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atum. It has been such because iron always has been, and now is, given under the hypothesis that it is directly assimilated. The theory seems to be that after it has gotten into the blood current, it immediately corpusculates. Either this, or that (contrary to the fundamental laws of histogenesis) the gates of the blood factories (the marrow and the spleen) are wide open to artificial iron. In this case the question would recur, why should the blood makers ever again become reconciled to Nature's iron? Since it is settled that none but the organic irons are absorbable, the fact becomes strikingly emphatic that all the putative iron cures of the past resulted not from iron, but from the elements associated with it. Further, if it is true that iron is being constantly eliminated from the system, whether any is ingested or not, it would seem that the blood makers are capable of elaborating it de novo, and of their own intrasystemic resources. From this it would appear that we might get along fairly well even if our food itself contained no iron. This scientific refinement pushes iron, as a direct tissue builder, clean out of sane consideration. The conclusion, however, that iron is created within the system, is not rationally acceptable, and it must be relegated to the realm of speculative transcendentalism. Whatever the secret of its evolution into living iron, it must be assimilated, and only food, as nature prepares it, can be assimilated. You may give all the organic iron you will, but it will be expelled from the system like any other foreign intruder.
After all, the only reliable test with reference to the merits of a drug, is unprejudiced experience. Doctor, divest yourself of all preteristic taint; cast from you all reverence for authority, and for current fashions and fads; in a word, strip yourself down to the soul and then, in a spirit of uttermost truth-hunger, retrospectively contemplate your therapeutic experiences. Do this, and see if you can recall one little instance in which you are sure that an iron preparation did for you what the compound minus the iron would not have done. Being a natural heresiarch, it has been easy for me to do this. I was quite an iron enthusiast in the start, and for twenty-five years was a lavish prescriber of it. I have prescribed hundreds of gallons of it in its various combinations, and I declare to you that it always disappointed me, and I declare to you that it has always
disappointed you. This will not seem so bold after I shall have explained. I mean that I almost never got results with it, which-in the light of past experienceɛI could not have gotten more quickly and pleasantly without other than hygienic means. "Almost never," in the foregoing sentence, covers those rarely exceptional cases in which the associated elements of the iron preparation evidently did such good as was medicinally done. Let it not be objected that there are possible salts of iron in which ferruginous identity is lost. This might, in an ultratechnical sense, be true; but that does not help the matter any, for the digestive juices always break up the combination, and iron produces its characteristic ill-effects. Whatever preparation of iron may be given, it always discolors the feces.
My uniform failure to get any results from iron that were positive, except in an adverse sense, set me to thinking. I had been giving it for years in that conformatory spirit which, to a great extent, controls us all with reference to classical drug preparations. drug preparations. I used to inform my patients that it had to do them good, for it had the endorsement of all the doctors that had lived and that were now living. It would "enrich the blood, and the blood is the life,' don't you know?" etc. There can be no doubt that these assurancesfestooned, as they were, with suave effusiveness-took some of the pucker out of the iron. But with all the moral buttressing I could furnish, the iron would not be assimilated. It had no better reason for this obstinacy than that it could not be assimilated.
Thru all those twenty-five years, the theory that a class of medicines are assimilated seemed reasonable enuf. It had never struck me that this made the establishment of a line of demarkation between food and medicine impossible. The inconsistency of at once construing a food to be a drug, and a drug to be a food, had not yet addrest itself to my understanding. Even in less degree had the tap-root of this absurdity manifested itself to me that psychic kink which postulates that a quality of fact may simultaneously be, and not be! It required some thinking to get to this point. But once attained, it became plain that drugs and food are antithetically related, and that this relationship is essential and fundamental.
Many have jumpt to the conclusion that food and medicine merge, because edibles
contain, as they assert, such drugs as iron, phosphorus, lime, hydrocyanic acid, etc. They are simply mistaken, for no food contains any of these, nor are any of them liberated in the system by the process of digestion, metabolism, etc. They exist in the food only in the sense that they may be chemically-not vitochemically-derived from it. Vegetable or animal phosphate of lime is not identical with the chemically prepared article, and upon the difference depends the assimilability of the one, and the nonassimilability of the other. In the face of this fact, nearly all doctors give such things as lime, iron, etc., under the hypothesis that they will add themselves to the tissue which so evidently needs them. The well-nigh universal assumption is, that there is no breach in the continuity of food and drugs. Tacit medical philosophy has it that food and drugs are mutual and reciprocal. It would be interesting to all, if actual believers in this fallacy would attempt to show the food-relationship of, say, aconite and belladonna, to the system. And yet these are, logically and practically, as nearly foods as are the various pharmacal preparations of iron, lime, soda, phosphorus, etc. They are all nonassimilable, and are therefore drugs, and not foods in any possible sense.
