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When we returned to our room the interne complained of fulness and pains all thru his chest-acute congestion. He folded his hands and arms over his chest, covered up warmly in bed and was soon asleep again. The next morning he was all right. Did he have pneumonia? True, congestion is the first step toward pneumonia, but is every congestion, like the above case, and Dr. Van Horne's case, pneumonia ? Decidedly not; tho the first step was made, and if the process had been continued, doubtless pneumonia would have been developt. Let us avoid "snap diagnoses." It is in this way that over enthusiastic men pile up a list of many cases of "pneumonia," "without a single death," while more careful and conservativ men have comparativly few cases of this disease, and a comparativly high percentage of deaths. We frequently say that there is much difference in patients. Yes, and there is more difference in doctors.-ED.]

Pneumonia.

[From an Eclectic Authority.]

My Dear DOCTOR TAYLOR:-I wish I had a dollar for every different method there is of treating pneumonia. What a huge, heartless joke on medical science it is-the possibility of such a wish! Necessarily every man is his own criterion, and no man can transcend himself. Every doctor knows that there is but one right way of treating this disease, and he knows that his way is that right way. I am not an exception to the rule, and I, too, would toot my little horn. I shall talk dogmatically, and consequently didactically, not because I am so phenomenally wise, but merely to avoid the tediousness of euphonisms and circumlocutions.

There are three or four axioms underlying medicin, the strict observance of which would eliminate about all errors in the practise of medicin. In this instance I shall cite but one, namely: Nearly all but causal treatment is malpractise. "Nearly all," because the use of anodynes is justified but rarely, and palliativ treatment should be employed only in those cases that will necessarily terminate fatally.

In the treatment of all diseases, the prime object is the conservation of vital energy. In each case of sickness, whether the patient will recover will depend upon the amount of his vital reserve. Enuf of vitality is all that makes recovery possible. The average layman does not know this. From that confidence in drugs which he has absorbed from all the medical past, he imputes a food quality to drugs, and believes that the right drug imparts vitality into the system. For instance, he takes the word "tonic "-as applied to a drug

seriously. Unfortunately, this superstition is not limited to the laity, for many doctors accept the "tissue-food" fallacy as philosophy. Many who have gotten beyond this, still believe that drugs are directly friendly to the system and that they cure by cossetting rather than by shock. Only food is friendly (homogeneous) to the organism, while drugs are the reverse of this. The drug's natural antagonism to normal vital movement is all that justifies the use of drugs in sickness. Drugs cure by shock. Along with its general hostility to the animal organism, each drug possesses a specific (hostil) affinity for a particular tissue or part. The acute drug student takes advantage of this fact, and uses that drug in a particular case which has a known affinity for the part affected. If it is the glandular system, for instance, he will employ phytolacca; if the circulatory system, he will employ veratrum or aconite, according 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) it will raise a local riot which may shake out the local morbid tangle, and restore the normal trend. If it does this, he has actually assisted Nature in effecting a cure. It is true that thousands of cures have been made by a huge dose of even the wrong drug, just as it is true that an earthquake may drive a rat from a house. But such a remedy for a rat is hard on the house, even as a horse dose of a drug is hard on the human system. It is a thousand times better to locate the rat and then send the cat in after it. In this age that is what all up-todate physicians try to do. We are all on the hunt for specifics, but it must be conceded that the eclectic and homeopath are in the lead on this trail.

I treat pneumonia (and all other diseases) deferentially to the principles above enunciated. Right here, I want to emphasize the fact that in the treatment of any disease, it is immeasurably more important to know what not to do, than it is to know (guess at?) what to do.

First, then, never commence the treatment of pneumonia with a cathartic, or even a laxativ. From a close study of this feature, buttrest by observations and comparisons which have run thru forty years of professional life, I know that it is wrong to thus "clear out" the bowels of a pneumonic patient. If the bowels must be moved, use an injection. This will subtract almost nothing from the patient's vital sum, and it will not detract from the digestiv and absorptiv powers of the stomach and bowels as the physic does. Can any one tell me what good is to be expected from this initial physic? It is certain (and I could prove it to you by private and collaborate statistics if I had the space) that this initial physic dimin

JANUARY, 1904]

Pneumonia from a Trained Nurse's Point of View

ishes the patient's chances for recovery at least 3 percent.

