-observing man of medicine expects his service will be required the next day, but lo! the cold is cured! What are we to infer from this?

The typhoid fever subject has been so thoroly discusst that it would seem there is "nothin' to say further." I do not think the profession can endorse Dr. McRae s routine of administering sufficient acetanilid to keep the skin moist. While I use the drug occasionally in typhoid, and often in pains and neuralgias of the sthenic type, yet I have seen too many collapses from the use of the drug to prescribe it indiscriminately, especially for a continued period. Doubtless it has a damaging action upon the ozoning function of the blood which may not be made manifest for months or years later. Nervous people in particular seem to have an idiosyncrasy against the coal-tar preparations.

The central idea in the treatment of typhoid fever is, I think, to prevent sepsis. Calomel meets this indication better than any drug thoroly tried thus far. I have treated many cases with no other drug. It is needless to state that careful attention to nourishment, nursing, etc., were rigidly enforced. I have one suggestion to make which I have not seen in print. After the premonitory nervous symptoms have abated and the patient is started out

on the proper line of treatment, blow out the light at night and let the patient sleep. Coddling and over kindness in sitting up kills many typhoid patients.

"Antiseptic obstetrics" is all right, but the most probable period of infection is not during delivery but a few days after. As a matter of fact a large percentage of deliveries are made under any thing but aseptic conditions, particularly among the poor and ignorant. I recently attended a primipara in a little hovel where only dirt, rags and squalor prevailed-not a clean towel or cloth to be had. The mother, an old crone who claimed to be a mid-wife, said she "dassent 'tend on one of her own folks because it was agin the law." How such foolish notions gain credence among the laity I am unable to say. Notwithstanding these microbic hot-beds, most of these cases make uneventful re

coveries. But the practice of asepsis and cleanliness among this class, aside from a bacteriologic stand-point, is a good object lesson toward wholesome, sanitary living if nothing else. W. T. MARRS, M. D. Jewett, Ill.

Things Learned About Typhoid Fever. Editor MEDICAL WORLD-I have been much interested in the various opinions of treatment of typhoid fever. I have recently had an interesting case in my own family, my son, taken sick at Camp Haven, a member of the First Connecticut Volunteers. To-day, November 29, marks the beginning of the eleventh week of the disease, tho I am happy to state that he is convalescing. I learned many things in connection with the case, and among them the following:

That I could not break the fever with the dosimetric trinity, tho I tried hard for a week, and pusht it until the digitalin affected the heart. That the triad of sulfocarbolates would render the bowels antiseptic by giving 90 grains daily, but they would not stay the fever. That guaiacol applied to the skin, in 20 drop doses, would drop the temperature from 104 3-5 to 99 in two hours, followed by a chill and collapse. That guaiacol carbonate, in 60grain doses daily,would surely destroy the typhoid germ, whatever it may be, and that the fever surely disappeared under its administration. That milk could not be tolerated by the stomach, peptonized or not; brandy, ditto. That bovinine, in teaspoonful-and-a-half doses every two hours for weeks, was very acceptable, the

!...

stomach never refusing it. And that strychnia arsenite is superior to whisky as a general stimulant in such cases.

I have learned much, unlearned much, and come to the old conclusion that the wise physician will individualize his cases and treat them accordingly. I am in hearty sympathy with all you have to offer in Monthly Talks. Unionville, Ct. E. M. RIPLEY.

To Abort a Cold.

Editor MEDICAL WORLD:- If colds are treated in time they can always be arrested in twenty-four or forty-eight hours. No one, even those with chronic nasal catarrh, need ever have a cold beyond the congestive stage. The following is my remedy:

Give an anti-bilious pill if the bowels are slow or tongue coated. At same time gargle the throat well (head well thrown back), with two teaspoonfuls of the following, without water, and then slowly swallow the mixture, taking no water within twenty mintes afterwards.

[merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small]

This never fails if taken before the stage of secretion. J. W. SANDERS, M. D Dover.

