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in restoring the normal equilibrium. All this leads to the inference that by lessening the intake of salt with the food we should abate its proportion in the blood only to a slight degree, but should diminish its proportion in the synovial fluids and fibrous tissues considerably. Acting on these ideas I have been in the habit for some years past of directing gouty patients to restrict, as far as practicable, the use of common salt with their meals.
Sick-Room Dietetics.—It is rarely easy, and almost always very difficult, to persuade the sick to take nourishment in sufficient quantity; and the successful nurse must be rich in expedients. Her persuasive power must be great. She must be patient, and yet firmly persistent, until her whole duty is done. There are certain general rules for her to observe. A few of them we will give. All foods for the sick should be of the very best quality, well cooked, pala tably seasoned, and attractively served. A savory dish will always sharpen the appetite of one in health; and it must have a stimulating influence upon a debilitated patient, to whom the flat and insipid preparations usually offered are loathsome and even nauseating. Surprise is frequently a useful element in the dietetic treatment of the sick. Something unexpected will often be acceptable, when, were the patient consulted and advised of what was being prepared for him, it would take away all appetite for it. Cooking in the sick-room is, of course, always forbidden; nor should the smell of food be allowed to reach the patient if it is possible to prevent it. Absolute neatness in the serving of food is a prime consideration. There is more to the patient in clean napkins, spotless china, etc., than many think. A slovenly nurse is out of place anywhere. If the doctor directs that certain foods should be given hot, he means that they should be hot, and not merely warm, in which condition some are very insipid.
Occasionally one sees the nurse tasting the food in the presence of the patient,-a most unpardonable habit. No more food should be at one time taken into the sick-room than is likely to be eaten, and whatever is not should be at once removed. Nurses often leave it in sight, in the hope that the patient may want it a little later; but almost invariably they are disappointed. It is quite a common thing for the physician to find milk in a glass or pitcher standing near the bedside of his patient; and often the appearance of the glass is such that even a person with the strongest kind of a stomach would not care to drink from it. Of all foods, milk probably takes up impurities the easiest. Hence to keep it exposed to the air of a sickroom or any other bad air is simply to render it unfit for use. A nurse with anything approaching neatness would never allow a glass which has held milk to be
used a second time without careful washing and rinsing. Some consult their own convenience altogether too much in feeding the sick.
Food ought to be given at regular intervals, when possible. If given punctually at fixed hours, a habit not only of taking, but of digesting it, will soon be acquired; for our most automatic functious are influenced by custom. In this connection there is a rule which nurses should never violate. It is that of keeping for the physician an accurate record of the quantity of food taken at each feeding. As to whether or not a patient should be aroused from sleep for food depends upon the disease from which he suffers, and upon his condition. The physician, of course, must advise. As a general rule, it is not best to awaken a patient for the purpose of feeding except in desperate cases. In feeding helpless patients, the food must be given slowly, and in quantities easily disposed of. See that each morsel be swallowed before another is given. A drinking tube is always of great assistance; and it is better to use that, when possible, than the spoon, not only for the reason of convenience to the nurse and comfort to the patient, but because he will often take larger quantities in this way than he can be induced to in any other. Drying the lips and the corners of the mouth after feeding is a necessary precaution against sore lips, which not infrequently result from want of this little care.-The Trained Nurse.
The Hydriatic Treatment of Sciatica. Among the one hundred and thirty-five cases of sciatica treated during the last twenty-five years at Prof. Winternitz's Hydriatic Institute at Kaltenleutgeben, fifty-seven per cent. were completely cured and thirty-seven per cent. considerably improved. A marked case of this disease is cited to illustrate the methods of treatment at this well-known institution. The patient, a man aged 25, was predisposed to tuberculosis and had suffered from two attacks of hæmoptysis, the first in his fourteenth year. In July, 1891, he acquired sciatica on the left side as the result of sitting on a cold and wet stone, and was seized with paroxysms of violent pains, during which his vertebral column was curved anteriorly and toward the right side.
In September, 1891, the patient was treated for four weeks with baths of a temperature of 104° F. and duration of one-quarter to one-half hour, with administration of eight grammes of salicylate of soda per day. After two weeks' treatment he was in a worse condition than before. The pains had increased, and scolosis had become SO marked that the upper cervical and thoracic segment of the spine was almost horizontal in position. A surgeon was consulted, who diagnosed disease of the vertebral bodies and practised extension during narcosis. Massage was again
resorted to, but after fifteen sittings was discontinued because of the increased pain produced. The hot baths, which were later supplemented by hot packs, also enhanced the subjective disturbances, while applications of ether spray were likewise ineffective. Three months after the beginning of the disease the case came under Prof. Winternitz's treatment at Kaltenleutgeben.