Do not apply to the chest of the patient any sloppy material or anything that has appreciable weight. Sloppy applications disturb the superficies and increase the tendency to chill with its direful consequences. All poultice applications are objectionable for this reason, but their weight constitutes the greatest obstacle to their use. The lightest of them will force the respiratory muscles to lift at least a ton in twenty-four hours. Think of imposing such a task upon the weak muscles of a sick child! Think of abstracting this much of life from the victim (young or old) of pneumonia! Is it not straight, unmitigated barbarism? Not that the physician who does it is a barbarian, but that he is inexcusably thoughtless. The ice-pack in pneumonia is a double-barrelled abomination. This is admitted by its champions in the confession that its use is admissible in only vigorous subjects. That is, the very strong may recover in spite of such an outrage.

The treatment of pneumonia might be nearly summarized in the injunction: Let your patient recover. That is, do not hinder his recovery by the use of any agent or method that would tend to make a well person sick. This rules out bad hygienic conditions, company, and very especially, heroic drugging. Avoid everything that wastes the patient's vitality, for in a sufficiency of this abides his only hope. Do not, I beseech you, be afraid to medicate little enuf. Remember all the time, that there is ten thousand times more danger in over, than there is in under medication. It is Nature who is doing the curing, and you are a very inconsequential understrapper in the case.

Whether your patient has lobar or lobular pneumonia makes no difference-it is all inflammation of the lungs. Whether he has the disease in the sthenic or asthenic form makes no difference, for all treatment should be supporting, unless it is a fact that in the sthenic form the patient is above par. Think of the idiocy of depletion in any form of sickness!

As to the drug treatment, I believe that in all diseases we should drive at the primal lesion. That means we should, as a rule, use but one medicin at a time. If causal treatment is right, and you are giving the right drug with reference to the cause in a given case, can you give me a philosophic reason why any other drug is called for? According to my own experience, and that of thousands of other physicians, a combination of veratrum and bryonia should be the central drug idea in pneumonia. For an adult, add six or eight drops of the veratrum and two or three of the bryonia to four ounces of water. Of this mixture give a

15

a teaspoonful every hour till the crisis is past, and then give it according to your judgment. In preparing the medicin, diminish the quantity of the drugs according to age. For years I have used Lloyd's specifics. Any other trustworthy make will do just as well, but be careful to make proper allowances for difference in strength. Over the chest I apply a greased rag (cotton rag) on which has been freely sprinkled the "lung powder "-compound lobelia and capsicum powder. This is to be renewed or changed every twelve hours. When fever runs high, sponge the patient with tepid soda water. Never give an antipyretic for the symptom, fever. All antipyretics are cardiac depressan's, and you want to save the heart. Never whip the over-workt heart with digitalis or strychnin. Its condition is the effect of lung engorgement. Devote all your skill and attention to the cause, and the effect will take care of itself.

I have been in the practise nearly forty years and have always had an unusual share of pneumonia cases. I have treated all of them in the temperate, conservativ way indicated in the foregoing, and I have lost less than one-half of one percent of my cases. Be brave enuf, doctor, to tear away from the heroic and unphilosophic drug methods so much in vogue, and give your patient a fighting chance. Let him get well. Cleves, Ohio.

W. C. COOPER, M.D. [Editor of The Medical Gleaner.]

Pneumonia from a Trained Nurse's Point of View.

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Editor MEDICAL WORLD: Excuse the liberty, but having been a constant reader of your excellent journal and seeing your late call to physicians for "what will you do in pneumonia this winter," will you accept a few remarks from a trained nurse?

