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Intestinal Antisepsis.—To depend wholly on diet, lavage and gavage to antisepti cize the intestinal tract is neither practical nor sufficient, and furthermore not neces sary. To be thorough it necessitates treatment in a hospital or other constant expert attention, which is not available to the large majority who are unable to allow themselves these attentions.
To the great satisfaction of a large and increasing number of physicians, it certainly has been proved, as the most favorable clinical cases show, that the excessive action of the ptomaine producing bacteria may be controlled and modified by the intelligent use of the antiseptics at our commana, enabling us to attenuate the pathogenic inhabitants of the intestines, thus controlling the generation of morbid influences which deteriorate tue blood or counteract their effect on the blood if absorbed, and by stimulating the peristaltic action, prevent the absorption of poisonous gases and fluids by removing the products of food decomposition, thus keeping the system in better condition to respond to the indicated remedy.
Some of the earlier advocates of antiseptic and eliminative treatment of typhoid fever received pretty harsh treatment from tne medical profession. The bacteriologist and pathologist condemn and ridicule it today. No doubt, the seemingly exaggerated claims made by some enthusiasts prejudice many against its use, to say nothing of conflicting with the up-to-date pathology of the disease. Yet I am a staunch advocate of just such treatment of typhoid fever and my experience with it gives me added confidence in the handling of the disease.
The action of the vitiated secretions or suructures is possibly for the most part chemical, yet we know that the vital functions are stimulated and tissues strength ened to resist and overthrow toxic influences by dynamic and physiological actions in certain drugs. Baptisia, rhus tox, echinacea, lachesis, potassium chlorate, hydrochloric acid, arsenicum and strychnine are well known examples of others more commonly used for their chemical action. Merc. dulc. may be considered almost an ideal laxative antiseptic for acute conditions. It induces free bowel movements, restrains excessive intestinal decomposition, does not interfere
with the digestive ferments, increases the flow of bile and stimulates elimination from the kidneys. The sulphocarbolates of lime, soda and zinc are deservedly popular for their antiseptic action after the bowels have been thoroughly evacuated. They should be given well diluted and until tne effects on the stools are apparent; enormous doses have been given with no toxic effects.
Guiacol carbonate manifests a powerful yat non-irritating antiseptic action destroying pathogenic organisms and their toxic products, arresting fermentation, aiding assimilation and nutrition. It is both sedative and astringent, acts quickly and is especially useful either alone or in combination in typhoid fever, acute and chronic intestinal catarrhs and tuberculosis.
Guiacol benzoate is similar in its action, though it seems especially valuable in pneumonia and other acute respiratory troubles.
Salol, naphthalin, copper, arsenite, turpentine and a long list of others have valuable properties and are much used. I will just mention one other mixture which I have found of great value especially in cases of chronic intestinal toxemias from one cause or another. Equal parts fluid ex. cascara sagrada and either listerine or boroTyptol, half to a teaspoonful once or twice daily as needed; it is antiseptic, antifermentative, a stimulating laxative, a tonic to the mucous membranes of the stomach and in test.ne, can be given a long time if needed and in decreasing doses.
It is to be hoped that the labor of chemists and other investigators along these lines will result in giving to medicine an ideal internal antiseptic, but if the principle is correct we do not need to wait till then to get manifest benefits from those we now have.
Dr. H. V. Halbert, in discussion, said: “In comparing these clinical cases with those in which no antiseptic is used, I must admit that, in my experience, those treated with the antiseptic run a milder course and the improvement is earlier and more pronounced. Since I have used methylene blue so persistently in the treatment of typhoid my cases do not suffer so much with the extreme temperature; the delirium is greatly modified and the hemorrhage is rare.”—The Clinique, January.
elevation of educational standards, which must of necessity be equal to those of the higher parent institution. Even if merely nominal, or under the exercise of mere supervisory functions, a valuable influence for the college would flow from it; while the more intimate the union the more helpful and elevating would the influence be, for no institution could fail to feel the lifting touch of the hand of the State government or course co-operation of universities would be required by law.-E. R. Eggleston.—The American Physician.-Jan.
The Profession of the Future.-1. The laws and State boards should yield to the colleges the functions of examination, graduation, and license, which are matters of plain common sense, of self-protection, of self-help, and of right under charters issued and guaranteed by the State. The colleges will deal honorably with the board, if the board will return in kind. The proper functions of the board should be limited to fixing and regulation of standards, supervision of work done, and registration.
