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treme southern portion of West Virginia, to the west and south of White Sulphur Springs, and embracing the headwaters of Big Sandy River; another small tract in the western portion of North Carolina, to the east of Smoky Mountains; quite a large tract in Central Georgia, comprising nearly one fourth of the area of the State; that portion of Florida lying between Cedar Keys and the Great Cypress Swamp; Northwestern Texas, Southern Texas, and Northwestern Minnesota.
By the same authority, we find that consumption is most prevalent in the New England States, more especially that portion lying within one hundred miles of the coast; the country bordering the Great Lakes; the valleys of many of the great rivers of the Mississippi basin; portions of Iowa, Wisconsin, Texas, and, what seems a little singular, the mountains of East Tennessee. In that tract lying between Knoxville and the western slope of the Smoky Mountains, the proportionte death-rate from consumption is as great as in New England. The death-rate is proportionately light along the Atlantic coast south of Cape Hatteras. The localities mentioned above, as comparatively free from consumption, are all, with the exception of West Virginia, Texas, and Minnesota, more or less subject to malarial influences.
For myself, I have small claims to any knowledge of what is contained in the authorities upon climatology. As a rule, we prefer to send our consumptives to a warm climate for the winter. South Carolina, especially in the neighborhood of Aiken, is said to possess many advantages. It is also easy of access, and the hotel privileges are now said to be very good. I wish I was able to speak from experience, for that is about the only way to really know anything. This remark is peculiarly applicable to climate. I think, however, all things considered, that Florida is the best winter climate we have for consumptives. New Mexico is also good, but too far away. For those who can afford to go abroad, Nassau and Santa Cruz have been highly lauded. Algeria is one of the best climates in the world, but best of all is the Nile. The least said of the fashionable resorts of Southern Europe the better. During the summer, send your consumptives to the clear, bracing atmosphere of the mountains. Prescribe life in the open air, I had almost added, day and night. Again, let me say,
VOL. XIV. NO. III.
keep always in mind the constitutional peculiarities of the patient. Different persons may be differently affected.
I read, with great interest, Prof. H. P. Gatchell's writings, in the journals, some years ago, upon the climate of Asheville and vicinity, in North Carolina, and sent a few patients there to the Sanitarium. It then proved to be very difficult of access, and there were very poor accommodations for the invalids when they got there. It reminds one of the story of a traveller, who told a gentleman that Arizona would be a splendid place to live in if they had good water and good society. The listener rather irreverently replied, "That is all they lack in hell!" Now, when I sent my first patients to Asheville they found themselves very much in the same condition. The houses, at that time, were reported to be in exceedingly bad repair; for instance, the best and most expensive house in the place had its front door standing nearly half-way open all winter for the lack of a little attention from the carpenter. No wonder Mrs. Stowe made Aunt Chloe say, " How shiftless!" and no wonder one of my patients said it was disgusting to stay a winter among such slatternly people. The climate is undoubtedly good, but what the invalid has to put up with in such a place often more than counteracts the good effect of the salubrious climate.
I have no definite plan as to a method or system of getting reliable facts from different localities to enable the honest and painstaking physician to approximate the truth about the advantages to be gained by the invalid for whom he prescribes.
Possibly some of the writers upon this subject have some welldeveloped plan for gathering the necessary statistics in relation to these places. If any such plan has been mooted, I am as yet unaware of it. I state this more especially in the hope of calling out some wise man's opinions, or better, his own observations in relation to these matters. Don't all speak at once! Which of you will be this modern Solomon? Perhaps some good doctor who understands the business of pulling wires at Washington may be able to get the government to take hold of this matter of climatology. Can't we get " Old Prob" to help us? When these facts are properly gathered and arranged, the physician will be able to say to the consumptive, " This or that change of climate will benefit you"; he will be able to say to the anxious.
father or mother, "Such a climate will cure, or at least greatly benefit your son or daughter"; he will be able to say to the distressed mother, "Go to this climate with your infant that is suffering from cholera infantum or marasmus, and attend to the hygienic directions which I give you, and your baby will get well again." Until we do have these facts properly arranged, our advice in relation to climate must be mere guess-work.
Who will "come over and help us" to search in this mine for the truth?
PATHOLOGY VERSUS SYMPTOMATOLOGY.
BY A. M. CUSHING, M. D., LYNN, MASS.