The patient was extremely emaciated and presented signs of phthisis at the apices. In view of these conditions mild hydriatic measures were at first resorted to, such as ablutions of part of the body. After the first and second partial ablution of a temperature of 63° F. the skin reddened only slightly and slowly, as is frequently observed in severe anæmia and neurasthenia. To stimulate fluxion to the skin, dilate the cutaneous vessels, and increase tissue metabolism, the temperature of the water was rapidly reduced from 63° to 59° and 54°, and the mechanical effect was enhanced by vigorous rubbing of the skin, except over the affected parts.
In this way the skin was prepared for the active treatment, which consisted chiefly in the use of the Scottish douche. After a general rain douche of a temperature of 86° lasting for ten seconds, the entire body, but especially the affected left extremity, was exposed to hot vapor of a temperature of 120° F., and after ten seconds to a spray of a temperature of 48° F. Hot vapor and cold spray alternated three to five times produced intense redness of the skin, after which the patient was subjected for about three seconds to a rain douche of 48°, and after being rapidly dried and dressed was exposed to the sunshine or put to bed.
As the patient was markedly anæmic great care had to be taken to prevent much loss of heat, and for this reason the partial ablutions were practised in bed, and the other procedures were arranged accordingly.
The Scottish douche was employed three times a week, and during the intervening days the patient was exposed to the effects of a cold shower bath (with movable spray) for fifteen seconds.
From the beginning of the hydriatic treatment a rectal irrigation of about one pint of water containing a little salt and having a temperature of 77° F. was undertaken every morning and continued for six weeks, notwithstanding regularity of the intestinal functions to remove fæcal accumulations.
Another important factor in the treatment of the sciatica was the employment of the moist pack, applied around the entire abdomen and region of the hip down to the middle of the thigh every night. A moist compress covered with a dry bandage was also applied to the left lower extremity.
The sensitiveness to pressure of certain lumbar ver
tebræ and the pains over the crest of the ilium on the left side were promptly relieved by Winternitz's cold coil (55° F.), which was placed between the layers of a compress. The patient's general condition greatly improved, and at the end of a week the partial ablutions were replaced by half-baths of a temperature of 84° to 77° F. and of three to four minutes' duration. The soothing effects of this procedure were enhanced, two weeks later, by moist packs applied threequarters of an hour previously. Eight weeks later the scoliosis had to a great extent disappeared, and the tenderness in the left trochanteric region had nearly subsided, while the kyphosis was no longer present. Since then the sciatica and kypho- scoliosis, anæmia, and neurasthenia have been completely cured, and the pulmonary condition is greatly improved.-Blätter für klinische Hydrotherapie, 1892, Dr. Pospischl.
The Mosaic Laws on Meat Sanitation. -The great sanitary importance of the Mosaic laws for a pastoral people pitching their tents on the open, grassy plains, and living, in a sense, in common with their vast flocks and herds, is manifest without argument. The parasites and contagia that they mutually harbor increase and dominate in exact ratio with the close aggregation of their hosts--human and bruteand the facility of their transmission from one to another. The prohibition falls first on those flesh feeders that are the most likely to reciprocate with man in the maintenance of parasites and infections. Then it denounces the sick as especially dangerous, and finally, that which dies full of blood and is correspondingly liable to early putrefaction. The prohibition of blood was probably ritualistic rather than sanitary in its object, yet we need not ignore the experiments of Signol, who showed that the portal blood of a suffocated horse contained a poison that could be conveyed from horse to horse with fatal results through several successful generations.
The simple avoidance of the dead body and uncooked meat iu the case of many early peoples, though showing a similar precautionary tendency, is far less effective than the prohibitions of the Jewish code. We can still observe the good fruits of the latter in the comparative immunity of the Israelite from such diseases as trichinosis, the pork tapeworm and tuberculosis.
These examples of tribal hygienic laws, however well suited to an age in which the knowledge of disease and its causation was but as a glimmering spark of fire sadly antiquated and ineffective in the strong electric glare of the nineteenth century; yet even now our hygiene of meats, as applied to our stockyards and markets, is far behind that which the Jews have practiced for over three thousand years.-Prof. Law, of Cornell.