2. The colleges should secure, according to United States standards of examination in medicine and cognate sciences, the adaptation of the pure sciences to the classroom; obviously that graduates may be able to enter the honorable and lucrative positions under the government, as well as to broaden their foundations for general or special practice. Again, every branch should be fundamentally extended; while in its specific
erms it should be specialized. Thus the student gains in the widest possible way the principles underlying the branch in hand, and in the special sense a completer view of details and relations and differentiations of the type chosen to represent a group or class of diseases. Those are indispensable to intelligent practice of any specialty, and they are alike indispensable to the general prac. titioner; and while the one is not burdened with a never-to-be-used mass of details, the other is in as good position to gain them as before. I do not insist upon it, but I am inclined to think that every student matriculated should be so in view of a preferred field of work, which should appear in his college record. It would be to his advantage to know whether he should prove fitted for that line, or better for another; and helpful to the college in fitting him for his choice or directing him into another. It is my firm belief that if they are not too much crippled by present limitations, and are not possessed of too few discretionary powers to work out such a scheme, the colleges would reap a vastly productive harvest in material and honorable benefits under such a system.
3. Every college should be required to take up an affiliation with its own State university; because, first, of the power, and authority, and stability naturally resulting from such association; second, the prestige and higher tone and wider influence of a school so connected; and third, the certain
Dr. Henry Freeman Walker, of New York, in the Medical Record, January 18th, 1902, takes up the discussion of "Prognosis: - Its Therapeutic Value." The entire article is really worthy of quotation, but space permits us to make only a few excerpts.
The relation of the physician to his patient has three hea has three bearings.
First, he is expected to make a diagnosis of disease. Second, he is asked for a prog. nosis. Third, he guides the patient on the way to recovery, or smooths the downward pathway to death.
The tendency, aside from keen discrimination, to make a favorable prognosis is partly due to natural temperament. The sanguine man, if a physician, is sanguine with regard to his patient. To another type the reason for making an unfavorable prognosis is grounded on fear that blame will follow if anything disastrous should happen, and its probability be unannounced. Another is due to a yet lower grade of thought. If a patient recover after an unfavorable prognosis, the greater credit will redound to the practitioner.
To this class belong the instances where we hear of the physician saving a patient from typhoid fever or preventing pneumonia. The typhoid fever certainly did not exist, and the pneumonia possibly. But both are sufficiently alarming diseases to make families grateful if they do not develop. Again, it rejoices some patients to have been given up by the doctor and to be able to tell the fact. They think they have outwitted death.
The relationship of the doctor to a patient and to the patient's family is wholly different. It is the physician's duty to give the most favorable prognosis possible to the patient as a part, and the initial part, of treat
ment. If he errs, let it always be toward the depends more upon the general intelligence favorable side.
and therapeutic skill of the practitioner To the family he may disclose his fears,
than upon the assiduity with which he carand dwell more on the hazards of the illness,
ries out specific therapy. but to the patient it must be hope and assur
"The general hygienic management of ance.
syphilis is of fundamental importance. In The consultant or the specialist is always
many instances mercury and iodides act badcompelled to give a prognosis more definitely, simply because the patient's eliminative than the family doctor; he, in people's areas are not functionating with their norminds, holds the life or death verdict, and mal activity. Injurious results from the to the patient the effect is often like that of a drug specifics occur under such circumsentence.
stances, and are explained by that explana. Two large classes ought never to be given tion which does not explain, 'idiosyncrasy.' up, even in the physician's own mind-the Ptyalism and iodism may both be avoided in very young and the very old. The laws of many cases by attention to the eliminative life do not apply to them as they do to those functions. The ingestion of large quantities in active life; so little is needed to preserve of water, with the concomitant increased life in the infant, while the vitality of the functional activity of the skin, kidneys and very old has already proved so tenacious. bowels, is very useful in syphilis. This As example, during last winter, I saw, with point is too frequently neglected. In giving a friend, an old lady of seventy-eight. She iodides it is best, as is generally known, to had pneumonia of great severity. Though administer them simultaneously with considthere was extensive solidification of the lung, erable quantities of water. It is impossible, my prognosis, based on her age and attend- however, without resulting stomachic dis. ant vigor, was favorable. The case pro turbance, to give a sufficient quantity of gressed to complete recovery. Another, of water in this way to perfect elimination by ninety-one, had an equally good experience. the kidneys in certain cases in which the Had they been sixty-eight, I should have felt renal function is inadequate. It is in just less confident of the outcome. In all cases
such cases that iodism from so-called idioof pneumonia of the very aged my expecta
syncrasy is liable to occur. tion of recovery is increased rather than di
"The best method of giving the iodide unminished by the very fact of age.
