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temperature of 104° to 105°, was carried to a successful issue by methodical bathing.
Let it not be claimed that the bath treatment cannot be executed in private practice. Whenever medical men shall study this subject in the writings of the masters and be convinced of its efficacy, these difficulties will vanish. A valuable contribution to the subject is Dr. Charles Sihler's little book on the "Hydriatic Treatment of Typhoid Fever," which furnishes an able survey of the writings and opinions of Brand, Vogl, Tripier, and which offers such a practical statement of the entire subject that there is no longer an excuse for the lack of information now existing on the technique and results of the Brand treat
We insist, in conclusion, that only by strict adherence to Brand's rules, even if they clash with our preconceived ideas on the subject, may we attain the results of this greatest life-saving measure of the present day.
Would any surgeon claim that he has carried out a strict antisepsis in his operations if he omits to clean his nails? The fact that he uses bichloride solution and iodoform gauze does not entitle him to the claim, unless he has made himself strictly aseptic by every known procedure. It is to the minute attention to every detail of asepsis and antisepsis that modern wound treatment owes its triumphs. So it is with the cool bath treatment of typhoid fever. If the temperature of the bath is not correct, or its duration is changed, or frictions are omitted, it is no longer a Brand bath, and we do an injustice to the great de
viser of the method if we claim that we have used it and our results do not correspond with his.
There are many prejudices to be overcome, but, above all things, let the true principle of the method and its technique be mastered. Then, if the family objects to the seeming harshness of the treatment, which should be explained in advance, the responsibility may be thrown upon them. The writer is in the habit of informing the family as follows: "Reliable statistics show that the mortality of typhoid fever under the ordinary method, approved by most physicians, is from fifteen to forty per cent; the mortality of the disease under the strict bath treatment, as ascertained by still more reliable statistics (in the army), has been reduced to near three per cent. You have the choice of the method. I shall pursue the former, if you take the responsibility of the known. difference in mortality." Rarely does this clear proposition fail to bring consent to the bath treatment.
We have endeavored, by a judicial and careful surof the discussion before the American Associavey
tion of Physicians, to impress certain important points of the Brand treatment which are very commonly overlooked. The chief lesson to be derived
from this discussion is the necessity off a rigid adherence to the technique, which should not be modified by our preconceived notions. The large statistical evidence in favor of the Brand method entitles it to a respectful and judicial obedience.
A modification of the technique must produce a modification of the results.-Editorial Journal Balmology, Aug.
THE DANGER OF MILK FROM TUBERCULOUS COWS?*
BY EDWARD F. BRUSH, M.D., MOUNT VERNON, N. Y. The domesticated Bovine animal appears to be, above all other animals, subject to Tuberculosis. This animal is capable of bearing the tuberculous processes in its natural state, that is, without breaking down and producing sepsis which is the cause of death in the disease known variously as phthisis consumption, and so forth. In other words, a dairy cow will have fulfilled her functions with profit to her owner, and only when she reaches the butcher, is it discovered that tuberculous growths are present in various parts of her body. No other animal that I know can be tuberculous for so long a period without exhibiting evidences of the disease, and hence the diagnosis of this disease in the domestic cow is often a very difficult matter.
The reason why the domestic cow bears the tuberculous processes without breaking down, is by reason of her natural bodily temperature, her normal average temperature being 102°. This I have ascertained from personal observation on hundreds of apparently healthy animals, extending over several years. is about the temperature that arises in the human subject during the stage of active tuberculization, and this high temperature in the human subject is a prominent etiological factor in the constitutional disturbance eventuating in the breaking down of the tubercle, that leads to the sepsis producing death. Now this normal temperature of the cow admits of the growth of the tubercle without constitutional disturbance and consequently the animal's resistance is retained and tuberculous processes attain enormous proportions without affecting the general health or usefulness of the animal. Therefore in order that a cow may develop the tuberculosis that kills some other morbid agency (traumatism, puerperal, septicæmia, etc.,) must supervene, to set up the breaking down process in the tubercle. When acute miliary tuberculosis takes place in the cow, old tuberculous processes are always found, and the temperature then is increased only a degree and a half. Acute miliary tuberculosis in the cow is a comparatively rare disease
*Read before the Medical Society of the State of New York at its eighty-sixth annual meeting.
and hence many dairymen, cattle dealers and breeders, imagine that tuberculosis is rare or more rare than is reported to exist in dairy cattle for this reason alone, or because so few cases die in comparison with the number of animals afflicted. Therefore these men do not see the latent evidences of disease, their standard of perfect health in dairy animals being the ability of the animal to perform its functions with profit to its owner; and having no comparative standard of health, they regard the animal as sick only when it refuses to yield milk or fatten for the butcher.
