Page images
PDF
EPUB

the removal of the examination requirement from its graduates, then it should be removed from the graduates of all other institutions. The state universities give their students no better instruction than do other colleges throughout the state. Judging from what we know of some of the students who have attended state universities for one or more years and finished their course in other colleges, we would, in fact, rather hesitate in placing the state university upon as high a level as some other colleges that we could mention.

We do not care to open up a discussion as to the utility of the State Board of Medical Registration, but we do desire to most earnestly protest against the legislature taking any action which will place the graduates of the Ohio State universities upon any other level than that occupied by graduates of other institutions in the state whose existence is sanctioned by the state and whose actions are governed by laws which the state officers enforce. If the examination is to be removed from any, let it be removed from all.

In this connection we would call attention to a note in the department. "Among the Journals," in which Dr. Eggleston offers some suggestions.

AND THE ANGLO-SAXON GOES

MARCHING ON.

City of Mexico, Jan. 5.-The department of public instruction has suppressed the study of Latin in the great preparatory school in this city, where young men are prepared for professional careers, and replaced it with English. The new course con

templated gives thorough instruction in English to young Mexicans in business life, which makes an extended instruction in English imperative.

English is now taught in many important schools here and in other cities, and in the great schools under clerical care English has practically displaced Latin.

What does that mean? It means that English is to be the language of the world and that the English speaking people are to rule the world. There is no other language with which alone one can go from the Orient to the Occident, from one pole to the other, and be practically unembarrassed on account of a lack of ability to make himself intelligible.

WHY NOT?

Sioux City, Ia., Jan. 5.-The ninety regular physicians of Sioux City, through the Sioux City Homeopathic Medical Society and the Sioux City Medical Society, will appoint a committee this week to organize a third association for the express purpose of combining to advance physician's fees from $1.50 to $2. Failure to comply with this scale will bring dismissal from the society. The physicians claim their expenses have increased while fees have not.

The laborer is worthy of his hire, and in the opinions of a good many the price of the laborer in the medical profession for his work could, particularly in the matter of compensation for visits, be subjected to a moderate degree of inflation without risk of reaching the danger point. We fancy we hear a chorus from the overworked, under-estimated, poorly paid general practitioner-"that's so."

ANTITOXIN AND DIPHTHERIA.

NEWS NOTE.-The deaths from diphtheria in Chicago this year will be fewer than five hundred, which is nearly four hundred below the average for the past eleven years. This is attributed to the use of anti-toxin. Figures of that kind tell a very comforting truth.

Granted that this statement is authentic it argues strongly for the use of antitoxin. No matter what may be said against its use, you may find in any large community physicians who use it in every case. They claim decidedly.

beneficial results. Still no one has shown conclusively just what it is that cures, if it does cure. Is it the toxin? Is it the medium which carries this toxin? Is it a chemical combination which may be formed between the two? After all there has been nothing advanced which shows that anti-toxin does any better work than the homeopathic remedy, in spite of the statement above noted, and this statement being a news note may not be true.

Original Articles

NOTES ON THE MANAGEMENT OF INCIPIENT TUBERCULOSIS.

By A. B. SMITH, M. D., Wellington, Ohio.

Of the spontaneous recovery of many cases of pure tuberculosis there can be no doubt. Unfortunately few cases remain of this type. By the entrance and development of the various pyogenic organisms which find in the already infected areas conditions eminently suited. to them, the case becomes one of the socalled "mixed infection," and we have the phenomenon of fever and other hectic symptoms in varying degrees of intensity. Uncomplicated tuberculosis is a slow process and amenable to treatment, the great aim being to keep the type as pure as possible or to accomplish a reversion of the mixed type to that of pure tuberculosis and thence on

to cure.

In the first place, the patient must be made to understand the true nature of his malady, in order that he may give us intelligent co-operation in our efforts.

He must be made to realize that it is not a question of weeks nor months, but in most cases one of years, if not a lifetime. He must realize that he is making a fight for his life and that a little indiscretion may be the cause of his losing a great deal of ground gained by hard struggle, if not even more serious results. Everything so far as possible must be made to conserve to this one end.

The management is both hygienic and therapeutic and of the two the hygienic is by far the more important. Rest, out of door life and superalimentation form the basis of all treatment. We prescribe rest and superalimentation, with such measures as will tend to improve the assimilative powers, to the end that we may improve the general nutrition; and out of door life, to insure the habitual breathing of pure air which is our chiefest weapon with which to fight the infection itself. As no drug has yet been found which has any special control over the disease itself, the

medicament must be carefully chosen to suit each individual case, with a view to improving the general nutrition.

