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ins reabsorbed from the bowels into the
Therapeutic Philosophy. blood, it does not follow that passing these
No. 7. substances thru the delicate renal struct. ures does them any good.
Editor MEDICAL WORLD:—This last of Have all of you found the exceeding my series of papers will be, in the main, eflicacy of quinin arsenate in malarial aildevoted to the treatment of certain disments? A gentlemen from Louisiana was eases. I will turn from the destructive to seized, shortly after his arrival in Chicago, the constructive. To many of those who with remittent fever, distinctly malarial. have thought it worth while to read my He took a scruple of blue mass and preceding papers, this will be a grateful one twenty gr. dose of quinin, followed by change, for most doctors--same as other small doses of a saline laxative, full dose's people-would rather be told what to do, of sulfocarbolates, and quinin arsenate, than what not to do. Now here comes the gr. every two hours. Five days cured rub; I could with a degree of certainty. him. Left him on the sulfocarbolates, a tell my brethren what not to do, but I canmorning saline, and iron arsenate. In the not tell them what to do–I can only tell district from which this patient came the
what I do. I am sure that whatever measfevers have assumed a grave type, many
ure of clinical success I have had has de cases being fatal and I have had inquiries pended very, very much more upon my as to whether it may not be a form of yel- abstention from doing wrong things, than
But it is purely malarial, only upon the certainty that I did the right that these people have taken so much things. quinin that they are “immune" against In number four of this series I exploited its effects as a remedy.
(briefly) my theory as to the modus operOn page 377 Dr. Harman asks whether andi of drugs. In saying “my theory belladonna should enter into the compo- I simply mean the theory which most sition of laxative mixtures. His objections strongly commends itself to my judgmeni. are well-founded, but they are based upon I suspect that for reasons dependent upon the action of this drug in full physiologic forgotten memories, there is not much that I doses. Brunton says that belladonna acts can claim as original about it. It will be by sedating the inhibitory nerves, divert. noted that the shock theory results directly ing the stimulus of the accompanying from the truth that drugs are necessarily cathartic to the accelerating intestinal heterogeneous to the animal organism. Any nerves. Wood credits very small doses treatment I may recommend will always with this power of paralyzing inhibition, be affirmatively related to these interdeand thus increasing the stimulant effect of pendent truths. I may remark, en passant, any agent quickening peristalsis, while that any favorable results from serum large doses paralyze the muscular fibers. therapy could-and as I believe wouldCushing, whose new work on therapeutics depend upon the verity of my theories; for is far in advance of most of the other what is more shocking (physically and American treatises, credits atropin with esthetically) than the injection of an preventing the griping caused by the animal poison into the blood ? cathartic ingredients. It will thus be seen To cure is to prevent. This a fundamental, that belladonna or atropin is a useful com- inflexible and eternal truth. This truth ponent of laxatives if given in very small constitutes the basis of the Healing Art. doses, but in large ones it antagonizes the If you perform a cure, you simply prerent cathartic action. Most of the laxative a farther progress of the disease, that is pills contain far too much belladonna, if all. Any damage which may have been the quality of the extract employed is inflicted by the disease, nature looks after. good, but so rarely is this the case that not you. To cure is to abolish the cause. they generally, tho ignorantly, meet the and this is to prevent further ravages of the desired indication.
malady. The clinical success of the phr. William F. WAUGHI, M. D.
sician who is not controlled by these basic
truths, will be inversely as the square of Ravenswood, Chicago.
his dosage. To direct treatment against mere effects is to violate the fundamental principles I have named. To treat thit
effect-a shortage of red globules; or th: I hope you will continue your Monthly Talks.
effect--softening of the bones, as in rickets: ing parts of them publisht iu one of our local papers.-JXO.
or the effect--neurasthenia ; or the effect
Dr. Wangh's book on Treatment and THE WORLD One year for $3.
I am hav.
