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When we returned to our room the interne -seriously. Unfortunately, this superstition complained of fulness and pains all thru his is not limited to the laity, for many doctors chest-acute congestion. He folded his hands accept the "tissue-food" fallacy as philosophy. and arms over his chest, covered up warmly in Many who have gotten beyond this, still believe bed and was soon asleep again. The next that drugs are directly friendly to the system morning he was all right. Did he have pneu- and that they cure by cossetting rather than by monia ? True, congestion is the first step shock. Only food is friendly (homogeneous) toward pneumonia, but is every congestion, to the organism, while drugs are the reverse of like the above case, and Dr. Van Horne's case, this. The drug's natural antagonism to norpneumonia ? Decidedly not; tho the first mal vital movement is all that justifies the use step was made, and if the process had been of drugs in sickness. Drugs cure by shock. continued, doubtless pneumonia would have Along with its general hostility to the animal been developt. Let us avoid “snap diag- organism, each drug possesses a specific (hostil) noses.” It is in this way that over enthusiastic affinity for a particular tissue or part. The men pile up a list of many cases of “ acute drug student takes advantage of this fact, monia, " " without a single death,” while more and uses that drug in a particular case which careful and conservativ men have comparativly has a known affinity for the part affected. If few cases of this disease, and a comparativly it is the glandular system, for instance, he will high percentage of deaths. We frequently say employ phytolacca; if the circulatory system, that there is much difference in patients. Yes, he will employ veratrum or aconite, according and there is more difference in doctors.—Ed.] to specific indications, etc. To be brief, the
astute clinician will send the right drug to the
right place where (by virtue of its foreignness) Pneumonia.
it will raise a local riot which may shake out [From an Eclectic Authority.)
the local morbid tangle, and restore the norMy Dear DOCTOR TAYLOR:-I wish I had a mal trend. If it does this, he has actually dollar for every different method there is of assisted Nature in effecting a cure. It is true treating pneumonia. What a huge, heartless that thousands of cures have been made by a joke on medical science it is—the possibility of huge dose of even the wrong drug, just as it is such a wish! Necessarily every man is his true that an earthquake may drive a rat from own criterion, and no man can transcend him- a house. But such a remedy for a rat is hard self. Every doctor knows that there is but one on the house, even as a horse dose of a drug is right way of treating this disease, and he knows hard on the human system. It is a thousand that his way is that right way. I am not an times better to locate the rat and then send the exception to the rule, and I, too, would toot cat in after it. In this age that is what all up-tomy little horn. I shall talk dogmatically, and date physicians try to do. We are all on the consequently didactically, not because I am so hunt for specifics, but it must be conceded that phenomenally wise, but merely to avoid the the eclectic and homeopath are in the lead on tediousness of euphonisms and circumlocu- this trail. tions.
I treat pneumonia (and all other diseases) There are three or four axioms underlying deferentially to the principles above enunciated. medicin, the strict observance of which would Right here, I want to emphasize the fact that eliminate about all errors in the practise of in the treatment of any disease, it is immeasurmedicin. In this instance I shall cite but one, ably more important to know what not to do, namely: Nearly all but causal treatment is than it is to know (guess at?) what to do. malpractise. Nearly all,” because the use of First, then, never commence the treatment anodynes is justified but rarely, and palliativ of pneumonia with a cathartic, or even a laxativ. treatment should be employed only in those From a close study of this feature, buttrest by cases that will necessarily terminate fatally. observations and comparisons which have run
In the treatment of all diseases, the prime thru forty years of professional life, I know object is the conservation of vital energy. In that it is wrong to thus “clear out” the each case of sickness, whether the patient will bowels of a pneumonic patient. If the bowels recover will depend upon the amount of his must be moved, use an injection. This will vital reserve. Enuf of vitality is all that makes subtract almost nothing from the patient's vital recovery possible. The average layman does sum, and it will not detract from the digestiv not know this. From that confidence in drugs and absorptiv powers of the stomach and which he has absorbed from all the medical bowels as the physic does. Can any one tell past, he imputes a food quality to drugs, and me what good is to be expected from this believes that the right drug imparts vitality initial physic? It is certain (and I could prove into the system.
