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Dietetic and Hygienic Gazette;
A Monthly Journal of Physiological Medicine.
able reaction in favor of tuberculin whose study seems really just to have been initated.
Creosote has long enjoyed a therapeutic éclat, obtained chiefly from Sommerbrodt's enormous and favorable stastistics. Now comes a related product, Editor Dept. Hygiene. guajacol, to share if not to usurp its older rival's position.
J. CLARK SLAY, M.D., Manager.
NEW YORK, JUNE, 1892.
Contributions upon subjects legitimately coming within the scope of THE GAZETTE will be always welcome, and if found to contain useful ideas or practical information, will be accepted for publication. Articles of exceptional value or embodying original research are especially desired, and if found suitable for the pages of THE GAZETTE, ample remuneration will be made to the authors.
All remittances, business communications, books for review, matters relating to the editorial department and to advertising should be addressed THE GAZETTE PUBLISHING Co., 1218 Broadway, New York.
Entered at the post-office, New York City, as second-class mail matter.
A NEW REMEDY FOR PHTHISIS. This arch enemy of the human race, before whom the medical profession has stood for many centuries in awe, has in recent years been the object of many bold and daring attacks.
Weapons, great and small, medicinal and otherwise have been summoned to batter down the stronghold of this scourge.
Although the most promising and widely heralded tuberculin of Koch has proved disappointing, it still has many adherents. One of these (Deutsche Med. Zeitung, March 24), Dr. E. Thorner, says that no other method of treatment of bacillary phthisis, not even the climatic and creosote method, may show such good results as Koch's. Some of the cases treated first by tuberculin improve later under creosote. And another writer, Dr. Aufrecht, says, in the Deutsches Archiv fuer Klin. Med. 49, that he has obtained by the selection of proper cases and the employment of the smallest dose at intervals of forty-eight hours and not exceeding 5 grammes brilliant results, frequently complete cures. His statistics present 112 cases. 48 cured, 37 greatly improved, 22 improved, and five discharged uncured. He regards tuberculin as affording immunity to those portions of the lung in whose vicinity tuberculous processes are developed, preventing diffusion of the latter, hence Koch's remedy is not a direct curative agent, but an unfailing auxiliary in lung and intestinal tuberculosis.
Judging, therefore, from these and similar reports in the foreign medical press, we may expect a favor
In the annotations we have made a liberal extract from Dr. Max Schueller's address before the German Medical Society of this city. The view of this trustworthy observer is confirmed by other recent authors. Seifert and Holscher (Berl. Kl. Mocheusch, 91) write favorably of a chemically pure guajacol, in the shape of a carbonate. This preparation has no odor or taste, is insoluble in water, of neutral reaction and unirritating to healthy mucous membranes. The authors used this preparation in the Muehlheim Hospital in 60 cases of phthisis, beginning with morning and evening doses, 3 to 5 grains, until 90 grains per day were slowly reached. Patients who had rejected creosote seemed to bear guajacol well. The appetite was improved, weight increased, cough improve, expectoration is loosened and becomes more abundant, fever and night sweats slowly subside and disappear, the physical signs improve, and the number of tubercles is diminished. The author's rationale of the action of guajacol is interesting. They claim that it does not circulate free in the blood, but that a new, not yet understood, combination occurs which does not possess the caustic and poisonous properties of free guajacol, and is without any effect upon the tubercle bacilli. They claim that it combines with the blood albumins by means of the sulphur contained in the molecules of the latter. The blood of the phthisis patient contains besides its normal albumins others produced by the pathological process, viz., by the products of the bacilli. The latter are very labile combinations which readily produce chemical processes and these become toxic, so long as these circulate in the blood guajacol prefers to combine with them, and this combination is not poisonous and after it is split up by oxidation, its products are eliminated by the urine. Thus the blood is permanently freed from the toxic products of the bacilli, when a sufficient quantity of guajacol is constantly supplied to it. The combination is specially fitted for the continued use of guajacol.