M. SEASE, MD., Little un
n, S. C.
fever, is to waste precious time, and to list of causes very considerably. The treatdiminish the patient's chances of recovery. ment infallibly given by every medical The doctor who goes to the bottom of things writer in the world (excepting me) is iron. will never make the fearful mistake of try- Iron italicized; IRON small-capped; IRON ing to directly supply a lack in the system. with pot-bellied exclamation points to it; Nor will he give antipyretics, and he will chalybeate iron of the most ferruginous be extremely cautious in the use of anal. type : IRON, a billion times repeated, world gesics, and so-called palliatives, etc. All without end-Amen! Too strong ? No, of this is frightfully heterodox, I know, sir. It has been at once the idol and the but by all the deductions of science, by all crux of the ages—the latter because of its the analogies of nature, by all the con- stubbornness with reference to assimilaclusions of doubtless philosophy, and by tion. The gnawing puzzle in this relation each cosmic canon, it is right. Many a has been, how to convert an essentially reader of this will have to stultify his non-assimilable substance into an assimiwhole past, and vault a deep and wide lable one. They are working at it yet, chasm, to get onto the plane I have pict- tooth and toe-nail. Now, doctor, brush ured. How many will do it? Very, very away any orthodox cob.webs which may few, for I have not attained to that emi- have accumulated in the corners of your nence out of which flows authoritativeness. inmostness; do this for a bit, and read on.
ANEMIA: This term applies properly to You may settle into the conclusion I but one condition-a state approximating arrived at long ago, namely: that of all exsanguinity. It is a
consequence of “legitimate" literature, the past and hemorrhage. It is not a disease. The
It is not a disease. The present prevailing literature of anemia is thing to do is to supply the lack, in exactly the most anemic. the same
as that in which you You have a case of anemia which is would replenish a boiler needing water. It caused by excessive lactation. If you beis all mechanical, both in relation to the lieve that the way to destroy an effect is patient and his physician. The direct to remove its cause, and you happen to be remedy would be transfusion; the indirect independent enuf to give your common one, natural reparation.
sense free swing, what will you do? You If hematology were a completed science, will seek to replace excess with temperance. it would contribute largely to that pleasing To do this would be to remove the cause and showy accomplishment-minute diag of the anemia. The cause being abolisht, nosis. As it is, we can reel off the verb- the effect would cease. No one with a itudinosities of its nomenclature to the forehead half an inch high will dispute dazed wonderment of the innocent lay- this. But, dear Doctor, this will not do. man. What unlearned mortal, who is not Only a few writers will tell us to do anypachidermatous, could withstand a fusil- thing excepting to give iron, and they all lade of erythrocytes, megalocytes, micro- agree that whatever else we do, we must cytes, macrocytes, oligocythemia, poly- give iron. Iron then is the remedy for exgocythemia, normoblasts, megaloblasts, cessive suckling. It is the remedy for poikilocytosis, etc., etc. It is handy and protracted diarrhea. It is the remedy sometimes effective to grab altisonance by for chronic lencorrhea. It is the remedy the butt end and swinge it about the con- for typhoid, and many other fevers. It is sciousness of a knowledgeous and nosy the remedy for malaria. It is the remedy individual. But alas! a knowledge of for deficiency of food, or light, or lack of hematology does not help us even a small warmth, or foul air, or squalor, etc., etc. bit in the treatment of anemia. It is not It does not make a bit of difference what so little as prognostically valuable to the school of medicine a writer may belong to, careful and experienced physician. In his advice is to give iron in anemia, aluays. whatever disease, we must experiment The astounding feature about the whole with drugs, that is all.