Now what is the danger of milk from tuberculous cows when used as human food? Of course an animal afflicted with acute miliary tuberculosis that kills-and this is the only form of tuberculosis that kills an animal-in this form the milk secretions are suppressed very soon after the onset of the general infection, and as the disease is comparatively rare, milk from these animals is not so common as the literature on the subject would lead one to suppose, while the chronic, latent form of the disease is always more or less present in the ordinary dairies that supply milk for food, and it is very safe to assume that everyone that drinks milk as it is furnished to cities, takes milk from animals afflicted with tuberculosisthe chronic form always-the acute form occasionally. So the question as it seems to me should be "When is the human subject fit to take the milk from tuberculous cows with impunity?" for there can be little doubt but that in a robust state of health the human being can ingest with impunity the food from tuberculous animals, and probably in many conditions of impaired health such food can be taken without apparent danger. Of course tuberculosis cannot be studied in the same light as other infec. tious diseases, because the introduction of the poison into the system to day may require a year, or ten years, before it is developed into a disease. It is therefore almost utterly impossible for anyone to say in a given case where the infection came from. In the study of this disease, taking isolated or individual cases, where apparent cause and effect stand in close relationship, it is simply a coincidence and is highly misleading. I have watched the medical literature on the subject very carefully for a number of years, and there are a few cases cited where the evidence pointed strongly to the domestic cow as the direct source of infection; in other cases where I have myself known children brought up on the milk of tuberculous cows, there has no evil as yet resulted, and I have never been able to associate any case of tuberculosis in the human subject, infant or adult, directly with a tuberculous cow. I know a girl to-day thirteen years old whose food for two years after weaning was mainly the milk of a tuberculous cow. The cow of
course was then affected with chronic tuberculosis, and ultimately succumbed to general infection. The milk was given to this child directly from the cow, and warm, and the child has always been remarkably healthy. About two years ago, a friend of mine wanted me to see his cow, and say what was the matter with her. I found her suffering from acute pulmonary tuberculosis of the miliary type; she was killed and we found old tuberculous processes in the mesentery glands. These were not broken down, but a large mass in the mediastinum was broken down and seemed to be the source from whence the general infection spread. The laryngeal glands were also chronically enlarged. This was a family cow and furnished three children of the household, aged from two to seven, with their daily supply of milk. The children, all of remarkably robust health, are perfectly well to-day. But this kind of negative testimony proves no more than the positive testimony that has been thus far accumulated. The disease must be studied not by isolated cases but on a broad field. There are some ludicrous instances in the history of the disease illustrating the fallacy of drawing deductions from circumscribed observations. "In 1677 twelve students who had taken their repast in the Convictorium of Leipsig died. At the inquest it was proved that the hotel-keeper had given them in addition to other food of a bad description, the flesh of emaciated and infected cows, whose viscera were covered with a great number of vesicles, of tubercular nodules, and of purulent tumors. Externally this flesh did not offer any abnormal appearance.” In the light of our knowledge of the present day, it is safe to assume that whatever else these students may have died from, it was not simply the tuberculous meat that killed them. Nevertheless this unfortunate accident stirred up and exaggerated public feeling on the continent of Europe, and most countries passed stringent laws. Three years after the Leipsig accident the German states enacted very severe means to prevent the sale of meat from tuberculous cattle. Butchers were afraid to have anything to do with animals showing the least trace of the disease, the carcases and even the instruments used in slaughtering such cattle, were turned over to the public executioner. These measures involved a heavy loss to the cattlemen; it was found that the executioners did not destroy the diseased carcases but consumed them in their own families or sold them to others, and that no injury resulted from the use of this flesh. Then the pendulum began to swing in the opposite direction, and the medical men began to teach that tuberculosis was not a contagious disease and that the flesh could be eaten. with impunity. In fact the meat of tuberculous cows was publicly advertised as of good quality. Zwierlein, a doctor of medicine and philosophy at Brokenau took
