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That medicine is progressive cannot be gainsaid. We who live and practice now should feel honored that we live in an age when it seems that medicine is reaching the acme of perfection in all lines. Possibly there is too much progression in one direction—a tendency to fatty degeneration. Probably the growth is becoming fungous-too many fads and theories, too many ideas and not enough practical application. Metabolism is out of time. The catabolic and anabolic forces do not harmonize. Neither an optimist nor a pessimist would we be, but a conservatist. We wish to accord our laboratory brethren all honor and credit for the brilliant results achieved by their constant work. Their researches have in a measure revolutionized the study of medicine and placed it on a high basis along with other sciences, but at the same time a halt must be called upon the wholesale, indiscriminate discovery and turning loose of bugs upon us. Too many bacilli are being discovered, more than we can accommodate. At the present rate of procreation a whole family of bugs will have to be assigned to one disease.
As regards the present status of medicine, it is patent to every intelligent thinker and reader that the pendulum is swinging too far in the direction of theories, scientific research (so-called), and laboratory perfection. The student, on graduating, becomes imbued with the idea that he must become a microscopist, a pathologist, a bacteriologist, etc. Research along these lines is all right and proper when practiced in a conservative manner, but the great danger is overlooking the clinical features and practical points. He depends too much upon what he will find by the microscope, instead of making his diagnosis by symptoms present.
The germ theory is the recognized one as regards the causation of disease, and yet the identity of the germ theory is in a great measure a nonentity. If we search our textbooks closely we soon learn that we have numerous diseases in which no given bacillus or germ is the causative factor. One disease to make the point clear-pneumonia. Here we have some half dozen microscopists claiming that his bug is the most popular. Klebs held the reins for a long while. His monas pulmonale reigned supreme till Friedländer came along with his diplococcus pneumonia. Then Fraenkel came out the victor
with his pneumococcus pneumonia. At present we say micrococcus lanceolatus. We expect a change soon. Stengel says: "It is difficult to prove the specific relation of bacteria to disease."
Serum therapy demands some attention. What it has led to and what will be its ultimate fate are questions that the careful physician must ask himself. Time is too limited to discuss the physiologic effects of serum as administered today.
Antitoxin has created almost a chapter in the history of medicine. We shall watch its progress. In hospital practice it is stated that all medicinal agents have been discarded for antitoxin in treating diphtheria. Many physicians in private practice claim the same. It is said that the statistics show a marvelous decrease in death rate since antitoxin was introduced. We have a high regard for statistics and those who' compile them, all things being equal, but when enthusiasm is wrought up to a high tension, when the experimenter desires that his results be brilliant, he is apt to classify simple cases that would have gotten well by letting them alone. I am more charitable than the fellow who said there were three kinds of lies, the plain lie, the d- lie, and statistics. Behring himself states in Gaillard's Medical Journal that since the introduction of antitoxin paralysis much more frequently follows, accompanied by glomerular nephritis. Antitoxin is all right when backed up by proper medicinal agencies. There is no doubt but that the mortality of diphtheria has been reduced since its introduction, but we believe that a large percentage of the cases used in making hospital statistics would have yielded to nearly any treatment. Let the progressive age think as it pleases, but we have not just enough confidence in antitoxin to administer it to the exclusion of other remedies. We will take a little calomel, or some other form of mercury, with stimulation, in our cases. Mercury has a happy tendency toward preventing nephritis during and after the acute attack. Upon the whole we predict that serum therapy will be relegated to a defunct throne ere long. The animal extracts seem to be stringhalted on the home run.
Now let us touch briefly upon the second clause of our title, clinical experience against laboratory research. What is the
relationship existing between the clinician and the laboratory man? There is a breach between them that must be healed before we can hope to have harmony. Each must make concessions to the other. There is a great tendency to run after fads. When a young physician once learns that he can manipulate the microscope fairly well he begins to look for something out of the ordinary. He becomes imbued with the idea of finding something under the microscope. If he does not, too often he wants to reject clinical features simply because he does not find what he wants. All things equal, the laboratory man should lead the clinician. But we ask, does he? Search medical literature and the answer comes, No!
We assert, the most valuable work has been done by the clinician. The pathologist often aids him by confirming with his microscope what the clinician has found by studying his On the battlefield of medicine you will find the clinician in the front rank. He has mapped out the pathway to valuable truth with pickax and spade. The pathologist comes behind with much pomp, after the road has been cleared, and says: "Well done, clinician; you have made me a good road. I will reward you by confirming with my microscope what you have learned by experience and hard work."