The Simplification of Therapeutics.— The day of a more precise, hence more scientific, application of remedies in the management of disease is dawning. Polypharmacy is the offspring of that mysticism with which our forefathers were wont to surround themselves unconsciously. In all other phases of human endeavor a spirit of inquiry is abroad; the devout churchman even asks questions to-day which a few decades ago he would have deemed sacrilegious to entertain. He does not on that account lose aught of the true essence of religion; but he satisfies his reason as far as is consistent with his faith. We cannot marvel, therefore, if the doctor's clients often want to learn something of the agencies resorted to in combating an enemy supposed to reside within them.
The multi-pharmaceutical prescriptions we give him are not open to his comprehension; indeed candor would oft compel the prescriber himself to acknowledge a lack of rational appreciation of the objects and aims of his medication.
It has come about, therefore, that the latter has become more simplified. The shotgun prescription of a former epoch is now rarely seen. The trend of teaching now is in the direction of the rationale of remedies. Thus the student becomes less slavish in his adherence to formulæ because he understands better the principles underlying the action of their component parts.
We may learn a valuable lesson on the Evolution of Simplified Therapeutics, and its enormous value, from the surgeon. When antiseptic surgery first astounded the filth-ridden surgical world, the minutia of spray, gauze, protective, etc., seemed absolutely necessary to success. We discover now that polyantisepsis is unnecessary; that the chief element of true antisepsis is asepsis or cleanliness. The scrupulous, unflinching, searching and skeptical cleansing of the field of operation, of the operator, and of the wound, proves to-day to be the source of the most brilliant surgical statistics. Dr. C. Schimmelbusch, upon whom devolves the preparation of cases for the most renowned surgical clinic in Germany, considers "boiling water as the most powerful of all disinfecting agents." He says: Instruments are best sterilized by boiling in a one per cent. watery solution of carbonate of soda for five minutes; the soda increases the sterilizing power of the boiling water, because it removes all fatty material and prevents rust. What is this but plain, unvarnished cleanliness. While this evolution to the simpler, hence higher, type of treatment is going on in the brilliant field of surgery, let the physician draw lessons of value from it. May we not by simplifying medication, by boiling down, as it were, our formulæ to active therapeutic entitles, by eliminating mystical, inexplicable
methods, and holding fast only to simple, rational, demonstrable therapeutic agents, do as much for internal diseases as the surgeon has done for the palpable or external. It is a consummation devoutly to be wished; it must come in good time. In the meanwhile the sick are languishing or dying under our ministrations. "Let us be up and doing." Who shall be the Lawson Tait of Internal Medicine? The man who is bold enough to combat the prejudices of that most prejudiced middle class-the medical practitioner.- Gaillard's Med. J. Editorial.
Dietetic Treatment of Bright's Disease. -Chronic Bright's disease is divided into three well recognized forms: (1). Chronic parenchymatous nephritis; (2). Lardaceous disease of the kidney; (3). Interstitial nephritis. (1). The first form may begin insidiously as a chronic disease, or may follow an acute affection. In either case the same rules of diet may be applied. As food, an exclusive milk diet is generally considered to be the best, and the author would favor its employment, because it is easily assimilated, gives sufficient nourishment, produces less urea and flushes the kidneys with a large amount of fluid. When milk cannot in any way be taken, we are obliged to resort to broths and light farinaceous foods. As a beverage the author prefers pure spring water, of which several pints a day should be drunk. Pure or mildly alkaline water in large quantities is an excellent, unirritating diuretic. When milk is not well borne alone, it may sometimes be taken mixed with lime water, carbonic water, Vichy, etc., or as kumyss or peptonized milk. When milk is used pure, it had better be unskimmed, unless it produces digestive troubles, in which case it is best to skim it. From two and a half to four quarts are sufficient to prevent bodily loss. As a result of clinical experiments instituted by him, and which he details, and from the experience of others, the author believes that a milk diet notably diminishes the amount of albumen excreted by the kidneys. After a time an exclusive fluid diet may be productive of harm by causing an over-dilution of the gastric juice and too great an excretion of urine, or the symptoms of a analmia and exhaustion. In such cases, especially if the amount of albumen be small, the exclusive milk diet may be supplemented by a certain amount of farinaceous or vegetable food. If even this diet becomes objectionable, a small amount of broiled or roasted meat must be allowed daily, taken at an early dinner. Alcoholic stimulants throw more work on the kidneys and increase the amount of albumen excreted. They are, therefore, to be avoided, except when called for by certain symptoms, as exhaustion or the profound cerebral anæmia which so often accompanies uræmio symptoms. (2). The dietetic treatment of lardace
ous disease of the kidney depends somewhat on its cause. If it be phthisis, the diet is that appropriate for this malady, without special reference to the renal disorder. When the disease which caused the renal changes has disappeared, the diet should be that advised for chronic parenchymatous nephritis. (3). In the dietetic treatment of this form of nephritis we must endeavor to prevent the accumulation of urea in the blood, and to make up for the loss of albumen. It is not possible to prohibit all nitrogenous food, but the amount allowed should be very small. Milk and cream should be given in abundance, and the other articles of the diet supplied from the vegetable kingdom. In advanced cases, an exclusive milk diet must be employed, and the milk may be diluted with Vichy, if necessary, to render it more palatable. Alcoholic stimulants should be avoided as far as possible, except sometimes in the treatment of uræmia, as stated above. The author closes his paper with a series of quotations of the views of various modern writers regarding the dietetic management of chronic Bright's disease. Am. Journal Medical Sciences.