twenty pounds of flesh from a tuberculous ox and ate it in order to show that such meat was not injurious. This doctor also prepared a broth made from the nodules of the ox, and drank it in the market place before a large number of people. Then about this time the various governments began to rescind the various stringent regulations, and the prejudice against the use of such food ceased to exist. Now in our day with the increased knowledge we possess as of the etiology of the disease, stimulating increased discussion and enlarging the literature on the subject, the public are in danger of adopting the same unreasoning prejudice. I say "unreasoning prejudice," not because I underestimate the danger of the presence of tuberculous animals as food-producers, but because the methods heretofore adopted are inadequate, and one-sided. I believe firmly that all the tuberculosis that affects the human race is derived from the domesticated bovine, because the only people on the face of the earth who enjoy immunity from tuberculosis, are those who do not harbor domesticated tuberculous animals. If this broad statement is true, what does it signify? Can we control the disease by condemning animals only when they come to the butcher, and allowing the milk to be used till he makes the diagnosis for us? If consumption is a contagious disease and the human race stands in danger of the contagion coming from this most useful food animal, would it not be wise to regulate the breeding of such animals? There are bovines that are reported to enjoy a total immunity from tuberculosis, and so it is possible for us to produce a breed that will not menace the human race. But until the vast number of earnest workers who are moulding medical and scientific opinion, unite their forces in this direction, and until we get an animal not tuberculous, we must use our best effort to avert the dangers that now threaten us. I do not believe anybody can tell at what stage of tuberculosis in the cow, the milk is safe or becoming dangerous. We have statistical facts enough pointing to the morbid conditions in the human subject creating a receptivity to the contagion. We know that nearly fifty per cent. of diabetic ubjects are carried off by pulmonary phthisis; surely we should guard a patient with this disease from the possibility of contagion. Also in all other condition of emaciation and lowered resistance in the adult. With children I have no doubt that the danger is far greater, as their food is solely or chiefly milk. I believe sincerely that a child in perfect health can take the milk from a tuberculous cow with impunity, but a child that is born with a feeble constitution, or of tuberculous parent, or parents, or suffering from cachexia or any of the wasting diseases, should not be allowed to have milk from a tuberculous cow, no matter what stage of the disease may exist in the
cow. As to sterilizing or boiling the milk for these children, the process may or may not eliminate the disease germs-and we have pretty good evidence that boiling does not-but we are certain that either process lowers the nutritive value of a food already below par (if from a tuberculous cow) by reason of the diseased condition of the animal itself. So in the same cases where the milk of tuberculous animals is to be prohibited, the absolute necessity of the highest type of food also necessitates the exclusion of boiled or sterilized milk of any kind. As all cows are not tuberculous it is perfectly feasible to select animals to supply infant food. to supply infant food. As, however, the chronic forms of tuberculosis in the dairy cow are not easily recognized, the medical man knows little or nothing about the cow, and as the American Veterinary schools have paid less attention than the subject deserves there are few people who are able to detect the earliest symptoms. The necessity for more definite knowledge of the cow herself by all practitioners is evident, so that when it becomes necessary to prohibit the use of food that is apt to kill, there should be more people able to detect the morbific conditions at work in the food producing animal. We can safely assert that in our time tuberculosis will not be entirely eliminated from the dairy cow. We are approaching the period when it will be; therefore meanwhile let us guard the susceptible, and aid in the advance towards the annihilation of one source of danger to the human race.-Pract. Monthly.