In this connection it is proper to call at 'tention to a dietetic fallacy which controls very many medical men. It is this that if we habitually eat a food which is rich in a particular substance, the quantity of that substance will be increast in the system. Thus, how common it is for the doctor, who has a patient suffering from phosphoric exhaustion, to advise him to eat plenty of fish, crabs, etc. And how equally common it is for this same doctor not to note that the patient's other habits remaining unchanged-this fish diet has not increast his supply of phosphorus. If there were anything in it, fishermen and fishmongers would be the brainiest people on earth; but are they? It is a great piece of foolishness to send people away off to chalybeate or sulfur springs, expecting these waters to increase these elements in their systems. If their financial conditions are such that the expense won't worry them, then the outing and the conviction that they are going to be cured may help them considerably-for a short time. Again, it is as cruel as it is useless to restrict a diabetic's diet beyond a limitation to digestible food. Carbohydrates may inrease the quantity of sugar in the urine.
but is this going to hurt the urine? It is not the fact that the liver is making too much sugar which constitutes the disease, nor the fact that it wastes what it makes, but it is the cause of either, or both of these, as the case may be. When sugar appears in the urine of a person it is not because there is too much starch in his food. If that were the cause, how easy it would be to cure him; the perspicacity of a street arab would be equal to such a medical problem as that. To eat less starch would be to remove the cause, when, of course, the effect would cease. To limit a patient to nitrogenous food, is to assume that carbohydrates cause diabetes mellitus. The system will absorb only a definit amount of any tissue element, no difference how much of it may be offered. You may feed great quantities of sugar to a diabetic, and beyond the harm it does his digestion, it will not injure him. It will not aggravate his diabetes. I have seen it tested and know whereof I speak, tho I should have known it under common sense pressure. without the test. Allow your diabetic patient a varied and generous menu, selecting with reference to digestibility, and give him infinitesimal doses of nitric acid, in connection with sensible doses of thuja, and you will be doing for him all that is possible up to date. It depends upon a wrong of some nerve center, possibly that which enervates the glandular system of the bowels; but up to the present no one can locate its primal lesion. If we could do so, we would be but little, if any, better off, for a knowledge of the intrasystemic cause of a disease carries with it not even a hint of what will remove that cause. This must be learned by drug experimentation alone. Diagnostic refinement is a little more than a learned accomplishment-but not much more-while a knowledge of symptomatology and drug-action is the heart and soul of the Healing Art. The regular school is losing ground by its over-attention to incidences, and under-attention to essentials. This is true, unless it is not true that, in disease, the right drug is promotive of cure.
A good portion of this paper has been devoted to the discussion of iron, because this may be taken as a type of the agents which are employed as tissue foods, so called. Whatever is true of iron in reference to tissue-feeding, is true of many other drugs which will be more briefly considered hereafter. As before stated. for twenty-five years I used iron very
freely, but for the last nine years I have used it in but three cases. I used it in these cases in deference to a brother physician's prejudices, and to demonstrate to him its inefficiency and harmfulness. More next month. W. C. COOPER, M. D. Cleves, O.
P. S.-I want to shake hands with Dr. Dumm and laughingly rebuke him for having accused himself of disagreeing with me, when the fact is, he is in perfect accord with me. He must have skimmed thru my article rather hurriedly. I cited those authorities merely to show that the results of hypermedication drive men into. medical scepticism. These were highly intelligent and thoughtful men, who saw that drugging, as practised within their sphere of observation, did vastly more harm than good. They saw that the prevailing method was wrong, and they accepted it as a fact that no other method was, or could be right. They had not tested the methods of protestant schools, and they were not familiar with the clinical results of successful individuals in their own school who, like Dr. Dumm, dared to be independent and rational in their modes of treatment. Dr. Dumm will agree that light medication is better as long as it will do at all. We want to be very sure of our ground before we "pour in our shots hot and heavy." Outside of six or eight diseases, including particularly malaria and syphilis, I know of no ailment in which heroic treatment would be justifiable.
I wish all physicians were like Dr. Dumm. If they were, hypermedication, and the other extreme, and tissue-feeding fallacies, and many other errors and abuses would drop back into oblivion, where they belong.
W. C. C.
Editor MEDICAL WORLD:-In spite of his infidelity, Rousseau followed closely the line of Biblical thought in representing man as fallen from a state of pristine innocence and contaminated by civilization. Following him a whole century of writers like Chateaubriand, Marmontel and St. Pierre furnisht the world its stock of thought, in glowing pictures of unsophisticated and most enticing barbarism. To this day we find constant references to this idea, altho the belief underlying it is no longer universal.