der such circumstances is to mix the daily On the other hand, an infant pinched and
dose of the drug with a given quantity of sunken with an exhausting diarrhea, with
pure water, say from two quarts to a galpulse so flickering that one hesitates to move
lon, and instruct the patient to drink the it on its pillow, may rally in a half-hour's
entire amount, a glassful at a time, at interdrive from its city home to the seashore,
vals during the twenty-four hours. I have
succeeded in avoiding iodism in this way Prof. G. Frank Lydston, of the University in patients in whom the smallest quantity of of Illinois, under the head, "General Medi
iodide given by the ordinary method procal Treatment of Syphilis," Medical News, duced iodism. January 8th, advises the following as adju "Hot baths are a very useful adjuvant to vants:
the treatment of syphilis. They increase “The pivotal point in the therapy of syph- tissue metamorphosis, favor elimination, ilis is of necessity the specific medication of and necessarily enhance the therapeutic acthe disease. In few or no instances, how- tion of the mercury and iodide, while limitever, can specific medication alone be relied ing any possible injurious effects of the upon for a satisfactory result. In many in- drugs. In many instances hot baths alone stances the importance of specific medica- will prevent injurious effects from mercury tion sinks into insignificance before the gen- and iodide. A very hot bath of short duraeral therapeutic indications present in the tion, taken daily and followed by a cold particular case. Specialism has done great shower or cold tub, is perhaps the best harm by limiting the range of remedies use- method of administration for the average ful in syphilis, independently of their spe patient. The ideal method, however, where cific effect. The success or failure of treat. its application is practicable, is the Turkish ment in by no means infrequent instances or Russian bath. The patient should drink
large quantities of hot water while in the bath. Much of the efficacy of the Hot Springs treatment of syphilis is dependent upon the free ingestion of hot water while the hot bath is being given.”
The introduction to Dr. Edwin W. Pyle's article in the Medical News on "A Conserva. tive Element in Acute Mastoid Surgery,” is interesting. The remainder of the article is technical.
"Two years ago a country youth of healthy parentage and wholesome surroundings, while convalescing from scarlatina, suffered irom an acute tympanic inflammation, followed by a purulent discharge which lasted two weeks, then abated with accession of pain and fever. The meatus was excoriated, fundus symptoms were pathognomonic, tenderness over the antrum was significant, with tumefaction extending from mastoid tip to temporal ridge. Operative suggestions did not meet with approval, but a compromise was effected in the hot bichloride douche and the patient kept under observation. Three days later all symptoms had become exaggerated, and, in addition, the integument involving the temple was red, tense, and imparted a sense of fluctuation. An immediate operation was advised and, upon this being refused, further responsibility was declined by the physician. The subsequent history was a continuation of douching, followed by gentle massage backward and downward, to dislodge pus from beneath the fascia into the external canal. Under the contracting influence of the former and the pressure of the latter, with general sustaining measures, pain, fever and swelling subsided with recovery more perfect than could have been wrought by surgery.
“The present condition is a slight tinnitus, watch-hearing distance 20 inches, and an area of cicatricial tissue in the posterior-superior quadrant. The operative indications were too pronounced to teach us conservatism under similar considerations; but the case illustrates that we do not always know what might have been' under other circumstances, and that there are many similar experiences wherein Nature is the great physician,
“Our profession has always had a monopoly in uncertain knowledge.
“'Whatever seed we may be sowing,
“The intricacies of the human mechanism and the spirit of life which pervades it are imperfectly understood. We are groping amid hundreds of reciprocal relations, numberless reactions, unlabeled conditions of various interpretations. When many of the grosser problems relative to function and to disease have been solved there remains the personal equation—the individualism which will always be an insuperable barrier to precise medical and surgical treatment. Our ignorance of the definite causes of pain, of that peculiar hyperesthesia which distinguishes nationalities, of the unforeseen manifestation of disease and recuperation, too often passes for real knowledge.