Preventive and Curative Drinks and Medicines.-Put not your trust in nostrums; cholera does not come by Providence and go by medicine," although that is a common and ignorant belief in respect to it, and many other diseases. A tried and safe preventive of the tendency to diarrhoea (which should always be checked) is sulphuric acid lemonade, made by acidulating boiled and sweetened water to taste with dilute sulphuric acid (or, as at the post-office, Dr. Waller Lewis's very palatable sulphuric orangeade.) The citric acid lemonade lately vaunted was rather inferior in value to this. The cholera bacillus, as we now know, was favored by an alkaline fluid, and did not live in acid media. An excellent and well tried preventive of the prevalent slight diarrhoea was the Vienna mixture (used in barrels formerly in hospital practice.) It consisted essentially of 15 drops of dilute sulphuric acid to 6 ounces. of boiled and sweetened water, to which might be added, under medical advice, 10 drops of sulphuric ether and 5 drops of laudanum for an adult. O icebags, camphor solutions, and other expedients of the kind no reliance could be placed, except in skilled hands and for selected cases. Many people poisoned themselves with camphor during a late epidemic, as a precaution against cholera. Once established, and in well-marked cases of Asiatic cholera, drugs would do little to cure. The mortality of cholera all over the world and in all epidemics had defied drugs-just as severe arsenical poisoning would do-and varied. according to intensity and the age and condition of the patient from forty-five to sixty-four per cent. It was eminently a case in which prevention was far more efficacious than cure.-Ernest Hart.
The Flesh of Diseased Cattle.-No idea can be formed of the amount of flesh of animals, which have died or been killed because of disease, that finds its way into the market as human food. There can scarcely be a doubt that thousands, perhaps tens of thousands, of cattle, sheep and pigs are bought by the less reputable butcher or the "dropped meat salesman," and prepared by them for consumption, the beasts being at the time of purchase hopelessly ill or already dead. A great traffic must be going on in such flesh, as the carcases are rarely buried, and inquiries at the knackeries tend to prove that they very rarely find their way to these establishments. It is generally the custom for the owners of sick animals to send for the butcher to take them away either dead or alive, and probably after they have received a large quantity of drugs, some of these being, perhaps, of a poisonous description. What becomes of the carcases we can only surmise, but that they are dressed and exposed for sale can scarcely admit of a doubt; indeed, it is a moral certainty to which veterinary surgeons and others could testify. Even in the ordinary slaughter houses diseased animals can often be seen either before or after death, and the fact of their flesh being refused sale is never heard of.
The butchers could tell some startling stories with regard to this matter if they cared to do so; but everything is kept dark respecting it, and it is only at rare intervals that a chance discovery is made of some carcase that should have been buried, being found either in transit to the meat market, or actually exposed for sale on the butcher's stall. The slaughterhouses are private places where anything may be done in the way of dressing up diseased carcases without much fear of detection, either there or afterward; and there is only too much reason to apprehend that great cruelty to animals is inflicted at times in such obscure places. The only remedy appears to be the introduction of public abattoirs whenever possible, and, where these cannot be established, the institution of a system of thorough inspection of the private slaughter-houses. There should also be some means of preventing the carcases of animals that have died from disease, or been killed on the owners' premises because of illness, from finding their way into the meat market, unless certified by some competent person as fit for human consumption. For it must be remembered that in the great majority of instances such flesh must be not only of poor quality, but possibly absolutely dangerous either from its own special poisonous properties or because of the drugs which may have been administered before death. When the carcases have once been dressed by a cunning butcher-as men who engage themselves in such a business usually are-it is very difficult indeed to detect anything amiss with them by even a moder
ately skilled person, and they therefore escape notice as a rule. Veterinary surgeons, especially those in country practice, could do much in restraining this nefarious trade of the "dropped meat" salesman; but a wide-ranging and systematic inspection of slaughter-houses and meat is the only sure safeguard for the public health. Of the prevalence of disease, parasitic and other, among animals whose flesh is consumed by man, we have ample evidence in the reports published periodically by the continental public abattoirs, and there is no reason to expect that such disorders are less extensive in this country; while added to these we have the secret disorders, such as puerperal fever, anthrax, tuberculosis, swine plague, etc., which are not in evidence in these establishments, with the exception of tuberculosis, animals which are so affected, but are in good or fair condition, being often sent there for slaughter.-London Lancet.
