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ted how long, there was apparent improvement in the local condition; but at the end of a week all of the phenomena became suddenly ag. gravated—the effusion over the surface becoming general. The Doctor endeavored faithfully to “ascertain, if possible, the real seat and nature of the complaint, as a foundation for a rational plan of treatenent; but was ever disappointed. None of the recognized causes of effusion were to be found “in the present or past history of the patient." “ Therefore," the Doctor gave more calomel, adding quinine. Five days more of this treatment, and “the circulation became involved," which, up to this time, had been normal.
Dr. Sexton was now called in. The symptoms were now, in addition to the general effusion, “fever-pulse one hundred, full and not resisting; tongue red, inclining to dryness; secretions of mouth adhesive; thirst and general suffering; urine scanty and high colored; bowels rather torpid, and the skin harsh and dry.” Three weeks of culomel not having accomplished satisfactory results, it was determined to continue the drug, with sufficient antimony tart. to effect moderate but constant nausea!” The antimony did not nauseate, but produced catharsis, which seemed to drain the body for a time, and febrile symptoms subsiding, the doctors were flattered with hope. A week longer, however, found the patient not only not cured, but growing worse; and it was determined “to give cream of tartar a fair trial;" but the Doctor dared not risk it without continuing his favorite calomel. Dr. Sexton came again and “cordially approved" of the plan—with the addition of friction applied to the lower extremities, with salt, vinegar and mustard! From one to two ounces of the cream of tartar were given daily, and also drink of cider holding in solution horse-radish, juniper berries, &c., was allowed. Morphine was administered at night to allay the pain produced by the other drugs taken during the day! Ten days of this treatment (added to all that had gone before), , and the patient chilled! and the Doctor found him hot with fever, with pain in the right thigh, the surface tender and swollen, with a blush simulating erysipelas. This rapidly extended downward to the ankle, upward to the umbilicus, including genitals, and right abdominal regions. The doctor now concluded that an abscess would form in the thigh, "and that its completion would be salutary.”
Dr. Helm saw the case, and expressed an opinion "that the pressent imperfectly formed erysipelatous action would, in all probability, result in a collection of semi-organized pus, and such an occurrence would be highly beneficial, working a crisis in the case; that it was
one of nature's efforts to form a crisis, to get rid of the large amount of morbid material effused into the cellular tissue." The Doctors agreed in the opinion, "and were an.cious that nature would accomplish it.” But nature, alas, like Mrs. Dombey, was too far spent to make "the effort," and the Doctors were left in their dilemma, with no alternative but more calomel, with the addition of squills. The inflammatory phenomena began to recede and disappeared; but there followed, or "arose a very curious state of the skin, corresponding to the seat of inflammation." We omit the Doctor's description, but can not omit his conclusion, that it was a varicose state of the capillaries of the integuments.” “The kidneys now failed to do their duty." "It became evident that effusion was taking place in the abdomen." “ The function of digestion exhibited signs of interruption." "Flatulency, griping, pains," &c., &c., &c. “Having satisfactorily persisted in the last course of treatment, and thoroughly convinced it was effecting no good,"—the Doctor wisely concluded that“"Some other agencies must be sought for and applied.” “ Calomel and squills were suggested, and the patient put upon their use."
At this juncture Dr. Arnold was called in, “and after careful consideration of the history of the young man, suggested the use of the inf. digitalis.” The patient then took, for two weeks, without intermission, calomel, squills and digitalis. Then, unfortunately, a malignant attack of "diphtheria" complicated the case. The treatment was now changed to meet the new invader, consisting of “muriated tincture of iron and quinine, with free exhibition of chlorate of potash,” constitutionally-nitrate of silver, per-sulphate of iron, vinegar, salt, soot, &c., as locals-together with animal broths, wine and brandy.
THE YOUNG MAN DIED!
The "remarks” accompayning this "case" contain nothing novel or suggestive. We forbear comment on the "case,” beyond the suggestion, that where “the seat of the disease is not clear"-in other words, where the doctor does not know anything about the morbid phenomena transpiring beyond their mere external and unexpected appearances, it would be prudence, if not wisdom, to adopt such a course of medication, if medicine must be administered, as would not of itself prove fatal if continued, ordinarily in a shorter period than this young man survived.
The medical ratiocination in this case seems to have been: “As the
morbid condition is not understood, an alterative is indicated-good may result from any change-calomel is an "alterative," hence calomel."
Symptoms of chemical violence are mistaken for aggravations of an obscure disease, and the drugs are multiplied and increased. The patient dies; and the doctor stands with arms folded, oblivious alike to the cause and the consequence. We do not say that this young man would have recovered, if he had been left to nature while nature was yet competent to make an effort. But we do say, with a burning blush upon our cheeks, that the same course of medication administered to a young man, beginning with a physilogical condition, would, in nine cases out of ten, result in death.
DIGESTIVE ASSIMILATION OF MEDICINES.