For instance, he takes it to you by private and collaborate statistics if the word “tonic”-as applied to a drug I had the space) that this initial physic diminJANUARY, 1904]
Pneumonia from a Trained Nurse's Point of View
ishes the patient's chances for recovery at least a teaspoonful every hour till the crisis is past, 3 percent.
and then give it according to your judgment. Do not apply to the chest of the patient any In preparing the medicin, diminish the quantity sloppy material or anything that has appre- of the drugs according to age. For years I ciable weight. Sloppy applications disturb the have used Lloyd's specifics. Any other trustsuperficies and increase the tendency to chill worthy make will do just as well, but be careful with its direful consequences.
All poultice to make proper allowances for difference in applications are objectionable for this reason, strength. Over the chest I apply a greased but their weight constitutes the greatest obsta- rag (cotton rag) on which has been freely cle to their use. The lightest of them will sprinkled the "lung powder"-compound force the respiratory muscles to lift at least a lobelia and capsicum powder. This is to be ton in twenty-four hours. Think of imposing renewed or changed every twelve hours. When such a task upon the weak muscles of a sick fever runs high, sponge the patient with tepid child ! Think of abstracting this much of life soda water. Never give an antipyretic for the from the victim (young or old) of pneumonia ! symptom, fever. All antipyretics are cardiac Is it not straight, unmitigated barbarism? Not depressan's, and you want to save the heart. that the physician who does it is a barbarian, Never whip the over-workt heart with digitalis but that he is inexcusably thoughtless. The or strychnin. Its condition is the effect of ice-pack in pneumonia is a double-barrelled lung engorgement. Devote all your skill and abomination. This is admitted by its cham- attention to the cause, and the effect will take pions in the confession that its use is admissible care of itself. in only vigorous subjects. That is, the very I have been in the practise nearly forty years strong may recover in spite of such an out- and have always had an unusual share of pneurage.
monia cases. I have treated all of them in the The treatment of pneumonia might be nearly temperate, conservativ way indicated in the foresummarized in the injunction: Let your patient going, and I have lost less than one-half of one recover. That is, do not hinder his recovery percent of my cases. Be brave enuf, doctor, by the use of any agent or method that would to tear away from the heroic and unphilosophic tend to make a well person sick. This rules drug methods so much in vogue, and give your out bad hygienic conditions, company, and patient a fighting chance. Let him get well. very especially, heroic drugging. Avoid every- Cleves, Ohio. W. C. COOPER, M.D. thing that wastes the patient's vitality, for in a
[Editor of The Medical Gleaner.] sufficiency of this abides his only hope. Do not, I beseech you, be afraid to medicate little Pneumonia from a Trained Nurse's Point of enuf. Remember all the time, that there is
View, ten thousand times more danger in over, than Editor MEDICAL WORLD : Excuse the there is in under medication. It is Nature who liberty, but having been a constant reader of is doing the curing, and you are a very incon- your excellent journal and seeing your late call sequential understrapper in the case.
to physicians for “what will you do in pneuWhether your patient has lobar or lobular monia this winter," will you accept a few pneumonia makes no difference, it is all in- remarks from a trained nurse? Aammation of the lungs. Whether he has the As to drug medication, I do not meddle; disease in the sthenic or asthenic form makes each physician has his own theory and mode of no difference, for all treatment should be sup- treatment. My province is in the nursing; and porting, unless it is a fact that in the sthenic I follow to the letter all of the physician's form the patient is above par. Think of the instructions in the line of medication. Howidiocy of depletion in any form of sickness !
ever my experience has taught me—when the As to the drug treatment, I believe that in “angel with the amaranthine wreath” stands all diseases we should drive at the primal on one side of my patient and I on the other, lesion. That means we should, as a rule, use and the doctor miles away with no telephone but one medicin at a time. If causal treatment near, then is the time when a nurse is of is right, and you are giving the right drug with inestimable value-especially when cardiac reference to the cause in a given case, can you failure begins to manifest itself. My watchgive me a philosophic reason why any other words are : Feeding, either by the mouth, or drug is called for? According to my own ex- high enema; moist air ; watching the heart; perience, and that of thousands of other physi- temperature of the room 65°. My favorit mode cians, a combination of veratrum and bryonia of feeding by enema is the use of white of one should be the central drug idea in pneumonia. egg, one tablespoonful of whiskey and one of For an adult, add six or eight drops of the milk (mixt), every four hours, if the patient veratrum and two or three of the bryonia to requires this form of nourishment, and severe four ounces of water. Of this mixture give a cases always do. If the patient will take nourishment by the mouth, I see that he has a “cussedness." Keep sending THE WORLD; good variety of nourishing diet, such as milk, I promise to do better. broths, meat juice, egg-nog, etc., increasing The season for pneumonia is here. After a the diet to soft solids. I always keep in mind good calomel purge, I give an alkaloidal that I must do all in my power to support life granule of aconitin, veratrin and digitalin, one until the disease, which is self-limited, has run of each every half hour or oftener until the fever its course.