1 usiness is, that all doctors of all schools The authorities give a great number of have always insisted upon causal treatcauses of anemia, thus: loss of blood, lac- ment, anal that in the face of this, they tation, protracted diarrhea, chronic leu- don't attempt to treat any thing but mere corrhea, typhoid, or some other form of symptoms. fever, malaria, deficiency of food, light, In treating any disease, I try to remove warmth or fresh air. This is the list that
the cause. I don't make an exception of Hartshorn gives in his “Essentials of anemia.
anemia. If the case is a mother reduced Medicine.” Other authorities extend the by excessive nursing, I have the excess abated, and I have her environment im- of its acid combinations, is a constituent proved as much as possible. This is act- of the blood. Some physiologists have ually all that the case calls for, but for doubtfully named it as an inconstant elemoral, if no other reasons, I give her ment of the blood, but such a statement such treatment as is supposed to improve contravenes natural consistency. It makes nutrition. If the anemia has resulted no difference whether it is such or not, it from protracted diarrhea, I address my is a medicine, for it is very pronouncedly attention to this. In such a case all doc- heterogeneous to the system. There will tors will do the same, but how many will yet
yet be evolved a straight manganie prodbe able to refrain from giving iron for the uct which will be the ideal remedy for a attending anemia ? And so I manage all large class of anemic cases. It is undercases of anemia whose causes are evident. stood, of course, that in these, as in all But in a great majority of cases the cause other similar cases, I exhaust hygienic apis not readable. Three-fourths of them pliances, including sea-bathing, change of will be girls from fourteen to twenty-five, air and scenery, etc., where the latter is and the largest factor in the etiology of possible. Where it is impossible to go to their cases is a specific form of malassim- the seashore, I have anemics, neurasilation. We all know this is true, because thenics, etc., bathe in a solution of seaanything which will improve their nutri- salt. It can be obtained at any drug store. tion will, to that extent, help their anemia. A necro-biotic condition necessarily repreA routine treatment is not adaptable to sents a more vitiated state of the assimi. anemia; it is not adaptable to any dis- lative function, and I cannot see that it ease. It is practist only by back-age doc- calls for any great variation of the treattors. In most cases of anemia nux vom- ment for plain anemia. There is a great ica is a prime remedy ; it is good in most opportunity for drug testing in all these atonic conditions. There is a class of cases morbid states depending upon elective in which strychnin does better than the faults in various classes of cells. If we nux. I have not differentiated them, but would give two-thirds of our time to the in cases calling for one of them, I try the study of drug action, and the other third nux first. If it is unsatisfactory, I sub- to the branches collateral to therapeutics, stitute the strychnia. If the patient is how much better physicians we would be highly nervous, I give ignatia instead of in a practical sense. The working fact of either of the others. If there exists a this stupendous fabric we call medicine, is cholemic tendency, I combine podophyllin the fundamental truth that the right drug with one or the other of the above-named is promotive of cure. It is a humiliating remedies. If there is anorexia, I substi. thing to acknowledge, but it is the truth, tute hydrastis for the podophyllin. If that the better the clinician, the poorer that is not satisfactory, I replace it with the general medical scholar. Medical calumba, or calisaya, or some other veg- learning should constitute a specialty, for etable drug of the bitter class. There are learned doctors have their uses; not, cases which call for some one of the min. however, at the bed-side. Closet students eral acids, each of which has a specific inand doctrinaires have a mission, but its dication. Hydrochloric acid is the most sphere is small and inconsequential, Actfrequently needed. Some cases require ually, what has Koch done for diseased cactus grandiflorus; some, pulsatilla ; humanity ? some echinocea, etc., etc. Some form of Owing to lack of space, I can only manganese is a most excellent remedy in glimpse at rachitis and neurasthenia. In many varieties of anemia. It seems to both conditions more depends upon hynudge the blood-maker as almost nothing giene than upon medicine, so far as we else does. Taking anemias as they run, now know. Gentle exercise-passive in it is, without doubt, more frequently indi: rickets,-plenty of fresh air and sunlight, cated than any other single remedy. It massage and skilfully-applied electricity, is good even when handicapt with pepsin nourishing and digestible food and wholeand iron. Pepsin is neither a medicine some moral surroundings, sea-salt baths, nor a food, and iron is merely an astrin- etc., these hold the major share of helpful gent, being strongly contraindicated in promise. I meet specific conditions with anemia, but manganese has the power to specific medicines, but it would require over-ride these and make itself curatively pages and pages to give details in regard evident in the condition miscalled anemia. to the drug treatment of these cases. Manganese, nor any salt of it, or product Twenty different drugs may be successively called into requisition in the treat- amount to put the gut on a stretch to the ment of either disease, but they are to be ileo-cecal valve. This will soon pass out selected, not under the tissue-feeding im- and drain the upper bowel of part of its pulsion, but with reference to their cata- contents. Keep the bowels open with lytic effects.
