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study of the urine, may be called the tripod for sustaining life and maintaining health in persons predisposed to suffering with gout, rheumatism, Bright's disease, or nervous affections.
In another column, evidence of a vegetable diet in the latter is furnished. We agree with the author quoted above that olive oil in the shape of the fruits containing it should become a more frequently used article of food. Children should become accustomed
There is no contingency which more forcibly re
to it in early life, and housekeepers should study minds the physician of the limitation of his power than the preparation of dishes containing it.
This general outline is intended as an introduction to future articles on this subject. It is the highest prerogative of the modern physician to prevent discase. This may be accomplished by teaching the members of his clientèle, as he alone may do with authority, how to adapt their food to the conditions of life in which they are placed. The farmer who wants to fatten a hog, gives him corn; if he wants to build up the nerve tone and spirit of a horse, he gives him oats. Why should we not adapt food to the work our clients propose to be or are engaged
It shall be the aim of this journal to advance the interests of its readers by plainly stated facts upon the subject of diet in health and disease.
In our last issue we dwelt at some length upon the unpromising financial position of medical men. We sought to arrive at some means to remedy the sad plight of the long-suffering but patient and plodding doctor. In a recent article in the Sanitarian, January, 1892, p. 20, we learn that on the Pacific Coast the weary and heavily laden from all lands may find food and shelter, which, after all, is the great desideratum of man-of the doctor even-on this sublunary sphere. We are told of the southerly coast of the Pacific Ocean :
"There is probably no region in existence where life from the cradle to the grave-the latter only reached at the natural declining periods of man -where existence is less beset with the quicksands of disease or the factors of physical degeneration.
"With the olive and the fig, the banana and other fruit, which are there easily grown; hills that swarm with quail and rabbits; inlets full of ducks and snipe, and a sea that abounds in the best of fish, man can live such a philosophical life that it will insure him. contentment in this world and one long life of everlasting bliss in the one to come, because in such a climate, where man is so physically perfect, his moral nature cannot go far astray; he is climatically made into a Christian."
Here is at last a chance for the overworked and also but too frequently underworked doctor. In the in
those hemorrhages which he cannot control by surgical means.
In hæmoptysis, for instance, the multiplicity of remedies bears testimony to their inadequacy. We have ergot and acet. lead, for instance, whose action may be explained theoretically, but is lamentably de. fective practically.
After all, rest and quiet-mental and physical-are the chief remedies.
Post partum hemorrhage is the most awe-inspiring of all bleedings, when we are unable to arouse uterine contractions. How helpless the physician stands at the side of the gasping, blanched woman, comes home to most of us at some period in our professional lives. Hence any method by which we may be able in the one case to harbor the blood supply and in the other to replace it so that the flagging heart may have something to contract upon should be welcomed.
Dr. Dawbarn, whose contributions to medicine usually bear the impress of practical utility, tells us in a paper read before the surgical section of the New York Academy of Medicine, that he has found a valuable resource in internal hemorrhage, the sequestration of blood in one or more extremities, until time has been given for the formation of a firm clot-say for an hour or so-and thus allowing the blood to reenter the circulation slowly. He thereby diminishes the blood pressure and conduces to clotting, especially if faintness is induced. Whenever there is bleeding, he says, acute enough to threaten life, and not within reach of direct pressure nor of the artery clamp, our main reliance should be the tourniquet or the twisting of a handkerchief near the junction of the limb and the body until the arterial pulse is just barely felt on the distal side. In pulmonary edema suddenly developed by cardiac exhaustion from any cause, he regards this procedure as the speediest means of relief to the tired heart, tiding over a critical period until by free stimulation the organ can be made to resume efficient work.
Dr. Dawbarn next discusses a novel method of infusion whose simplicity commends itself at once to our practical adoption. The day of transfusion of blood, he justly remarks, is past, because as good if not better results may be obtained from infusion of a simple salt solution, 6 to 1,000 of boiled water. This would be, roughly, a heaped teaspoonful to a quart of
the boiled water as hot as the hand can bear. this solution must be rendered strictly asceptic by boiling and be it remembered not rendered septic again by dipping the uncleaned hand into it for testing the temperature-goes without saying. An ordinary hypodermatic needle is pushed into the femoral artery until bright red blood issues from it. It is then connected with the upper end of a cleaned rubber catheter or drainage tubing, and the lower with the nozzle of a Davidson syringe. Care having been taken that no air remains in the rubber tube, the fluid is slowly injected. It requires considerable force to overcome the intravascular pressure, even in a flagging circulation; there is so much resistance that it seems as if a clot must be plugging the needle, but by half an hour of steady work a pint or more may then be injected. In the absence of the Davidson syringe a fountain syringe of the height of six feet may answer the purpose.