is reduced, pulse soft and full, and patient I have used with great success (on approval better in every way. Also an excellent thing of the physician) the cactina pillets, beginning is antikamnia and heroin for cough and restlesson the fifth day of the disease, making them a ness. When temperature is near normal, give prophylactic remedy. However, as is some- quinin and nourishment. Before I stop I want times the case, we are suddenly confronted by to tell you that your style of dunning a fellow the alarming condition of a threatened collapse- has been worth the $3.00 to me; you do it so cyanosis of the face, etc., with which we are all nicely, so gentlemanly, yet so fairly; no loop too fearfully familiar. Then I turn to that little hole is left to squirm; and you leave a fellow friend, the hypodermic needle, and inject sy gr. feeling good, also. Yours till the rope breaks. of strychnin, use mustard over the heart, high Berryman, Mo.
W. J. PARKER. enema of one tablespoonful whiskey or salt solution, with heat to the body. We nurses must improvise many things in
Turpentine Will Prevent Tetanus. private practise. Immediately upon taking a
Editor MEDICAL WORLD :-Experience case of pneumonia, I begin and keep up for
teaches me that spts. of turpentine freely three or four days and nights a system of arti- applied to a wound after cleansing is a sure ficial moisture in the room.
Should there be preventiv of traumatic tetanus. I have applied a stove in the room, I hang up three or four
it on a pad made of cloth folded several times wet sheets, keeping them wet enuf not to drip,
with never failing results. A horse with a nail all the time, while there is at the same time a
thru hind foot; a pad saturated with turpenkettle of water constantly boiling on the stove.
tine around foot, and foot placed in a can to If a steam heater is in use, I hang the sheets
fit, filled with turpentine, relieved him in a over and around the radiators, using kettles of
few hours from violent tetanic symptoms, so boiling water from the kitchen range, changing limping. Have applied it to scalp and other
that he was able to travel next day without them as they cool off. “Eternal vigilance is the price of safety."
wounds with invariable success, wounds healAs for the use of antiphlogistine, I value it
ing by first intention. It will prevent tetanus greatly in all cases where there is not a weak
in Fourth of July and Christmas wounds. heart to combat; but if so, I prefer the cotton
Sneads, Florida. W. B. FORMAN, M.D. jacket, which is readily made by basting two
Cold Feet. layers of sheet cotton inside an undershirt, which can be removed gradually by cutting off
Editor MEDICAL WORLD:-Dr. Geo. E. from the bottom about two inches each day. Ehinger, page 515, of November WORLD, When temperature is very high, I bathe in gives a treatment for hot feet. If he or some equal parts of alcohol and water, which reduces other gentleman will give a successful one for the fever and quiets the patient.
cold feet, a number of us will be under many To summarize: I have never lost but two obligations to him. Thos. B. CRITIENDEN. patients out of twenty-seven that I have nursed Horton, W. Va. by this method, and I reiterate : Nourishment, moist air, watching the heart, and uniform Medical Society Meetings.-Some Criticisms. temperature of the room.
