Billeder på siden

brandy. Corn starch or rice flour gruel is made in the same way.- Boston Journal of Health.

Hydrotherapeutics in Locomotor-Ataxia.-In the external employment of water we have an important element in the treatment of chronic diseases of the chord, as well as in many other acute and chronic disorders. A generation ago hydropathic institutes and the like were frequently in the hands of empirics, who in their crude way of applying water on general principles, either too cold or too hot, did more harm than good. If the action of this great and useful thermal stimulus on the nervous system is not yet properly understood, we have certainly learned by experience, in the last twenty years, a better method of its application, for we now know that high as well as low temperatures are to be avoided. Patients are treated at home or in special institutes with plain water, though they may also take natural or artificial salt water baths, mud, or sulphur baths. Sea and river bathing, Turkish and Russian baths, have done more harm than good, and are now generally avoided. The methods in bpdropathic institutes and in thermal watering-places have come to be alike, inasmuch as the cold bath, the cold douche, cold rub have been discarded, and been substituted by the cool and tepid baths from 90° F. down to 72° F., and the results of treatment are better now than they have been. For at least ten years I have followed what I believe to be the late Dr. Runge's method in cases of tabes, which consists in putting the patient in a tepid half-bath of about 85° F. for five minutes, and pouring a pailful or two of water of 75 to 80° F. gently over his back and shoulders before he leaves the tub. This may be done daily or every other day, and I know of no other plan by which I had better, or even as good, temporary or permanent relief; and it deserves to be recommended. Runge claimed to have cured some cases of tabes in this way. I have not been so fortunate, but have certainly seen marked improvement in some cases. The natural salt-water spring baths contain from two per cent. to three per cent. salt; for the artificial bath of that kind, from five to six pounds of salt to an ordinary bath-tub full of water is generally used. The patients now are kept in the tepid baths for five minutes, in the cooler baths for three minutes, generally. In various wateringplaces I have seen patients kept in longer, up to ten and fifteen minutes. Sulphur baths are especially recommended in spinal disease of specific origin, but nobody believes now that they could be of much benefit by themselves in such cases, but they may assist the action of antisyphilitic remedies. In sending patients with more or less advanced spinal disease, to a watering-place, it is well to remember that they do not bear well long and fatiguing journeys,

and that a sojourn there of four or six weeks, embracing the usual number of twenty-four baths, does not promise much success. To obtain a fair and lasting result, the patient must be prepared to stay two or three months, and longer if required, and he ought to be informed of that before he sets out on his journey. Dr. Weber, Med. Record.

The Therapeutic Uses of Oxygen.— When a member of the medical profession, by original work, by valuable medical writings, or by other means, places himself above his fellows in the treatment of disease, it is but natural that anything which he may write will be received by those who are familiar with his name as valuable and reliable therapeutic evidence.

As a consequence, when Dr. Brunton published in the British Medical Journal a short note, detailing the good results which he had obtained in the administration of oxygen to a patient who was at death's door from pneumonia, the medical journals throughout England and America hastened to abstract his article, and to endorse in every way that they could the recommendation of so eminent an authority.

Probably reiteration of valuable facts in medical literature can never be carried to excess, because there are always some members of the medical profession who have not received, or have failed to note, some points in therapeutic progress. Yet it strikes those of us who have practiced medicine for any length of time in America that the results which have been published by Dr. Brunton are nothing more than those with which we have been familiar for a number of years. Certain it is that oxygen is being more widely employed every day and in the treatment of a large number of ailments. Indeed, its sphere of usefulness has been extended, until it includes not only those diseases associated with interference with respiration and consequent partial or complete asphyxia, but also those conditions in which it is evident that the vital processes are carried on feebly or too slowly. Thus, a popular use of oxygen gas in this country is its administration in cases of anæmia.

A series of researches, carried out several years ago by two of the editors of the Gazette, indicated very, strongly that oxygen gas was of the greatest possible value in the resuscitation of persons asphyxiated by ordinary coal, or illuminating gas, it being possible. to revivify animals apparently dead by the forced inspiration of oxygen. It seems, however, when we consider the matter rationally, that the value of oxygen as a remedy has the same distinct limitations which govern the employment of almost all other agents possessing curative powers. It is well known that the hæmoglobin of the blood will not take up more oxygen than is in the ordinary atmosphere, and

it becomes a matter of grave doubt whether, in cases of anæmia or other disorders of the general system, inhalations of oxygen produce any effect whatever, except through the increase in respiratory activity of the patient, who voluntarily fills and empties his chest thoroughly while using the oxygen apparatus. It may be, however, that advantages are obtained by its employment in these conditions, and it will require further clinical experience to determine whether the oxygen itself has any direct effect under these circumstances.