So long as the patient shows an evening temperature of 100 F. or over, absolute rest must be maintained, not in bed, but, the weather permitting, out of doors. Let a couch or a steamer chair be arranged on the porch or under the trees, and on this the patient made comfortable. A bedside table, which can be gotten with very little expense, should be provided, as it will enable the patient. to read or do some light task which will keep the mind occupied, without exertion. During pleasant weather by far the greater part of the day should be spent here. On windy days the couch should be moved to a sheltered spot and the patient warmly covered, but kept out of doors. During the pleasant summer months this rule is not hard to enforce, but with the advent of cold and storm it requires no little heroism on the part of the patient and determination on the part of the physician to persevere in this regime. The patient and his friends must first be made to understand that, if reasonable care is taken to protect him from the wet and from direct wind, there is practically no danger of his taking cold. As a toughening measure, the entire body, or if this is too severe, at least the neck and chest should be sponged with cold water and the skin rubbed to a glow immediately on rising. He should, of course, be warmly clad. Woolen should be worn next the skin, but without the insane bundling of the chest with "chest protectors" and many thicknesses of flannel which we so often see, and which, I am satisfied, in making the patient more susceptible to cold, is productive of far more harm than good. Sea salt baths and alcohol rubs are not only very grateful to the patient, but have a very salutary effect in stimu

lating the always sluggish circulation, thus increasing the powers of resistance. Cold in no way contra-indicates this life out of doors. On the contrary, the bracing effect of the cold should be utilized. It is, I think, the general experience at the various sanatoria that even greater improvements are noted during the winter than during the summer months. So long as the patient is protected from the wind, blankets and furs with hot water bottles at the back and feet may be depended on to keep him warm and comfortable. The raw, damp atmosphere, with which we of the lake. region unfortunately have to contend, greatly embarrasses our attempts to keep our patients out of doors, for such weather is not good for the tubercular patient; he should be in doors the greater part of the time, but good and sufficient ventilation must be insured.

When it is necessary for the patient. to spend his time indoors, it should be spent in two rooms, occupying one during the day, the other at night. During the day the bed chamber should be thoroughly fumigated by evaporating formaldehyde in it, and afterwards thoroughly aired, the same process being gone through with in the living room at night. One of the advantages claimed for the arid Southwest is the aseptic state of the air, thus minimizing the danger of mixed infection. By this process we arrive as nearly as possible at this condition, and the danger of mixed infection and of re-infection is consequently reduced.*

Simple rest in the manner indicated is in most cases the only measure needed to effect a reduction of temperature. Where medicines are required. I prefer the use of appropriate treatment directly

*For this suggestion I am under obligations to Dr. Wm. C. Bunts, of Oberlin. It appeals to me as very rational, and I have put it in practice with my own patients.

aimed to that end. One of the best remedies is Guiacol Carbonate, in 15 grain doses twice daily, or in extreme cases, a few drops of liquid Guiacol rubbed well over the region of the liver. If this is not well borne, Thiocol, 5 grains t. i. d. often renders good service. Thiocol is one of Merck's newer products and may be given in larger doses than that mentioned. Phenacetine, 5 grains, three times a day, or even quinine in the same dose, will often stop a temperature habit. Goodno speaks very highly of the Arsenate of Quinine in the second attenuation. Baptisia Tincture should be considered also. Here is a place where antipyretics are emphatically of service.

When once the temperature shows but slight variation from the normal, exercise should be encouraged, but always very guardedly. The temperature should be taken repeatedly and any rise regarded as an indication that the exercise has been too violent or too prolonged, and a limitation insisted upon. If the high temperature persists, the patient should again take to his chair and stay there until equilibrium is regained. At first he may take a short walk, and the result be noted. If no rise in temperature follows, a longer one may be taken the next day and so on until he is governed in the matter by his strength, being careful never to get tired beyond a slight passing fatigue. Driving should be encouraged as affording a pleasant diversion and at the same time passive exercise out of doors. He should be made to realize that when the fever declines and nutrition improves, his strength will return and his muscles will take care of themselves. As soon as exercise is allowed, the patient should be instructed in the use of some simple, deep-breathing exercise.

