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Use of Drugs.Douglas.


tient's idiosyncrasy to a drug does not lie more in the vague ideas of his doctor, druggist and nurse in regard to liquid measure that it does in his own proper person. The experimental observer and author, the physician, the druggist and nurse are all actors in this Comedy of Errors; how often is the end of it all a tragedy for the unfortunate patient?

But in this happy age of improved pharmacy, when our office tables are thickly strewn with circulars, pamphlets and other publications of the enterprising drug-firms who have kindly taken upon themselves to save the physician the mental wear and tear of thinking out his own prescriptions, and when the once broad boundary between rational medicine and patent nostrums has become a line almost mathematical in its tenuity: under such favorable conditions there should be some remedy found for this state of things, particularly in this year of Grace in which it is to be determined what preparations the Great American Public is to be dosed with for the next decade. Of all the problems of medicine, this should be the most readily settled on an accurate basis.

The fundamental error of the Pharmacopoeia consists in maintaining the strength of a standard measure of a liquid preparation in reference to a given weight of the crude drug. This merely adds to the liability to confusion, for not only must the dose of the drug be remembered, but also that of each of its preparations. First, let the average dose of the drug for a robust adult be determined. This would seem by no means an easy task, but the discrepancies of therapeutical writers are manifestly more the result of carelessness than of inability to state what such average dose would be. Then let one set of preparations, preferably the tinctures, be made of such uniform strength that one-half a fluidrachm would, in one and all, represent this average dose of the crude drug. This would at one stroke do away the necessity for a vast deal of memoriztng in regard to the proper quantity to be given of each of the hundreds of preparations; and at the same time would take away the constant temptation to think in drops instead of minims in prescription-writing. The standard of strength would thus be arranged for the convenience of the physician who is responsible for the action of the remedy, and not for the convenience of the manufacturing pharmacist, as it now is.

In regard to the measurement of the dose of a given mixture less could be done, but a step in that direction might be made by the general use of graduated medicine-glasses; they are cheap, and not beyond the means of any one able to pay for his own medicine, while a general demand for them would render them still cheaper.

There are yet other sources of error in the great variations in quality of the crude drugs used by the manufacturing pharmacist in the preparation of fluid extracts and tinctures; but this, though a most important matter, is one which lies beyond the power of the profession to prevent,


and hence out of the scope of this paper. But we can, and should, insist on more correct statements in our leading therapeutical works; cultivate a more careful method of prescription-writing; see to it that the doses when given are accurately measured; and, more than all, demand that at least one set of preparations be made of a uniform dose strength.

We have abandoned the awful bolus and the apalling apozem of the days of our grandfathers, but we have gained little in accuracy. The present system, or lack of system, can add nothing to the respect felt by. any pains-taking person towards what should be the most exact and accurate department of medical science.



In closing my former paper, I stated that there was at least one special department in medicine whose field was not overburdened with investigators, and which, in my judgment, is the department of study preeminent in medicine, viz.: Neurology. It will be my aim in that which is to follow to show why I think this is so.

In making this claim I trust I may not be understood as saying that consequently all the other allied branches already referred to are not necessary or important, or as even attempting to rob them of their specific value; indeed, they are just as indespensable, and their uses as manifold and equally as good; yet when we remember that it is by means of the nervous system that we see-feel-hear--touch-taste-smell,--that in our brains are stored all the memoirs of the past, and present events; that in fact we perform every act of our animal life by the same agency; who will be found to deny the claim I make in assigning to Neurology the very highest place in Medical Science? And hence the necessity of knowing the latest information regarding it becomes apparent at once.

If the brain is the supreme controlling center of all our actions and related, as we believe it is, to every tissue and energy of the body, surely a thorough knowledge of its functions and structure is indespensable to the scientific physician; and yet we are all conscious of the fact that, as a rule, it receives less attention in our colleges than perhaps any other branch of medical science.

One reason for this, perhaps, is its acknowledged complexity and intricate mechanism ; but, thanks be to specialism, many of its former difficulties have to a large extent been overcome; and to-day its study is comparatively easy. The famous American crow-bar case, although ocSpecialism in Medicine.-Punton.

*Concluded from last number.


curring less than forty years ago, may be said to be the starting point of neurological science proper.

In this case, we have an iron bar three and a half feet long, one and a quarter inches in diameter, and weighing about thirteen and a half pounds, completely perforating the skull and passing through a man's brain, due to the premature explosion of some gunpowder. After the accident the man walked up a flight of stairs, and told his friends how it happened. For some time his life was despaired of, and, strange to say, he developed no paralysis or marked impairment of the intellectual faculties. He finally recovered, and worked as a day-laborer on a farm. Twelve years after the accident he died, and as the facts in the case were so unusual many laughed at the possibility of such an occurrence; while others pronounced it an American invention, and in order to satisfy and demonstrate its genuineness the skull was exhumed after death, and it is now in the medical museum of Harvard University.

Its remarkable features startled and confounded the entire medical world, and rendered untenable all previous theories regarding the architecture and functions of the nervous system, and, more especially, the brain.

