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ment. Temporizing measures to be mentioned later on, will sometimes be required.
Headache due to arterial changes, impaired renal function, the infectious diseases, anemia, and the reflex causes usually disappear under appropriate treatment of the local condition.
In the symptomatic treatment, the immediate relief of the pain is the first consideration and Doctor Joseph Collins, in speaking of the remedies applicable to these conditions, classifies them under the following heads:
“(1) Drugs derived from coal-tar distillation possessed of analgesic properties—phenacetini, acetanilid, salol, exalgin, and the like.
“(2) Drugs that are plant derivates acting principally upon the vascular system-caffein, cannabis indica and opium.
"(3) Mineral compounds, such as the bromides, acting principally upon the nerve cells and the salines acting upon the circulatory fluids.
“(4) Antispasmodics and paralyzers of striped muscular fibres such as ethereal substances and belladonna."
“It is often necessary to combine remedies from these four classes. Speaking generally, it may be said that those of the first class may be relied upon to ameliorate the pain in all headaches except those due to inflammatory disease and pressure. Those in the second group are serviceable in headaches characterized by marked deviation of blood pressure, caffein being the medicine par excellence in headache associated with lowered vascular tone and cannabis indica in those occurring with a pulse of high tension. The bromides have their chief use in epileptic headache and the salines are narrowly confined to the headache of autointoxication.* The drugs of the fourth class are of use principally in headache associated with spasmodic and fatigued action of peripheral muscular apparatus."
Doctor Wharton Sinkler, in speaking of the therapeutic status of the coal-tar products in painful conditions, says that "While they have fallen into disuse as antipyretics, they are now more relied upon for the reliei of pain by the medical profession than ever before and will continue to be until some better remedy is developed.” He also speaks of aspirin as one of the newer remedies of this class, and the writer has found this to be of special value in conditions wherein the salicylates are indicated because of the smaller dose and that it is nonirritating to the stomach.
Doctor Solis, of Ann Arbor, in a recent article, says "static electricity is a powerful adjuvant in the constitutional state. It is given as the breeze followed by a half minute to one minute application of sparks along the length of the spine, the spark varying from a friction spark to a spark one inch in length. By this treatment every cell in the body is stimulated to better and more vigorous action, in consequence of which elimination is increased from every excretory organ and the patients' circulation, digestion, and general feeling are improved.” The writer has also found the general application of static electricity a valuable tonic to the nervous system as well as a stimulant to the metabolic processes. In the relief of the paroxysm it is useful as well. The friction spark to the spine and the direct spray to the head or painful area affording very marked relief in many cases. A mild glavanic current may be used, one to five milliamperes for five minutes with one pole on the forehead and the other at the back of the neck, with good results, particularly if there is a marked psychical element present. In congestive headache an ice cap or other application of cold to the head in conjunction with a warm sitz bath or hot foot bath, will oftentimes afford relief.
Doctor William Browning finds aconite, veratrum, and gelsemium in doses sufficient to soften and control the pulse, by relieving intracranial pressure are of great value in mitigating the pains due to tumors of the brain. The local application of fomentations, menthol, stimulating liniments, or a mustard paste, the use of massage both general and to the scalp and neck, a darkened room, and quietude may afford some relief and are a source of much satisfaction to many patients.
Hardest of all to combat will be the habitual headache, a type which we all encounter from time to time, amounting in many instances to a degenarative neurosis. By maintaining the highest possible degree of nutrition with the occasional use of symptomatic remedies, scrupulously avoiding opiates, and by mental suggestion with its various methods of application, something can be done to mitigate the sufferings of these unfortunate ones.
After all is said, and despite the greatest diagnostic skill and most vigorous and painstaking therapeutic efforts, some headaches will remain unrelieved.
SOME LAWS IN MEDICINE.