Laboratory work is to be commended but not extolled and made pompous to the detriment of clinical research. To make the point clear, I wish to quote Dr. J. M. Baldy, the eminent gynecologist of Philadelphia who, in a letter published in the October number of the Memphis Lancet, says: "All the laboratory work in the world will not take the place of clinical da ta well gathered and well weighed. A wide clinical experience is worth more than all the microscopes ever invented, By this I do not mean to deny the value of the microscope to the physician, but I do mean to protest against the habit, which is growing so universal, of trusting all to the instrument, to the neglect of a close clinical study of the case. The tendency to abandonment of careful clinical and bedside study for that of laboratory is the crying medical evil of the day."
Let both the clinician and the laboratory man not "o'erstep the modesty of nature." Let each remember that "this world. was not made for Cæsar alone, but for Titus too." Lord Bacon
once said: "Some books were made to taste, some to swallow whole, and some to chew and digest." The same thought can be applied as we progress in medicine. Let us taste the fads, swallow whole the numerous vague theories, chew and digest the practical points gleamed by experience and bedside practice.
A REMARKABLE CASE OF AUTOHYPNOSIS.*
BY E. H. MARTIN, M.D.
President Tri-State Medical Association of Mississippi, Arkansas and Tennessee.
If I have been guilty of giving a new name to an old disease my excuse must be that cases of the kind are so rarely met that each one can have a new name. I have only been able to find two similar cases in the literature at my command, both reported by German authorities.
Dr. Moyer, of Chicago, also recently reported in the Medical Record "A Case of Paroxysmal Sleep, Sleep Epilepsy or Narcolepsy," but the condition he describes is not at all like that found in the case I have to report. Moyer says: "Comparatively little has been added to our knowledge of morbid drowsiness since the paper of C. L. Dana in 1884. In that article Dana collected forty-nine cases, which he divided into three classes-epileptoid, hysteroid and 'other forms.' In the first class the disorder seems to have some relation to epilepsy, the morbid drowsiness in some cases apparently replacing an epileptic seizure.
"His second class, the hysteroid, include the lethargics, sleeping girls, and individuals subject to short attacks of sleep and persistent drowsiness. Under the division other forms' he includes those cases in which the patients seem to be the victims of a special morbid hypnosis not allied to epilepsy or hysteria."
This third division is so broad that it must manifestly take my case, but such a classification is very like none at all. Bernheim mentions that there are some subjects who, after
* Read before Tri-State Medical Association (Miss., Ark. & Tenn.), Memphis, December 22, 1898.
having been hypnotized a number of times, preserve a disposition to go to sleep spontaneously. The two cases which I first cited as similar to this one were probably of this class of artificially-prepared autohypnotics. So, as far as I can learn, this case is unique.
Mr. J. G., the patient, came to me for treatment in April, 1893, with the following history: Five years previously he had been a very healthy boy of 16 or 17 years of age. After having taken unusually violent exercise on a very hot day he had been found by members of his family in an unconscious condition. He was placed in bed and a physician was called in, but every effort to arouse him failed. He remained in this condition for two weeks, having remissions of the stupor, during which he would take nourishment and medicine, but no distinct intermission. His physician said that he had pneumonia. After having fully recovered his physical health he had occasional attacks which were described as "spells." These "spells" would come on at any time, but usually when he came in the house after a day's riding and sat down to rest. In the middle of a sentence, or while dressing or undressing or at the table, he would suddenly go to sleep. Every effort to awaken him would fail; shouting at, shaking or dragging him around were entirely unnoticed. Soon he would pass into a somnambulistic condition, and would hold long conversations with himself or would sing or play on some musical instrument.
While his friends could not change his train of thought or alter his discourse ordinarily, it was evident that his senses were not entirely in abeyance, for if the dogs outside began to bark he would at times begin to talk to himself about dogs.
Or if he was playing one tune on the mouth harp and some one began another on the piano he would gradually take up the other tune and play second to the piano.
After a varying length of time, from twenty minutes to an hour or two, he would suddenly awaken and continue what he had been doing when he went to sleep, finish a sentence or go on pulling off his boots or complete his toilet, as the case might be. He would not only have no recollection of anything which he had done or said, but he would actually not remember having been asleep.