These are my
Editor MEDICAL WORLD:- Doubtless many watchwords.
readers of The MEDICAL WORLD attend meetBy this manner of treatment, applied by a ings of medical societies and take part in the vigilant and conscientious nurse, accompanied proceedings. They either read papers, take by a strict observance of the skilful physician's part in the discussions, or at least listen to orders, we can almost always, in the words of what others may have to say. Undoubtedly Conan Doyle, “Shoo death out of the room many have felt as I have, that from mismanlike an intrusiv hen." Mrs. M. W. NEES, agement, much precious time is wasted, and Brazil, Indiana.
the great majority of such meetings are far less
interesting and profitable than they should be. Editor MEDICAL WORLD:-Inclosed find It is the purpose of this paper to point out P. O. order for $3.00, and my thanks for your a few of the notable causes of such shortcomkindness and forbearance with me in my ings. negligence, for which I have no excuse but The first noticeable feature is the inordinate
length of the usual program. The effort is ing the debatable points in the subject properly apparently made to cover the entire field of under consideration. medicin, surgery, or whatever specialty is the Who has not felt humiliated at the bungling, occasion of the meeting. Paper after paper hesitating, monotonous and expressionless readis fired at the listeners, with no reasonable in- ing, and the stammering, illogical and inconsetervals for deliberate discussion. It is not un- quential speaking in doctors' meetings? It usual to find half a dozen papers on important might be profitable for a goodly number to subjects crowded into a single session of two or take a few lessons in elocution. Excellent three hours. Those who devise the programs ideas are often murdered in the rendering, and ignore the fact that there may be subsequent Spalding's glue can hardly restrain people from medical meetings, and that it will be wise, if vacating their seats, rather than listen to prosy, not generous, to leave some topics for their hum-drum, uninteresting readers who address consideration.
themselves, and gesticulate to their manuscript The next cause of complaint is the inordinate rather than to their auditors. It is a relief to length of the majority of the papers presented. have some man rise in his place and deliver himEven in meetings, where it is well known that self of ideas in language that is unmistakable, only a stated and definit time limit is allowed that strikes home and makes itself felt. to each paper, not seldom does the reader There is a great difference between what is flounder in the prolog and introduction until barely tolerated and words that are irresistible his time has expired by limitation, and then he and convincing. is either untimely cut off by the chairman's If these suggestions serve in any way to gavel, or perchance, the good nature of the repress the interminable bores, and rouse to hearers, with more or less forbearance, extends forceful expression readers and speakers, they his time, often infringing on the rights of sub- will have served their purpose and will make sequent numbers on the program.
medical meetings more interesting and profitThere are very few medical papers presented able.
BENJ. EDSON, M.D. in the course of a year that could not be profit- Brooklyn, N. Y. ably compassed in the space of fifteen minutes. [It seems that some men are so constituted Many of them are not worth ten minutes of the that they cannot aim directly at the point, time of an audience of intelligent professional whether speaking or writing. What should be men. And yet men of standing and reputa- done with them? We freely “ blue pencil” the tion continue to inflict their tiresome com- useless preliminary verbiage on contributions pilations upon suffering hearers in secula that come here. -Ed.] seculorum.. If those who prepare “ literary” papers
Consultation among the Various Schools. would at the outset grant that their hearers Editor MEDICAL WORLD:-1 am interested possess at least an elementary knowledge of the in your open discussion concerning consultarudiments of medical science — would give tion among the various schools. The question Hippocrates, Galen, Arataeus, and the defunct is a broad one and has two sides. However, it ancients generally a rest and burial —would seems to me that preponderant arguments are realize that an assemblage of learned doctors is deducible in favor of intra-sectarian consultapresumably beyond the kindergarten stage of tion. These arguments will naturally fall into medical lore-would in short give us some- two divisions : The doctor's reasons, and the thing new and up to date, personal experiences patient's. and observations, deductions and conclusions The first readily offers itself for division into from their own field of investigation, it might three sub-heads : Social, scientific, and sectawarrant traveling long distances to listen to
rian. something interesting and profitable.
Socially, common human interests favor As it is, the social functions of many a liberality rather than bigotry, for after all, the medical meeting are all that rescue the gather- doctor is merely a man, and whenever he ing from being “flat, stale, and unprofitable. ” permits sect prejudice to interfere with his
Those whose province it is to discuss the relationship to the humanities, his value as a papers are often sinners likewise. Some so healer diminishes. The tradition of all ages like to hear the sound of their own voices that points to the doctor as an altruistic and optithey are oblivious to the passage of time and to mistic adviser. Aside from this are the fellow. the fact that possibly some one else may have a ship and sympathy desired and neeeed, from co
workers, by every man. An even more selfish We have all seen the man who comes pre- reason for consultation is the mental and social pared with a pocketful of specimens, and who, broadening always possible. Whether the coninstead of fairly discussing the subject in hand, sultant is our superior or inferior mentally, proceeds to exalt himself and his doings, ignor. socially, or scientifically does not affect the
word to say.
truth of the preceding statement.
medical unity is chimerical, and should be such, who is as thoughtful as the medical man should methods as herein suggested will remove rebe, will deduce beneficial comparisons, either movable friction. thru approbation or reprobation.