This simple procedure not only acted well in Dr. Dawbarn's experiments on animals, but also in a case of post-partum hemorrhage that seemed hopeless.
After the circulation was somewhat restored, Dr. Dawbarn used in this case the intra-cellular injection of the six-tenths per cent. salt solution, described in our issue of May, 1891, viz., injecting a few ounces at different points.
The readiness with which the necessary elements of the treatment may be obtained, renders it a valuable addition to our therapeutic resources. It is hoped that our readers will contribute to its furtherance by publishing their actual results with it.
Striking Results in the Treatment of Incurable Diseases.-A large number of cases of incipient phthisis, rheumatism, hysteria, and others whom the general hospitals either could not or would not care for, have been treated during the past year. Among 302 patients (affected with incurable diseases, seventy-eight (78) died). Many of the fatal cases occurred within the first week following their arrival, some not being here more than one or two days.
Of those discharged sixteen are entirely cured, and forty-three (43) much improved. Of the latter, five (5) to our knowledge, are practically well, and actively engaged at work. Amongst those cured we wish to refer to a young girl who came to us with a complete palsy of the left arm and blindness of the left eye, of functional origin. For two years she sought relief everywhere without avail. She was then referred to us as a hopeless case, but it has been our
good fortune to completely restore the power to her arm and vision to her eye, and remove her intense depression of spirits. She is now supporting herself as a domestic. This is the type of a number of similar but less severe cases where we have been equally fortunate. In all these cases hydrotherapy has been an important therapeutic agent. In one case of severe hystero-epilepsy in a man, it has been the one agent to which improvement is due.
As typical of another class may be cited the woman who left the institution just prior to the issue of the last report. She entered with a number of severe and often repeated hemorrhages. She also showed signs of extensive involvement of the right lung. She left the hospital with a gain of twenty-three (23) pounds, and every sign of marked general improvement. Now, at the end of a year, her husband reports her entirely well, and never having felt better in her life. During the past year, a man offering similar conditions was treated with a similar result and a gain of twenty-five (25) pounds. It is too soon in this case to speak of a cure, but the man is now a conductor on one of the elevated roads and seems entirely well. A few more cases of phthisis of less severity have also been treated with equally good results.
Incidentally in the treatment of phthisis, we have relied largely on creosote as a specific remedy, and aided it with cod liver oil, good food, fresh air, outof-door exercise and cold water externally as a general tonic.
Suspension has demonstrated its value in the treatment of locomotor ataxia. Some of our cases have been much improved. One in particular, who was hardly able to walk at all, has just left the institution feeling in excellent health.
Two cases of chronic Bright's owe marked improvement to the systematic application of hydrotherapy. Both had been treated for several months elsewhere, without benefit. Both suffered from extensive dropsy of the abdomen and legs. One had been repeatedly tapped. In fact on the day of admission it was found necessary to remove eight (8) quarts of fluid. Under the treatment indicated the dropsy has progressively disappeared, until now it is entirely gone in both instances. One of the cases, the father of a family, has left the institution and returned to work. Of course a cure is not to be expected, but what we have gained is a source of extreme gratification.
One hundred and twenty-four (124) are at present in the hospital. Of these seven (7) are entirely well and will be discharged at an early period. Forty-nine (49) are improved, some very materially (1890).
During the past year there have been treated three hundred and four (304) patients, including every possible type of chronic and incurable disease. Our death-rate has been sixty-three, representing the
smallest percentage (204 per cent.) in the history microbic rule ; putrid and more or less toxic gases and of the institution.