As to drug medication, I do not meddle; each physician has his own theory and mode of treatment. My province is in the nursing; and I follow to the letter all of the physician's instructions in the line of medication. However my experience has taught me-when the "angel with the amaranthine wreath" stands on one side of my patient and I on the other, and the doctor miles away with no telephone near, then is the time when a nurse is of inestimable value-especially when cardiac failure begins to manifest itself. My watchwords are: Feeding, either by the mouth, or high enema; moist air; watching the heart; temperature of the room 65°. My favorit mode of feeding by enema is the use of white of one egg, one tablespoonful of whiskey and one of milk (mixt), every four hours, if the patient requires this form of nourishment, and severe cases always do. If the patient will take

nourishment by the mouth, I see that he has a good variety of nourishing diet, such as milk, broths, meat juice, egg-nog, etc., increasing the diet to soft solids. I always keep in mind that I must do all in my power to support life until the disease, which is self-limited, has run its course.

I have used with great success (on approval of the physician) the cactina pillets, beginning on the fifth day of the disease, making them a prophylactic remedy. However, as is sometimes the case, we are suddenly confronted by the alarming condition of a threatened collapsecyanosis of the face, etc., with which we are all too fearfully familiar. Then I turn to that little friend, the hypodermic needle, and inject gr. of strychnin, use mustard over the heart, high enema of one tablespoonful whiskey or salt solution, with heat to the body.

We nurses must improvise many things in private practise. Immediately upon taking a case of pneumonia, I begin and keep up for three or four days and nights a system of artificial moisture in the room. Should there be a stove in the room, I hang up three or four wet sheets, keeping them wet enuf not to drip, all the time, while there is at the same time a kettle of water constantly boiling on the stove. If a steam heater is in use, I hang the sheets over and around the radiators, using kettles of boiling water from the kitchen range, changing them as they cool off. "Eternal vigilance is the price of safety."

As for the use of antiphlogistine, I value it greatly in all cases where there is not a weak heart to combat; but if so, I prefer the cotton jacket, which is readily made by basting two layers of sheet cotton inside an undershirt, which can be removed gradually by cutting off from the bottom about two inches each day. When temperature is very high, I bathe in equal parts of alcohol and water, which reduces the fever and quiets the patient.

To summarize: I have never lost but two patients out of twenty-seven that I have nursed by this method, and I reiterate: Nourishment, moist air, watching the heart, and uniform temperature of the room. These are my

watchwords.

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"cussedness." Keep sending THE WORLD; I promise to do better.

After a

The season for pneumonia is here. good calomel purge, I give an alkaloidal granule of aconitin, veratrin and digitalin, one of each every half hour or oftener until the fever is reduced, pulse soft and full, and patient better in every way. Also an excellent thing is antikamnia and heroin for cough and restlessness. When temperature is near normal, give quinin and nourishment. Before I stop I want to tell you that your style of dunning a fellow has been worth the $3.00 to me; you do it so nicely, so gentlemanly, yet so fairly; no loop hole is left to squirm; and you leave a fellow feeling good, also. Yours till the rope breaks. Berryman, Mo. W. J. PARKER.

Turpentine Will Prevent Tetanus. Editor MEDICAL WORLD:-Experience teaches me that spts. of turpentine freely applied to a wound after cleansing is a sure preventiv of traumatic tetanus. I have applied it on a pad made of cloth folded several times with never failing results. A horse with a nail thru hind foot; a pad saturated with turpentine around foot, and foot placed in a can to fit, filled with turpentine, relieved him in a few hours from violent tetanic symptoms, so that he was able to travel next day without limping. Have applied it to scalp and other wounds with invariable success, wounds healing by first intention. It will prevent tetanus in Fourth of July and Christmas wounds. Sneads, Florida. W. B. FORMAN, M.D.

Cold Feet.

Editor MEDICAL WORLD:-Dr. Geo. E. Ehinger, page 515, of November WORLD, gives a treatment for hot feet. If he or some other gentleman will give a successful one for cold feet, a number of us will be under many obligations to him. THOS. B. CRITTENDEN. Horton, W. Va.

Medical Society Meetings.-Some Criticisms.

Editor MEDICAL WORLD:-Doubtless many readers of THE MEDICAL WORLD attend meetings of medical societies and take part in the proceedings. They either read papers, take part in the discussions, or at least listen to what others may have to say. Undoubtedly many have felt as I have, that from mismanagement, much precious time is wasted, and the great majority of such meetings are far less interesting and profitable than they should be.

