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How is Tuberculosis Acquired?-It is clear that a certain amount of direct inoculation occurs.
Evidence is not in favor of flesh, after passing
inspection, being a factor of any import.'
Milk is clearly a source of danger, though, judging from the data at large, not a considerable one.
Indirect infection is probably the chief mode of infection, the bacilli entering through the lungs, the skin and the alimentary tract, with but few exceptions.
The application of these conclusions is very clear : the inspection of food'should be kept up as at present. People keeping private cows should be taught to be cautious of those which cough, and milkers' herds should be watched. To offset indirect infection, the
State should see to it that the rooms occupied by phthisical patients are properly cleansed. At the time of the millennium people may always cough on handkerchiefs, keep their hands free from sputa and always spit into improved cups, rather than on the floor; but at present they will not. The wealthy, who have more or less followed these rules for a long time, are relatively exempt from tuberculosis.
The one sure and ready way to kill a tubercle bacillus is to cook it hard for at least fifteen minutes; antiseptics are not safe in the people's hands. All infected clothing should be boiled before handling, not tucked away in a bag, then shaken out, counted and washed. Everything coughed up should be put into special cups, and thoroughly steamed before emptying and washing. Patients should not cough all over the room, but hold a handkerchief before the mouth. All rooms liable to infection should be carefully cleaned, especially the floors, furniture, and first six feet of the walls. For this we must rely on washing, out-door beating and dusting, and antiseptic solutions. The best antiseptic is carbolic acid, the stronger the better (never less than one per cent.), applied long enough to soak in thoroughly.
At some future time people may wake up to the conditions of the case, and demand wall and floors both smooth and washable, and the banishment of the dust-traps called modern furniture, provided they do not demand a certain degree of isolation, of the phthisical and the systemtic destruction of all tuberculous cattle.-J. A. Jeffries in the Sanitarian.
Feeding in Youth.-The rather general statement, that all our diseases, acute and chronic, can be traced to habits of improper feeding, originating during childhood or adolescence, is at the present time commanding recognition from the best chemical physiologists and pathologists.
The conclusions which may be drawn from the brief consideration of some of the chemico physiological laws governing the vital activity of our bodies are as follows:
That the period of youth is the most important one; That the different organs accustom themselves to
change in function at this time;
That it is a period of rapid impression;
That we must divide food into its elementary divis
ions, namely, the "CHO" and "CHNOS" classes; That the "CHO" class supplies to the organism heat, energy, lubrication and rotundity of form;
That the "CHNOS" compounds supply heat, energy, lubrication, rotundity of form, elements for anabolic processes, and important constituents for the ferments;
That one class cannot be constituted for the other, nor have the same unit of value;
That the oxygenating capacity of the body is a limited one, and a too large ingestion of the more easily oxidizable "CHO" compounds will rob the proteids of the requisite amount of oxygen for complete transformation;
That the partial metamorphosis of the proteids is the cause of many disease processes and of the formation of poisonous compounds;
That the degree of physiological perfection is determined by an examination of the urine;
That the body needs an approximately known amount of energy to carry to perfection its functional work;
That the amount of food ingested daily must be limited to a degree where, other things being normal, no products of incomplete metabolism will appear in the urine;
That the proportion of the two classes of foodstuffs must bear a relation to each other, determined by the degree of physical exertion;
That the atomicity of the food, the oxygen used, and the work accomplished, bear a given relation to one another;
That the body should depend almost exclusively on the animal albumins for the requisite amount of proteids;
That the oxidation of the proteids and their combined fats plus a minimum quantity of cereals supply all the energy needed, per diem;
That "an inherited vice," is an expression of ignorance, the functional perversion being due rather to continued physiological derangement;
That many of our acute diseases of youth are due to malnutrition, producing a systemic condition unable to successfully antagonize the poison;
That the chronic diseases of late life are the result of a continued irritant, causing pathological changes in the protoplasmic elements;
That the use of alcohol-C,H,O-is often induced by the cravings of the system which has formed a habit for stimulants from the long use of sugar (CH2O), starch (CHO), or allied substances;
That the proteid feeders withstand disease better, are capable of greater concentration of energy and mental activity, and live a longer and more successful existence.