Of those discharged-eighty-nine (89)-seventeen (17) are well and thirty-eight (38) much improved. Of the former, ten (10) were cases of phthisis. Cold water externally and creosote and good food were the chief agents in the treatment. Of course an important factor here was in the selection of appropriate cases, incipient ones being preferable. As examples may be cited, H. S., infiltration of upper lobe of right lung, repeated hemorrhages, loss of weight, night sweats, profuse cough and expectoration. Result : entire disappearance of all objective symptoms, increase of twenty pounds in weight and entire disappearance of the phthisical signs. During the past six months he has been engaged as a fruit peddler, with increase of seven pounds, and no signs of recurrence. Another, B. S., with large cavity in left lung, increased thirty pounds and has been sent to the country with marked amelioration of the objective signand contraction of the cavity on physical examination. Want of space forbids my going into further details, but those interested may refer to the New York Medical Journal (Aug. 15, 1891). The man referred to in the last report as much improved is now working at picture frames, with no signs of his disease.
The use of water as a therapeutic agent in Bright's, rheumatism, and various diseases of the nervous system, has maintained its past record. J. D., sciatica, discharged from another institution as incurable, is now entirely well, treatment having lasted three months. T. R., cataleptic hysteria, has been discharged as cured, and has been engaged for months in the service of a prominent house of this city, without any recurrence of her disease. T. H., representing another and severe type of hysteria, with partial palsy of right arm and complete of the fingers, with severe contracture of the fingers, with signs of organic changes in the fingers and wrist, is now gradually recovering from those conditions. For four years she had been treated by some of the most eminent men outside of our institution with no apparent result. (1891.) Drs. Ettinger and M. Rosenthal in Reports of Montefiore Home for Chronic Invalids (Incurables.)
The Treatment of Insomnia of Gastrointestinal Origin.-An instructive editorial in the Therapeutic Gazette contains the following practical conclusions as to the dietetic treatment of insomnia from indigestion:
1. Errors are most frequently committed as to quantity. The digestive organs may be competent to dispose of a certain bulk without pain or difficulty, while an excess causes embarrassment to the stomach ; decomposition and flatulence set in under unmolested
ptomaines are generated, and a "bilious" condition supervenes, such as every one has experienced at times. It is, doubtless, true that while multitudes are underfed, more persons are injured by excessive eating than by a spare diet. Insomnia naturally comes in as one of the consequences of overeating and overdrinking, for a burdened stomach will not let the brain rest.
The proper remedy for sleeplessness arising from this cause is apparent it is to curtail the daily rations to the physiological standard. The necessity of eating slowly and deliberately with thorough mastication of the food is apparent; those that "bolt" their food are sure to eat to excess.
2. Food of poor or insufficient quality produces anæmia and starvation of vital organs, including the cerebrum, and hence engenders insomnia. Physicians cannot too much insist on the necessity of a full diet
that is, of an adequate admixture in the daily fare of albuminoids, fats, and carbohydrates. Food of indigestible quality produces essentially the same evils as excessive alimentation. Under this head may be included food improperly or insufficiently cooked (good cookery under our civilization has become indispensable to healthy digestion), and foods that most persons of sedentary habits find hard to digest, as unripe fruit, pastries, hot bread, fried pork, confectionery. Of course butchers' meats should be selected that are tender and juicy, and in the light of recent discoveries (Gautier, Selmi, etc.), it is doubtful if meat or game that has become high (faisandé) is fit for food.
Foods of themselves sufficiently digestible may become indigestible if too many kinds are eaten at a meal. But this brings us again to the evils of excessive eating.
It need not be repeated that he who would sleep well must avoid those articles of diet which have been found to be indigestible, or should indulge in them sparingly. Much depends, of course, on the muscular work done. Horace speaks of the dura ilia messorum, The hay-makers on the salt marshes need food hard of digestion that is, food that is slowly digested, yielding up force for many hours; food that in common parlance "stays by," such as baked beans and pork, boiled beef and cabbage, and mince pie. Such persons sleep well, despite their hearty fare; it is especially the "brain-workers," the men of sedentary habits, that are upset by a rich diet.
3. A healthy digestion presupposes a healthy state of the stomach, intestines, and accessory organs, and any derangement of these viscera must be corrected by suitable medicinal and dietetic means before normal sleep can be enjoyed.
To enter on a consideration of all these derangements would take more space than we have at our
command. The hygienic treatment of indigestion includes dieting, exercise, recreation, cold bathing, etc. The cold shower-bath in the morning is sometimes a powerful aid to digestion. Exercise promotes a more vigorous circulation, and favors peristalsis and chymification; equally necessary are change of scene, diversions, and the cultivation of a contented, cheerful frame of mind.