Typhoid Fever, Homeopathic Treatment.-A Protest.

Editor MEDICAL WORLD: - From the number of "sure cures" given in the scores of different treatments by so many writers for THE WORLD within the last year, one might be led to the conclusion that just any old thing would abort or even cure typhoid fever. The article which strikes me a knockout blow right over the cardiac plexus, is one on page 480

of the November WORLD, under the above heading.

Now, I do not object to "A. E. M." having his own peculiar treatment, for it is about as rational as the hundred other "sure cures," but I do object to his calling it homeopathic. To prescribe homeopathically, is to give a single remedy, which, when given to a healthy person in poisonous doses, or when given in continuous small doses till morbid symptoms appear, will produce symptoms exactly similar to the totality of the symptoms presented by the patient for whom we wish to prescribe homeopathically. Nothing else is or can be a homeopathic prescription.

If A. E. M. has for ten years found every case of typhoid fever presenting a totality of symptoms similar to those produced by rhus tox, baptisia, muriatic acid, nux vomica, bryonia, hydrastis, calomel, bismuth subnitrate and podophyllum, then his treatment was homeopathic, otherwise his article presents homeopathy in a false light. It is just such practice as this in the name of homeopathy which brings our school into disrepute.

W. E. ALUMBAUGH, M. D.

Vacaville, Cal.

Wind as a Factor in Spreading Infection. Editor MEDICAL WORLD:-There in one point in regard to the spreading of disease to which attention may be called. In rural districts, especially in the prairie sections of the country, the physician is often puzzled to account for the origin of many isolated cases of say typhoid fever occurring apparently without connection with each other or with pre-existing cases. Now that the bacterial nature of the infection in typhoid has been satisfactorily establisht, we can no longer fall back on insanitary conditions as being the source of the outbreak of this disease. These can only be regarded as accessory and contributory causes. The drinking water is, of course, the favorite, but by no means the only, medium of introduction into the system; milk, butter and other articles of diet being also vehicles for the contagion. The real problem is how do the germs get into the food and water? The usual explanation is that of soaking into the wells, but in many cases this explanation does not apply. It explains the presence of the organic matter, but very seldom the presence of the germs. Typhoid is as generally diffused in rural as in urban communities, and yet the sources of water

supply are largely independent of one another, each house on the farm and many in the villages and small towns having its own well, while rain water is often used.

The wind, I believe, has much to do with this general distribution of the germs. Bacteria cling to dust particles and may be carried by the wind to places where conditions favor development and multiplication. Residents on the prairie are quite familiar with the long distances to which dust may be carried by the high winds, and the agriculturist recognizes this as one of the most active agents in distributing the seeds of noxious weeds.

That this agency of wind is also at work in mountainous regions, the following incident will show. Early this year there was a fall of dirty, yellow-colored snow at Engadi in Switzerland. When the snow was boiled and allowed to settle, there was a thick deposit of mud which was found to contain iron in combination with other minerals-a particular combination characteristic of certain iron ores in Hungary, hundreds of miles away. The dust had been swept up from the plains and carried in the higher currents of the atmosphere till intercepted by the falling snow. What happened to the iron ore might also happen to typhoid and other germs, which retain their vitality for some time, even when subjected to drying. They could be carried along with the dust particles into open wells, into vessels containing water, milk, butter and so on; into stagnant sloughs, and be deposited on the roofs of houses, thence to be washed by the next rainfall into the cisterns. In this manner many epidemics and isolated cases may be accounted for.

There are two points of practical impor-1 tance to be deduced from the above. The first concerns the management of the individual case of typhoid. The physician directs the attendant to disinfect excretafeces, urine and sputa-but as the thoro disinfection of a typhoid stool is a matter requiring time and trouble and is very disagreeable, it is safe to say that it is never completely done. Indeed there is often great carelessness in the disposal of typhoid excreta, and sometimes they are thrown out on the surface, whence they may be carried by water into the wells, but more likely on the plains, after becoming partially dried, to be swept with the dust to neighboring farms. In rural districts all typhoid stools should be buried in a hole, away from the water supply,

[merged small][ocr errors][merged small]

the bottom of the hole being first covered with a liberal quantity of lime or other disinfectant; or, they should be burned.