We should endeavor, in the great task of bringing up children to manhood, to obey these laws of nature, and leave to the world a posterity which will not only be efficient in the propagation of our race, but the progenitors of such types of humanity as shall ever advance in the scale of capacity for physical, mental and moral attainments toward human perfection.Dr. Jas. Wood, in Medic. Bulletin.
Treat the Patient.—In an address to the graduates of the Woman's Medical College of Pennsylvania, Dr. John B. Roberts said:
I beg you to remember above all things that it is your patient that is to be treated and not the disease. Some practitioners seem to retain the idea, which before they began medical study they possessed in common with the public, that each disease is an entity, which must be combated with a specific remedy. This belief, born of ignorance, assumes that the first duty of the physician is to give a name to the disease afflicting his client; the second to select from the drug-shop labels a ready-made curative medicine. Such physicians fail to realize that the practice of medicine consists in so directing vital processes that the perturbations due to disease may be lessened and finally replaced by the normal functions of health. A doctor must necessarily study at first the pathological changes underlying and causing the symptoms; he then gives a distinctive name to the disease, just as a man does to his child, not to select the remedy by which to neutralize its evil powers, but for use as a distinguishing mark. The wise physician Statistics of Eleven Hundred and Fif- knowe, for example, that one patient with pneumonia teen Operations on Adenoid Tumors.will be killed by bloodletting; that another with the Dr. Menière's (Revue Therapeutique Medico-– Chir- same disease will die if it be omitted. The judicious urgicale, December 15, 1891) lecture draws its practitioner examines circulation, respiration, digestprincipal interest from the great experience which he ion, secretions, nervous system; and prescribes to possesses on this subject. He prefers, for diagnosis, bring aberrant tissues and organs into nor mal digital exploration to posterior rhinoscopy. He activity. He will, perhaps, give the same drug in a insists on the grievous modifications which these case of pneumonia, peritonitis, scarlet fever, or broken growths cause in the skeleton, the facial expression, leg, because the patient's condition is more important the hearing, and the general condition of children than the name of the affection. who have them. The only treatment is removal, and the only instrument advised for this purpose is the cutting forceps. The operation may be done in many sittings, separated by an interval of from five to eight days, removing only one piece at a time, which is done so rapidly that children bear it well as a rule. After each operation the patient gargles with cold water, an antiseptic nasal injection is given, and the ears are closed with cotton. On the day of the operation the patient stays in one room. number of sittings is three, and often, at the last one, the pharyngeal wall is scratched with a rigid metallic ring [presumably on the tip of the forefinger.-REV.], which procedure clears completely all points not reached with the forceps. Several paintings with pure tincture of iodine complete the cure. above method is the one always used by this writer.
The second method is to remove all at one sitting. It is necessary to give an anæsthetic. The flowing of blood is often considerable and a febrile reaction may ensue. The child should keep its bed for some time. Chloroform or any other anaesthetic not being absolutely without danger, it appears useless to employ one in "an operation so mild and exempt from real pain."
Do not think I undervalue the studies carried on by the investigator in diseased structures, whom we call the pathologist. You must all be pathologists, so as to be able to examine circulation, digestion, secretions, and nervous system. What I am trying to impress upon you is that he is an unsafe physician who, after giving a name to a disease, always treats that disease with the same powder, potion, or surgical appliance. This will be clear when I remind you that one case of typhoid fever may be as different from another as inflammation of the brain is from mere physical fatigue. The safe rule of practice is the common-sense rule: "Find out what is the matter with your patient, then treat him for his individual condition." No physician can treat disease successfully without attention to the physiological characteristics of the person affected.
The Posture of the Puerperal Patient. -Duke considers the usual custom of keeping the puerperal patient upon her back for a long time after labor to be most injurious. He claims that drainage of the birth-canal is least thorough in this position. and that retro-displacements of the uterus frequently
The Bean Diet.-Dr. Porter (Mercks Bulletin) says: As our knowledge advances it will become clear that a vast majority of our chronic diseased conditions to say nothing of the many acute manifestations are clearly traceable to errors in diet. Further, they will be found readily amenable to treatment when the physician intelligently directs the diet to his patients, instead of leaving that important duty to the whimsical dictates of the individual's palate.
