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DEPARTMENT OF MEDICINE.
BOILING POINT OF WA, ER.Most persons are apt to regard the point at which water in the domestic saucepan boils as a fixed quantity, unalterable as the laws of the Medes and Persians; but the cooks of a certain town in New Mexico have discovered that in consequence of its great altitude above the sea, water boils there at 202 deg. F., instead of at the normal 212 deg. This means that all the cooking calculations depending upon the heat of the water have to be revised. Everything from a breakfast egg to a silver side of beef takes longer to cook than it does lower down in the atmosphere. Another thing which militates against the calculations of the ordinary cook of the same town is that the air is so dry that vegetables are deprived of half their natural moisture, and must be left a long time in water to recover themselves before being cooked. In connection with this matter of the boiling point we might observe that if our cooks at home could only realize the fact that it is impossible to heat the water in an open vessel above boiling point, they would save much of the gas used in so many houses for fuel.-Chambers' Journal.
a large blade, and divided into small masses the size of a hazelnut or strawberry, of which the patient takes from 100 to 300 grammes a day in apricot jelly, powdered sugar, etc., without prejudice to his usual diet. Alcoholic stimulants exhibited in hourly doses of tablespoonful constitute necessary adjuvant of the method. Favorable results obtained by this plan of treatment, as conårmed by Richet and Chantemesse's experiments upon animals, are not-as Bouchard would have it-traceable to mere overfeeding. The elder Furster claims excellent practical results from thirtyfive years' experience with this method.
TUBERCULOSIS ALTITUDE AND
THERAPEUTICS. Dr. S. D. Van Meter, in the Philadelphia Medical Journal for December 1, 1900, says: “I have yet to see the direct curative effects of any drug in constitutional tuberculosis, and believe that pure air, the direct rays of the sun, pure, nourishing food, an altitude of from 4000 to 8000 feet, and careful hygienic regime, constitutes the major part of the logical treatment of this dread disease.” Also, in the same journal, Dr. S. Edwin Solly, who has been visiting the sanatoria of Europe, says the open air treatment is he carried out to its fullest extent, except that the patients do not sleep out of doors; the patients sleep with wide-open windows and take their meals in the hall, where the windows are all let down on three sides, except in stormy weather. When the patients are outside of the house they walk, sit
RAW MEAT AND ALCOHOL IN TUBERCULOSIS. - Furster, at the Thirteenth International Medical Congress, Paris (Wiener Klin. Woch., September 20, 1900), indicated the following technique for the employment of this latest plan of treatment, which has been favorably reported upon even by the lay press: Raw beef or mutton is scraped witu
or stand in the open air, and generally without their hats. Certainly there is much less risk of cold catching from sitting in draughts than in using rest halls and pavilions, because the patients are always in the full air. Dr. Solly says: “I have always shared the belief with Dr. Walther that most consumptives live or die according to their strength of character in adjusting their life wisely to their disease, and for this reason many cannot be trusted to live again among the environments in which their disease was acquired."
In the same journal, Dr. Henry L. Shively, in speaking of the treatment of pulmonary tuberculosis, says: "He should be told to spend as much time as possible in the open air, and the cultivation of an erect attitude, with the shoulders back and the chest forward, should be advised. Twice a day or oftener the inflation of the chest by a series of gentle, deep, prolonged inspirations and forced expirations, when the practice does not provoke coughing, is useful. The living and sleeping room should be the largest and best ventilated available. In the tenements and small flats occupied by most dispensary patients the sleeping rooms are usually small, and either without windows or opening stuffy, cramped, dingy air-shaft. These small bedrooms and the kitchen are the ordinary living rooms. The one room opening on the street and accessible to abundant sunlight and air is usually least occupied by the family and is the one to which the consumptive patient should be removed. Where it is possible, he should sleep alone. He should be instructed to avoid exposure to cold and damp, and it is undesirable for him to frequent crowded halls and places of entertainment where the air is vitiated. Woolen underwear, but of lighter weight in summer, should be worn next the body
throughout the year. The entire surface should be uniformly clad, discouraging all coddling with the popular red flannel chest protector or the familiar porous plaster. The use of water in the form of the daily sponge bath, followed by brisk friction with a rough, huck towel, is a wholesome practice. If there is fever or nightsweats, the bath is better taken in the afternoon or at night before retiring, otherwise the first thing on rising. At first the bath should be warm enough to avoid chill or shock, but the temperature should be gradually reduced until cold water can be used. The addition of a little alcohol or spirits of camphor to the water may be recommended. The bath in the evening, besides its desirable effect on fever and night-sweats, is often useful in promoting sleep. In afebrile cases moderate exercise may be permitted, always stopping short of the point of fatigue. Chest-weights, light dumbbells, or Indian clubs may be cautiously used, but never as a substitute for or to the exclusion of exercise in the open air. In progressive cases exercise of any kind is undesirable.