Nourishment in Acute Disease.--Dr. F. H. Williams (Boston Medical and Surgical Journal) writes as follows on this subject :
In acute diseases accompanied by fever, what are the conditions? The body loses weight, the urea especially is increased, and carbonic acid and water are excreted in larger amount than in health. All of this loss is not dangerous if allowed to go on for a few days only, and if the amount does not exceed certain limits.
But to replace these losses we are at a disadvantage as regards the ability of the system to assimilate food. In fevers, the appetite is small, or may be completely lost. The saliva, the gastric juice, the pancreatic fluid, the bile, are less efficient in action, or are diminished in amount during high temperature. The stomach is very sensitive, in part perhaps through sympathy with the increased sensitiveness of the nervous system as a whole. If there is much hyperæsthesia of the digestive tract, as in typhoid, in peritonitis, in dysentery or gastro-enteritis, one must be careful not to give too much food, and it should be in liquid form.
It is not, however, the administration of food, but the administration of unsuitable food, that we have to fear, and also the giving of nourishment in quantities unsuited to the digestive powers of the patient.
One should not give the patient what he cannot digest, nor should we give him less than he can assimilate. The attendant must have a constant watch over the condition of the patient's powers of digestion, and carefully adapt his food to his capabilities, especially during convalescence.
Our attention should be devoted not only to what is put into the alimentary canal, but also to what goes out. For example, if curds of undigested milk are found in the stools of a typhoid patient, the quantity of milk should be diminished, or it should be diluted.
Large quantities of milk are often given to typhoid fever patients, to their great detriment, and excess of zeal in feeding and too little care in the preparation of the food, cause much of the intestinal trouble that complicates these cases. In diphtheria, foods which are soft in consistency, rather than liquids, may be used, as they are less apt to get into the trachea.
Every careful observer of the sick will agree that many patients are starved in the midst of plenty,
simply from the want of attention to the ways which alone make it possible for them to take food. For example, if the patient has a fever with remissions or intermissions, it is of the first importance to remember that the ability to digest food at these times is greater, and the more nourishing portions of the diet should be given during the remissions and intermissions.
As far as practicable, the mouth should be kept clean. The tongue may become cracked and dry; it may stick to the sides of the mouth, and cause so much pain when the attempt is made to swallow that the patient refuses food which he would otherwise take. The mouth should be rinsed with water after taking food, and should be carefully cleansed with an antiseptic solution from time to time. In a word, for extreme cases the important thing is liquid food. We should give water. We should give sugars (starches have no taste, but are less readily absorbed). are not tolerated. Salts are present in nearly all foods. We should give albuminoids, in beef juice, in peptonized milk. Ordinary milk becomes solid in the stomach.
The physician should never lose sight of the patient's likes and dislikes; one cannot diet a patient from a book, or from the chemical composition of foods. On the other hand it is incumbent upon the physician to know how to choose such a variety in diet as to include both what is palatable and what will include a proper amount of nourishment.
Premonitory Indicaton of Typhlitis in Children. An article on this subject in the Revue de Thérapeutique Medico-Chirurgicale, August 18, 1891, states that before the acute explosion of the disease there is always a period characterized by a number of symptoms independent of typhlitis, and J. Simon is quoted as saying that at the outset inflammation of the appendix is not the rule. The predisposing causes of typhlitis in children are heredity, improper alimentation, and neurasthenia, and such states of the nervous system as hinder the normal contractions of the intestine, which, however, may be secondary to the derangement of the digestive apparatus. In some cases the main premonitory symptom is an obstinate constipation, the stools are scanty, hard, and covered with a glairy mucus; the bowels are never fully emptied, and a doughy, painful tumor is felt in the right iliac region. A good appetite may be maintained for a long time, until the gravest symptoms set in. In other cases there is anorexia, with a disgust for meat, offensive eructations, intellectual and physical apathy, and obstinate headache. In this period the local condition becomes aggravated, the doughy tumor persists, and serious and slowlyhealing lesions may be set up in the cæcal region. The muscular coat does not act the cæcum is filled
up, the appendix is invaded by foreign bodies. Local signs determine the diagnosis, and the cæcal region of a child with these symptoms must be examined. If nervous or reflex symptoms dominate, the existence of other conditions, such as urinary lithiasis, floating kidney, hernia, and lymphatic hyertrophy, must be sought for. The treatment is essentially hygienic; regularity in meals, soft foods, coffee, tea, beer, and a slightly alkaline water. Augment these with oil in small, frequent does, a tablespoonful of flaxseed in half a glass of water every morning, or a mixture of a teaspoonful of castor oil and a half teaspoonful of oil of sweet almonds. Faradization of the intestine through the abdominal walls may be tried, as well as massage for the nervous system. A trip to the country is good, but the seashore should be avoided.University Medical Magazine.