EXPERIENCE IN SCARLET FEVER. EDITOR DIETETIC AND HYGIENIC GAZETTE :
An epidemic of scarlet fever prevailed in this section (Shelby County, Tenn.) during the years 1861 and '62. Scarlet fever was prevailing in Memphis, but up to this time it was unknown in this neighborhood. I was called to see Miss B-, to assist the attending physician in making a diagnosis, in March, When I arrived the attending physician had left-the patient was in articulo mortis. I examined her throat; the tongue and fauces were of a scarlet red. The skin had a uniform, livid appearance. The family were very much alarmed at the rapid fatal termination of the case. I ventured to diagnose the case scarlatina, of the congestive form. From this case the fever spread in all directions; was not fatal with proper treatment, only in the congestive form. The treatment I practiced may be called symptomatic; it was based upon the indications of each individual case. If there was congestion, I used hot sponging. If the skin was generally hot and dry I used cold sponging. Small portions of hyd. chlo., mit. with ipecac, rhubarb, or compound extract colocynth; later on, sodium hyposulphite and quinine. Strong solution sulph. cupri. with
oil capsicum on the outside and inside of the throat (chlorate of potash did no good for me), keeping the room in equable temperature. With the above simple treatment the cases generally terminated favorably those of the violent congestive form, fatally.
I had heard my father say that I had the scarlet fever when I was very young, consequently I had no fear of contracting the disease. I had been visiting scarlet fever patients eighteen months, and had had no symptoms of it during the time. Just at that time I sat up all night with a little boy who had the fever and died. I came home, and while sitting at my writing desk making charges, I felt chilly and stretchy; for two days I had fever and sore throat; thought I had taken cold from being up during the night. I had two boy children, the elder two years and the younger six months. In a few days they had scarlatina. A neighbor lady came to see me while sick, and brought her little two year old daughter with her; she took the scarlet fever. These cases recovered nicely under the above simple treatment. The little boy I spoke of dying, had some cousins who came from N. C. twelve months after the fever had subsided; some of his clothing was given to one of the little boys, who put on the clothes and had scarlet fever; and from him the balance of the children took the fever. There was no spread of the disease. CUBA, Tenn.
SAM'L HAMMONTREE, M.D.
THE NURSING OF
All who are interested in the care of children must hail with delight the improvement in their dress which has gradually taken place. The light and warm woolen materials of which such pretty costumes are made, and the high necks and long sleeves which have replaced the low bodies whose sleeves were chiefly "conspicuous by their absence."
The long, warm stockings which have ousted the white cotton socks of our own childhood days, and the lambswool of "Jaeger" combination garments, which would have scandalised our good grandmothers, who considered that fine linen underclothes were the only ones suitable for themselves or their children.
And if our winters continue to lengthen and our summers to shorten, we shall learn still more of the value of those materials which give warmth without undue weight—an important consideration for us all, but especially in the case of children.
And this question of weight is not yet sufficiently thought of in respect to the bed clothes of little people, for the quilt, which makes the cot so pretty and neat during the day, should be banished at night, when the blankets alone form a better covering, as they lie lightly over the sleeping child, and do not weigh him down as most counterpanes will.
All children should sleep in flannel nightgowns during the winter, and these can be made as pretty, if not even prettier, than calico ones. If subject to cold feet, knitted sleeping socks should be worn, but the latter must fit loosely, or else they may do more harm than good by their interference with the circulation.
If it is very cold weather, or if the child be delicate or chilly, a small blanket placed next to it is admissible and comfortable; but any heavy coverings are undesirable, and tend to make him restless and uneasy -this is proved if the removal of one blanket enables him to settle down into quiet and refreshing sleep.
Children suffering from rickets and from some other diseases habitually free themselves from their bedclothes; hence, to them, the value of flannel gowns and sleeping socks is very great, and these render the practice of sleeping outside the bed comparatively harmless as regards a risk of cold catching.
We have heard of a fanciful and, of course, wealthy lady, who engaged a trained nurse merely to sit up at night and replace the clothes when her children kicked them off. As the children were healthy, we may rest confident that either their suppers or their bed coverings were of an injudicious nature, and that an alteration in these would have obviated the necessity for a night watcher.
It is a great mistake to let little children, or big ones either, go to bed with cold feet, for the discomfort keeps them wakeful and fidgety, and this certainly does not improve either general health or temper. It is one of the points not sufficiently considered-one of the small miseries which need not exist -and yet it is one that is frequently overlooked in luxurious nurseries.
The ward nurse who makes children her special study soon learns the care that is needed in watching over little feet confined to splints, and she packs the tiny toes into a nest of heated cotton wool if the hot water tin does not suffice for their comfort.
We need hardly mention here, perhaps, the invariable rule that no tin or earthenware foot-warmer must ever find its way into a bed until it has been securely enveloped in a closely-fitting flannel case, and it is sometimes well, in addition, to put a fold of blankets between it and the child's sensitive skin.