The Bean Diet.-At one time, on account of the highly proteid nature of beans, it was supposed that beans and that class of food-stuffs would be the very best, most available and perfect of all nutriment. Practical usage, however, proved this class of foods. to be a failure save in certain conditions of life.
In mountainous districts, and among a class of humanity whose life is spent mostly in the open air and in physical exercise, and in whom the actual expenditure of energy is not absolutely great, beans can be used and are found to yield fairly good results. Now, with a clear conception of the percentage composition of these substances, together with our present exact chemico-physological knowledge, it becomes perfectly explainable why the bean diet cannot be made to meet the actual requirements when put to the practical test.
Upon a bean diet which will yield the required amount of energy, double the amount of constructive material has been used, and the system has been greatly overtaxed and damaged by this overwork. If on the other hand the bean diet is cut down to the point where it will furnish just the required amount of proteid material, or to 497 grammes (174 ounces) of beans, which quantity will give exactly the required 130 grammes of proteid substance, the consequent decrease in the starch, sugars, and fats, causes the results of the oxidization of this smaller amount
of beans to yield a deficient quantity of energy. For the amount of energy obtainable from 47 grammes (174 ounces) of beans is only 456,654 kilogrammemeteres (3,301,823 foot-pounds.)
Thus we have it demonstrated, upon sound chemical and physiological principles, that a bean diet cannot be so arranged that the system can obtain the requisite nutrition, and at the same time produce the required heat and energy, and still use the smallest amount of oxygen, and eliminate the smallest quantity of nitrogenous excretory matter.
WORDS OF WISDOM TO MEDICAL GRADU. ATES.
In his able address to the graduates of the Buffalo University Dr. Geo. M.Gould, editor of the Medical News, offers many valuable suggestions, which are worthy of being read in full.
To be explicit and detailed, let me counsel a few "don'ts."
1. Don't be in a hurry for success.
2. Don't consult or fraternize with quacks of any kind or degree.
3. Don't be afraid of speaking out your denunciation of quackery, regardless of the loss of a few possible patients and the charge of jealousy.
4. Don't support medical journals run in the interests of the advertisers, journals that are muzzled, that are conciliatory to, or non-denunciatory of quackery. 5. Don't sign a single certificate as long as you live, as regards special, proprietary, or secret preparations.
6. Don't write a medical article in which such preparations are praised or even mentioned.
7. Don't accept commissions of presents from druggists, manufacturers, opticians, or surgical-instrument dealers.
8. Don't let any professional allusion to yourself, your opinions or your work get into the lay newspapers. Don't be a sneak advertiser, a "newspaper doctor."
9. In your own righteous wrath against quacks outside of the profession, don't forget that there are many within the profession, and that they are the most despicable-true wolves in sheep's clothing. I would rather be the "Wizard King of Pain," and buy affidavits of impossible cures at twenty dollars each, than a respectable hypocrite indirectly or secretly hobnobbling with newspaper reporters and supplying them with "data."
As physicians charged with the health of the present and future, our duty must become clear: the entire witch's Sabbath of 'pathies and 'isms, the morbid cranks, drunk with ignorance and conceit; the sly cunning of advertising schemers, the tricks and frauds of medical parasites to suck the blood of their dupes, the patent medicine disgrace-all these things must be choked out of existence. It is a warfare, not a compromise, we are entering upon. It is not a theory,
it is a condition that confronts us.-Medical News.
Experiments Upon the Infectious Properties of the Flesh of Tubercular Animals.-A recent series of experiments practised by Galtier upon this question consisted in the feeding of the raw meat from tubercular cows to chickens, cats, dogs, and guinea-pigs. In none of his subjects, even in the last-named animals, was he able to pro
duce any tubercular lesion; consequently he believes that the flesh of tubercular animals, except such parts as may show the actual tubercles presence, may be safely used for food.