In pneumonia, however, the rationale of the employment of oxygen is entirely correct, provided the right side of the heart is not so engorged as to prevent it from doing its work. The main danger that threatens the patient is asphyxia, or failure of respiration, owing to the consolidation of a large area for breathing. It becomes evident that if one lung is so consolidated that respiration must be carried on entirely with the other, this remaining lung must take in double the quantity of air which it usually contains in order to provide the general system with its ordinary quota of oxygen. It also necessitates a large increase in the area of the blood vessels, through the walls of which the gaseous interchanges of respiration take place, and it is perfectly just to suppose that the admixture of an increased quantity of oxygen with atmospheric air under these circumstances will permit the hæmoglobin in the red blood-corpuscles to change into at least an approximate normal amount of oxyhæmoglobin. Oxygen is probably of great value under all circumstances where asphyxia is present through the imperfect oxidation of the blood.-Therapeutic


A Skin Stimulant.-The special stimulants necessary to the skin are at once external and internal; because the skin is properly both the continuous covering and lining of the body, and also a connected system of minute organs all around, outside and inside, for a variety of vital purposes, and all of them more or less inter-dependent and sympathetic. The inside part of this great organ of organs is prominently occupied with the complex processes of alimentation, dependent mainly on its absorbent and secretive organs. The outside organs share to a minor degree in similar powers, but predominate in the faculty of elimination which regulates the heat and assists in the purification of the blood.

Of all this inquiry the cardinal point is this unity and sympathetic communion of the outside and inside. skin, with their organs, respectively, for the sustenance and preservation of life; the inner skin to nourish, and the outer to regulate. But for the inner we should starve; but for the outer we should burn out. From this it follows that the stimulants we ap

ply to the outside skin immediately and powerfully affect the inside with all its vital processes, and vice versa. Everyone is familiar with the phenomena of counter-irritation and sympathetic irritations from outside to inside and from inside to outside.

The directly essential question, as to operating the skin, proves to be this simply: What are the proper stimulants required externally, to excite this whole round of vital organs and nerves within and without, to their highest healthful activity?

The rude state of nature affords the skin of men and animals a large variety of effective stimulants; such as insects, vermin, friction casual, voluntary and involuntary; which answer all necessary purposes for those whose neglect of more refined adjuvants secures them abundance of these. But when we pass from these to the delicate conditions and surroundings of cultivated refinement, we must find substitutes by cultivated and intelligent care. When insects and briars become unavailable for the purpose, we ought to stimulate these accessible springs of all vitality to smartness by systematic excitements. To change the figure by one letter, we are a harp of a thousand strings-nay millions-which we must play on ourselves if there are no parasites to do it for us.

Heat, cold and friction are the chief external and

physical stimulants of vitality and of vital action. The discussion is already verging too near to tediousness to allow of due attention here to the important factors of heat and cold, to their almost universal abuse, and to the discriminating application and adjustment of them in bathing, to all sorts and conditions of the constitution; a field in which the competent medical adviser, if permitted, could do more to prolong and sweeten our lives than with the entire materia medica. But this allusion illustrates our main point, to wit: that stimulation of the system through its accessible nerves and organs is the essential purpose of bathing-in this case by appropriate influences of temperature-to which the cleansing of the skin and "opening of the pores," so much harped upon, is usually a minor incident, of much value if not carried to excess.

We fall back to friction, as the grand agent of this group, for heightening vitality. We have repeatedly urged the use of the bath brush, as worth more than all the soap and crash in the universe. Its stimulating power is such that most persons would needs begin very delicately with it at first. For perfection of cleansing, especially in hollows and at the roots of hair, it speaks for itself at the bare suggestion of it. But what we would have remembered is not so much this, (nor even the chill-proof glow and animation of the skin, which it imparts) as the quickening effect of this lively stimulant on the nerves and vital organs that lie in the so-called mucus membrane that is the

continuation of the skin throughout the interior system, and which harbors our dyspepsias, manifold weaknesses, inactions or failures, and disorders innumerable; a majority of which are more or less accessible through the skin by this stimulating peripheral massage, to say nothing of the incidental massage of the muscles and the invaluable development of the peripheral nerves themselves. We would have the bath practised with this means and with this end in view, and the soaping and soaking limited to mere necessity for cleanliness, which the brush (with a handle, for reaching all parts) will reduce to a minimum. It may not carry us to the age of Methuselah, but it is next to exercise among the positive helps to longevity. The Sanitary Era.