It is the purpose of this paper to point out a few of the notable causes of such shortcomings.

The first noticeable feature is the inordinate

length of the usual program. The effort is apparently made to cover the entire field of medicin, surgery, or whatever specialty is the occasion of the meeting. Paper after paper is fired at the listeners, with no reasonable intervals for deliberate discussion. It is not unusual to find half a dozen papers on important subjects crowded into a single session of two or three hours. Those who devise the programs ignore the fact that there may be subsequent medical meetings, and that it will be wise, if not generous, to leave some topics for their consideration.

The next cause of complaint is the inordinate length of the majority of the papers presented. Even in meetings, where it is well known that only a stated and definit time limit is allowed to each paper, not seldom does the reader flounder in the prolog and introduction until his time has expired by limitation, and then he is either untimely cut off by the chairman's gavel, or perchance, the good nature of the hearers, with more or less forbearance, extends his time, often infringing on the rights of subsequent numbers on the program.

There are very few medical papers presented in the course of a year that could not be profitably compassed in the space of fifteen minutes. Many of them are not worth ten minutes of the time of an audience of intelligent professional men. And yet men of standing and reputation continue to inflict their tiresome compilations upon suffering hearers in secula seculorum.

If those who prepare "literary" papers would at the outset grant that their hearers possess at least an elementary knowledge of the rudiments of medical science - would give Hippocrates, Galen, Arataeus, and the defunct ancients generally a rest and burial-would realize that an assemblage of learned doctors is presumably beyond the kindergarten stage of medical lore-would in short give us something new and up to date, personal experiences and observations, deductions and conclusions from their own field of investigation, it might warrant traveling long distances to listen to something interesting and profitable.

As it is, the social functions of many a medical meeting are all that rescue the gathering from being "flat, stale, and unprofitable."

Those whose province it is to discuss the papers are often sinners likewise. Some so like to hear the sound of their own voices that they are oblivious to the passage of time and to the fact that possibly some one else may have a word to say.

We have all seen the man who comes prepared with a pocketful of specimens, and who, instead of fairly discussing the subject in hand, proceeds to exalt himself and his doings, ignor

ing the debatable points in the subject properly under consideration.

Who has not felt humiliated at the bungling, hesitating, monotonous and expressionless reading, and the stammering, illogical and inconsequential speaking in doctors' meetings? It might be profitable for a goodly number to take a few lessons in elocution. Excellent ideas are often murdered in the rendering, and Spalding's glue can hardly restrain people from vacating their seats, rather than listen to prosy, hum-drum, uninteresting readers who address themselves, and gesticulate to their manuscript rather than to their auditors. It is a relief to have some man rise in his place and deliver himself of ideas in language that is unmistakable, that strikes home and makes itself felt.

There is a great difference between what is barely tolerated and words that are irresistible and convincing.

If these suggestions serve in any way to repress the interminable bores, and rouse to forceful expression readers and speakers, they will have served their purpose and will make medical meetings more interesting and profitable. BENJ. EDSON, M.D.

Brooklyn, N. Y.

[It seems that some men are so constituted that they cannot aim directly at the point, whether speaking or writing. What should be done with them? We freely "blue pencil" the useless preliminary verbiage on contributions that come here.-ED.]

Consultation among the Various Schools.

Editor MEDICAL WORLD:-I am interested in your open discussion concerning consultation among the various schools. The question is a broad one and has two sides. However, it seems to me that preponderant arguments are deducible in favor of intra-sectarian consultation. These arguments will naturally fall into two divisions: The doctor's reasons, and the patient's.

The first readily offers itself for division into three sub-heads: Social, scientific, and sectarian.

Socially, common human interests favor liberality rather than bigotry, for after all, the doctor is merely a man, and whenever he permits sect prejudice to interfere with his relationship to the humanities, his value as a healer diminishes. The tradition of all ages points to the doctor as an altruistic and optimistic adviser. Aside from this are the fellowship and sympathy desired and neeeed, from coworkers, by every man. An even more selfish reason for consultation is the mental and social broadening always possible. Whether the consultant is our superior or inferior mentally, socially, or scientifically does not affect the

truth of the preceding statement. The man who is as thoughtful as the medical man should be, will deduce beneficial comparisons, either thru approbation or reprobation.

consult.

