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clearly that we have in pneumatic differentiation a powerful cardiac agent. The best results would seem to have been obtained in cases of valvular disease with imperfect compensation. When complete compensation has occurred, nothing can be expected from pneumatic treatment. In those cardiac lesions, accompanied with pulmonary engorgement, compressed air is a very effective agent in restoring the circulatory equilibrium, whether the lesion is situated in the aortic or mitral valves.
Waldenburg has obtained good results in the pneumatic treatment of fatty heart.
Further observations are wanting to accurately determine the value and indications of pneumatic therapeutics in cardiac diseases.
In concluding this outline, permit me to urge upon the members of this Society a fuller recognition of an important force in therapeutics, which comes to us with its value impressed by the seal of an extensive and successful experience.
Dr. Hibberd-Mr. President, I am very sorry to have to start all these discussions, but a paper that has been prepared with so much care and given to us with so much earnestness, and that covers such an important region of therapeutics ought not, it seems to me, to be passed quietly into the hands of the Publication Committee without any comment. I agree with the author that the subject has not had sufficient consideration from the medical profession; and I think it will require really a more careful consideration logically than has been given to it at all. I do not think that I can agree with the inferences that seem to have been drawn by the paper nor entirely indorse the conclusions which the author has reached. I am not going over the whole ground, but will state a few thoughts in my own mind. I think there must be some error in the logic of that paper as to the effects that are ultimately produced. I suppose we send a phthisical patient to the mountains for recuperation and, if it be in the early stages that he is sent to an elevated region, he will be benefited thereby. That is to say his general health will improve; the local difficulty will gradually give way and there will be a better condition of his respiratory air cells and he will come out of it very much benefited. Now, the
paper seems to indicate that the value comes from the fact that the person lives in the compressed air. It was my supposition that a phthisical patient receiving benefit did it chiefly from respiring an attenuated air. Instead of it being really the result of a particular change in the condition or pressure of the air in the lungs it was this: There was a natural and unconscious effort on the part of the patient to get enough oxygen to supply the demands of his system, and in order to do that in that attenuated air there must be a constantly increased effort of the respiratory muscles to enlarge the capacity of the chest; there must be more room in there for the air that it may contain the amount of oxygen, necessary to the regeneration of his tissues. That must be kept up, not only for the time being, but is kept up unconsciously night and day until it establishes a change. It is simply the replacing of one atom that has left this life and become excrescent matter by another and new atom. If the air be pure, as well as rare; if the nutrition be simple and nitrogenous instead of very highly spiced, then all of the conditions by which this poor poverty-stricken victim had been surrounded pass away and the old dead tissues are replaced by healthy tissues. Now, the difficulty I have is in seeing how any cabinet in which a patient may be immersed for a little while can give the benefits that are clearly derived by living in an attenuated air. I do not speak from any experience, because I have had no experience. I do not see the logic of it. When one is put into compressed air I do not see the logic by which they arrive at the conclusion that the lungs are made anæmic; there is actually a paleness of the surface, still it is not satisfactory; that may be the first step in it and the other may be that there is excessive blood in there. If you put hot water to your hand the first effect is you have a greater amount of blood there, and the next effect is that you have less blood. May it not be so under the influence of compressed air?
Dr. McCaskey-Mr. President, I wish to say that I did not expect the views expressed in this paper to be accepted. As I said at the close of the paper, my principal object in presenting this was to bring this matter before the Society-to get the gentlemen of the Society to discuss it or to think about it. I do know
that the subject has not had the attention to which it is entitled. Regarding phthisis and its method of treatment by sending to elevated regions, I think Dr. Hibberd's theory is correct. But does it necessarily follow that these conditions we produce are entirely temporary in their results? I can hardly agree in that respect. I had made many observations myself two or three years ago, before I had this cabinet. I used an ordinary tank and pumped the air with an air pump. I have found the vital capacity increased 10, 15, 20 and 25 per cent. I will cite one case within the last six weeks. A young German girl, twenty-two years old, was brought to me suffering from hemorrhagic phthisis; she had had hemorrhage every day for a month. I placed her in the pneumatic cabinet and made her breathe against a pressure of about a quarter of an inch of mercury. The hemorrhages disappeared from the very first treatment. Day before yesterday I saw her and she had not spit one drop of blood since the treatment began. It clearly shows that it is not a temporary effect. I will not occupy the Society longer; I thank the Society for this attention. As I said, I do not expect these views to be accepted fully.