The Medical Calendar.
The Colon Douche in Acute Diseases. -It has come to be regarded as a necessary part of the treatment of chronic complaints to use the colon douche, but so far as I am aware it has not been recommended in what are called acute attacks. When intelligently and faithfully applied it is none the less beneficial for a great many conditions that we find in acute attacks of disease than in the more chronic forms where its use is not questioned. In congestion of the lungs, congestion of the liver, in acute jaundice, typhoid fever, and many of the different phases of la grippe, and in acute rheumatism, I have succeeded in relieving attacks that threatened to prove serious, by using the colon douche.
Mrs. B., aged 76, contracted a hard cold that threatened to result in pneumonia, her pulse 136, temp. 104, resp. 32, skin dry and hot, tongue dry, with red edges, hard dry cough and sharp pain through the lungs. After trying for three days to change the conditions with medicine, gave her a colon flushing of nearly four quarts of hot water, in three hours the skin was covered with profuse perspiration, the cough was not so dry, the fever much less, and all the conditions were better, and from this time the remedies that before seemed powerless to do her good, now had a positive action and the case went on to a quick recovery. She had had several attacks of pneumonia before, and this was the first time it had ever been aborted when it had attacked her so violently.
Mr. H., aged 30, had migratory rheumatism of the larger joints, affecting in turn the wrist, elbow,
shoulder, hip, knee and ankle. It had made three successive round trips and was starting on a fourth when we concluded to try colon flushing giving him nearly four quarts of hot salt water at once. The reaction thus induced was sufficient to completely stop the fourth trip, and in four days he was out-of doors for the first time in as many weeks.
These are only a few of the cases in which I have used the colon douche and I think when there is an interruption of the circulation, as in many cases of acute diseases, that much good oft-times results from the use of the colon douche, I would recommend it after it has been demonstrated that remedies are not sufficient to produce the desired result.-Dr. Coggswell in Jour. of Orificial Surgery.
The Epidemic at Hamburg: Its Explanation.-Hamburg, which had been poisoned by immigrants and sailors from Russian ports, had unhappily presented filth conditions not inferior to those which had invited the devastations recently of Russia, and of late years of Naples, Sicily, Spain, Marseilles, Toulon, and the mild outbreaks of Paris-all epidemics spread by filth in water and soil-of which Mr. Ernest Hart stated he could give, if time allowed, exact, authentic and fully-admitted details. Most of those cities had learned the lesson and taken it to heart more or less completely; to the extent to which they had done so they would have relative immunity in the future. Hamburg had not; the Elbe was filthily polluted, and it furnished the drinking. water of the city, very ill-filtered or unfiltered. The drinking of the water, except after boiling, had now been strictly forbidden, and the river baths were closed. According to the extent to which these edicts were rigidly enforced and carried out, the present epidemic would be limited and rapidly decline. This would do more than the "sprinklings" with tons of disinfecting powder and "vague libations" of thousands of gallons of antiseptic fluid, of which much had been heard during the last few days. Hamburg had sinned against natural laws, and was unhappily paying the penalty in suffering. "The soul that sinneth it shall die."-Ernest Hart.
Chloro-Phenique in Diphtheria.-Dr. W. N. Bahrenberg, of St. Louis, writes: "In twelve cases of scarlatina accompanied by diphtheritic sore throat, treated by me recently, I used a spray composed of equal parts of Chloro-Phenique and water as a topical application. It caused an immediate cessation of fetor and gave great relief to the patient. Convalescence was rapid in every case. I have also used Chloro-Phenique as a gargle and mouth-wash, and as a spray in otorrhoea and ozcena, with uniformly good results."