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The results of our efforts, if successful, would not be confined to this State. They would, to an appreciable degree, affect every college in the Union which has a single student looking to the Centennial State as a future home, strengthening those that demand high attainments, repressing their opposites.
The influence of low grade colleges to control, to paralyze the efforts of those whose standard is known to be high, is past the belief of those who have given the subject but little thought. Among the 130 medical colleges of the United States and Canada, there is none better known than that of Bellevue, New York. In no college are men more prominent, in no medical college, it would seem, are the teachers by professional standing or by pecuniary position better able to withstand the pernicious influence of low grade schools, yet when four years since it demanded of matriculants a preliminary examination, and required attendance upon a graded course of lectures, its class was so diminished that before the proposed course had continued the half of a session, a halt was called and a humiliating retreat was ordered. It was driven back to a position for which it had no respect-and the profession in the United States are in part responsible for their action. If it were understood that a thorough medical training was a pre-requisite to obtain a license in Colorado, young men seeking our favored State as a professional field, would first seek the academies and preceptors and colleges, where such training would be obtained, and would enquire not "From what college can I obtain a diploma in the shortest time and with a minimum of knowledge," but, rather, would ask, “Whose alumni show the smallest per cent. of failures before the Colorado Examining Board."
Whatever shall strengthen the colleges that are honestly striving for a high standard, and whatever action is taken to secure to all States the better type of professional men, must emanate in great part from physicians.
Gentlemen of the medical profession of Colorado, and more especially those of this respectable body, you are one of the factors that shall produce this desirable condition,
I have spoken of the influence of a high State standard in modifying Colorado's medical future.
It is almost unnecessary to say that any project making further requirements of physicians already licensed to practice in Colorado, would be impolite, unwise and certain to meet with no encouragement. But no such objection should be urged regarding those who may come hereafter.
As suggestive of the change that a few years might work, I will mention that nearly one-third of the six hundred and sixty practitioners now in Colorado have entered the State within the past four years.
If our standard was an approximation of that requisite to enter the Medical Department of the United States Army or Navy, less than a score of years would behold the profession of Colorado more competent, better informed, more skillful than could be found to-day among the general practitioners of any State in the Union.
May God speed the day when civilians shall receive an average medical attendance equal to that of our sailors and soldiers, and grant that it fall to the lot of our State to lead the van in the noble work.
In conclusion, gentlemen, let me return my sincere thanks for the esteemed courtesy, for the honor most highly valued, conferred upon me by this vigorous, progressive Society.
TREATMENT OF DISEASES OF THE STOMACH.
BY DR. M'CALL ANDERSON.
In the first rank must be placed diet and regimen, as many disorders can be cured by attention to them alone, while few can be treated successfully without them.
As an instance of a disease in which they are indispensible, let us take the case of ulceration of the stomach. In this affection absolute rest in bed is generally indicated, although I am by no means, prepared to deny that many can and do recover without it. Here the diet must be of the simplest kind, given in small quantities, and at short intervals; and a good rule for our guidance is, that anything which causes pain or sickness, and this remark applies almost universally to all affections in which these symptoms are present–is injurious. Milk, in combination with lime, Vichy, or seltzer water, and well iced, is usually the best; or if this does not agree, butter milk or koumiss, peptonized farinaceous food (such as that prepared by Savory & Moore) or what is known in commerce as “Solution of Meat” may be tried ; the quantity administered at a time being reduced to the point in which it occasions no discomfort. Even a teaspoonful may be all that can be borne at once and it is much better to give a very small quantity which is retained than a larger amount which disagrees. In extreme cases the best practice is for a time to suspend the administration of food by the mouth altogether, and to
feed the patient per rectum, allowing him, however, to slake his thirst by sucking a small piece of ice occasionally. The enemata which I have latterly been in the habit of using are Savory & Moore's “nutritive enema” and “Carnrick's beef peptonoids.” Leube's meat pancreatic clysters-a solution of meat treated with pancreatine-are also worthy of trial. But it must never be forgotten that feeding per rectum is only a temporary expedient, with the view of giving perfect rest to the affected organ, because the co-operation of all parts of the digestive tract is required ; Voit and Bauer having shown that the rectum is only capable of absorbing about a quarter of the albumen necessary for the maintenance of life with the addition of fat of hydro-carbons. And yet, in the case of an eminent citizen well known by reputation at least to all of you whom I saw several times in consultation, life was maintained for a whole month by the use of nutritive enemata alone, not even a drop of water having passed his lips during the whole of that time.