BY N. FIELD, M. D., JEFFERSONVILLE, IND.
The present generation of young surgeons are greatly harrassed with fear of blood poisoning from wounds and surgical operations. That seems to have been the principal difficulty in the treatment of the wound of the late President of the United States, Gen. Garfield. He was severely tortured in search of pus cavities. Deep incisions were made into his side and into an indurated parotid gland for the evacuation of a few drops of pus, lest its absorption should fatally poison the blood of the unfortunate patient. Had a regimental surgeon of the late civil war, of extensive experience and good judgment, had the sole management of the case, he would have been glad to see free suppuration, especially in the track of bullet. He would have entertained the hope that, by permeating the wound to its utmost extent, the deadly missive might be disentangled from the tissue in which it was embedded, and by a proper position of the body made to gravitate toward the point of entrance. But the fear of blood poisoning from the absorption of pus prevented the vis medicatrix from having anything to do in the management of the case. At last, after suppuration was prevented, and all danger obviated from that source, the fatal termination was attributed to malarial poison emanating from the banks of the Potomac. The removal of the President to Long Branch was to place him beyond the influence of the newly discovered malaria. He was encouraged with the hope when that was done he would. speedily recover. One hundred thousand dollars was thought to be a moderate compensation for the extraordinary display of surgical knowledge in the treatment of his case.
According to Prof. Bartholow, the blood is never free from poison. He asserts that there is not a cubic inch of pure air on earth. From the summit of the highest mountains to the lowest
valleys it abounds with malaria, the prolific cause of all the diseases that afflict humanity. The word malaria signifies bad air, which, by being inhaled, enters the blood through the lungs, causing disease and death. His antidote for this form of blood poisoning is quinine; hence he recommends it for nearly all diseases. This theory virtually charges the Creator with having poisoned the air we breathe for the purpose of destroying the human race. While he made the atmosphere to support life, he at the same time injected it with a deleterious agent to destroy it!
But Bartholow's malaria is now among the things that were. It may be classed with the exploded hobbies and dead issues which have arisen and flourished for a time, since the days of Hippocrates. A new discovery has superceded it. The bacterian theory of morbid causation is everywhere being accepted as the most rational explanation of ærial blood poisoning. These living germs are said to pervade the atmosphere in countless myriads from top to bottom, filling our mouths, noses and lungs, and swimming in our blood and literally eating us up. Koch, of Germany, and Pasteur, of France, with their laboratories and microscopes, are hard at work demonstrating this mighty problem that is destined to turn the medical world upside down. The medical journals are full of bacteria. New medical authors will abound with learned disquisitions on the wonderful discoveries of the German and French savans. We shall have no trouble hereafter in accounting for and treating all kinds of diseases. Whatever will kill bacteria will cure disease. Our therapeutics will be greatly simplified, and the labor of the doctor very much abridged. Blood poisoning is not half so dangerous as is generally supposed, as the blood possesses an inherent power of eliminating whatever impurities may enter it. The effluvia of measles and small-pox enter the blood but are eliminated through the skin. Bovine virus is a poison to the blood, but is thrown off without difficulty at the point of inoculation. The syphilitic virus is a formidable blood poison, but not necessarily fatal. Dissection wounds, the most dangerous of all forms of blood poisoning, are not always fatal. Various kinds of medicines are forced into the blood, such as calomel, corrosive sublimate and arsenic, and finally carried out of the system by the emunctories without permanent injury to health. The fundamental principle of the old