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completely insensible, and the anesthesia crept up the body as far as the sternum. The effect lasted forty-five minutes, and then gradually disappeared. None of the patients presented any uneasy symptoms, but three of them, however, suffered from vomiting and headache for a few days. All of them looked while being operated on, with complete sangfroid, asserting that they felt no pain.
CLIMATOLOGY AND PHTHISIOLOGY.
UNDER CHARGE of Llewellyn P. Barbour, m.D., Boulder, Colorado. Climate and Sea Voyages in the Treatment of Tuberculosis.
Sir H. Weber, in a paper before the International Tuberculosis Congress at Berlin (Philadelphia Med. Jour., June 10) holds that climate is really important in the treatment of consumption, but is insufficient in most cases; that careful supervision and guidance as to exercise, diet and general hygiene is necessary. He discussed climate under four heads:
1. Climate of Mountains and High Altitudes. In former years the prevailing opinion was that consumption was more likely to be cured in warm health resorts than in cold. The grounds for this opinion were scanty. In Lima, 12 degrees south of the equator, consumption is very frequent, and runs a rapid and fatal course. But if patients from Lima go into the neighboring Andes to an altitude of 7000 to 10,000 feet above sea level they mostly improve. The main characteristics of high altitudes are:
(a) Low atmospheric pressure.
(b) Small amount of absolute and relative humidity.
(c) Low temperature in the shade.
(d) Great warmth in the sun.
(e) Great amount of light.
(f) Rarity of clouds.
(g) The purity of air, especially in regard to microbes, to which bright sunshine is antagonistic.
The physiologic effects of high altitudes are:
(a) Amplification of the respiratory movements. (b) Strengthening of the muscles of respiration. (c) Strengthening of the heart and circulation.
(d) Increase of watery vapor and carbonic acid given off by the lungs. (e) Increased activity of the skin.
(f) Increase of appetite, improvement of digestion. (g) Improvement in the quality of the blood. (h) Increased activity of the nervous system. Briefly, mountain climates are highly tonic and stimulant, but require a certain amount of resistance on the patient's part. The results of high altitudes are good. Of 144 patients in his own experience he has noticed cure in 36, improvement in 56, no improvement or deterioration in 52 cases. The results would doubtless have been better if the patients had placed themselves under strict medical supervision as advised. In many cases, as a result of a false step, as overexertion, relapses occurred which confined the patients to their beds or rooms for weeks, and prevented a recovery which had previously seemed probable from taking place. In regard to prevention of tuberculosis by high altitudes his results have been better. In 10 children from consumptive families, education in the mountains with good hygiene has had good results.
2. Inland Climates of Low Elevation, Including Those of Forests and Deserts. Weber has seen recoveries on low and level land and even in large cities, but these The effects of forests on tuberculosis are limited. In the forests the ground (on the average of a year) is several degrees colder, and ground and air are moister, the difference between day and night temperature is less, the movement of the air is diminished, rain is more frequent, and there is less light and more ozone. There are also possibly exalations from the trees when the aromatic substances may possess some antiseptic influence. This would be favorable, as would also be the protection from wind. He would not, however, favor level, dense forests as sanitaria, as the increased moisture and diminished light would be unfavorable. However, on the slope of wooded mountain, where there is a clear space, with free access of air and light, the forest, especially when of pine, may constitute a favorable element. A desert climate has the advantage of purity of air, richness in ozone, great warmth of sun, abundance of light, dryness, and great rarity of rainfall. The disadvantages are obvious, and the desert climate is not much used.
3. Climates of the Coast and Small Islands--Sea Voyages. Among coasts and islands there are the more humid and warm climates, as the Canary Islands, the West Indian Islands, the peninsula of Florida, and the coast of Georgia and South Carolina, which can be termed sedative or relaxing. Formerly, when cold was feared and warmth was regarded as specially beneficial, these climates were much employed. They are not regarded as good climates now. The dryer coast climates, and not so warm, are somewhat used, and author's results have been good in the treatment and prevention of scrofula. Especially is this true of the North Sea and English Channel coast. Ocean voyages can do good service in a certain number of tuberculosis cases, but in most such cases other climatic con. ditions would do just as much good. If, however, persons of strong constitution who like sea voyages should develop phthisis under the influence of overwork or mental worry, long sea voyages are to be advised in preference to any other mode of treatment. A decided advantage of sea voyages is, that patients are more protected from excesses than at many well-known health resorts.
