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thing, be careful that atmospheric air is not introduced. I made that mistake in the first cases in allowing it to be introduced. Have all atmospheric air expelled so that nothing but the gases pass up and you will avoid colicky sensations. My patients have not suffered anything except a few colicky pains at first. I went into this prejudiced against it, believing it was one of these newspaper remedies that are so constantly vaunted in our sight, but I am now persuaded it is a good thing.
Dr. Lewis-How often do you administer it?
Dr. Elder-At first once a day, but I soon ascertained that it required twice a day. The patients ask that it be administered twice a day. They say they feel better when it is administered twice. I have a five gallon bag filled and the patients administer it themselves. At first I gave them a few lessons, and now they administer it themselves with perfect satisfaction. They take the bag to Dr. Hurty's and get it filled. I visited all of them last night in order to know their condition. My judgment is that the solution as given by Dr. Maxwell is too weak. I think five grains is too small an amount to generate with; we use double that amount in generating the gas; we throw in at least ten and sometimes fifteen grains to twenty-four ounces of water.
Dr. Morgan-I have been fortunate or unfortunate enough to be the first one to introduce this subject to the local medical society. As I took somewhat positive grounds in regard to my opinions about this treatment at that time, I would like to say a few words in regard to the treatment now. The reports in the medical journals have almost universally borne out the good opinions which were formed by myself at the time I gave this report to the local medical society. On account of the opposition and in some cases ridicule with which this treatment was met I was somewhat loath to put my patients under this treatment until other treatments had proven ineffectual. I have one case, an old lady sixty years old, suffering from fibroid phthisis. I kept that old lady on a treatment of quinine in different forms to reduce the temperature, and failed. By the use of antipyrine I reduced the temperature for a few hours, but that was all; it would return. Her temperature went as high as 103 and her pulse 120. It continued for three days in spite of the
treatment I had instituted, except for the space of four hours, by the use of antipyrine. This lady has been under this new treatment about one week, and the result is that, whereas she had night sweats previously, they have been entirely abolished; she had no appetite before and now her appetite has increased. Her pulse was 120 before, almost continuously, and it has been brought down so that in the last three examinations that have been made her pulse was 100. Her temperature one day-I think it was the third day after the administration of this gas had begun-went down to 98. Why it went this low I am unable to say. Suffice it to say that her temperature since the institution of this treatment has not gone over 1013; for the last two days it has been 99. I instituted the same treatment on a lady beginning to-day. Of course I have no results to report of that case, except for the last eight or nine days I have been using other treatments to reduce a temperature of 101 and pulse of 105. My idea of the action of this remedy is that it is germicidal, and that the results we have from consumption principally—and when I speak of consumption I mean fibroid phthisis and tuberculosis-are on account of blood poisoning generated in the lungs. I believe this remedy will prove beneficial in all cases that would come under the head of septicemia or pyemia.
