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small quantity of pus. There was no marginal redness or swelling. The cut healed in six weeks and he walks on it very well. There is quite a fissure remaining not filled, though sound.
Georgia A., a little girl, aged four years was accidently wounded by the discharge of a shotgun which was loaded with four buck shot and some squirrel shot. She was standing at a distance of ten feet, when the load struck her right thigh just below the insertion of the gluteus maximus and destroyed all the soft tissues to a depth of two, and to a width of four inches, leaving the thigh torn and pulpous to a fearful extent. The buckshot made two openings through the left thigh into which I easily passed the index finger. The little one was fearfully :shocked, but I felt that she would react without stimulants and did not administer them. The absorbent cotton was wrapped over these wounds and the roller loosely put on, no fluid was used.
After it was dressed she had a placebo made of listerine, one drachm; water, two ounces, a few drops to be put on the outside of the dressing, night and morning. The treatment was the same as given in the preceding cases. There has been no trouble or unfavorable symptoms. It will soon be filled and healed over.
It has always been claimed that gunshot wounds must slough, but there has been nothing of the kind in this case. ings through which the buckshot passed in the left thigh have already healed and there is no soreness remaining. The swelling was more marked in the right thigh of this case than any one of the four, and yet it never was half so great as we frequently have in those cases washed and dressed and medicated every morning.
That these wounds healed as rapidly and perhaps more so, that the quanity of pus was reduced to the minimum, and that the tissues destroyed were as largely re-supplied, and the cicatri. ces were as favorable as could have been obtained from any treatment that I have known, is true. If the theory, that a living organism, begotten and propagated in a wound, produces the pus, and that suppurative action is the result of their presence is correct, and, further, if it is true that the greater quantity of pus generated is most detrimental to the healing trauma, then this dry treatment is the best aseptic or antiseptic that I have ever known.
The openThe vis medicatrix naturæ as a factor in the healing art has been almost forgotten in the race for remedies with which to cure and prevent disease. If the atmosphere is burdened with germs, always waiting and in readiness to pounce upon the tissues as soon as there is a solution of continuity, then, in my opinion, the best antidote to their deleterious effect is found in the blood which nature pours out instantly, and with which she soon covers and coats the wound if allowed to do so.
If the little giants are waiting and watching in the atmosphere, and on the surface of the skin, and hidden in the dirt, until the wound is made, and the ptoma is prepared for their development and rapid multiplication, then the best method, according to my observation, is to keep the water and all other fluids away, notwithstanding they may be vaunted as germicides. Permit nature to coat over the surface and seal it up-killing those within and keeping out those external—thereby acting as an antiseptic and germicide.
If the ptomaines, of which it is uncertain and unsettled whether they follow or precede the germ, are to be gotten rid of, then the best method is to allow no external moisture and as little air as possible.
There are some facts in connection with the maintainence of organic life, even of the most minute germs, without moisture and air, which I should like to notice, but cannot now.
Now suppose we look at this question from a different standpoint. Inflammation for many decades attracted the attention of pathologists. It was said to be cured or to end in resolution, or suppuration. If the trauma healed by the first intention, as it was called, it was the result of plastic lymph never reaching the inflammatory condition, but if there was pus and granulation, then it was the sequence of inflammation.
It is interesting to notice that the earlier writers speak of it as a disease, or as a morbid process, or as a series of morbid conditions. It is a misnomer, and yet the successive conditions which the term represents are so well defined that it should never be changed. This so-called morbid process is one of the factors which the overlooked vis medicatrix naturæ, if permitted to do so without molestation, used for the relief of an injury. I will anticipate the thought, which I suspect arises in your minds, by
admitting that nature, in handling this particular remedy, is much like the doctor, she sometimes overdoes the thing. Inflamtion has had the misfortune to be regarded by the doctor as an enemy, and if it had any good intentions, they could only be accomplished under his protest.
Now I am inclined to think that the three or four phenomena, which we so often observe, are rarely intended by the economy for the relief of some morbid condition. I wish to assert that inflammation is nature's effort for the relief of an injury. That these phenomena are abuormal is true, but we must remember that this is the effort of the whole physical economy to rid itself of a disease or injury.