From the patient's view-point, the matter is As a scientist, any opportunity for patholog- one of his paramount right to the best obtainical review should command a willingness to able treatment. What is a certain school to consult. Scientific experience and research is him if he die? The correlativs of the arguof value, whoever its medium. Every scientistments used in discussing the physician's phase must have learnt something of value. The real of the question, apply with full force here. All student rises above school limitations in mat- the arguments of selfishness and also of altruters of original research. The man in the ism are his in favor of consultation. Not all scientist prevents his classification as a mere consultants will be ideal ; nor will all patients sectarian. The sciences of anatomy, pathology, recover if a consultant of differing school is etc., recognize no sect, and it is as often diag- called, but I believe nothing but good can nosis, as treatment, that brings us to our knees. come from a discriminate choice of consultants I once consulted with an elderly allopath. He from different sects. did not wholly understand the rationale of my
WALTER S. BOGART, M.D. treatment, but admitted the point after expla- Cleves, Ohio. nation. There was a stubborn feature in the case under consideration which seemed unac- Prevention of Mould in Aqueous Solutions. countable, owing to absence of objectiv symp
-Long Continued Typhoid. toms. My consultant, after a long résumé of Editor MEDICAL WORLD:-Some time ago, the mutually perplexing case, said, "Have you in The World or some other journal, I saw a suspected syphilis?” I had not, but his sug- prescription given for the preservation of solugestion offered a solution of the whole prob- tions of epsom salts and other solutions from lem. Could he have done more for me if a moulds, which we know so soon form on and member of my own school? His leading spoil such aqueous solutions. The simplest and question was the result of experience and re- cheapest way I ever saw or tried is to keep a search. Might not this be true of any con
little pure chloroform at the bottom of the stock sultant of any school in any particular case ? bottle; the vapor is continually present at the
As sectarians, there are numerous reasons top, and as it is death to all kinds of moulds, it for professional communion. As one of your very effectually prevents their growth in any contributors says, pathology, symptomatology, solution, and it gives a sweet, pleasant flavor and therapeutics are best represented in differ- that helps to mask nauseous mixtures. I have ing schools. Is not that a fact, if we will let never seen it in print, but have used it for ourselves admit it? And should it not be taken many years, and no doubt others have done so advantage of? If the difference between your also. knowledge of one of these three fundamentals, I have treated my share of typhoid fever and that of your neighbor, should justify your cases in the past forty years. I have tried calling him, and you do not, for school reasons, most of the abortivs for the same and the difand a life is lost, aren't you a long way toward ferent modes of treatment that worthy men in being a murderer? Or if, as an individual, he the profession have found so successful in their has buttrest himself firmly in some department practise. I have been blest with good success of science, can you lose by conferring with him? under the intestinal antiseptic plan of treatIs dogmatism compatible with an increasing ment, and have a good deal of faith in it, even civilization or with your own best business or tho some of our professional brethren try to moral interests? Then, there is the individu- show us that the proportion of the antiality in treatment. Do you know of many septic to the body avoirdupois can never be physicians in any given school who treat ex- sufficient to affect the disease working bacillae ; actly alike? Are doctors machines, any more even Nothnagel in his late work on the subject than patients? The results of such individual gives little credence to the good they do in experience cannot fail to benefit somewhere. that direction, but notwithstanding the adverse Above all else, in choosing your confrere, should opinions of so many, I feel confidence, to a you look to his ego? Lastly, I believe free great extent, in their beneficial action, and I consultation would redound to the benefit of use them in every case. Some years ago I had all sects. It must be true that each can learn, a typhoid case that hung on for sixty-two days in some things, from every other, and learning in spite of all the antiseptics I gave, with a means elimination of errors. Thus can each fever line of about 100°. I never had one of school be taught its own errors and bettered, these cases again until the past fall, when I got and the entire medical body be leavened with four of them, three in one family and one in the disseminated knowledge. While absolute another many miles away, all boys from 5 to