“The illumination of the mysterious darkness that for centuries shrouded wound-infection has resulted in surgical transition with the promise of a still more brilliant day. A distinguished English physician observes that 'in this very security, linked with our desires to meet the exigencies of the present, we unconsciously favor the tide of unrest which looms up with an ominous future." Though the average life be lengthened, disease and complaint are no less in evidence. People are no longer inclined to rest and to work out their health problems in natural processes, but run impatiently to surgery to have the same accomplished by them, knowing nothing of shock, nothing of failure, only its successes.
"On the other hand, the specialist is apt to cultivate a morbid readiness to detect disease, to place the standard of health too high for practical purposes, forgetting that a good degree of being is compatible with innumerable departures from the normal standard. Health is relative; it is not a direct dial, pointing to zenith, but an arc of considerable latitude.
"The pendulum swing between medicine and surgery tends to extremes. The excursion from the former to the latter in appendicitis has met with reaction in favor of time, but not until the penalty was paid in operating too early, thereby confounding the diagnosis with ailments of gastro-intestinal character. In gynecology pelvic surgery has become a too-absolute specialty, dissociated with the relative importance of the great sympathetic nervous system and the general field of scientific medicine. Dr. Goodhart tells us: ‘Organs have suffered from the lust of the people for operations and from
the insufficiently non-repellant attitude of surgery.'"
Apropos of our article by Dr. Smith on “The Treatment of Incipient Tuberculosis” are suggestions by Simon Baruch on the Post Graduate, November, 1901, concerning the bath.
"In this condition the patient cannot properly respond to pouring cold water over his skin or dipping him in a cold bath; wash him with a bath-glove and gentle friction, a small portion of the body at a time. Take a basin of water at 90 degrees F.; put the patient on one side of the bed; place a blanket and linen sheet under him, and, dipping the hand into the water, rub him on succes. sive parts of the body. At each application reduce the temperature of the water, and, if
the fever reaches 102 degrees F. bathe every two or three hours. The parts below the knees and elbows should be skipped, as they do not react well. 'Cold water is about the poorest antipyretic I know of,' but it is used to stimulate and refresh the nervous system, and thus improve the patient's resisting power. For the hectic fever, tub-baths at 90 degrees F., perhaps reduced gradually to 80 degrees F., with friction, are of great bene. fit. A good and simple method of educating and disciplining the nerves and blood-vessels of the skin to bear colder and colder water and greater and greater force, with a fruitful reaction, is to throw forcefully six to twelve dipperfuls of water at 85 degrees F. daily over different parts of the body. There is no danger of taking cold after these baths."
(The following letter may prove of interest to some physician who is thinking of locating, or making a change in his location. -Ed.)
Austin, Tex., Nov. 19, 1901. Dear Doctor: There are many towns in Texas where from one to eight homeopathic physicians are already established, and some of these places could support another, but I would advise the occupancy of a fresh field if you hope for a quick start. In the railroad towns will be found many people who were patrons of homeopathic physicians before coming South; and very generally, the people take kindly to the practice where the physician will go to the trouble to explain its superiority over old school methods.
Collections are good; much better than in sections where the equilibrium of business is so often disturbed by strikes. In the summer months money is slow, and much of the country practice must be booked for collection once or twice a year; but the land owner will often so security for the negro tenant, or the latter will pledge his personal property for security.
If you speak German, we have some towns in Texas composed almost entirely of this nationality. I have recently located a Chi.
cago woman physician in one such place and she is doing well. The German towns mostly have from 1800 to 2500 population-growing towns, but comparatively young. Weimar, 2,300, with nine allopaths, is one. New Braunfels, 2,300, five allopaths, is another. The latter is a neat, pretty, thriving town, one I would recommend to a man who is content to go to a small place and grow with it. There is a good deal of wealth there, and it is far more healthy than Wiemar.
All Texas towns have an excellent public school system. New Braunfels is less than thirty miles from Austin, where we have the State University, which caps the public free educational system,
If you have children to get started in life, it is an additional reason why you should come to a new and growing state where the openings are varied and more numerous than in the East.
Every well educated homeopathic physician who has come among us of recent years has done well, and there is a living for at least 300 more without crowding. The Texas towns are rapidly growing, and new places springing up all the time.
The Board, at its October meeting, granted thirty licenses, and inquiries such as yours