The Therapeutical Application of Cycling. In the current number of the Semaine Médicale there appears a valuable contribution to our knowledge of cycling as a therapeutical agent from the pen of our compatriot, Dr. Oscar Jennings of Paris. Dr. Jennings is well known as an enthusiastic advocate of this most pleasant form of exercise, and his opuscule "La Santé par le Tricycle," is widely read in the different languages into which it has been translated. The paper in question is full of information concerning the advantages to be derived from cycling in such divers maladies as gout, rheumatism, metritis, obesity, phthisis in the first and second stages, asthma, diabetes, dyspepsia, hypochondria, neurasthenia, agoraphobia, etc. No one who carefully reads Dr. Jennings' paper can avoid coming to the conclusion that a large proportion of the sufferers who crowd the waiting rooms of fashionable physicians would soon forget much of their troubles were they wise enough to take a daily spin on an easy-running machine. It is characteristic of the altered views held on the subject of the treatment of cardiac affections to see cycling actually recommended for this class of cases. Sir Walter Foster states that in aortic insufficiency it is important to increase the frequency of the cardiac pulsations, and most people will agree with Dr. Jennings in regarding gentle cycling as a pleasanter form of exercise than the climbing of mountain slopes advocated by Oertel.-Hygienic Review.

He'll get lots of patients. - Dr. York Davies, the apostle of Bantingism, has been writing on "Proper Diet for Hot Weather," in the Gentlemen's Magazine. For breakfast he recommends two cups of tea or coffee, sweetened with saccharine, one or two teaspoonfuls of cream in each, 1-oz. of dry toast, thinly buttered; 4-ozs. of grilled or boiled fish, such as plaice, sole, whiting, haddock, cod, or trout, or 4-ozs. of cold chicken, cold tongue, or of grilled

steak or chop; for lunch, 2 or 3-ozs. of cold mutton, beef, or lamb; 3 or 4-ozs. of green vegetables, plainly boiled, plenty of green salad made with vinegar, but without oil; 4 or 5 ozs. of stewed fruit; water, or 2 or 3 glasses of pure dry Moselle or other Rhine wines; for dinner, Julienne or clear vegetable soup; 3 or 4-ozs. of fish; 3 or 4-ozs. of any red meat, or of chicken, rabbit, game, or venison; 6-ozs. of any green vegetable with gravy from the meat only; 4-ozs. of stewed fruit, or of raw fruit; a little stale or pulled bread, and a small piece of cheese. One wonders, if this is a sample of a hot-weather dietary, what Dr. Davies would recommend, say, with the thermometer at zero-Hygienic Review.

Advances in Physiological Chemistry. The progress of physiology and physiological chemistry gives every now and then a sharp turn to our methods of viewing and treating disease. Thus, for example, in times past the profession has starved fevers, then it has fed fevers, now it is inclined to water them.

Perhaps in no direction have medical views changed more than in regard to the dieting and feeding of the sick and to the medication of nutritional disorders. For two decades a vast deal of attention has been paid to the subject of making things easy for the stomach. Pepsin, ptyalin, trysin, peptones, peptonic pills, digested and half-digested milk and beef have been prescribed in enormous amounts, and no doubt with some benefit.

But there is a possibility that too much of this sort of thing is done, and that much of the supposed help to digestion given by prepared food is fanciful. It has been demonstrated beyond any doubt that albumin is absorbed from the rectum and stomach without first being changed into serum-albumin before. they enter the blood, and finally there is good ground for believing that all the proteid matter, which is used in the building up and repair of tissues comes from albumins, which escape being converted into peptone in the alimentary tract. Peptone supplies force, unchanged proteids supply tissue.

A good deal of medication has been based on the supposed fact that the secretions of the intestinal tract are alkaline. The studies of Macfayden, Woricki and Sieber show that this is not entirely true, for the secretion, as found in the lower part of the small intestine, is uniformly acid.