This is a paper by Dr. W. J. Elstun of Indianapolis, one of our younger but more promising of the profession. This paper indicates both reading and reflection, and a disposition to penetrate the arcana of medical science-humbly, yet earnestly, carefully measuring every step, and making sure of the ground on which he treads. We give the Doctor's propositions. He says:
(" Remembering that a perfect organ consists of itself as a whole, its nerves, its blood vessels, and its glandular or other structures; either or all of which being affected, may change the functions of the organ.)
“I. Medical substances are assimilated by the ultimate tissues of the various organs in the same manner as the nutriment is assimilated from food. The organs are affected by aliments; they are toned up, strengthened, stimulated; or the activity of organs may be depressed by the effects of ordinary kinds of food. So with medicines, but in a more active and greater degree.
"II. Medicinal substances are assimilated by the same selective or physiological affinity, through which each organ selects from the blood the particular food material required for its own support, nourishment or vitality.
"III. Medicinal substances may be either selected by an organ throngh direct affinity (for the substances), or the substance may be combined so intimately with the nutriment, or aliment, appropriated by an organ, as to be taken with the food material independently of any affinity for the medicinal substance."
Well does Dr. Moffett say in the discussion which followed the reading of this paper: "If the position of the paper be true, we commit a great many errors in the application of remedies."
Now, therein consists the great value of such inquiries. If sincerely made and considered, they open our eyes to this important fact, more important than any other fact relating to medicine, and that is :
that "we commit a great many errors in the application of remedies," in our blind empyricism. Remember Dr. Moffett's “case of Anasarca," just before us—remember a large proportion of cases, in which we have prescribed "drugs,” and test the “application of the remedy" by what we know and are certain of, respecting the action of the remedy, its specific force, and the condition of the organs to be influenced, and who of us is not ready to confess that his blows have been dealt in doubt and in darkness more frequently than otherwise?
We do not propose to discuss these propositions of Dr. Elstun's in this connection; but we hope that every practitioner into whose hands these “Transactions” may fall, will read the articles and so discuss them in his own mind as to awaken inquiry respecting the power, adaptability and use of drugs; and conduce toward an improved practice. There is room for it in Indiana. We are far in advance of Eberlie to-day. We are moving in the direction of Truth. But our progress is retarded by indolence and timidity, if not by stupidity or stubbornness.
CASE OF DISLOCATION OF FEMUR, REDUCED BY MANIPULATION.
Dr. Sexton of Rushville, presented a case of dislocation of femur, upwards and backwards, reduced by manipulation, describing method and movements. This paper gave rise to considerable discussion, and "Jarvis Adjuster" came in for some criticism-the balance of opinion being in favor of “manipulation" in all cases of dislocation.
Dr. Harvey of Plainfield, introduced the subject of
Stimulating an animated discusion, eliciting various opinions respecting cause and treatment, leaving the general impression, however, that but little is known definitely and clearly respecting the disease; and no rule of treatment can be safely adopted, applicable alike to many cases. One regards the condition of pregnancy as essentially anemic, another as essentially plethoric; and they account for the convulsions upon opposite theories. One thinks the convulsions result from poison incident to perverted elimination during pregnancy; another attributes them to eccentric irritation, &c., &c. Dr. W. F. Harvey condemns the use of chloroform, just now the popular remedy in these
The reports of officers and business committees seem to be satis
factory. There were, however, no reports from committees on scientific subjects whatever.
The following standing committees were announced for the ensuing year:
On Prize Essays—Drs. Bobbs, Curran, of Huntington, and T. B. Harvey.
On Arrangements-Drs. J. J. Wright, Todd, Chas. E. Wright, Avery and Gaston, all of Indianapolis.
On Finance-Drs. Athon, Oliver, Harding, Hobbs, and Pugh.
On Publication-Drs. Waterman, W. F. Harvey, Woodburn, and the Secretary and Treasury of the Society.
REPORTS AT THE NEXT MEETING.
The President appointed the following gentlemen to report at the next meeting:
Dr. J. S. Bobbs, of Indianapolis, on Diseases of the Prostate Gland.
Dr. J. H. Woodburn, of Indianapolis, on the Symptoms and Treatment of Incipient Insanity.
Dr. D. Morgan, of Evansville, on Resections.
Dr. J. A. Comingor, of Indianapolis, on the Pathognomonic Signs of Nephritis.
Dr. R. A. Curran, of Huntington, on any subject he may choose.
Dr. G. W. Mears, of Indianapolis, on the Most Effective Remedies for Arresting Uterine Hemorrhage.
Dr. W. Lomax, of Marion, on the Auscultatory Signs of Valvular and Ven. tricular Diseases of the Heart.
Dr. L. M. Martin, of Clinton county, to take his choice of subject.
Dr. H. V. Passage, of Peru, on the Influence of Malaria in the Production of Diseases.
Dr. P. W. Payne, of Franklin, on Intestinal Digestion.