of various forms of impaired nutrition, and especially of tuberculosis. It has been thought, and seems to have been shown, that more improvement in heart strength and in the red blood count is caused by these raw beef preparations than is produced when the meat is cooked. Also, in cardiac weakness in serious illness, as in pneumonia and typhoid fever, the serum prepared by covering a pound of chopped round steak with cold water, allowing it to stand for two or three hours, and then expressing, with a meat squeezer, all of the juices from the beef, and administering this juice (which should be slightly salted and kept on ice) during the twenty-four hours, has been of advantage to patients. Whether this is one of the left-over fads to be abolished as the egg-albumen fad should now be abolished, on account of lack of nutritional efficiency, must be determined later. At the present time this muscle juice nutrition seems to be valuable.

The administration of raw beef for a long period of time to tuberculous patients has had its strong advocates, but is not now considered necessary, and has fallen into disuse, the same as hyper-alimentation in tuberculosis is now believed to have been a mistake.

There is always a possible danger in administering these uncooked meats and meat juices that they may be contaminated with tuberculosis or with tapeworm embryos, although with first-class round steak the danger from either of these infections is very slight.

It has lately been shown that one of the causes of shock after injury is the absorption of muscle extracts from the crushed tissues, and it has also been shown that injection of crushed tissue extracts is toxic and can cause shock. Probably when raw meat extracts are taken into the stomach no such undesirable action can occur; however, it suggests the importance of not depending entirely upon meat extracts and raw eggs to promote nutrition during illness, and that carbohydrates and fruit juices are needed.

PART V

PRACTICAL THERAPEUTIC MEASURES

INHALATION

The value of breathing exercises, without restricting clothing, in fresh, clean (dustless) air is not sufficiently recognized. Such exercises, taken for some minutes once or twice a day, promote health, and, when under medical supervision, are of benefit in asthma, in cardiac weakness, and in anemia. Breathing exercises are necessary to develop the lungs of children and youth especially when the expansion is poor and the thorax small. Whether the added benefit of sea air, mountain air (altitude), dry air, or balsam (pine woods) air is advisable is for decision by the patient's physician, but these climatic advantages should be utilized in proper cases.

The inhalation of ether, chloroform, or nitrous oxide gas for anesthesia need only be mentioned to show the profound impression made on the system by the character or content of the inhaled air or gas. Oxygen inhalations for the dyspnea of pneumonia and tuberculosis were much in vogue, but its value was over-estimated, and harm was sometimes done by such inhalations, especially in phthisis. Since the open air treatment of these diseases has been found to be essential, oxygen gas has been less used and less needed. It has been used, however, with advantage in great dyspnea, or apnea, whether the cause be pneumonia, tuberculosis, cardiac failure, sudden stoppage of respiration during anesthesia, carbon monoxide poisoning, or oxygen starvation from sewer, well and cellar gas poisoning. In the latter acute conditions artificial respiration or the use of a pulmotor may be of greater value, but, if an oxygen tank is at hand, the heart may be stimulated by inhalations of the gas in conjunction with the forced breathing. In sudden emergencies inhalation of oxygen may be almost curative, and in chronic dyspnea it may relieve the discomfort but it cannot

cure. The gas should be passed through warm water before it is inhaled from a tube passed into a nostril, so that it may be moistened and not be dry and irritate the mucous membranes. Its administration should be intermittent, each inhalation period lasting a few minutes.

Various medicaments may be inhaled either by vaporizing them in a room or in an improvised tent; or a drug may be administered more directly by impregnating a respirator apparatus with it. This method of treatment is used more especially in children who have laryngeal diphtheria or croup, and also for all forms of asthma. The air of a room may be filled with the vapor of cresols for whooping cough. These phenols thus inhaled are said to be germicidal, and it is possible that they may kill the germ of pertussis, which is one that is readily killed. All creosote or cresol inhaling treatments, whether for whooping cough or for laryngeal tuberculosis or for some other condition, may cause kidney irritation by the absorption of phenol. Many times the most benefit from such inhalations is due to the steam or moisture with which the room or the inhaled air is impregnated, especially if there is dryness of, or membrane in, the larynx.

In bronchitis, in acute nose and throat colds, in chronic catarrh of the nose and throat, in tuberculosis, in all forms of laryngitis, and in edema of the glottis, inhaling mixtures may be used. They are best administered by means of steam vaporizers or kettles. An emergency apparatus may be readily constructed as follows: A cornucopia is made from any stiff wrapping paper, the small end is clipped off and the large end is placed over a bowl of boiling water to which has been added the medicament to be inhaled. The cornucopia and bowl are wrapped with a towel, and then the small end of the cornucopia is placed in the mouth and the medicated vapor inhaled. To improvise a more continuous steam apparatus, a small pan containing water and the medicament may be placed over an alcohol lamp, and then proceed as above. The vapor from various drugs and preparations may be thus inhaled, but the most useful are the aromatic substances, such as the benzoins, pines, and turpentine. The tincture of benzoin is

especially beneficial, or it may be used as a base and other medicaments added to the solution.

The cornucopia for inhalation must be long enough so that the steam carrying the medicament is not received into the larynx too hot. Also, the preparation used must not be so strong as to irritate, therefore when turpentine, creosote, eucalyptol, menthol, or spirit of chloroform are thus given the dose must be small.

The tincture of benzoin may be used for inhalation every three or four hours, a teaspoonful in a steam atomizer or in boiling water, or a prescription may be written as:

S. Place a drop on a cube of sugar and dissolve in the mouth.

After any steam inhalation the patient should not.go out into the open air for a number of hours.

If more continuous inhalation is desired, various simple apparatus, made of fine wire mesh covering a cotton or absorbent pad for the medicament, may be obtained and fastened over the nose and mouth. These inhalers will probably prevent contagion. A gauze mask may prevent an individual infected with influenza or other germs from spraying the atmosphere and therefore spreading contagion. Whether these gauze masks will prevent the inhalation through this open filter of the minute germs of disease is another question.

Asthma has long been treated by inhalations with the object of administering medicaments that relax spasm of the bronchial tubes, by a sedative action on the peripheral nerves in the upper air passages or by allaying irritation and inflammation of the larynx, trachea, and upper bronchial tubes. Most of the papers, pastiles or powders that are burned and inhaled for asthma contain potassium nitrate (giving some nitrite action) and stramonium, more frequently than any other atropine carrying drug. The beneficial action from the stramonium is due to its atropine, and atropine dulls the peripheral nerves, while nitrites relax spasm. Cocaine and morphine have been added to such inhalations, but such medication is rarely justifiable. If these drugs are given, the physician must understand that he is likely to cause the necessity for more such doses and perhaps cause the formation of a habit.