A very important and dominant idea in practical medicine is that the tissue changes of nutrition and functions are chiefly oxidations. Hence we insist on fresh air, exercise and abundant supplies of oxygen. But it is known that synthetic processes also occur in the processes of digestion and absorption as well as in tissue making. In digestion, for example, hydra

tion is an important factor, and in the absorption of fats there is a synthesis of fatty acids and glycerine, so that as a result neutral fats alone enter the lymph. The investigations of chemists have also shown that the liver-cells do synthetical or constructive as well as oxydizing work. The old view of Liebig, that our bodies are mainly furnaces, is not, therefore strictly true, and we are learning to day that rest is as important as exercise in securing improvement

in nutritive functions.

These views, which are in part suggested by an able address of Dr. V. C. Vaughn, of recent progress in physiological chemistry, show that certainty has not yet been reached in our knowledge of diet, digestion and nutrition, and that the modern physician must kept ever alert to the progress made in the physiology and chemistry of the human body.-New York Medical Record.

Food in Disease.-I will give you my conclusions:

1st. That nourishing food is a great desideratum; 2nd. That digestibility is also a great desideratum; 3rd. That concentrated foods should be allowed in quantity not much in excess of the requirements of

the system;

4th. That foods possessing high nutritive power should be associated with foods of very low nutritive power, the latter to be the bulk of the diet; 5th. That concentrated foods cause constipation and irregular action of the excretive function;

6th. That bulky foods, of low nutritive power, exert a marked salubrious tendency toward keeping the bowels regular, and enhancing the health of the patient.

Fruits and vegetables, as a rule, are acceptable to most patients. They are not very nourishing, (comparatively) since they contain so much water and fibre; still they are very useful in the "make up" of a regimen for the invalid. What portion of them that is digestible, is digested, and the remainder (with some few exceptions) passes on without irritating, to swell the volume of excreta, thereby giving the intestines something material to work upon, and forcing a passage. It is not the quantity retained in the lower intestinal tract, but the length of time it remains there, which favors the putrefactive changes taking place in the fæces of the constipated. This process of ultimate decomposition renders the condition constipation, so inimical to the patient's health, or progress towards health.

Some fruits or vegetables are agreeable to one patient and the reverse to another. Find the one that suits and eliminate the other.

Personally, I believe that a well-baked apple at each meal, or even two, if the patient's appetite permits, is

about the proper thing, suitable, as it is, to the great majority.

Don't forever be dosing your poor patient with physic; rather, choose some food which will answer the purpose!

The ideal diet, then, in my estimation, is a variety, containing a small portion of highly nutritious food and a larger portion of food, possessing easy digesti bility, but low nutritive power.-Dr. Frank S. Hough in Detroit Emergency Hospital Reports.

Intestinal Gymnastics.-In many cases of chronic constipation, the cause of the disorder is simply the lack of muscular activity in the lower bowels. Many methods have been employed for increasing the muscular activity of the intestines-such as massage, muscle beating, the galvanic and faradic currents, and a variety of gymnastic exercises. Walking, horse back riding, and especially Swedish gymnastics, are certainly very useful means of stimulating the intestinal peristalsis. The purpose of this note is to call attention to a fact well known to practical physiologists, but perhaps not so widely known among practicing physicians as it should be. Physiological experiments have shown that rapid voluntary movements of the external sphincter ani and the levator ani produce very active peristaltic movements of the large intestine. This effect is produced by the mechanical excitement of the plexus myentericus of Auerbach. This curious automatic center lies between the two muscular coats of the intestine, and controls the peristaltic movements. A patient suffering from constipation should make powerful movements of the sphincter ani, and of the levator ani, in as rapid succession as possible, continuing the exercise for three or four minutes, or until the muscles are fatigued. The time chosen for the exercise should be either before breakfast, or an hour after breakfast, according to the natural habit of the individual in respect to the evacuation of the large intestine. Bact. World.)

What the public should know about Scarlatina.-Scarlet fever (called also scarlet rash, canker rash, malignant sore throat, etc.) is one of the infectious diseases distinguished by its peculiar rash or "eruption." The essential facts of this disease needful to be known for its prevention or restriction


First-That its special infection is developed in the eruption in the skin, and given off thence to persons and clothing, and to bedding and other things in occupied rooms, and that it continues to be given off constantly till the skin is entirely well and all scruff or scruffiness has entirely disappeared.