Dr. Debove does not approve of milk diet, owing to its tendency to dilate the stomach. He prescribes three meals daily, each composed of 25 grammes of meat powder mixed with 1 of burned magnesia, 2 of prepared chalk, and i of saccharrated lime; and a quarter of an hour after each meal he administers 4 grammes of bicarbonate of soda. The gastric juice is thus neutralized and no peptone are formed in the stomach. On the other hand many are in favor of a method of treatment, whose · principal exponent is Prof. Ziemssen, and which consists in the administration every morning of an alkaline aperient whose basis is Glauber's salt. For this purpose he gives Carlsbad water, or the natural, or —best of all, because most aperieut—the artificial Carlsbad salts dissolved in water, "I make my patients," he says, "take every morning, fasting a solution of from 8 to 16 grammes, or 2 ao 4 drachms (one or two teaspoonfuls heaped up) of the salt to a pound (one pint) of water which has been poured on when boiling, and then the whole cooled down to about 44° R. A quarter of a pint is taken every ten minutes. Two or three motions are necessary ; if the bowels are moved only once, or not at all, an enema should be used, and on the following morning the quantity of salt should be increased by 72 or doubled, the quantity of water remaining the same. Subsequently as a general rule less concentrated solutions are sufficient and then the patient may return to a teaspoonful of the salt to a pint of water, In cases where the gastric catarrh is very intense, and the pyrosis particularly obstinate it will be found advantageous to administer every evening during the first week, another bottle of an acidulous soda water (Giesshubel, Bilin, or Vichy). "The carbon
ate of soda, the chloride of sodium, and the Glauber's salts neutralise the acids and check the fermentation. They therefore suppress the corros. ive action upon the floor of the ulcer, and the reflex contraction of the pyloric muscular fibres, and by their strongly excitant action upon the peristaltic movements of the stomach they cause the fermenting liquids to be rapidly discharged into the bowel. It is evident that if the stomach is thoroughly emptied, at least once a day, its contents are much sooner rendered temporarily alkaline, or neutral, and their tendency to fermentation restricted.”
In many cases of ulceration sedatives, such as small doses of morphia with bismuth and hydrocyanic acid, are valuable, but constipation is apt to be induced or aggravated by such medication, and then they may be combined with the use of the alkaline aperient above mentioned or resort may be had to the black oxide of magnese-a gastric sedative not so well known, which was introduced by the late Dr. Leared and which, in doses of 10 grains, has proved most useful in my hands for this and similar conditions. In chronic cases small doses of arsenic-from one to two minims of Fowler's solution three or four times a day often yield the best results,
In acute catarrh of the stomach, even greater care is required as to food than in the case of ulceration. Indeed, on the principle of keeping an inflamed organ at rest, it is often the wisest course to abstain altogether for two or three days from the administration of food by the mouth, although ice may usually be sucked with comfort and advantage. Hot applications to the epigastric region often afford some relief, while calomel is one of our sheet anchors, especially for those in whom it may be given in a dose of 5 grains, which may be repeated in a day or two, if need be, or in smaller doses at shorter intervals. In addition to this other gastric sedatives, such as those already mentioned, may be used, but none are so likely to prove beneficial as the subcutaneous injection of morphia, If there is great exhaustion, a little well-iced champagne may be tried from time to time, and as the symptoms subside, the utmost caution must be observed in improving the dietary.
It is often difficult to say whether we have to deal with dyspepsia or with chronic catarrh of the stomach (inflammatory dyspepsia as it is sometimes called). We may, however, suspect the existance of the lat
, ter if there is slight fever at night with some loss of flesh, if the tongue is coated and red at the tip and edges, or red smooth and glazed, or raw looking; if thirst is present, if the uneasiness after food ever amounts to pain, if there is tenderness in the epigastric region, if there is nausea or
vomiting, if mucus is vomited in the mornings, and if the urine is high colored and deposits lithates. Having satisfied ourselves that we have to deal with chronic catarrh, our first aim in treatment is to remove the causes—such as irregularities of diet and regimen, constipation, the excessive use of stimulants, gout, disease of the kidneys, obstructive disease of the liver, lungs, or heart-which we must attack on the same principles as we would do if they occurred independantly of stomach catarrh. This having been done, and the symptoms persisting, we may resort to the use of occosional doses of calomel and of saline purgatives--such as Friedrichshalle, Hunyadi Janos, Pullna, &c., or a visit to one of the more celebrated spas—such as Homburg, Kissingen, Carlsbad, or Wiesbaden, may be recommended. When there is evidence of fermentation in the stomach-flatulence, acid eructations, &c.-permanganate of potash is specially to be recommended, and often speedily gives relief.
In the latter stages the saline treatment may be combined with ton. ics—the sulphate of magnesia mixture in combination with sulphuric acid, strychnia, and columba for example. The diet must all along be most carefully regulated, consisting of milk, beef-tea, and farinaceous food, while, in the slighter cases, fish, poultry, and game may also be allowed. The meals should be small, and not too numerous; and, as a rule, all stimulants should pe strictly forbidden. During convalescence, tonics may be cautiously administered-being selected in accordance with the surroundings of each case.
Arsenical treatment has already been alluded to as being sometimes useful in cases of ulceration, but there is another class of affections in which it, as well as other anti-neuralgic remedies, is sometimes of the utmost value--viz., "neuroses of the stomach." These usually give evidence of their presence by the occurrence of pain of a neuralgic character, or of vomiting. Such cases are very apt to be mistaken for ulceration on the one hand, and dyspepsia on the other; and we may frequently aid our diagnosis, as well as contribute to their successful treatment, by means of diet, for the symptoms are sometimes relieved by giving nourishing food-even solid, hot and stimulating food and by administering stimulants, while those of the above-mentioned disorders are pretty sure to be aggravated thereby.
In other cases the stomach pain is but a symptom of chlorosis, and its true nature may be suspected if there is an absence of other symptoms of stomach disorder on the one hand, and the presence of waxy pallor of the surface and other symptoms of chlorosis on the other ; but care must be taken to exclude ulceration, which is by no means an uncommon