Out of nineteen attempts to establish an intra-uterine transmission of tuberculosis in bitches and guinea. pigs, the author succeeded but four times, thus indicating that the progeny of a phthisical mother is usually born healthy, and that the hereditation of tuberculosis, is only exceptional.-Lyon Medical, p. 10
Glycerin in the Treatment of Hepatic Colic. At the meeting of the Académie de Médecine, March 8, 1892, Dr. Ferrand read a paper on this subject, of which the following are his conclusions :
1. Glycerin administered by the stomach is absorbed as such by the lymphatic vessels, notably by those which proceed from the stomach to the hilus of the liver and to the gall-bladder; it is found even in the blood of the subhepatic veins.
2. It is a powerful cholagogue and a valuable remedy in hepatic colic.
3. In large doses (20 to 30 grammes-5 to 7 drachms) glycerin cuts short the paroxysm at once.
4. In smaller doses (5 to 15 grammes-1 to 3 drachms) glycerin taken daily, in a little alkaline water prevents the return of the attacks.
5. Glycerin, although it is not a lithontriptic, is, however, the remedy par excellence for biliary lithiasis. La France Medicale, March 11, 1892, p. 174.
Guaiacol in Tuberculosis.-Dr. Max Schuller said, in his paper before the German Medical Society of New York, he had used this agent since 1880 for the treatment of tuberculosis pulmonalis also in the tratment of so-called surgical tuberculosis, accounts of which he published in 1891, in which a record is given of such cases extending over a period of ten years. Since the appearance of that work he has had opportunities of favorably extending his experience and observations and carrying out the treatment with a large number of additional patients.
In tuberculosis pulmonalis he gave two to three drop doses to children, three to five drops to adults four times daily. It should be well mixed with a glassful of salt water, milk or broth, according to circumstances, or with wine, and so taken.
The results of his therapeutic experiments with the different remedies as applied to men led him to the conviction that among the most valuable were extract guaiac, guaiacol and creosote.
In T. pulmonalis he combined with the guaiacol treatment the usual remedies when necessary, i. e., expectorants, digitalis and anti-pyretics. The indirect specific effects of the guaiacol on the fever, especially
in the beginning, were manifested only after some time from the commencement of the treatment. In many cases he administered the remedy by inhalation, mixing it in the proportion of 5 parts to 3,0005,000 parts of water or turpentine, camphor, etc.; the inhalations must, however, be closely watched by the physician; above all things must overexertion of the respiratory organs be avoided. As a rule there was an increased but easier expectoration, then a change in the character of the sputa, the hard, firm purulent masses changing to a viscid fluid, increase in body weight, a general constitutional improvement and finally disappearance of the bacilli. He gave the history of many striking cases, several among which had been previously unsuccessfully treated with tuberculin, all of them under the guaiacol treatment terminating with the above favorable results.
In one case the patient had been suffering with a profuse diarrhoea for several months, due probably to intestinal tubercolosis, which had resisted all previous treatment, and which was entirely checked eight weeks after the guaiacol was commenced. The treatment should be continued for six to eight months after a cure is apparently effected.
He had seen most striking improvement and overwhelming proof of the value of the remedy in the course of the first four to five weeks. The treatment should by all means be continued several months after the disappearance of the bacilli and of all local symptoms. He claimed to have treated up to the present time eighteen patients suffering with T. pulmonalis, all with the best results-in fact cures were effected. Most of these patients had been under his observation for several years after, and repeated examinations indicated them to be completely cured.
In cases which seem to demand a more or less surgical treatment, he deemed constitutional treatment with guaiacol as both necessary and essential, because in many patients other parts or organs beside those surgically treated may be infected with the disease, and which is apt to lead to tuberculosis of the lungs, menings or other organs, or even an acute miliary tuberculosis, notwithstanding the fact that the primary lesion treated might have healed.
In a number of such cases he had seen improvement and even cures effected by use of guaiacol alone without any surgical interference. Many of these patients. are at the present time, 2 to 10 years after treatment was discontinued, enjoying good health and are robust in appearance. In so-called chronic scrofulous eczema, which he claimed to have shown was due to tubercle bacillus, he has seen cures effected in a short time, the usual attending glandular swellings bei g quickly reduced. The swellings in cases of extensive cheesy, glandular affections of tuberculous origin were reduced in the course of three to six months;
simple cases of joint tuberculous, cessation of pain, reduction of swelling, decrease of functional disturbances, are followed by a complete cure.