Second-That the slightest attack of the disease in one child may provoke a severe attack in another exposed to it, and that when it is epidemic a large proportion of the cases are often of so slight a type as not to be recognized at first, or, often, till the affection has been given to others.

Third-The period of "incubation" (time from taking the infection till the first symptoms appear) is rarely longer than seven days (one week), sometimes

but a few hours.

Fourth-The patient is infectious, and so dangerous to others, for at least forty days, and as a rule for seven or eight weeks, i, e., till the skin is entirely well and free of scruff, particularly on the palms of the hands and soles of the feet.

Fifth-The infection preserves its virulence in clothing and bedding hung up in closets or packed in trunks, clothing of the patient or his attendant or others exposed to him. So stored, the infection. clings to such things, sometimes for months, ready, when the article is shaken in the air, to float off and infect the nearest child.

Sixth-Boiling water or a strong solution of quicklime will destroy this infection in clothing or bedding,

and the last will do the same for floors and walls if

freely applied. On the person of the sick a simple ointment (one part mutton tallow, two parts fresh lard melted separately and mixed thoroughly till cold) is the best and easiest means of limiting the spread of the infection. Used all over the body it does two things-relieves the fever and itching of the rash, and confines the loose particles of skin containing virus to its surface or to the body, clothing or the sheets of the bed, thus preventing its escape into the air.- Minnesota State Board of Health.

Cow's Milk in Infant Feeding.-Dr. M. F. Cupp, speaking from experience states (Lancet Clinic) that among children in large cities, with bad sanitary surroundings, or under other unfavorable circumstanees, where artificial feeding cannot be practiced with any degree of success, owing to inability to procure pure cow's milk in an assimilable condition, it is doubtless true that even a poor wetnurse is the only safe alternative. He does not speak of children suffering from gastro-intestinal diseases, but of those whose digestive organs are as yet in a state of comparative health. Among children in the country, with whom we may deal differently, as a plentiful supply of cow's milk of good quality may generally be obtained, we may frequently advise the relinquishment of the mother's breast and the substitution of the former nutrient with the most happy results.

We do not advocate the general abandonment of breast feeding, but would simply call attention to the fact that cow's milk may often be substituted for that of the mother with good advantage.- Western Med. Reporter.

The Medical Calendar.


Tobacco-smoking among Boys.-As long as the habit of tobacco-smoking remains a common practice among men, so long may we expect that the boyhood of the time will acknowledge its fascinations. It is therefore in a sense as natural as it is morbid that the soothing weed should be numbered among the mischievous absurdities of growing youth. This is much to be regretted for several reasons. Constitutionally, the boy is not even a lesser man. Between his young and vigorous nervous system and that of the male adult there is this essential difference-the one is developing, the other formed. Endowed with greater elasticity, the former is also in proportion lessstable, and such effects as the narcosis of tobacco, cannot at all assist, but must more or less pervert, its normal activity. The man's more settled nerves are less affected.

Then with boys the smoking habit is,

in its way, a first love, and as such is almost certain to be indulged to excess. The circulatory and nerve suffers, and whatever may survive of physical energy, structures are overworked in consequence, digestion

we have often to note a decrease in constitutional soundness. Influenced, no doubt, by such reasons as these, and others of more general and social significance, the medical faculty in Manchester, in reply to a circular issued by the Anti-Tobacco League, have set themselves to seek a mitigation of the foolish evil. Their recommendations follow much the same line as that adopted by the Manchester Conference a year ago, in advising the suppression by law of smoking among boys under sixteen years of age. The wellknown example of Germany in this matter is worthy of general imitation. It has already been reproduced (vide THE LANCET, August 25, 1890) in the State law. of New York, boys under the said age being forbidden to smoke in public.-Hygienic Review.

Stop Spitting.-The modern gospel of prophylaxis teaches that phthsis can be abolished from the face of the earth if only people will stop spitting. Says Dr. T. M. Prudden :

"If the vile and increasing practice of well-nigh indiscriminate spitting goes on unchecked in nearly all assembling places and public conveyances; if the misguided women who trail their skirts through the unspeakable and infectious filth of the street are to be admitted uncleansed into houses and churches and theatres; if theatres and court-rooms and schoolhouses and cars are to remain the filthy lurking places of contagia which their ill ventilation and their

« ForrigeFortsæt »