Billeder på siden

tablished for his own Self with the Not- great world-stream, the mighty flow of Self, power for success of which is irre

which will carry him, almost without efsistible. From the humble source of a fort of his own-certainly without disasimple and intelligent, albeit disinterested, greeable effort-on and on to the ocean of desire to be of service, the physician hias success, known by many names, but most floated quickly into the main channel of the often as heaven.



Professor of Genito-Urinary Surgery and Syphilology, Chicago College of Physicians and Surgeons.

I wish first, to renounce any claim to a taste and capacity for the digestion and laboratory expert knowledge of dietetics. assimilation of a vegetarian diet resulted What I am about to say is based entirely from the adaption to the exigencies of enupon clinical experience and observation of vironment. However this may be, it is more than thirty years.

certain that we are descended from a long Some of the prevalent opinions regard- line of flesh eaters. Hereditarily, thereing dietetics, particularly in renal diseases, fore, we should expect not only a demand are, it seems to me, absurd and illogical; for meat as a part of the human dietary, at least, when carried to the extreme which but also a capacity for its digestion and ascharacterize the practice of some physicians similation and for the excretion of the waste of excellent repute and wide experience. products thereby formed. It is reasonable A point that is uppermost in my mind at to suppose that the kidney itself has bepresent is the abhorrence of proteids ex- come accustomed to proteids, not only to hibited by practitioners in certain condi- their nutritive properties, but also to the tions. I am willing to concede that, other stimulus of the retrograde products of things being equal, a diet which is fairly protein metabolism. free from proteids is often essential in the It is to be admitted that an excess of protreatment of renal disease. Especially is


tein or even the average normal amount such a diet of value in certain forms as- of protein ingested by individuals whose sociated with general arterial disease, or, digestion and assimilation and excretion are as Fothergill termed it, cardio-vascular dis- impaired must be productive of harm. ease. I am confident, however, that in the This, however, does not militate against the later stages of chronic Bright's disease, argument that a certain amount of meat which have been treated by a restricted diet, is valuable or even necessary in the dietary we are often confronted with anemia, car- even of certain nephritics.

I am satisdiac weakness and renal inactivity which are fied that I have prolonged life and made the due to too great restriction of diet in gen- patients more comfortable in many cases eral or too great diminution of proteids in of chronic nephritis by removing some of the dietary. A cardinal point in dietetics, the arbitrary restrictions that have been which is too often forgotten by otherwise laid upon the diet and giving meat in modcommon-sensible physicians is that man in erate amount. A weakened heart muscle, all his organs and functions has evolved low blood pressure, and a sluggish kidney into an omnivorous animal. Away back

Away back often respond to such a change in dietetics. in our ancestry we were essentially flesh- I recall a personal experience which oceating animals merely because preying up- curred some twelve years ago that is very on other animals was the easiest method of pertinent in this connection. I was sufsupplying the larder. It is presumable that fering from an attack of subacute desquamative nephritis, as the French term it, ly prescribe an arbitrary diet and rely too resulting from gastro-intestinal disturb- confidently upon the composition of the ance. The prominent features were gastric dietary for the salvation of our case. The derangement, edema of the extremities, and quantity and quality of the dietary on the an extremely weak heart. Despite the fact one hand, and the condition of the digesthat I ingested apparently sufficient quanti- tive functions, metabolism and elimination ties of milk and vegetables and cereals to upon the other, must all be taken into consustain nutrition, the aforesaid symptoms sideration.