Another recent contribution to the British Medical Journal (Nov. 14, '91) by Dr. R. Robertson praises a combination of guajacol and iodoform, dissolved in olive oil and injected subcutaneously in Pulmonary Phthisis and Empyema. It would seem therefore from recent developments that guajacol is a promising remedy, whose harmlessness to the stomach is not the least of its good qualities. It behooves us to utilize medicinal agents in connection with the valuable
natural remedies to which we have devoted much attention in these pages. In a disease whose ravages are so extensive and which baffles our best directed efforts, the latter must continue unabated until we have mastered it.
THE READING NOTICE.
If a diligent reader of medical journals, during a period of thirty years, may be entitled to express an opinion upon this subject we would say that there exists no greater error in the mind of advertisers than the idea that a notice of their wares, presented in the reading or editorial columns of a journal, will bring them better returns than an advertisement in the columns devoted to this department. Our own experience, corroborated by conversations with many physicians, warrants us in saying that the latter almost invariably avoid reading such notices, and if they find themselves led into reading them by some seductive introduction, the feeling of disgust usually experienced by a man who discovers himself duped, overcomes any desire he may have of becoming farther acquainted with the author of the deception.
When a busy physician settles himself down to the perusal of his medical journal, his object is defeated if he finds interesting medical matter interspersed with uninteresting commercial matter. On the other hand every physician who has the welfare of his patients and his own financial and professional success at heart, feels interested in the advertising columns of his journal and glances over them at such times when his mind is not bent upon matters scientific before he begins to read his journal. The impression left by such leisurely reading of the announcement of a new infant food or cod liver oil preparation; of a carriage or harness manufacturer; of some new medical book or electric battery, mineral water, medical college or sanitarium, will surely be far more enduring than that produced by a reading notice in the regular columns of the journal, which has been hastily glanced at with the resentful feeling that it has usurped the more legitimate reading matter. In his address before the Wisconsin Editorial Association at Milwaukee, the publisher's side of this question was ably discussed by that veteran publisher, Mr. Chas. A. Dana, of the New York Sun. He told his hearers: "Never print a paid advertisement as news matter. Let every advertisement appear as an advertisement -no sailing under false colors." The importance and value of this warning is further evidenced by the fact that the New York Herald prints it almost daily at the head of its editorial columns. These facts are cited to prove that even respectable newspaper publishers disdain the so-called reading notice.
Why, then, should this practice continue among
medical journals which are supposed to appeal to a class of readers who are much less commercially inclined, and who would be far more readily offended by interruption in their reading of serious professional subjects demanding their attention than the ordinary newspaper reader whose mind is taking a panoramic view of the daily doings of the whole world. The fact that some of the foremost medical journals of the country do not admit reading notices into their columns is sufficient proof of the correctness of our view.
We feel at liberty to refer to the subject since we are personally not under any obligations requiring this protest. Upon assuming editorial charge of the GAZETTE We stipulated with the publisher that nothing of a commercial nature should be admitted into its editorial and literary columns, and that even the advertisements were to be subject to removal if objectionable to the editor. That this agreement has been faithfully fulfilled our columns will testify. The profitable advertisement of a certain skin doctor, which had gotten into the GAZETTE of May, 1891, through an advertising agent, was removed at once when its objectionable character was pointed out to the manager. It shall continue to be our aim to keep our literary and editorial columns clean and devoted purely to the scientific and literary interests of the profession.
To aid our confréres of the press, many of whom share our views, we would appeal to advertisers to consider the fact that their financial interests would be best subserved by avoiding the reading notice, which does not make as good an impression upon the reader as we have pointed out above. Let them insist, moreover, that the publishers place their announcements before the medical public in a pleasing form, and that an index of advertisers be furnished in each issue to facilitate the search after information, which the physician may need in haste.
We speak from the disinterested standpoint of a diligent reader of medical journals, and express the view of one who has been active in town, country and city practice, hospital and private, and whose view is shared by thousands of other practitioners.
opinion that I regard any case in which the temperature cannot be controlled as being entirely beyond the pale of relief.