Epsom salts. The next thing that deThis completes my series of papers. mands your attention is the skin. Give Very few editors would have publisht the patient a hot bath, with sufficient them, because of their heterodoxy. It is soap in it to cleanse the skin of all oily rather an astonishing fact, however, that matter that may be deposited, checking since the first article a number of eminent perspiration. The outlet thru the skin is medical editors have insistently invited just as essential to relieve the blood of the
to contribute like articles to their toxic poison as opening the fountain in journals. It was kind, progressive, and the bowels. If free perspiration does not above all, brave, in Dr. Taylor to publish occur after the bath is taken, and antipythem. From my heart I thank him for retics are given (remember to watch the his noble courtesy, and I thank The effects of your antipyretic, let it be gelWORLD readers for the generous spirit in semium, veratrum, aconite or any of the which they have received them.
coal-tar preparations; they are all heartCleves, 0. W. C. COOPER, M.D. depressants, and your patient's heart is
[The Editor wishes to thank Dr. Cooper already in a weakened condition), and if for his original, interesting and instructive you fail to get a free perspiration, then series of articles. He thinks that herein try massage with a weak Faradic current, he expresses the sentiment of THE WORLD putting the positive pole to the sole of the readers in general. He also wishes to feet and using the negative in your left invite Dr. Cooper to the columns of The hand while you massage with the right. World whenever he feels inspired to commence at the neck and rub the entire address the readers of THE WORLD.] body, including the upper and lower ex
tremities. Let the sitting be forty or fifty Treatment of Autumnal Fevers,
minutes. Then if your patient does not Editor MEDICAL WORLD :-As the au- sweat freely in three hours, use the cold tumnal fevers have set in, it is possible pack. Here in the country I fix it in that some brother M.D. might be profited this way: I have water fresh from the and aided in saving a life by me jotting spring or well put in a wash-tub; I wet a down a few lines from my note-book of woolen blanket in this; I have the bed experience. I have treated quite a num- protected by old quilts, then spread the ber of cases of remittent fever in the last wet blanket on the bed, have the patient twenty-five years with success. I say stripped of all clothing and rolled up in success because I never had a case to die the wet blanket; then plenty of cover is on my hands that was of a remittent form. piled on. The shock to the skin carries The typhoid types I believe to be auto- them in imagination to the North pole ; toxic; that is to say, they are due to but as soon as reaction takes place, which absorption of the effete matter accumulated is within a half an hour, they think they in both the upper and lower bowels. In are transported to the infernal regions. the typhoid type there is imperfect elimi- They will sweat and steam like a boiler. nation. This class of cases require heroic Keep them in this sweating stage for at treatment from the beginning; clean them least an hour, then take them up, dry out and disinfect them before there is any them off well, and put to bed. Give a abrasion of the mucous membrane. This little whisky or brandy, and the sweathas always been my plan of treatment. ing will commence again. At this stage, First I take into consideration the age of give quinin, one grain, every two hours, the patient; second, the corpulency or with stimulants to keep the temperature leanness of the patient; and third, the from going below normal. More patients idiosyncrasy of the patient, if any. These die at this time than any other, and nineitems are for the purpose of regulating the tenths of them die between eleven o'clock dose. If the patient be robust, I give ten at night and seven o'clock in the morning. gr. calomel with two gr. of ipecac every There is less vitality at this time than at four hours until I get six or seven free any other; consequently four-fifths of the actions from the bowels. After I obtain deaths from all causes in disease are bethat number of operations I flush the colon tween eleven at night and seven in the with water at 112°, using a sufficient morning.