Man is better for civilization.
age is not amiable, or otherwise superior or attractive. He is dirty, squalid, in constant danger, and consequently cruel and selfish. The social conditions described by Marmontel never existed on this earth. No tribe of men ever lined up each evening while the women walked by and each chose her mate for the night, without dispute on either side. virtues are matters for derision on the part Savage beauty and savage of all who come into actual intimacy with the savage.
Nevertheless, there is truth in the idea, better exprest by the Antaeus myth, of a certain rejuvenation obtained by a return to primitive ways. Antaeus renewed his strength whenever he toucht his mother
Earth. The Hebrew was directed to return to the tent of his nomad forbears every seventh year and leave the earth untilled. And every man who, like Mitchell, has studied deeply the problems presented by human biology of modern times, has advocated a return to primitive ways as a remedy for the ills of overwork of the mind. The camp-cure is now establisht as the most effective known means of restoring the vitality exhausted by too long and too steady brain work.
Work is a pleasure to well men. It is a pleasure to him who is fit, to do work beyond the power of ordinary men. It is the delight of youth in the flower of his days. Exult, oh young man, in the strength of thy youth. Seek far and wide for tasks that will tax thy muscles. Burn the midnight oil, draw heavily on the deep fountain of youthful vitality, and take pride in achievements beyond the reach of ordinary men; but know that for all this thou shalt give account. The day will come when thou shalt say, I have no pleasure in success palls on you; the evil days "when them;'" when that fatal question arises, "What's the good of it all, anyway?" Then the drafts made on youth are presented for payment; the Sunday rests you have stolen from yourself must be replaced with interest and penalties; and in the end you are glad to find your success up to the average.
The man who lived longest didn't accomplish much else. Every one knows that Cornaro lived a century, but what else did he do? Barring the value of his example, history does not tell us of a single work accomplisht by that century.
A certain selfishness is every man's first duty; to develop his own powers, regulate his own life so as to get the greatest possi
Let him see what men do in the great hives; show him workshops, department stores, theatres, libraries; and let him hear some of the great preachers who are well worth a trip to the city.
I have said all this before. But it seems to me that each year, since failing health taught me the lesson, and since curtailment of work, with rest when needed, has restored my strength, I feel the duty of preaching this doctrin to my fellow-men. A bright Methodist whom I sometimes go to hear said the other Sunday that man had really only two duties; to get converted and to go out to preach. I carried on the high-pressure system for eighteen years, working about 18 hours a day, keeping it up from waking until deep in the night when my eyes would no longer stay open, when I dragged myself to bed, scarcely able to climb the stairs. Then I collapst; made a great resolve, cut loose, came to this wonderful city whose air has the stimulant properties of champagne, and settled down to rest. When I found that four colleges and eight lectures a week were ceasing to be restful, I cut each down to two. When being wakened in the middle of the night, to go out and tell a young mother nothing ailed her baby, made me cross, I quit it. When a lazy spell overtakes me I just laze. I have gotten a wheel and am fast learning its peculiarities. My forthcoming paper on the application of arnica, hamamelis and other remedies for local injuries will bear on it
the imprint of vast personal experience. My boy and I hold daily consultations over our fishing tackle. A man can shirk heaps of work when he really puts his mind to it; and a return to a wholesome way of living makes what he does of so much better quality that neither he nor the public is the worse.
There is a good deal in Dr. High's suggestions (page 230) in regard to the necessity of keeping phthisical patients quiet during the febril period. The less the exercise the less fever and consequent waste. Moreover, fatigue seems to lessen the resistance of the tissues (or the leucocytes?) and a markt increase in the tubercular invasion is apt to follow overexertion. Patients do better if compelled to remain in bed, even if nothing else in the way of treatment is done. The minute care of a really capable and faithful nurse is of inestimable advantage to any one of those patients who require this nursing. But, in how many cases this is after all only the prolonging of the life of a body that has received already its death blow. Truly has it been said that what we call consumption is often merely the molecular death of a body whose stock of vitality has been exhausted. We see the flickering spark of life nurst carefully, fanned into a feeble flame, carried along with the utmost care thru childhood and youth, and, as early manhood is reacht, the vital force is exhausted. While the patient falls into consumption, it is evident that death would have commenced elsewhere were it not that the lungs presented the feeblest resistance to the tendency to decay. The bacillus is but an accident here. Had he not happened in, death would have come anyhow.