sideration. This may seem trite, but all became more and more prominent. My the same several of the factors mentioned consultant finally becoming alarmed by my are often known to be ignored by many cardiac weakness, prescribed heart tonics. physicians. Having begun to acquire some notions of The late Dr. George Chismore, of San my own regarding my condition and the Francisco, in a conversation with me just treatment therefor, I informed my consult- before his death several years ago, told me ant that my cardiac muscle had been used that he had arrived at conclusions similar to a meat diet. Furthermore, I was con

to my own regarding the dietetics of chronfident not only that the essentially non- ic nephritis. He apparently proved his point proteid diet which had been prescribed, was by his case books. I saw at once that my not being properly digested and assimilated

friend was inclined to extremism because of but also that my heart muscle was "crying the insistence with which he called attention for beef steaks and mutton chops." Very

to the fact that the excretion of urea was much to the disgust of my medical friend,

largely increased in many of his patients I avowed my intention of following my own

after the administration of a strictly meat sweet will in the matter of diet, with the result that in three or four days there was

diet. Obviously this did not of itself prove a marked change for the better in all of my

that a nitrogenous dietary was beneficial. symptoms, and I shall never forget the mar

The blood pressure, pulse, the cardiac recvellously beneficial effects of my first rare

ord, the hemoglobin estimate, and the rebeef steak taken against the advice of my

lief of edema were, however, sufficient to consultant. I am quite certain that my

convince the most skeptical that in Dr. patients have on the average since derived

Chismore's own cases and under his direcenormous benefit from my own personal

tion a meat diet was beneficial and unexperience.

doubtedly prolonged life. A point which we too often forget is that Theorizing aside, a weakened heart musin many instances the composition of the cle and diseased kidney must be "fed," and dietary does not matter so much as does disaster is likely to result from adding what becomes of it after it is ingested and semi-starvation to the dangers of chronic digested. I am confident that we frequent- nephritis.

[ocr errors][merged small][merged small][merged small]

and injured men, women and children are is alcohol. Fortunately the antidote is daily taken care of, given first aid treat- easier to obtain than the poison itself. ment by the ambulance surgeon in cases of Never use olive oil or any other oil in a injury and removed to a nearby hospital. case of carbolic acid poisoning, but adMany cases of injury and poisoning would minister as soon as possible alcohol in some terminate fatally were it not for the quick form, full strength alcohol itself is to be and skilful treatment of the ambulance preferred, but alcohol in any form, diluted surgeons.

alcohol, whiskey, brandy, gin, beer, wine, The eight ambulances are stationed in or any alcoholic beverage may be used. police barns in different parts of the city Nowadays a person can buy carbolic ready to respond instantly to a "hurry up acid only 33 1-3 per cent. strong, and call” to a poison case, an injury, to the naturally it requires a larger amount of this birth of a baby in an open doorway, or to to produce fatal results than of the full any other emergency. Before the person strength carbolic acid. Moreover, many calling on the telephone has had time to cases of carbolic acid poisoning that I have give a complete history of the case, the am- treated, previous to their drinking the acid bulance with its attending surgeon is on have imbibed freely of beer or whiskey, its way, its great gong changing the "clear and thereby, unwittingly helped to save the way" alarm.

themselves. A stomach pump is a valuaIn several of the police stations of the ble instrument to use in these cases, and it city there are established fully equipped may be employed without any danger of hospitals, each having five or six beds, and puncturing the stomach wall, at least I in charge of an ambuiance surgeon and have never had any untoward results from his orderly. Many cases of minor surgery a quite extended use of the instrument. are treated in these hospitals daily, partic- A person dies from shock in carbolic ularly at the Harrison and Des Plaines acid poisoning and it is the surgeon's duty Street stations, there being on an average

to combat the shock in every way possible. of 150 patients treated every week in these For this purpose I give strychnine gr. 1-30 two hospitals alone. These police emer- and nitro glycerine gr. 1-100 hypodermicgency hospitals are the means of the sav- ally. ing of much time and many a mile run to Gas poisoning. Many cases of poisoning the County Hospital which is always from illuminating gas come under the obovercrowded.

servation of the ambulance surgeon.

We There are 24 ambulance surgeons em- treat these cases by the free use of oxygen, ployed by the City of Chicago working on hypodermic stimulation, and external the ambulances and in the eight hospitals. warmth. The patient is covered with Some of these surgeons are assigned to any blankets, and hot water bottles properly large meeting such as conventions, water protected, placed about the unconscious pacarnivals, aviation meets, etc., where temp- tient. We see to it that plenty of fresh orary hospitals are established and first aid air is had, mixed with oxygen if necessary, given to the puble free of charge.

and continue our methods of resuscitation I will now describe our methods of for a long time; by refusing to give up treating the various cases that come under when apparently there was no more hope, the observation of the ambulance surgeon. I have saved many a life.