In joint diseases of tuberculous origin he had used guaiacol with iodoform-glycerine injections (strength as above given) with the most gratifying results. In four cases of severe coxitis which ordinarily would have demanded resection he had used the injections in the affected centers, capsule and surrounding fascia as above described, with such good results that neither shortening nor sensitiveness nor swelling existed and the patients were able to walk without trouble. In two of the cases motion is perceptible. In all such cases the after treatment by bandages of soluble glass, massage and baths is very important. For further particulars he referred to his vast book (Wiesbaden, 1891). In all cases in which surgical interference is practised the patient should be put under the guaiacol treatment, which he insisted should be kept up for some time after the operation. His varied experience, extending through many years, had convinced him that the guaiacol treatment as introduced by himself, internally and also locally in surgical cases demanding it, if followed by his esteemed colleagues of this country, would yield as good results as it had been his fortune to secure.- Gailaird Med. Journal.
The Medical Calendar.
Washing Out the Stomach in Infantile Diarrhea-Dr. Paul Champonniere (Jour nal de Medicine) reports the following case:
An infant three months old, and nursed by a drunkard, was lately brought to the hospital for contracture which presented all the characters described by Trousseau, but the interesting point was the form of the diarrhoea present and the means taken to combat it; diarrhoea is, besides, a habitual cause of tetany. The diarrhoea was abundant, green, and attended by so much cold and such a state of collapse that the death of the child some days after its admission appeared certain. Cow's milk was so badly tolerated that it was replaced by albumen water with a little alcohol. This gave good results, but washing out of the stomach and rectum was also employed. Amelioration was immediate and continued. To the other treatment were also added baths of warm wine, a very good excitant of the skin in these cases. The good effect of the washing is shown in the fact that the diarrhoea reappeared as soon as it was stopped. When we attempted to give asses' milk in small quantities, in spite of all precautions, the diarrhea, convulsions, etc., recommenced. The washing treat
ment was then resumed, and, after some days, milk could be tolerated mixed with seltzer.
This case is of great interest as the tetany, as well as the other symptoms, indicated intestinal intoxication. After the first alteration of the digestive function, the infant was unable to support any lacteal alimentation, but was able to support for a sufficiently long time the albumin water and brandy.
Sometimes lactic acid gives good results in these cases, but it must be given continuously-every ten minutes so that the digestive tube will always A solution can be madecontain a certain quantity.
containing one part of the acid to fifty of syrup. The washings of the stomach were made with a. soft tube of about three-eighths of an inch in diameter, and with boric acid water. They were continued until the water returned clear. Not only diarrhea, but vomiting yields readily to this measure. Medic Age.
Traumatic Hæmaturia complicated with Acute Inflammation of the Bladder successfully treated with Tritica.By A. W. Sawyer, M.D. September the 10th, 1891, my youngest son, a strong, healthy young man ageď 21 years, while unloading railroad iron from flat cars. on the Santa Fe Railway, near Gorin, Mo., accidentallyfell between two cars, that portion of his back over the kidneys striking full upon one of the rails. The injury was such as to produce syncope. After recovering from the shock he returned to work the next day, got wet in a heavy rain shower, grew worse, went to bed and began taking large doses of quinine for what he thought were malarial chills. In the night of the third day he came home from Gorin, a distance of seven miles, through a cold rain, arriving thoroughly saturated,and was almost immediately attacked with severe and protracted chills. The next morning the thermometer showed temperature 106, patient delirious and suffering greatly. This precarious condition alarmed me and I at once sent for Dr. J. L. Davis of Granger, Mo., a very excellent physician, who came and after careful examination concluded that the malady was typhoid fever. He advised large doses of quinine to reduce temperature and other measures generally used in the outset of typhoid. Not satisfied in my own mind that the diagnosis was correct,. I did not give the quinine, but administered every hour small doses tincture of aconite, which in a short. time brought temperature down to 100, but upon discontinuing the aconite the temperature rapidly rose to 106 again, accompanied with difficult breathing and deliriousness. I again resorted to aconite in larger doses which had the effect of rapidly reducing the fever and the patient returned to consciousness. His first act after regaining consciousness was to