4. Brief Indications for the Use of Different Climates in Different Cases of Tuberculosis. It is very difficult to formulate exact rules, partly because tuberculosis occurs in such various forms and with such various complications, and partly because the constitutions of affected individuals are very different. In all our medical work we consider constitution at the same time as the disease, and in tuberculosis we should do this very particularly, and in slight cases as well as severe cases. Family history will help us to decide whether we are dealing with a weak or strong constitution. If the family is a long-lived one, we may presume the individal has a strong constitution. Again, those whom from youth up have felt better and been more energetic in warm weather, but in cold weather are less strong and able to work, generally are of weak constitution. And those who from youth up have had high fever with slight ailments, who have recovered from sickness with difficulty, are usually of a weak constitution. If we come to the conclusion that a patient is of a weak constitution, we should be careful about advising high altitudes or long sea voyages, but recommend instead warm, sunny, elevated places.
In regard to the following indications the constitution is always to be considered:
1. In cases with limited disease at one or both apices, without or with only slight fever, nearly all climates can be made use of, but high altitudes are especially recommended.
2. Cases with limited local disease with high fever should be treated at home till the fever is controlled.
3. Cases of extensive disease of lungs, but only slight fever, are more difficult to advise; moderate altitudes or seaside localities usually are best.
In advanced disease with fever long journeys should be avoided.
5. In progressive tuberculosis with many foci in the lungs, sheltered resorts near the patiant's home should be advised.
6. Cases of chronic, slowly progressive phthisis the author has seen do better on the whole in warm winter resorts, or on long sea voyages.
7. Quiescent cases with extensive damage or cicatrization are usually best at slight elevation.
8. Cases with albuminuria without fever should select warm, equable, dry climates.
Moderate diabetes does not exclude high altitudes.
10. For the prevention of phthisis, high altitudes are best.
For the prevention of scrofula, marine climates are best.
12. The cure of tuberculosis in early stages is best obtained in high altitudes, though possible in any good climate.
But climate by itself, without medical supervision, is generally insufficient. The patient's blind reliance on climate often leads to errors and excesses. Patients should have medical supervision wherever they go. For the treatment of the poor, sanitaria are a necessity. The erection of sanitaria for the poor is a national requirement for the cure and prevention of tuberculosis.
Prevention of Tuberculosis from Articles of Food.
Professor Virchow, at the International Tuberculosis Congress (Phila. Med. Jour., June 17), said the chief spreaders of the disease were cattle, by their meat and their milk; then pigs, and lastly, poultry. The existing German reg. ulations for the examination of meat in slaughter houses would suffice if made general. Animals introduced from other countries should be subjected to the tuberculin test. The greatest danger lay in milk. Cow's milk might contain bacilli from the udder which is sometimes studded with foci.
The only rational treatment for this tremendous danger is the destruction of tuberculous cattle. As this is not possible at present, the only remedy is in boiling or sterilizing the milk. Hogs are more subject to tuberculosis than has been supposed. Its chief seat is in the lymph glands in the wall of the neck (scrofula), but these parts can be excised if proper care be taken. The danger from poultry is not great, as their tuberculosis is not identical with human tuberculosis. Nevertheless, tuberculous poultry should be destroyed.
In conclusion, Virchow disputed the dogma of congenital or inherited tuberculosis, on the strength of his own pathological investigations. Infection takes place after birth; it may be in the first days of life.
The Control of Tuberculosis.
The following resolution was passed at the late meeting of the American Medical Association at Columbus, Ohio:
Resolved, That the President appoint a committee of five, with power to add to their number, who shall prepare a report on the nature of tuberculosis, its communicability and prevention, the more effectual means of controlling its dissemination, the advisability of establishing National and State Sanatoria, etc. Resolved, That the report shall be presented to the Congress of the United States and the Legislatures of the various States, urging upon them that proper measures be taken.