The ugliest thing that can be said against inflammation is that it sets up one disease to cure another, which, you know, is allopathic, and this method is used by some very regular physicians.
Take, for example, the furuncle or boil. A little arteriole by some means gets injured, or a minute thrombus, or some other foreign substance, comes floating in the blood and lodges in the arteriole, obstructing the circulation, or perhaps producing a complete infarction; immediately there is an increased quantity of blood sent there for the purpose of relieving this injury. It is done through an extra amount of the nutritive forces, and if you will give the parts rest and allow nature to have her own way, and only assist her when necessary, she will restore the part. She oftentimes is compelled to destroy some of the tissues, as in carbuncle, before health can be restored.
Nature does everything through the blood. It is the common carrier by which everything foreign, obsolete or effete, is handed over to the emunctories and eliminated from the system.
It is also the happy and welcome messenger which brings nutrition (synonym for food) to every tissue in the body. The ealiest wri. ters on hygiene said “the blood is the life."
There is another factor in this complicated machine which has something to do with these phenomena. It is the ganglionic nervous system, or sympathetic system, and frequently mentioned as the vaso-motor nerves.
The function of these nerves is prominently that of nutrition, presiding also over every function in which animal life is involved. The man who wrote “Ubi irrita
tio ibi fluxus” penned a truth; and it is so, because these nerves stand continually on guard for that purpose. I mention this function of the sympathetic nervous system to show that there is a determination of blood to a part, not from any specific phlogistic condition of the blood itself, but rather, that in its inception it is a physiological act.
It is worthy of notice that, as early as 1854, Sir Joseph Lister, in describing certain phenomena of the inflammatory process, said : “inflammation is only one of the various shades of derivation from the normal processes of nutrition.” The plea which I make is that nature in her effort, through the nutritive and eliminative forces of the blood, to heal an injury ought not to be molested to the extent often done. Over-much washing, cleansing, disinfecting, and antisepting, will thwart her best
When the injured tissues are put as nearly as possible in situ, and covered with a dry absorbent material, and given as perfect rest as circumstances will permit, then the surgeon has discharged his duty. After this he is to watch, with an intelligent eye and educated touch, for the earliest indication that nature is about to fail, or in any way needs his coöperation.
You will see that I look upon inflammation in the field of traumatism, not as a disease, but as a general term, covering a series of phenomena, each of which is an effort at restoration.
The air and water, or other fluid, applied, whether it be medicated with an imaginary germicide or not, only retards the restorative process by inciting an excess of blood to the part, and increasing suppuration. Leave the blood there. Cover the wound with a dry absorbent material, exclude the air, and never disturb it with a second dressing in less than five to ten days. Then, if pus has ac ulated, wipe it off and redress without water or other fluid, or na icine of any kind.
I might here enter on a discussion of plastic lymph, and of effusion, and the formation of pus, showing how these successive steps are intensified by wet dressings frequently repeated, but must desist for the present, as this paper is intended to be suggestive rather than elaborate. Again let me express the great pleasure afforded me in being with you to-day in the discussion of practical medicine. The science of medicine is progressive,
broad and deep, and invites all her followers, in every sphere, either humble or exalted, to work-constant, energetic and earnest work. The difficult problems of life yield only to those who persevere.
I cannot close this paper better than in reoalling Longfellow's * Ladder of St. Augustine.'
“Ye mighty pyramids of stone
That wedgelike cleave the air,
Are but gigantic flights of stairs.
The distant mountains that uprear
Their solid bastions to the skies,
As we to higher levels rise.
The heights of great men reached and kept,
Were not attained by sudden flight,
Were toiling upward in the night.
Standing on, what too long we love,
With shoulders bent, and downcast eyes,
A path to higher destinies.
Nor down the irrevocable past
As wholly wasted, wholly vain,
To something nobler we attain.
TREATMENT OF PNEUMONIA.
BY W. C. BOMAR, M.D., OF HOLLOW ROCK, TENN.
There is and has been a diversity of opinions in regard to the treatment of pneumonia, and of the use of different drugs and their therapeutical effects. Some physicians insisting that the modern plan of treatment, with opiates to relieve pain, quinine as a febrifuge, and alcoholic stimulants, with good nourishing
it fa superior to the old heroic plan of treatment, and that