Above all the antipyretics in our materia medica in the treatment of phthisical fever I would place rest. This is the remedy beside which all the others dwindle into insignificance. So important do I regard rest that I make it an invariable rule with my patients that they must allow me to control their bodily movements. Nearly all comsumptives improve while they are kept quiet, and become worse when they are permitted to have their own way in regard to this matter. It is astonishing to see how easily the temperature of phthisical patients is influenced by slight exertion. On receiving a patient the diurnal variation of his temperature is tested and if it exceeds one hundred he is placed in the recumbent position and kept there until it is brought under control.
Objections are often and freely raised against such a procedure because it is not in conformity with the prevailing doctrines which teach that patients of this kind should take an abundance of exercise in the fresh air out-of-doors. Confinement to bed, however, gives him neither, and hence it is a hard precept for him to accept. But a direct appeal to the reasoning faculty will convince most of these patients that exercise and fresh air are, after all, not so necessary
secure restoration. You can assure them on physiological grounds that by exercising, they elevate and aggravate the fever, and defeat the very end and purpose which the physician has in view. Prac
tical results will in a short time assist in confirming the correctness of your course. Instead of losing their appetite, which they feared in consequence of a lack of exercise, they will improve in eating. This can likewise be readily explained. Muscular exercise implies the expenditure of energy, which is of course subtracted from the whole sum of energy of the body; or in other words, that which is spent in the perform
ance of muscular work is taken from that which maintains the process of digestion, absorption, circulation, etc. By stopping one form of expenditure there is more energy remaining to carry on the other functions. The stomach, the heart and all other organs, are enabled to perform their functions more vigorously, the whole economy is placed in a more normal and satisfactory condition, and the patients eat more and digest better in consequence of this.— Dr. P. J. Mays in Practitioner's Monthly.
Nourishment in Acute Disease.—In acute disease, accompanied by fever, what are the conditions?
The body loses weight, the urea is increased and carbonic acid and water are excreted in larger amount than in health,
All of this loss is not dangerous if allowed to go for a few days only, and if the amount does not exceed certain limits.
But to replace these losses we are at a disadvantage as regards the ability of the system to assimilate food.
In fevers, the appetite is small, or may be completely lost.
The saliva, the gastric juice, the pancreatic fluid, the bile, are less efficient in action, or are diminished in amount during high temperature.
The stomach is very sensitive, in part perhaps through sympathy with increased sensitiveness of the nervous system as a whole.
If there is much hyperæsthesia of the digestive tract, as in typhoid, in peritonitis, in dysentry or gastro-enteritis, one must be careful not to give too much food and it must be given in liquid form.
It is not, however, the administration of food, but the administration of unsuitable food that we have to fear, and also the giving of nourishment in quantities adapted to the digestive powers of the patient.
We should not give the patient what he cannot assimilate. The attendant must have a digest, nor should we give him less than he can watch over the condition of the patient's powers of digestion, and carefully adapt his food to his capabilities, especially during convalesence. Our attention should be devoted not only to what is put into the
alimentary canal, but also to what goes out.
For example, if curds of milk are found in the stools of a typhoid case, the quantity of milk should be diminished or it should be diluted.
Large quantities of milk are often given to typhoid fever patients to their great detriment, and excess of zeal in feeding and too little care in the preparation of food cause much of the intestinal trouble that the sick will agree that many patients are starved in complicates these cases. Every careful observer of the midst of plenty, simply from the want of attention to the ways which alone make it possible for them to take food.
For example, if the patient has a fever with remissions or intermissions, it is of first importance to remember that the ability to digest food at these times is greater, and the more nourishing portions of the diet should be given during the remissions and intermissions.
As far as practicable the mouth should be kept clean by being rinsed with water after taking food, and carefully cleansed with an antiseptic solution from time to time. In a word, for extreme cases the important thing is liquid food.
We should give sugars (starches have no taste but are less readily absorbed),
Fats are not tolerated. We should give albuminoids, in beef juice, in peptonized milk.
Ordinary milk becomes solid in the stomach.
