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tablished for his own Self with the NotSelf, power for success of which is irresistible. From the humble source of a simple and intelligent, albeit disinterested, desire to be of service, the physician has floated quickly into the main channel of the

great world-stream, the mighty flow of which will carry him, almost without effort of his own-certainly without disagreeable effort-on and on to the ocean of success, known by many names, but most often as heaven.

NOTE ON DIETETIC FADS AND PROTEINPHOBIA.

By G. FRANK LYDSTON, M.D., CHICAGO.

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

I WISH first, to renounce any claim to a laboratory expert knowledge of dietetics. What I am about to say is based entirely upon clinical experience and observation of more than thirty years.

Some of the prevalent opinions regarding dietetics, particularly in renal diseases, are, it seems to me, absurd and illogical; at least, when carried to the extreme which characterize the practice of some physicians of excellent repute and wide experience. A point that is uppermost in my mind at present is the abhorrence of proteids exhibited by practitioners in certain conditions. I am willing to concede that, other things being equal, a diet which is fairly free from proteids is often essential in the treatment of renal disease. Especially is such a diet of value in certain forms associated with general arterial disease, or, as Fothergill termed it, cardio-vascular disease. I am confident, however, that in the later stages of chronic Bright's disease, which have been treated by a restricted diet, we are often confronted with anemia, cardiac weakness and renal inactivity which are due to too great restriction of diet in general or too great diminution of proteids in the dietary. A cardinal point in dietetics, which is too often forgotten by otherwise common-sensible physicians is that man in all his organs and functions has evolved into an omnivorous animal. Away back in our ancestry we were essentially flesheating animals merely because preying upon other animals was the easiest method of supplying the larder. It is presumable that

taste and capacity for the digestion and assimilation of a vegetarian diet resulted from the adaption to the exigencies of environment. However this may be, it is certain that we are descended from a long line of flesh eaters. Hereditarily, therefore, we should expect not only a demand for meat as a part of the human dietary, but also a capacity for its digestion and assimilation and for the excretion of the waste products thereby formed. It is reasonable to suppose that the kidney itself has become accustomed to proteids, not only to their nutritive properties, but also to the stimulus of the retrograde products of protein metabolism.

It is to be admitted that an excess of protein or even the average normal amount of protein ingested by individuals whose digestion and assimilation and excretion are impaired must be productive of harm. This, however, does not militate against the argument that a certain amount of meat is valuable or even necessary in the dietary even of certain nephritics. I am satisfied that I have prolonged life and made the patients more comfortable in many cases of chronic nephritis by removing some of the arbitrary restrictions that have been laid upon the diet and giving meat in moderate amount. A weakened heart muscle, low blood pressure, and a sluggish kidney often respond to such a change in dietetics. I recall a personal experience which occurred some twelve years ago that is very pertinent in this connection. I was suffering from an attack of subacute des

quamative nephritis, as the French term it, resulting from gastro-intestinal disturbance. The prominent features were gastric derangement, edema of the extremities, and an extremely weak heart. Despite the fact that I ingested apparently sufficient quantities of milk and vegetables and cereals to sustain nutrition, the aforesaid symptoms became more and more prominent. My consultant finally becoming alarmed by my cardiac weakness, prescribed heart tonics. Having begun to acquire some notions of my own regarding my condition and the treatment therefor, I informed my consultant that my cardiac muscle had been used to a meat diet. Furthermore, I was confident not only that the essentially nonproteid diet which had been prescribed, was not being properly digested and assimilated' but also that my heart muscle was "crying for beef steaks and mutton chops." Very much to the disgust of my medical friend, I avowed my intention of following my own sweet will in the matter of diet, with the result that in three or four days there was a marked change for the better in all of my symptoms, and I shall never forget the marvellously beneficial effects of my first rare beef steak taken against the advice of my consultant. I am quite certain that my patients have on the average since derived. enormous benefit from my own personal experience.