A Plea for the Liberal use of Butter.Hutchinson, of England, makes the following earnest plea for the free use of butter: No dietetic reform would, I believe, be more conducive to improved health amongst children, and especially to the prevention of tuberculosis, than an increase in the consumption of butter. Our children are trained to take butter with great restraint, and are told that it is greedy and extravagant to eat much of it. It is regarded as a luxury, and as giving a relish to bread, rather than as in itself a most important article of food. Even in the private families of the wealthier classes these rules prevail at table, and at schools and public boarding establishments they receive strong reinforcements
from economical motives. Minute allowances of butter are served out to those who would gladly consume five times the quantity. Where the house-income makes this a matter of necessity, there is little more to be said than that it is often a costly economy. Enfeebled health may easily entail a far heavier expense than a more liberal breakfast table would have done. Cod liver oil costs more than butter, and it is besides often not resorted to until too late. Instead of restricting a child's consumption of butter, I would encourage it. Let the limit be the power of digestion and the tendency to biliousness. Most children may be allowed to follow their own inclinations, and will not take more than is good for them. The butter should be of the best and taken cold. Bread, dry toast, biscuits, potatoes and rice are good vehicles. Children well supplied with butter feel the cold less than others, and resist the influenza better. They do not "catch cold" so easily. In speaking of children I by no means intend to exclude other ages, especially young adults. Grown-up persons, however, take other animal fats more freely than most children do, and are besides allowed much freer selections as to both quality and quantity. It is not so necessary to raise any clamor for reform on their account.
may be out of place to remark that if a greatly increased demand for fresh butter should result from a change of custom such as that suggested, it could easily be met by those concerned. There need be no increase in the cost of the article, whilst at the same time a benefit would be conferred on our home farmers.-Columbus Medical Journal.
A Prolonged Fast.-Dr. S. Seilikovitch (Times and Register) relates an interesting case, reported by Warshawsky in Vratch, Nov. 19, 1891. The patient, a woman thirty-five years old, who had made up her mind, in consequence of extreme poverty, to starve herself to death. For this purpose she found refuge in the garret of an uninhabited house at a distance from town. The garret had broken windows, admitting of free access to winds and frost. In the first days of her fasting she was still able to get up to pass urine; but afterwards she lost the strength to do this, and could not leave her seat. The janitor of that house accidentally entered it, and hearing feeble human cries and sighs in the garret, he immediately notified the local authorities of the fact, and the sufferer was removed to the hospital.
The patient was in full consciousness; but the pulse in the radial artery could not be appreciated; the heart sounds were scarcely to be heard; the body extremely emaciated, covered with and eaten up by insects; the skin had assumed a yellow earth-like tint; the cardiac region and the whole upper part of the abdomen extremely tender. According to the patient's statements she had not taken food for twentysix days; neither did she have a drop of water; her bowels had not been opened in this time.
In the hospital she was given to drink a little port wine and milk. Epigastric pain disappeared after a spoonful of castor oil. Then the patient began to improve gradually; but the radial pulse could not be felt as yet. During the first two weeks of her hospital life she suffered from a slight diarrhoea and oedema of the legs. Little by little, however, all the pathological symptoms disappeared, and the patient finally completely recovered.
NUTRITIVE VALUE OF MILK.
A child brought up on milk alone, and weighing at birth 3,200 grams, will gain in weight as follows: During the 1st three months. 23.35 gr. daily.
Making the increase of weight during the first year about 6 kilograms.
During the 2d year the increase in weight will be about 2 k., 000 gr.
During the 3d year the increase in weight will be about 1 k.. 200 gr.
During the 4th year the increase in weight will be about 1 k., 700 gr.
Making, up to 5 years, a total increase of 12 k., 570 gr. -M. P. Cules, in Rep. de Pharmacie.