The second point concerns the public health authorities, and has to do with the water closets in use on the railway trains. These are, for the most part, open chutes down which the excreta are projected to the railway track. Many people with ambulatory typhoid, and patients in various stages of the disease, en route to hospitals or home, use these closets, and thus typhoid stools are spread along the railway, ready for distribution by the wind all over the neighboring country.

The same thing might happen were cholera ever to obtain a footing on this continent; but apart from the specific danger in such cases, the method is unhygienic and offensive. It should not be difficult to attach a box below the chute and adopt some modification of the earth closet, the excreta being removed and burned at divisional points along the line. R. S. THORNTON, M. B., C. M.

Deloraine, Man., Canada.

Potassium Permanganate as an Antidote for Opium-Typhoid Fever.

Editor MEDICAL WORLD:-I like THE WORLD, and so will anybody who can bring his views above preconceived prejudices-your method of arrangement, taking up of different subjects according to their season," many of the original communications, the quiz department, formulas, and above all, your editorials and current medical thought departments.

I think THE WORLD is, particularly for "beginners", one of our most valuable medical journals. I believe in keeping the practical in view; but, while we are concise, we should not lose sight of, or omit important points, the omission of which will leave an "unclearness" or doubt in the mind of those unfamiliar with the idea or experience to be conveyed.

For instance, on page 488, November WORLD, Dr. Sanders gives his experience with potassium permanganate in opium poisoning. There are two points which I would liked to have seen brought out, and upon which I wish Dr. Sanders would give us further information:

(1) As to the amount of potassium permanganate, and degree of dilution, given hypodermically in both cases-without effect-and the amount of morphin given to the child?

(2) The amount of potassium perman

ganate, and degree of dilution, given per rectum, resulting in recovery, and how long the doctor was obliged to apply digital pressure over the anus; or, more important, how soon were the beneficial effects noticed?

As a rule, we obtain more prompt and certain effects from drugs administered hypodermically, but if Dr. Sanders' experience should prove to be correct, I would offer the following explanation:

(1) Opium, in its various forms, taken per mouth or rectum, reaches the portal circulation and thence the liver, from which absorption gradually takes place. If now we follow with potassium permanganate by the mouth or rectum, it will travel the same route and directly antagonize the opium (changed into dioxymorphin) either in the gastro-intestinal tract, portal circulation, or liver. If, on the other hand, the potassium permanganate is given hypodermically, it is improbable that it will have any effect whatever on the morphin still situated in the above named anatomic localities.

(2) Opium or morphin, after having reacht the general circulation and the tissues, either primarily, thru hypodermic administration, or secondarily, thru the mouth or rectum, is eliminated to a large extent (between 40 and 50 per cent.), as has been shown by Fauber, thru the feces. It is not only excreted by the intestinal tract, but also to a considerable amount by the stomach, as proven by Prof. Hitzig. Undoubtedly the kidneys also eliminate a large share of the drug, but the final escape from the body, to my mind, occurs only after repeated reabsorption, and it is this at least which we very likely can prevent by repeated doses of potassium permanganate by mouth and rectum, thus reaching the gastro-intestinal tract, portal circulation, liver and even kidneys more or less directly. Administered by these routes it will, in addition, after reaching the general circulation, have the same effect as when given hypodermically—if any effect it has at this stage. I hope to arrive at some definite conclusion on some of the cases which will come under my care during my senior medical service. In either case, the drug ought to be given in free doses, and to my mind, well diluted. If I should employ it hypodermically I would use one or two pints of normal salt solution as a vehicle and give it as an "infusion."

It may, perhaps, interest some of THE

« ÎnapoiContinuă »