“The patient should be carefully 16structed as to the proper care of sputa, an appeal being made to his instinct of self-preservation by telling him that not only is there danger of infection to others, but that his own condition may be made worse by the inhalation of infective material. He should be specifically told to exercise care to avoid soiling his clothing and linen. Handkerchiefs are not proper receptacles for sputa. When away from home, pieces of cloth, or, better, Japanese paper napkins, which are inexpensive, should be employed for this purpose. When soiled they are folded and inclosed in a stout envelop, which, with contents, is burned as soon as convenient. At home the crachoir should have a sufficiently large open
ing to avoid soiling the side, and should contain either plain water or a solution of a simple disinfectant. The patient should be cautioned against swallowing his sputa, as there is good reason to believe that this practice is frequently a cause of intestinal tuberculosis. If there is any obstacle to free nasal respiration it should be corrected by appropriate treatment. An examination will often reveal a hypertrophic rhinitis, polypus, spur, deflected septum, or adenoids.
"In the diet of the consumptive the keynote is the administration of milk, and its assimilation by the patient will often afford reliable indication of the prognosis. In my experience patients who can take large quantities of milk, month after month, usually do well. When milk cannot be taken in some form the prognosis is likely to be bad. Too much importance should not be attached to the patient's statement that he cannot take milk, or that it makes him 'bilious.' The aďdition or a little bicarbonate of soda, lime-water, vichy will often make it well borne. Hot milk may agree better than cold. In some
cases peptonizing the milk may be necessary, or matzoon or koumiss may be tried. In summer buttermilk is often relished for a change. For an adult as much as two quarts of milk a day is desirable, and where it is taken well a little cream may be added. In addition to the milk when the patient's stomach is in good condition, a full nitrogenous diet, with an abundance of fats, is advised. Broiled steak and chops, roast beef, eggs, poultry, oysters, soups, and a liberal quantity of butter are recommended. Pork and veal are excluded and the starchy vegetables are restricted. Cereals should have a minor place in the dietary. If milk cannot be taken the next best thing is malt liquors in moderation, such as beer, ale or stout, but I never advise them when milk agrees.
“As regards drugs, the best routine treatment is the administration of creosote or some of its derivatives with cod liver oil and some preparation of malt. During the hot weather of the summer months the hypophosphites may be advantageously substituted for cod liver oil for a time. Nothing, however, can replace the latter as an easily assimilated fat and valuable tissue food, nor are any of its numerous commercial derivatives or so-called active principles to be considered as representing it. Wnen it is well borne the pure oil may be taken. Children often become fond of it, and poor patients can obtain it fresh and of excellent quality at the fish markets. The amount of creosote given daily is from 24 to 60 minims, preferably in the form of an enteric salol or keratin-coated pill of three to five minims each, which is not dissolved until it reaches the intestine, thus avoiding the gastric disturbances so often occasioned by the drug. There is no advantage in giving it in the enormous doses sometimes advised. It may also be given with glycerin and whisky, in emulsion, or shaken up with milk. Sometimes guaiacol or creosote carbonate or thiocol, which is freely soluble, agree better with the stomach, but are too expensive for general dispensary use. I was well impressed with ichthyol in one case complicated with tubercular infiltration of the pelvic floor, in which it was used locally with good results. I have since tried it internally in a series of sixty cases, giving ten minims every four hours. Of these cases twenty-nine reported regularly for treatment, and of this number twenty-five were much improved, gaining in weight and the temperature diminishing, with a corresponding improvement in all subjective symptoms. The average gain in weight was four and one-half pounds, and the highest observed was ten pounds. In five cases it was necessary to discontinue the drug on account of the eructations and nausea produced.
“When the progress of the disease has been rapid, the administration of opium in small doses for a short time is often very satisfactory in its results. Besides its effects in improving couga and arrestng hemoptysis when present, it appears to exert a decided tonic effect, changing the entire morale or the patient and encouraging him in the beginning of the treatment. Or course, it should be given with caution, but I have never seen any tendency to the formation of habit or other bad effect when thus administered. The old combination of opium with quinin and digitalis—the Niemeyer pill-is a valuable one. For neuralgic pains, apply a small cantharidal blister and rub the chest with the following liniment: Menthol
.3 drams Chloroform
.3 drams Chloral
. 12 oz. Camphor
.3 drams Alcohol enough to make......4 ounces
"For night-sweats, the afternoon bath and friction, or the administration of atropin or agaricin, are usu· ally efficient. In some persistent cases, potassium tellurate in daily doses of half a grain at night will relieve when other drugs fail. For blood-spitting and hemorrhages, opium and rest, with iced compresses to the chest, are employed. When sudden and profuse, a full hypodermatic injection of morphin should be given. But little dependence can be placed on internal hemostatics. When the appetite is poor, bitter tonics such as gentian, cinchona and nux vomica or strychnin are useful. Iron in any form is of very doubtful value in the anemia accompanying an active tubercular process.