A point which we too often forget is that in many instances the composition of the dietary does not matter so much as does what becomes of it after it is ingested and digested. I am confident that we frequent

ly prescribe an arbitrary diet and rely too confidently upon the composition of the dietary for the salvation of our case. The quantity and quality of the dietary on the one hand, and the condition of the digestive functions, metabolism and elimination upon the other, must all be taken into consideration. This may seem trite, but all the same several of the factors mentioned are often known to be ignored by many physicians.

The late Dr. George Chismore, of San Francisco, in a conversation with me just before his death several years ago, told me that he had arrived at conclusions similar to my own regarding the dietetics of chronic nephritis. He apparently proved his point. by his case books. I saw at once that my friend was inclined to extremism because of the insistence with which he called attention to the fact that the excretion of urea was

largely increased in many of his patients

after the administration of a strictly meat diet. Obviously this did not of itself prove that a nitrogenous dietary was beneficial. The blood pressure, pulse, the cardiac record, the hemoglobin estimate, and the relief of edema were, however, sufficient to convince the most skeptical that in Dr. Chismore's own cases and under his direction a meat diet was beneficial and undoubtedly prolonged life.

Theorizing aside, a weakened heart muscle and diseased kidney must be "fed," and disaster is likely to result from adding semi-starvation to the dangers of chronic nephritis.

THE WORK OF A POLICE AMBULANCE SURGEON.
By CLARENCE H. WALL, M.D., CHICAGO, ILL.

OF all the departments connected with the suppression of vice, the protection of individuals and property and the care of unfortunates provided by a beneficent municipal government none probably is less. familiar nor more interesting than the police ambulance service.

Few people living in Chicago, are aware of the great work performed by the eight. ambulances belonging to the city of Chicago and under the direct supervision of the Police Department. Under the able management of Dr. George C. Hunt, who is chief of this department, over 200 sick

and injured men, women and children are daily taken care of, given hrst aid treatment by the ambulance surgeon in cases of injury and removed to a nearby hospital. Many cases of injury and poisoning would termmate fatally were it not for the quick and skilful treatment of the ambulance surgeons.

The eight ambulances are stationed in police barns in different parts of the city ready to respond instantly to a "hurry up call" to a poison case, an injury, to the birth of a baby in an open doorway, or to any other emergency. Before the person calling on the telephone has had time to give a complete history of the case, the ambulance with its attending surgeon is on its way, its great gong clanging the "clear the way" alarm.

In several of the police stations of the city there are established fully equipped hospitals, each having five or six beds, and in charge of an ambulance surgeon and his orderly. Many cases of minor surgery are treated in these hospitals daily, particularly at the Harrison and Des Plaines Street stations, there being on an average of 150 patients treated every week in these two hospitals alone. These police emergency hospitals are the means of the saving of much time and many a mile run to the County Hospital which is always. overcrowded.

There are 24 ambulance surgeons employed by the City of Chicago working on the ambulances and in the eight hospitals. Some of these surgeons are assigned to any large meeting such as conventions, water carnivals, aviation meets, etc., where temporary hospitals are established and first aid given to the puble free of charge.

I will now describe our methods of treating the various cases that come under the observation of the ambulance surgeon.

First cases of poisoning. Carbolic acid poisoning is by far the most common and dangerous poisoning that we have to deal with. The best and, indeed, the only antidote worth considering, not only for carbolic poisoning, but for carbolic acid burns,

is alcohol. Fortunately the antidote is easier to obtain than the poison itself. Never use olive oil or any other oil in a case of carbolic acid poisoning, but administer as soon as possible alcohol in some form, full strength alcohol itself is to be preferred, but alcohol in any form, diluted alcohol, whiskey, brandy, gin, beer, wine, or any alcoholic beverage may be used.

Nowadays a person can buy carbolic acid only 33 1-3 per cent. strong, and naturally it requires a larger amount of this to produce fatal results than of the full strength carbolic acid. Moreover, many cases of carbolic acid poisoning that I have treated, previous to their drinking the acid. have imbibed freely of beer or whiskey, and thereby, unwittingly helped to save themselves. A stomach pump is a valuable instrument to use in these cases, and it may be employed without any danger of puncturing the stomach wall, at least I have never had any untoward results from a quite extended use of the instrument.