He

As a scientist, any opportunity for pathological review should command a willingness to Scientific experience and research is of value, whoever its medium. Every scientist must have learnt something of value. The real student rises above school limitations in matters of original research. The man in the scientist prevents his classification as a mere sectarian. The sciences of anatomy, pathology, etc., recognize no sect, and it is as often diagnosis, as treatment, that brings us to our knees. I once consulted with an elderly allopath. did not wholly understand the rationale of my treatment, but admitted the point after explanation. There was a stubborn feature in the case under consideration which seemed unaccountable, owing to absence of objectiv symptoms. My consultant, after a long résumé of the mutually perplexing case, said, "Have you suspected syphilis?" I had not, but his suggestion offered a solution of the whole problem. Could he have done more for me if a member of my own school? His leading question was the result of experience and research. Might not this be true of any consultant of any school in any particular case?

As sectarians, there are numerous reasons for professional communion. As one of your contributors says, pathology, symptomatology, and therapeutics are best represented in differing schools. Is not that a fact, if we will let ourselves admit it? And should it not be taken advantage of? If the difference between your knowledge of one of these three fundamentals, and that of your neighbor, should justify your calling him, and you do not, for school reasons, and a life is lost, aren't you a long way toward being a murderer? Or if, as an individual, he has buttrest himself firmly in some department of science, can you lose by conferring with him? Is dogmatism compatible with an increasing civilization or with your own best business or moral interests? Then, there is the individuality in treatment. Do you know of many physicians in any given school who treat exactly alike? Are doctors machines, any more than patients? The results of such individual experience cannot fail to benefit somewhere. Above all else, in choosing your confrere, should you look to his ego? Lastly, I believe free consultation would redound to the benefit of all sects. It must be true that each can learn, in some things, from every other, and learning means elimination of errors. Thus can each school be taught its own errors and bettered, and the entire medical body be leavened with the disseminated knowledge. While absolute

medical unity is chimerical, and should be such, methods as herein suggested will remove removable friction.

From the patient's view-point, the matter is one of his paramount right to the best obtainable treatment. What is a certain school to him if he die? The correlativs of the arguments used in discussing the physician's phase of the question, apply with full force here. All the arguments of selfishness and also of altruism are his in favor of consultation. Not all consultants will be ideal; nor will all patients recover if a consultant of differing school is called, but I believe nothing but good can come from a discriminate choice of consultants from different sects.

Cleves, Ohio.

WALTER S. BOGART, M.D.

Prevention of Mould in Aqueous Solutions. -Long Continued Typhoid.

Editor MEDICAL WORLD:-Some time ago, in THE WORLD or some other journal, I saw a prescription given for the preservation of solutions of epsom salts and other solutions from moulds, which we know so soon form on and spoil such aqueous solutions. The simplest and cheapest way I ever saw or tried is to keep a little pure chloroform at the bottom of the stock bottle; the vapor is continually present at the top, and as it is death to all kinds of moulds, it very effectually prevents their growth in any solution, and it gives a sweet, pleasant flavor that helps to mask nauseous mixtures. I have never seen it in print, but have used it for many years, and no doubt others have done so also.

I have treated my share of typhoid fever cases in the past forty years. I have tried most of the abortivs for the same and the different modes of treatment that worthy men in the profession have found so successful in their practise. I have been blest with good success under the intestinal antiseptic plan of treatment, and have a good deal of faith in it, even tho some of our professional brethren try to show us that the proportion of the antiseptic to the body avoirdupois can never be sufficient to affect the disease working bacillae ; even Nothnagel in his late work on the subject gives little credence to the good they do in that direction, but notwithstanding the adverse opinions of so many, I feel confidence, to a great extent, in their beneficial action, and I use them in every case. Some years ago I had a typhoid case that hung on for sixty-two days in spite of all the antiseptics I gave, with a fever line of about 100°. I never had one of these cases again until the past fall, when I got four of them, three in one family and one in another many miles away, all boys from 5 to

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