I AM a firm believer in the necessity of having as thorough a knowledge of pathology as possible, but as some claim, is it always safe to be guided by that alone, or is symptomatology sometimes better? I will report one case, and ask some of the believers in pathology alone what they would have done. January 20th, I was called in haste to see Mrs. -, aged fifty-four, rather above the medium size, full habit, wide awake, active, healthy looking. She had not been sick for several years, to my knowledge. As I entered the room, I found one attendant (an excellent nurse) rubbing and working over the patient, who was sitting upon the side of the bed. As I approached the patient, she looked up, and a more suffering, death-like patient I never saw. She could only say, "Doctor, such distress!" placing her hand over the heart and epigastrium. Her flesh was cold, her pulse weak, fluttering, and just perceptible, she had nausea, and tried to vomit. What should I do? Wait for the husband to come home to tell me how long she had been sick and what the symptoms had been? Get a stethoscope and examine the heart and lungs, make a chemical and microscopical examination of the urine, and then attend the funeral? Or should I accept symptomatology and go to work? The nurse said it relieved her to be rubbed over the spine between the shoulders. I gave Veratrum alb. 3dec., and with coat off I rubbed her back, while the nurse brought hot irons, etc., and she was soon better. Then I learned that for several weeks she had been suffering from neuralgia of the shoulders, back, and arms, and had bathed them with strong liniment. She abandoned the liniment and took little pills.
EXPERIENCE WITH DIPHTHERIA.
HAVING, through my association with Dr. J. H. Woodbury, been the attending physician at the Home for Little Wanderers for several months past, during which time a large number of cases of diphtheria have occurred, I offer a short account of the epidemic, with some observations and conclusions drawn therefrom.
No assignable cause for the eruption of this disease could be discovered, either by the authorities of the institution or by the Board of Health, the general sanitary conditions being all that could be asked. Notwithstanding this, every case of sore throat which occurred among the children developed a diphtheritic tendency. In all instances, as soon as the first symptoms of the difficulty were observed, the child was at once removed to the hospital, and kept wholly apart from those not affected. At some times more cases were brought together in the hospital wards. than I could have wished, but it seemed unavoidable.
The number of cases treated was forty-seven, of which nineteen were mild, though all were characterized by the prostration, languor, loss of appetite, soreness and swelling of tonsils with membranous patches thereon, offensive breath, and more or less catarrhal discharge. In these nineteen cases, by the aid of such remedies as were found efficient (or through other influences) the disease was arrested, and the patients discharged in a few days. Some of the earlier cases had Merc. sol., Merc. biniod., Lach., Phyto., or Bapt., according to the indications, while to others was given only Am. mur. internally, and as a gargle. These latter cases, almost invariably, did better than the others. Relief came more surely and speedily, and this treatment was therefore generally adopted in the cases occurring after this fact had been demonstrated. Eighteen other cases were of the same type, i. e., pharyngeal, but more severe. In most of these the disease had progressed further before being discovered, though some few went from the mild into severe in spite of the means used to prevent it. In all of these eighteen cases the tonsils, uvula, posterior wall of pharynx, and in two instances the nares, were largely covered with the characteristic exudation, while the prostration was intense, and the taking of nourishment almost
an impossibility. Am. mur. was used in all of these cases, after they became alarming, while Chlorate of Potass. was given in alternation when there was profuse catarrhal discharge from the nose. A gargle made by dissolving paraffine soap in water (one cubic inch of soap to half a pint of water) was used, when the child was old enough to gargle, with the effect of destroying the offensive odor of the breath, and apparently of helping to heal and remove the membrane from the throat. All of these eighteen cases recovered. The other ten cases were of the dreadful croupous or laryngeal type. While there was little or no visible exudation in the throat, all the general symptoms of the disease were present, and the peculiar croupous cough, with inability to speak aloud, and the anxious, labored breathing, as in membranous croup, made them very alarming. Nearly all of these were taken suddenly, and were in the condition described when first seen by me. Some of these cases were treated with Acon. Spong., Iodine and Iodine vapors, Hepar. and Am. mur., but they all failed, though seeming well indicated in the particular case in which they were applied. Kali. bich. was also used, and with good results, but at first it was used in the third dec. trit., and was only partially successful. Later it was used crude, as strong a solution as could be taken without causing vomiting, and in this form it was wonderfully potent. Every case in which this preparation of Kali. bich. was given recovered completely, although several of them were terribly severe, and considered utterly hopeless by the attendants and others who saw them. The first three cases of this croupous form died. I believe Kali. bich, crude might have saved them. I would only add that in all cases the strongest and most nourishing diet was given when it could be taken, and in cases where very little could be eaten, I gave a little brandy or whiskey. If I have left unmentioned any points of interest, I will gladly answer any inquiries privately, or through the GAZETTE.
RAPID ANESTHESIA. Give the patient the ether-inhaler; let him hold it to his face with one hand and elevate the other. In few minutes the arm will drop, and there will be from thirty to fifty seconds of unconsciousness, during which minor operations of surgery, reduction of dislocations, etc., can be performed. The right moment must be seized; for, if the patient returns to consciousnesss, full etherization will then have to be employed. Phil. Med. Times.