From clothing and warmth we pass naturally to the subject of food, which has so much to do in the production of heat. Good and proper nourishment being an essential part of treatment, and coming into the province of nursing, of which Dr. Eustace Smith, in his introduction to his book on "Diseases of Children," says, "The details of nursing should always take precedence of those of drug giving."
In district nursing amongst the sick poor, the question of warmth and food are perhaps the most diffi
cult with which we have to deal, and it is only when we are able to administer, or to see administered, the proper amount of properly prepared nourishment, that we can feel any confidence that the child has some chance of recovery. Who can realise, as do the doctor and nurse, the value of hospital routine? the regular food given at stated hours and in proper quantities, for too much is as dangerous to a sick child as too little. How this contrasts with the haphazard feeding of the thoughtless, who give large quantities at long intervals, or else keep the unfortunate patient supplied constantly with things to eat, which, whether suitable or unsuitable in kind, are alike disastrous in quantity, giving no chance of rest to the already disorganized digestion.
In getting the proper nourishment not only swallowed, but enjoyed, the true nurse shines, for all her intelligence and tact are brought to bear upon the subject, and few indeed are the little ones who do not yield to her pleasant coaxing of their wayward tastes.
In the capriciousness of their appetites when ailing, children are all pretty much alike, but whereas an unusual dainty is easily suggested for the child of poverty, it is far more difficult to provide a novelty for the delicately nurtured child—but it can be done by the exercise of some ingenuity, and, in fact, we go further, and say that it must be accomplished; probably some quite simple article may answer the desired end.
To some of us may be given an instinct so reliable that we know how to satisfy, and, therefore, how to manage children, and this with but little effort to ourselves. To others it is as a difficult lesson, and one needing much study and many repetitions before it is mastered at last, for learnt it can be by all who are willing to try. Only they must start with respect and reverence, as well as love, for "the little ones;" they must not expect miniature men and women, but they will find something a great deal better. They will discover fresh, pure natures ready to be moulded into good and noble characters, a capacity for generosity and patience, hopefulness beyond description, and faith and affection without limit, for all who have charge of them. -The Hospital Nursing Supplement.
macology and Modern Therapeutics." Medicine, in its largest and broadest significance, is at once an art and a science, and is based upon observation, experiment and practice. As a science it must necessarily be inexact, for it deals with the highest organismthat of a man-under conditions the most uncertain, unstable, and complex. Hence the apparent fallacies in experiment, the errors in observation, and the slow and uncertain advance in practice. In purely and simply experimental research and laboratory work, at least some of the ordinary sources of fallacy may be controlled or eliminated, and thus more definite and correct conclusions be arrived at. To few, however, are such opportunities afforded, and with the rank and file of the profession rests not merely the recognition of disease and its treatment, but to no inconsiderable extent the advance of medicine in its practical issues.
If, however, it cannot be claimed that experimentally very large additions have in recent years been made to our powers of cure, in two directions at least there have been originated methods of procedure which have already added somewhat to these powers, and which are of great promise for the future. Most of our present remedies are the outcome of experiments made on natural products, animal, vegetable, or mineral, or on compounds which the chemist has put at our disposal in his efforts to penetrate those secrets of nature with which he is specially concerned.
Chemistry has taught us that the various organic groups may be combined in an almost infinite variety of ways, and that it is possible thus to produce thousands of new bodies, each of which will have a special action on the tissues and organs according to the groups of which they are composed, and the method by which the groups are united. Of late the chemist and the pharmacologist, working together, have built up for medicinal use a large number of these new compounds, joining together organic groups for definite
At least a score of new substances have been introduced during the past twelve months for the purpose of fulfilling some definite therapeutic want, and though doubtless many, probably the majority, will not be of practical service, still there is evidence that some may prove to be very useful medicinal agents and there is great hope that with increasing knowledge new compounds will be formed which will be of incalculable value in the treatment of disease.
The second therapeutic departure to be noted is for the most part one of promise only. It comprises the use of the products of the lower forms of life which are connected with disease, or, again, of the use even of microbes themselves as therapeutic agents.
The question whether the experiments made on the