But there is another class of consumptives, those to whom the disease has come as would have happened a broken bone. An unusually large or virulent colony of bacilli have been inhaled at a time when the body was unusually deprest, and a lodgment has been effected in the lungs. But this is no surrender. The patient is fighting for his life with all the energy of his nature. He may succeed by the "coddling process, tho the chances are against it. But, suppose instead of this he resolutely refuses to consider himself ill, and, fever or no fever, persistently goes out in the open, climbs mountains, sleeps in tents and lives the rugged life of a nomad.
It is "kill or cure."
the deadly foe; the strength revives, the appetite and digestion respond to the demands, the fever and cough subside, the pulmonary lesion cicatrizes, the tubercles calcify or remain encapsulated, a beleaguered garrison in a victorious land, perhaps in time to fall, perhaps to scatter the besiegers in some murderous sortie. These are the noblest of cures, for these are the men who face death unflinchingly, yet who will only be content to die fighting.
But for one who wins thru, the hills are dotted with the graves of hundreds who have succumbed. It is a method that promises success only to the few exceptional individuals-death to the many. And, yet, die we may and die we must." If it were you, dear doctor, wouldn't you rather make one grand fight for your life than be coddled thru a few weary years of invalidism?
The next article, that of Dr. Ritter, (page 230) gives another phase of the same subject. How can you deduce rules for the civilized woman from the customs of savages? The Indian woman whose system is inured to hardships, exposure, and hunger and labor, may not need repose after child-bearing. But how can anyone expect this from our delicately nurtured Caucasians? As well ask the portly alderman to go into the circus ring and compete with the trained athletes. Dr. Ritter's conclusions are in harmony with my
Dr. Souder, also (page 235), refers to the variability of resistance in the tissues of various individuals, in the production of hernias and in methods for their cure. One cannot hope for much success in our profession until he learns to individualize.
Dr. Adolphus' steel sounds are all right, as far as they go, in treating gleet. They open the door, let light into the dark corners in which the festive gonococcus has been lurking; but what then? Does he come out? Not much. The reflex nervous phenomena due to the stricture may cease, but the gonorrhea remains. And, while zinc chlorid is sometimes of value, in more cases it fails. No urethral injection will go as far in curing gleet as the mixture of europhen in fluid petrolatum, one part to eight; but if you wish to render the body uninhabitable by the gonococcus you must saturate the body with the sul fids. Give seven grains of calcium sulfid daily till the breath has a stercoraceous odor, and the task is completed.
Dr. Mask (page 242) asks for treatment
for hemicrania. The causes modify the treatment. Many cases are due to uricemia, and the remedy is the adoption of the vegetarian regime. Others are attributable to degeneration at the nerve roots, the socalled inveterate neuralgias, and yield to vigorous treatment with zinc phosphid, strychnin arseniate and quinin. For the paroxysm, a scruple of chloral just after taking a hot foot bath, the patient covered up warmly in bed, has often given great relief. But, latterly, I have found that the dosimetric granules of glonoin, aconitin, strychnin and hyoscyamin, each, every fifteen minutes, till the skin begins to redden, answer very well. As the cutaneous vaso-motor spasm relaxes, the blood leaves the congested centers and the pain subsides. But this does not strike the cause, and a man who has suffered from this malady so long ought to know to what they are attributable.
To Dr. Warner, (page 243): A correspondent writes me that he has succeeded in relieving infantile constipation by dissolving lobelin granules in water and administering one-tenth to one-half a granule three times a day. The granules had to be dissolved. This is a good remedy if the stools are too dry.
WILLIAM F. WAUGH, M. D. Ravenswood, Chicago, Ill.
Calcium Sulfid for Phthisis. Editor MEDICAL WORLD:-Two years ago you askt for experience and notes on the treatment of phthisis pulmonalis with calcium sulfid. I send notes of three cases:
Case I: Mrs. T., age 26, white, twopara, youngest child 6 months old. Was called in consultation October 27, 1896. Found her very much emaciated. Temp. 102° F.; hectic flush; eyes brilliant and glassy; weight 91 lbs. Without further description, will say this was a typical case. Made no microscopic examination of sputa. Auscultation revealed the tinkling, cavernous sound at apex of left lung; diarrhea; very scanty urine. I put the patient on calcium sulfid, 1 grain, three times a day, together with iron tonics, and after bowels became costive, prescribed pill lapactic, S. & D. The lady began to recover almost from the first, and to-day weighs 140 lbs., and looks the picture of health.
Case II: Mrs. G., aet 29, white, married 8 years, six-para. Was called to see her on July 7, 1897. Found her with severe