When the patient first wakens in the morning he should take a glass of hot

water and a little later, after his bath, glass of milk punch with a tablespoonful of peptonoids or a raw egg; half an hour after this he has breakfast, which may be a rare broiled steak, boiled or poached eggs, toast and a great deal of butter. Two or three hours after, a glass of milk, with or without peptonoids, or soup, or an egg. The heaviest meal should be in the middle of the day and should be full and nourishing. Rare roast beef should be the principal dish, and vegetables, greens, spinach and the like, may be taken. Fruits are the only permissible dessert.

Milk or cream or

an egg should be taken in the middle of the afternoon and again before retiring. A glass of milk or liquid peptonoids should be available, so that the patient may have it when awakening in the middle of the night. In fact, not more than three hours, except during sleep, should pass without food taken. If the vitality is very low in the morning, the eggs may be taken in sherry. Save in such cases, I do not use alcohol in any form, as I am convinced, contrary to the somewhat prevalent opinion, that alcohol in a majority of cases does more harm than good. Starchy, farinaceous and saccharine foods should be avoided, as well as pastries, puddings, hot cakes and hot bread and all fried foods. Speaking generally, nitrogenous food should form the bulk of the dietary. Clinical experience and laboratory evidence go to show that a diet largely of animal extraction induces a state of the system unfavorable to tubercular process. Evidences are not wanting as to the incompatibility of the so-called "gouty" and tubercular diathesis. Some practitioners, notably in New York, have ordered a diet exclusively of rare beef, supplemented with copious potions of hot water, and the results as reported are very satisfactory. This, it seems to me, represents the ex

treme swing of the pendulum, and while there may be good results reported from it, it is necessarily very irksome and I think as a rule these patients will do better on a more liberal diet. Our aim should be always to keep in harmony with nature. Man is not a carnivorous animal and beef and hot water can hardly supply all of the elements necessary for a healthy and natural metabolism. In one case which came under my observation this diet was in a measure approximated, and while it was a very favorable case in the first place, I must say I never saw one do better.

Unfortunately in some cases loss of appetite is one of the first symptoms, and, occasionally, it persists. If it does a bitter tonic before meals is indicated. Gentian or Cinchona or Nux Vomica will most always accomplish our purpose. This may not be homeopathic, but it is a rational medicine. Homeopathy has its limitations and this is one of them. Constipation is sometimes a troublesome symptom, but the appropriate homeopathic remedy will be found the best treatment. A glass of Hunyada or Friederishal before breakfast is often all that is needed. This condition is not a feature of the disease, but is an independent condition and must be so looked upon and treated. A healthy and vigorous action of the stomach and bowels must be maintained, if possible. This is imperative.

Cough in this stage of the disease rarely gives any trouble, but should it be so severe as to tire the patient or disturb his sleep, it must be quieted. The homeopathic remedy will do this; Hyos., Ars., Phos., Bell., Ipec., Puls., Dros., are remedies that will be thought of in this connection. When we do not get prompt relief, a dose of Codeia onefourth to one-half grain, will give a comfortable night's sleep. If the cough

be tight and harassing, Heroin, onetwelfth grain, given preferably in an elixir, will quickly loosen it. Heroin should under no circumstances be given continuously, as it tends to disturb digestion and impair the appetite. The underlying diseased condition must be eradicated before the cough, which is but a symptom, can be quieted, and while we are waiting for this to be accomplished, we must not let our patient use all his strength coughing.

Anaemia is almost always a factor and should be met with iron. This is not the anaemia of leucocytosis, but rather a poverty of red corpuscles and of haemoglobin, the latter often being reduced to 75 per cent or even lower. I have grown to rely on the preparation called "PeptoMangan Gude" in these cases. It exhibits iron in a form readily assimilated, causes no unpleasant intestinal complications, and can be given for a long period. Tincture of the chloride may be used, or our ferrum phos., but iron in some form must be given and for long periods. Hensel's Tonicum affords a very palatable and efficient preparation. in these cases, and seems to have a slight stimulating action as well. Cod liver oil is of service if it is tolerated. I always order the clear oil, beginning with teaspoonful doses one hour after meals. It is much better borne this way than when given with the meal or immediately after. The dose should be increased to one ounce as quickly as possible, for it must be remembered that to get any effect from oil it must be given in large doses. It is especially well borne in

winter.

I have recently been using tuberculinum in my private practice, and though the period of time I have used it has not been sufficient to warrant any definite conclusions, so far as I have gone, I am inclined to believe that in tuberculinum

« PreviousContinue »