When there are high afternoon or evening temperatures, the temporary administration of antipyretics-one dose of phenacetin or acetanilid early in the afternoon-are
sometimes useful; but generally the fever can be controlled by baths and other treatment.
"Grafted upon a chronic tubercular inflammation there may be acute attacks of bronchitis and broncho-pneumonia, which are treated as when they occur alone. For irritating, nagging cough, unaccompanied by expectoration, heroin in one-twelfth to one-sixth grain doses is valuable, as, indeed, it is in all cases of symptomatic cough. It is also useful in relieving dyspnea and chest-pains. Its action appears to be much the same as that of morphin, but its administration in full doses is attended with less somnolence, constipation, and stomach disturbance. Ammonium carbonate, senega, dilute hydro-cyanic acid, codein, and hydrobromic acids have been useful palliatives in the cough of phthisis. As a rule, sirupy mixtures should be avoided, on account of their bad effect on the stomach. When the sputum is scanty and tenacious, the administration of potassium iodid will promote freer secretion, diminish the severity of the cough, and add to the comfort of the patient.
"In cases of mixed infection, when streptococci swarm in the sputum, when there are severe chills and wide excursions of temperature, with profuse sweating and septic symptoms, I have seen improvement from the injection of Marmorek's antistreptococcus serum, as prepared at the Pasteur Institute of Paris. In one case, after the administration of three injections of 20 ccm, each, there was a complete disappearance of the streptococct from the sputum, the chills and sweats ceased, the temperature diminished, and there followed a marked improvement in the appetite and general condition of the patient. In other cases no improvement was seen, or the results were slight or of brief duration. Serumtherapy in general, however, as
applied to tuberculosis, has not appeared to have been developed to a point to warrant its extensive trial in dispensary practice."
sary to our physically active and vigorous, savage ancestors may not become a redundancy when it is transmitted to our higher civilization, in which everything tends to produce a condition of physical inertia.
EXERCISE IN THE TREATMENT or TUBERCULOSIS.–Parker Murphy (Albany Medical Annals, November, 1900) insists that a proper system of respiratory gymnastics is very essential in the treatment of tuberculosis. This is especially necessary for persons leading a sedentary life and who for that reason are denied the invigorating fresh air and the deep, full respiration induced by vigorous exercise. He says the splendid results of high altitude in the treatment of tuberculosis have not been due to any curative constituent of the atniosphere or any peculiarity of temperature, but entirely to decreased barometric pressure upon the external surface, compelling a greater expansion of the chest, opening up a larger surface for the interchange of gases and consequently a greater oxygenation of the blood. It is self-evident, then, that the forced distention of the lungs and bronchi in those who live in high altitudes, alone confers immunity against the disease. The exercises available to produce better respiration are very numerous and varied, but the underlying principle is simply to bring into more vigorous play the muscles which expand the thorax and at the same time excite deep, full and free breathing; to bring the vital force of the lung to its maximum. All exercises of the thoracic muscles for the purpose of producing an increase in that cavity must at the same time be coincident with deep breathing. The amplitude of the respiratory movements must be increased; the lungs must push out from within, as well as the thoracic muscles pull from without. We should labor incessantly in the advocacy of a more general use of physical training so that the large lung surface neces
FOOD IN TUBERCULOSIS.-Mitchell Bruce (Treatment in Practical Medicine, 1900) writes: "When anorexia, discomfort, vomiting, and the other evidences of indigestion, such as depression, languor, headache, constipation and turbid urine, make their appearance in phthisis, they are too often directly referred to the tuberculosis or to the fever. The patient is ordered milk, essences, and every description or patented and advertised foods and 'wines;' oil, tonics, malt, and the latest specific for tuberculosis are given even more freely than before. The exercise of a little common sense ought to have prevented all this. The first step to take in such a case is to prescribe a mercurial purge, followed by a saline. The second step is to order a diet of light solids, and specially to supervise the breakfast and supper menus, and to cut off stimulants and all manufactured materials, excepting a good peptonized cereal food at the evening meal. Thirdly, the times and manner of taking food must be revised. Excessive frequency and excessive amount must be temporarily avoided. If sickness be prominent and persistent, bodily rest is indicated; and the patient should lie down for half an hour before his midday meal and for at least two hours after it. Sometimes, indeed, obstinate cough and vomiting have to be met by confining the patient to a couch and bringing him his meals, which he takes in the reclining posture. Counter-irritation is often successful in the distressing cases where feeding provokes paroxysmai cough, ending in vomiting and loss of the entire meal, a fly-blister to the epigastrium, application to the pha