Let me recapitulate : Govern your dos- Blindness Due to Meningitis Spontaneously age by the age and condition of your
Recovering. patient; govern your local applications by Editor MEDICAL WORLD :—This case I the strength and condition of your patient; wish to report, as it has been one of intertreat all indications as they arise, and est. Boy, B., 8 years old; white. Was watch the physiological effect of everything called to see him April 1st. Temperature
There are no two patients alike 102°; accelerated pulse, headache, and all in disease, temperament or habit, and symptoms common to acute meningitis. there is no routine treatment to be fol- I diagnosed the case meningitis, and the lowed.
E. T. LEWIS, M.D. treatment used was cold and hot applicaWoolworth, Tenn.
tion to head and spinal column. In about the third week of his sickness he became
blind. After about two months' severe Reply to Dr. G. D. Quinn.
sickness he began to improve and I dis. Editor MEDICAL WORLD :-Dr. Quinn's charged him perfectly blind. About July case of fever, described on page 372, Sep- 15th his sight began to return, and at tember World, is interesting from the fact present writing, August 28th, bis sight is that there is a question about the diag. very good and continues to improve. He nosis, also a doubt about the cause of
is getting so he can stand alone, but can't death.
walk; is improving all the time. Just beWith our Editor, I believe the case was
fore he was taken, another one of the same one of typhoid fever, but in the absence of family was taken, a boy older than this more markt symptoms, cannot think death
He died in three days with menin. was caused from intestinal hemorrhage. gitis.
S. M. DORRIS, I think that in the plethoric condition of Bandana, Ky. the patient, the large dose of podophyllin, and the menstrual epoch, will be found
Heart on the Right Side. the clue to the fatal issue.
Editor MEDICAL WORLD :- A few days At the menstrual period all the blood
ago I was present and assisted in conduct. vessels of the abdominal viscera are en
ing a post-mortem, held by request on one gorged, preparatory to the natural func
of my brother doctor's patients. This tion of the uterus and its appendages. man had been in delicate health for some Now then, create the abnormal and vio.
nine years. Illness dated from an attack lent peristaltic action of the intestines of grip. His health previous to this was that will occur from such drastic cathar- not of the best. He was a sufferer with tics as podophyllin, and what is the re- and died of that dreaded disease, consult? Naturally, the engorged vessels sumption. The interesting and striking will empty themselves, and cause conges- feature in the case was that his heart lay tion in some more or less remote part of
on the right side. The post-mortem the system. In my opinion, this congest- showed the right lung to be wholly gone. ive condition occurred in the brain, and
so far as lung tissue was concerned. the patient died from acute congestion of There was, however, the roots of the the brain. Nature attempted to rid the bronchi, showing that a lung had once er. system of the “ flood tide?' by one of her isted. The heart was found wholly on the emunctories—hence the relaxt skin. Dr. right side, lying at least half an inch to Quinn speaks of the profuse sweat, but it
the right of median line.
The apes was not sufficient to eliminate the burden, pointed directly downward, resting near and the brain, with its vessels already en- the diaphragm. The heart was in a feebled by the congestion incident to all healthy condition. The pericardium was febril conditions, was literally swampt attacht to the anterior portion of the under the influx of vitiated blood.
chest. The attachment was a perfectly Such cases as Dr. Quinn's should make
normal one, no indications of any exudate us all think, and think hard. Some of us
ever having been present, as the memwill get the next similar case, and the los- brane was not thickened, but perfectly ing of these cases, whether due to any smooth and firmly attacht. On the left farılt of our own or not, does not tend
side the lung seemed at one time to towards medical reputation, either indi- have filled the whole chest cavity, the vidual or general,
pleura being attacht where the pericardium B. A. SOUDERS, M.S., M.D. normally should have been. It is my beWinchester, 0.
lief that the heart was always on the