Since then a large number of scientists have devoted their exclusive attention to its study, and the conclusions drawn from their ingenious and elaborate experiments have definitely established many wonderful scientific facts and discoveries, which had hitherto been unknown and even unsuspected, and which in themselves have been sufficient to justly place neurological science at the very summit of medical specialism. To-day the crow-bar case is no longer a mystery to neurologists, or even regarded as an American invention by foreign critics, but by grasping the principles therein enunciated the science of neurology was made possible, which, by its further elaboration, has become the grandest tribute to medicine as well as to mankind.

By the application of its principles, and a correct knowledge of the symptoms present in any given case, a skilled neurologist can determine the exact situation, extent and possible cure of the disease or injury.

We know to-day that a slight injury to the medulla oblongata may produce immediate death, while a crow-bar or bullet may traverse another portion of the brain and recovery be possible. Hence we find one limited part essential to vital processes; another presiding over voluntary motion ; another over sensations of pain, touch and temperature, while other portions dominate the functions of the various special senses. Any injury to any of these parts causes a suspension, loss or exaltation of the parts or functions which they supply.

The nervous system, with the brain at its head, bears the same relation to the body as the helm does to the ship; it is its supreme directing force; or it may be likened to the steam in the main office of a complex system, where messages are constantly being transmitted to all its various ramifications.

Any interference, be it ever so slight, in any of its component parts meets with a proportional effect at headquarters, and by its reflex powers influences the more remote parts of the system.

Thus the whole human organism may be said to subserve the brain, indeed everything that lives, looked at from an evolutional point of view, tends towards mentalization, and all the tissues of all the organs of all types of animal life find their acme in the human brain convolutions hence, to understand the full relation and influenee of mind to the body, an accurate knowledge of the structure and functions of the nervous system is absolutely essential and necessary to success in the healing art. This is further illustrated by the fact that it is now claimed by many of the more advanced teachers that at the present time and for the last half-century there has been evolving an altered relation between mind and body; that is to say, that the mind of the present generation is more generally and intensely active than the mind of the immediately preceding generations.

This is not the same as saying that the average man of the present generation has more sense and judgment than his grandfather, or that the men of the present age are greater than Shakespeare or Washington. It is simply affirming what I believe to be true, that the average mind of the present age is much more active, and subjected to much more wear and tear, than was the average man's mind of the past few centuries; and if this be true, it is only reasonable to believe that that they are infinitely more susceptible to nervous diseases. As the brain is the recognized organ through which the mind is made manifest, and as having relationship, by means of the nervous system, with every part of the body by affecting all its tissues, controlling all its functions and regulating all its energies, surely its study becomes of paramount importance and takes precedence of all others.

The time is fast approaching, or even at hand, when in the consideration of almost every and any disease it is as necessary to recognize the state and influence of the mind as it is to include the condition of the bowels, liver or stomach, or the standard of the pulse and temperature, or any of the other collateral functions of the body ; and the future of our success in therapeutics will be in proportion to the amount of attention we give to this unwritten law, and allow its influence to direct and govern our actions. Indeed, the supreme influence and power which the brain and nervous system exercise over the animal economy is in itself sufficient to force us to recognize its claims and authority, and thus urge us to give it the due prominence in medicine it richly deserves.

Now is the time to send $2.00 to the INDEX.

Treatment of Sore Throat-Ingals.




[ Professor of Diseases of the Nose and Throat, Rush Medical College.]

In the College and Clinical Reporter (April, 1890) is given a valuable article, from which the following abstract is taken:

In treating these cases, our first attention should be directed to prophylaxis. With this in view, we must be careful that the patient is well clothed and housed, and that he is not exposed to undue changes of temperature or to wet or damp atmosphere. Rheumatic patients should always wear wool or silk next to the body throughout the whole year, light in summer and heavy in winter. They should be careful that all the excretory organs of the body perform their functions.properly. They should eat sparingly of such albuminous substances as meat or eggs, and should live largely on vegetables or fruit. The vegetable acids are often advantageous. Whatever is eaten, it is especially important that digestion be perfectly performed, so that the system be not poisoned by the formation of ptomaines.

For the local treatment of the disease, sedative or stimulant applications may be made with almost equal chances of relief. Applications of the tincture of aconite to the painful spot four or five times a day will sometimes give considerable relief. I have frequently found relief from the action of stimulants, as, for example, solutions of sulphate of zinc. The application of morphine in solution or in powder is sometimes a source of much comfort to the patient. I have derived more benefit, I think, from the application of a spray composed of morphine, carbolic acid and tannic acid, in glycerine and water, than from anything else. This solution consists of 4 grains of morphine, 30 grains each of carbolic and tannic acids, and 4 drachms each of glycerine and water. I apply it in full

4 strength, and frequently give it to the patient in a solution of half this strength, to be used daily in the form of spray. In some cases the strong tincture of iodine gives relief; in others the application of a sixty-grain solution of nitrate of silver has proved beneficial. These applications do good on the same principle that blisters sometimes relieve a rheumatic joint.

The most important part of the treatment is the internal medication. For this purpose salol, the salicylate of sodium, iodide of potassium, guaiac, phytolacca, and the oil of gaultheria may, one or all, be used at different times with benefit. The salicylate of sodium in doses of from 772 to 10 grains four or five times a day; the oil of gaultheria in doses of 15 minims three or four times a day; the ammoniated tincture of

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