First cases of poisoning. Carbolic acid Most of our ambulances are now equipped poisoning is by far the most common and with small oxygen tanks, ready for instant dangerous poisoning that we have to deal use in cases of emergency. with. The best and, indeed, the only anti- Alcoholic intoxication. This is one of dote worth considering, not only for car- the most common forms of poisoning with holic poisoning, but for carbolic acid burns, which the anibulance surgeon has to contend. I have found that the easiest and by the use of the interrupted current, one quickest way to “sober up” a drunken man sponge being placed over the abdomen and is by the use of electricity. At the hospital one pole attached to a rectal speculum located at the Harrison Street police sta- wliich is inserted in the rectum. I have tion, the writer installed an electric wall treated a large number of cases of morplate operating both the galvanic and fara- phine, or opium poisoning and since I have dic current. A couple of large wet sponges used the interrupted electrical current in are attached to the cords of the electric the manner described, I have not lost a case wall plate, one of which is applied over the when there was the remotest hope of reabdomen, the other one to the calf of one covery. Strychnine and atropine hypoof the legs of the patient and the faradic derinically, are good adjuncts but are not so current turned on. A few good shocks efficient as one would be led to believe by usually produce emesis. Many a “drunk" reading the text books. Stimulation in any I have sobered in this manner thus pre- form, if electricity cannot be obtained, is venting his being locked in a cell to sleep useful, of course. Artificial respiration is off his "jag." The use of the stomach

The use of the stomach good but mignty hard on the physician and pump in these cases is not necessary because his assistant, as often it has to be practised the electrical shocking makes the patient for hours and is not nearly so efficient as vomit. I believe the use of apomorphine the interrupted current. A pint of black is both unjustifiable and dangerous, I have coffee per rectum is very good. After seen several men go into a condition of washing out the stomach I fill it with black shock after its employment and for this coffee and leave it ihere. reason we have abandoned its use entirely Burns and their treatment. Few people in the ambulance service.

know how many cases of burns are cared Morphine poisoning. Opium in any for by the police ambuiance service in a form, whether taken internally, used hypo- large city like Chicago. The principal dermically, or the fumes inhaled from remedies we use are picric acid and unopium smoking acts primarily as a stimu- guentine.

guentine. The picric acid is used in a i lant and secondarily as a depressant. Most per cent. solution and in this strength can of the cases that we, as ambulance sur- be employed freely without any toxic efgeons, are called upon to treat are due to fects. It is clean, and effective, in rethe smoking of opium by beginners and lieving pain, especially if large areas have to the over dosing by old timers, especially been burned. My method is to saturate a in the Harrison Street district. The symp- sheet in a one per cent, solution and wrap toms are all the same: depression of the it about the burned part, cover the parespiratory apparatus, contracted "pin- tient with a blanket and rush him to a nearpoint" pupils which do not react either to by hospital. Pain, which is the most imlight or accommodation. The patient can portant factor in the emergency treatment be aroused in the early stage, but in the of burn cases is relieved by picric acid. latter stage he is totally unconscious and Unguentine is also good but expensive cannot be aroused by ordinary methods. when large amounts are required, besides The first thing I do in the way of treat- being an ointment, it is hard to apply in ment is to wash out the stomach with a cold weather. Carrencil and linseed oil solution of potassium permanganate, color may be used if nothing else is obtainable. of wine, or a saturated solution of epsom I never apply cotton directly over a burn, salts, because most of the drug is excreted but cover burnt area with sterile gauze. by way of the stomach, irrespective of how The emergency treatment of fractures. it has been taken. I have found that the Many cases of fractures are treated daily most efficient method of treating these cases by the ambulance surgeon. The proper after the preliminary stomach washing, is treatment, in my opinion for a simple frac

[graphic][ocr errors][merged small]
« ForrigeFortsæt »