The physician should never lose sight of a patient's likes and dislikes, but should know how to choose such a variety of diet as to include what is palatable and what at the same time contains a proper amount of nourishment.-Dr. Williams, in Boston Medical and Surgical Journal.
Diet for Nervous People.-An exaggerated alimentation excites the plexus and the brain, and produces a nervous state. The following example is a proof of this statement: A young girl cf nine years presented herself with her mother at my consulting room. She had been sickly for many months. The skin was yellow, and she suffered continually with pain in the head, was sad, weeping much of the time, and unable to work. The skin and muscles of the entire body were very sensitive to the touch. She suffered continually from nausea and constant eructations of gas during the entire day.
I questioned her mother respecting the treatment which she had been following for some months, and I learned that her physician had administered iron, quinine, and flesh food three times a day. This regimen produced in the child excitability of the solar plexus, and consequent excitement of the brain. I completely changed the medication and the food. The food which produced irritation of the plexus and caused the disease was replaced by the following: A quart of milk each day, with a couple of eggs, and simple soups. I allowed flesh food only twice a week, and then only fowl, avoiding such stimulating meats as beef or veal. After two months and a half of this regimen the young invalid was again brought to my office. She was so transformed as to be unrecognizable. In place of her pale countenance she had rosy cheeks, and had recovered freshness and vigor. The headaches, tenderness of skin and muscles, nausea, and gas had disappeared. Her appetite had returned, and the little girl was so satisfied with the regimen that she requested it should be continued. I might cite a great number of facts of the same sort. I have cured a large number of invalids by similar regimen.
The physician who prescribed for the child the improper regimen to which I have referred, had evidently an incorrect idea of her disease. Observing a great number of nervous symptoms and a pale countenance, he concluded that the condition was one of impoverished blood, and prescribed iron, quinine, and meat three times a day. Poverty of the blood is in vogue in our day, as were inflammations in the beginning of this century. For sixty years every
body believed himself threatened with congestion and inflammation. Everybody was bled. To-day another error has become popular. Every one believes his blood impoverished, and thinks himself obliged to take iron and quinine to fortify himself, according to the popular term. Impoverishment of the blood has certainly produced as many errors from a dietetic point of view as did the inflammation of Broussais. They stuff the child with raw flesh, with cooked flesh, and with pure blood. Everybody eats and drinks to excess, and in all classes of society people make themselves sick under the pretext of avoiding anæmia, or impoverished blood. The excess creates not only organic diseases of the stomach, liver, kidneys, and heart, but has a pernicious influence on the brain, thanks to the relation of the brain to the plexus.
Up to the present time we have had no knowledge upon the subject of dietetics; we have known only that man loses in twenty-four hours certain quantities of nitrogen and carbon, in consequence of which he is obliged, in order that he should not lose weight, to take each day a mixture of these elements. quantity of food which we really need to repair the losses of the body is very small; for example, two pounds of bread, or two quarts of milk, associated with two or three eggs, is sufficient to nourish an adult. I have observed in a great number of invalids that the last named regimen is sufficient even to increase the weight. I am now treating a woman who, within a few months, has gained thirty-six pounds. Her food consists of one quart and one-half of milk each day, five or six eggs, and a biscuit. The quantity of food which we need to take, then, is quite small. The quantity usually taken by both rich and poor is much greater than necessary. greater part is useless, must be elminated, and is only a burden to the body.
Chemistry teaches us what the body loses each day in nitrogen and carbon, and how much food is necessary to repair the loss, but it says nothing about the nature of the foods which should be supplied the body to preserve health. Is the nature of our food a matter of indifference to the body? Can man nourish himself according to his tastes, his caprices, his fancies? Can he, as he finds convenient, adopt a flesh diet or a vegetarian regimen-eat of flesh or legumes? Can he replace the nitrogen and carbon which his body consumes, by milk exclusively? Many opinions without foundation have been expressed upon the question. Certainly there is a tendency to the abuse of flesh foods, for the double reason that they are easily procured, and that they are believed to be necessary, even indispensable, elements of a complete dietary. It is certain that lentils, beans, potatoes, bread and milk are able to