A person dies from shock in carbolic acid poisoning and it is the surgeon's duty to combat the shock in every way possible. For this purpose I give strychnine gr. 1-30 and nitro glycerine gr. 1-100 hypodermically.

Gas poisoning. Many cases of poisoning from illuminating gas come under the observation of the ambulance surgeon. We treat these cases by the free use of oxygen, hypodermic stimulation, and external warmth. The patient is covered with blankets, and hot water bottles properly protected, placed about the unconscious patient. We see to it that plenty of fresh air is had, mixed with oxygen if necessary, and continue our methods of resuscitation for a long time; by refusing to give up when apparently there was no more hope, I have saved many a life.

Most of our ambulances are now equipped with small oxygen tanks, ready for instant. use in cases of emergency.

Alcoholic intoxication. This is one of the most common forms of poisoning with which the ambulance surgeon has to con

tend. I have found that the easiest and quickest way to "sober up" a drunken man is by the use of electricity. At the hospital located at the Harrison Street police station, the writer installed an electric wall plate operating both the galvanic and faradic current. A couple of large wet sponges are attached to the cords of the electric wall plate, one of which is applied over the abdomen, the other one to the calf of one of the legs of the patient and the faradic current turned on. A few good shocks A few good shocks

usually produce emesis. Many a "drunk" I have sobered in this manner thus preventing his being locked in a cell to sleep off his "jag." The use of the stomach pump in these cases is not necessary because the electrical shocking makes the patient vomit. I believe the use of apomorphine is both unjustifiable and dangerous, I have seen several men go into a condition of shock after its employment and for this reason we have abandoned its use entirely in the ambulance service.

Morphine poisoning. poisoning. Opium in any form, whether taken internally, used hypodermically, or the fumes inhaled from opium smoking acts primarily as a stimulant and secondarily as a depressant. Most of the cases that we, as ambulance surgeons, are called upon to treat are due to the smoking of opium by beginners and to the over dosing by old timers, especially in the Harrison Street district. The symptoms are all the same: depression of the respiratory apparatus, contracted "pinpoint" pupils which do not react either to light or accommodation. The patient can be aroused in the early stage, but in the latter stage he is totally unconscious and cannot be aroused by ordinary methods. The first thing I do in the way of treatment is to wash out the stomach with a solution of potassium permanganate, color of wine, or a saturated solution of epsom salts, because most of the drug is excreted by way of the stomach, irrespective of how it has been taken. I have found that the most efficient method of treating these cases after the preliminary stomach washing, is

by the use of the interrupted current, one sponge being placed over the abdomen and one pole attached to a rectal speculum which is inserted in the rectum. I have treated a large number of cases of morphine, or opium poisoning and since I have used the interrupted electrical current in the manner described, I have not lost a case when there was the remotest hope of recovery. Strychnine and atropine hypoderinically, are good adjuncts but are not so efficient as one would be led to believe by reading the text books. Stimulation in any form, if electricity cannot be obtained, is useful, of course. Artificial respiration is good but mighty hard on the physician and his assistant, as often it has to be practised for hours and is not nearly so efficient as the interrupted current. A pint of black coffee per rectum is very good. After washing out the stomach I fill it with black coffee and leave it there.

Burns and their treatment. Few people know how many cases of burns are cared for by the police ambulance service in a large city like Chicago. The principal remedies we use are picric acid and unguentine. The picric acid is used in a I per cent. solution and in this strength can be employed freely without any toxic effects. It is clean, and effective, in relieving pain, especially if large areas have been burned. My method is to saturate a sheet in a one per cent. solution and wrap it about the burned part, cover the patient with a blanket and rush him to a nearby hospital. Pain, which is the most important factor in the emergency treatment of burn cases is relieved by picric acid. Unguentine is also good but expensive when large amounts are required, besides being an ointment, it is hard to apply in cold weather. Carron cil and linseed oil may be used if nothing else is obtainable. I never apply cotton directly over a burn, but cover burnt area with sterile gauze.

The emergency treatment of fractures. Many cases of fractures are treated daily by the ambulance surgeon. The proper treatment, in my opinion for a simple frac

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