Dr. Lewis-I have just been reading a lecture delivered in London, by a professor there, and he makes a few points which I will mention. In speaking of the preparation of carbonic acid gas he says that carbonic acid gas prepared with mineral acids often gives rise to colicky pains from the irritating particles mechanically carried He recommends that the preparation be made with vegetable acids. He also recommends very strongly that the carbonic acid gas be washed once or twice; that is, that it be passed through water once or twice. There are two cases in which it has been tried at Crawfordsville, about which I know, although I have not seen the cases. In one case in which the remedy was used it seemed to give no relief, but seemed to produce distress; but the lady was at the point of death. She died two days after the use of the remedy. It was only used to comfort her friends. Her lung was so much destroyed that it was impossible for her to eliminate the gas that was introduced, and the pulse fell so rapidly and her strength
failed so rapidly that I am sure in that case the remedy did harm. In another case in which it is being used I have reports almost daily. The results are, that the temperature is being reduced, the night sweats have entirely stopped, and the diarrhoea has been. checked. In regard to the mechanical part, I wish to say a word. I am decidedly of the opinion that the mixture ought to be made as Dr. Elder says. This doctor in London recommends the same thing. He doesn't approve of passing the carbonic acid gas through the sulphuretted hydrogen into the patients. I have read in the last two or three months all I could get on this subject and I have failed to find a case in England or in France where mineral acids are used; they all use and recommend vegetable acids. If it is prepared with mineral acids it is in a condition to be easily decomposed; it won't remain very long without decomposition of the sulphuretted hydrogen gas taking place. I had a case brought to me two weeks ago for trouble of the throat. I examined and found ulcers which seemed to me like tubercular ulcers. I examined the
history of the case. While the lady had all the appearance of being a consumptive patient, her family physician said he had found no evidence of consumption. I examined her lungs and found no evidence of consumption except a little jerky breathing in the left. lung; but there were several ulcers, and there was characteristic swelling of the arytenoid cartilages. She was brought to me by friends as a case in which to use this new remedy; that is to say, they wanted to use gaseous injections, and it was a case which has been recommended as the kind to have this remedy tried. I recommended before trying this to use iodoform. I applied it and it immediately yielded to it. The case has been under treatment for two weeks. When she came she could hardly swallow. The pain was so severe that she did not eat. The ulcers yielded to the treatment, and when I left yesterday there was no sign of any ulcer; the swelling had all gone down and the lady was apparently recovering. Here was a case where it was possible, instead of getting at the local place through the blood, to apply the remedy directly. It was a case where, if I had not used iodoform, I would have used inhalations.
Dr. Hibberd-You are a teacher, Dr. Lewis; what acid would you use in this preparation?
Dr. Lewis-Tartaric acid. In France they put up little parcels in little bottles, carbonate of potash and tartaric acid in proper proportions, then drop into the bottles a little water; as soon as the gas is formed it is liberated. Even in that case they wash the gas; I have not read a paper that did not recommend washing the gas. Dr. Morgan-Mr. President, I would like to beg the indulgence of the Society for a moment. There is no use in paying ten or even five dollars for apparatus for making this gas. Any doctor can make it for himself. I have made my own myself. I would take two ordinary Mason fruit jars, a quart or half gallon. Into the top of these cut two holes in each lid. Then just beneath the lid place a section of India rubber. Where these perforations are, make a slight perforation in the India rubber. Buy two tips of a gas jet; on the top of the larger end of one have a small funnel; in the bottom have a small tube. Place the acid in the jar and through the funnel pour the bicarbonate solution. Into this tube you can place a small glass tube to go down into the acid so that the tube will not be affected by the acid. Then a small rubber tube will do for a connection to carry away the acid from the glass. You prepare the other jar just the same. My instrument cost me about $3.25. I paid $2.00 for the rubber. I should think what it really ought to cost would be about $2.50.
Dr. Lewis-I hardly see why all that is necessary. The pupils in our high schools know how to prepare carbonic acid gas. Then all that is necessary is to have a quart bottle with a tube leading from the bottle in which the carbonic acid gas is formed and another tube leading from the bottle which holds the mixed gases to the bag. Into one bottle you put the bicarbonate of soda. All that passes from the first bottle is the carbonic acid the carbonic acid gas; that passes through the other bottle; we then pass it through water and the gas is washed, and then into the bag. It seems to me that the outlay ought certainly to be within a dollar just in preparing the gas; then the bag would be $1.25 to $2.00. I would like to ask Dr. Elder how often this bag is filled.
Dr. Elder-Every second day.
Dr. Lewis-I should be a little bit afraid of the decomposition of the gases of the sulphuretted hydrogen.
Dr. Hibberd-If you have them pure will they undergo decomposition?
Dr. Lewis-Not so much.
Dr. Hibberd-That would not hurt the patient, would it?
Dr. Lewis-No, sir; it is only the loss of the gas.
Dr. Maxwell-Mr. President, I am sorry that I was not present to hear the discussion of my paper; therefore I will make no remarks at all.