[This is an important step in the right direction. For many years the editor of this department has been urging the establishment of State sanatoria for the tuberculous poor. In a paper read before the Tri-State Medical Association (Miss., Ark. & Tenn.), and published in the MEMPHIS MEDICAL MONTHLY of January, 1897, I urged this very work and other lines of prevention, which are now beginning to be popular. We shall not get the State sanatoria and other preventive measures by the State for some years after we ask for it. The asking will be educational, and should begin at once.-L. P. B.]
Other Papers of the Month on Climatology and Phthisiology.
Hot Springs, S. D., as a Health Resort-Holscher (Jour. Amer. Med. Assn., June 17).
Pneumonectomy, the Future Treatment of Incipient Pulmonary TuberculosisJno. S. Pyle (N. Y. Med. Jour., June 10).
Pelvic Tuberculosis-A. P. Clark (Jour. Amer. Med. Assn., June 24).
Need of Sanatoria for Treatment of Pulmonary Tuberculosis-J. H. Stuart (Med. Dial, Minneapolis, June).
Description of Climate of New Mexico-Francis Crosson (Med. Dial, June). Tubercular Pelvic Peritonitis-C. C. Allison (Jour. Amer. Med. Assn., July 1). Tent Life for Invalids in Colorado—G. T. Gardiner (Tri-State Med. Jour. & Practi., May).
Miliary Tuberculosis of Pleura Without Other Tuberculous Involvement of Lung-Eugene Hodenpyl (Med. Record, N. Y., June 24).
Subsequent History of Arrested Cases of Phthisis, Treated at the Sharon Sanatorium-V. Y. Bowditch (Boston Med. & Surg. Jour., June 22). Serotherapy-C. P. Ambler (Jour. Amer. Med. Assn., July 8).
Surgical Treatment of Pulmonary Tuberculosis-Editorial (Jour. Amer. Med. Assn., July 8).
Tuberculosis of Mesenteric Glands - R. Peterson (Amer. Gyne. & Obstet. Jour., N. Y., June).
Tuberculosis of Urinary Tract-A. Vander Veer and W. G. McDonald (Amer. Med. Quarterly, N. Y., June).
Three Steps in the Tuberculous Process in Children-D. Bovaird (N. Y. Med. Jour., July 1,.
Pulmonary Tuberculosis with Intercurrent Typhoid Fever, Complicated by Pneumonia-(Amer. Jour. Med. Sciences, July).
Coexistance of Carcinoma and Tuberculosis of Mammary Gland —(Amer. Jour. of Med. Sciences).
Phthisis and Tuberculosis-C. Baumler (Deutsch Medicinische Wochenschrift, Berlin, May 25).
Cervello's Treatment of Tuberculosis-F. Maragliano (Gazette degli Ospedale, Milan, May 21 and 28).
Meningitis Tuberculosa-F. Bulmar (Revista Medica, Mexico, May 1).
Formalin as a Remedy for Surgical Tuberculosis-J. Hahn (Centralblatt f. Chirurgie, Leipsic, June 10 and 17).
Progress of Chronic Phthisis-M. Pickert (Muenchener Medicinische Wochenschrift, June 13).
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THE TONSILS AS A GATEWAY TO INFECTION. It has heretofore been the custom to use as almost the sole argument for the removal of hypertrophied and diseased tonsils that they act as foreign bodies and obstruct the respiratory tract. But the investigations of latter years have given to these apparently otherwise innocuous organs a role of much more serious import; in fact, conclusive demonstrations have been made that the tonsils are, in a diseased state, oftentimes portals of entry for germs of infection, which give rise to varied disturbances of the general system. It has been observed that endocarditis may follow non-scarlatinal tonsillitis. Chorea and arthritis have been traced to the infection of tonsillitis, and the fact that acute rheumatism may often be ushered in as a sequence to a tonsillitis is no longer disputed. Indeed, it seems that infectious processes ad infinitum may be ascribed to the ingress of infection via the tonsils. We are told that in health these organs are but slowly absorptive of deleterious matter, and in truth are possessed of a phagocytic action upon the germs of disease, but just as soon as they