By EPHRAIM CUTTER, M. D., NEW YORK. CARNIVORA have small alimentary canals. Herbivora have large ones. That is, relatively, as to their diameters. The young of herbivora are carnivora. They feed on milk normally. Milk is animal food made from animal tissues by the protoplasm of the epithelia of the mammary glands. Vegetarians err when they class milk as food of the botanic kingdom. Calves fed on milk that they suck from their dams have small bellies, smooth hair and sleek looks. Calves fed on slops (vegetable food) have bay-window bellies, staring hair and rough looks. The reasons are (some of them), animal food is easier to digest and assimilate and confers more force or dynamics than vegetable food. Animal food has all the elements needful to build normal tissues, especially in the newborn, else said suckling calves would not thrive nor grow. As man is omnivorous, if man has enlarged, expanded, thickened, dilated alimentary canals, it may generally be assumed that said man has fed largely on vegetable kingdom foods. The law above furnishes a rational basis for treatment when said alimentary canal is abnormally enlarged laterally or not with fibrous thickening even to stricture. The writer has found this law true in practice.
HEARTY FOOD IS FOR THE HEART. This is almost an axiom. The evidence is as follows: More than twenty years ago a man said to me in my office, “Doctor, I want you to examine me, but I do not want treatment,” and he added, “Fifteen years ago my doctor said I could not live because of consumption. I tired of awaiting death and thought I would not worry any more but live as long as I could. I cough and raise and have night sweats; twice a month I spit up a half pint of blood, et cetera." The first exploration of microscopic inspection showed no morphology of tuberculous blood. I said to him, “The one thing you have not is consumption." "What is it then?" "I do not know; wait until I have finished the examination.” The lungs were found normal, although lungs tuberculous for fifteen years ought to show marked lesions. But the heart's area of dullness and impulse was twice the normal area. There was also a mitral murmur. The left costal cartilages were pushed out about one inch more than the right, et cetera. I diagnosed the condition enlarged heart. The hemorrhages were caused by the heart driving so hard against the lungs. Doctor W. W. Gerhard, of Philadelphia, showed a like case during my pupilage. “What shall I do?" asked he. “But I was not to treat you." "I want you to,” he said. After some skirmishing I felt I had a peculiar case to deal with and one much out of the ordinary, so I drew a bow at a venture and executed an idea given me, and then I said: “You eat anything you please but at each meal take additional one pint of beef essence and more if you can. He paid me and went away. Six months later he called and said: "I have not had a hemorrhage since I was, here; neither does my side stick out.” I had forgotten the case, but after recognizing the patient, said: “You are talking nonsense about your side." But I found his heart's area, sounds and impulse normal, and his left side as he said. At last accounts he was still alive and well.
Twenty-two and a half years before her death a lady had angina pectoris. Her husband, a physician, used to start on his rounds expecting to find her dead on his return. Palpation and percussion revealed her heart enlarged. Auscultation disclosed a mitral murmur. In attacks of dyspnea she had pain running from the heart to the left shoulder and down the left arm. She felt as if a giant grasped her chest so she could not breathe. Relief was afforded usually by a dorsal decubitus with feet higher than head. Sometimes Hoffmann's anodyne or brandy or other stimulant was given. But her sole solid food was beefsteak thrice daily. On this hearty food she recovered and her heart became so normal that two and a half years before her death from locomotor ataxia, a physician chancing in could discover no cardiac lesion on physical exploration.
A New York policeman, about forty years old, presented the signs of enlarged heart and a fibrinous concretion inside. Also of dullness on percussion and of wavy impulse twice the normal. Sounds were confused and mixed. The pulse was quick and irregular and the volume and impulse of the right radial artery were twice as strong as that of the left. There were paroxysms at time of palpitation, faintness, livid face, hippocratic countenance and a feeling of impending death. Faithfuliy had he been through the conventional treatment with digitalis and other heart sedatives, et cetera. There was some albuminuria, renal casts and fatty epithelia ; also oil in the blood and fat in leukocytes. I kept him on beef as sole solid food, with sufficient water to maintain the specific gravity of the urine at 1015 to 1020 and thus have the blood of normal density, thereby making it less work for the heart to propel the blood. To cut a long story short, the radial pulses became equal, the heart's area and dullness much lessened, sounds distinct and the man felt well enough to undertake (without my knowledge and consent) to do night and day duty! This devoluted him and he died. It may be added that he came into my office once with a pulse of 160. With dorsal decubitus and feet higher than his head, after ten minutes had elapsed his pulse was 80, which demonstrated the value of physics in physic by lessening the heart's work as follows: In the standing posture of the body the heart drives the blood through arteries, capillaries and veins against a hydraulic (hemostatic rather) pressure of the height of the subject. In the dorsal decubitus with feet higher than the head not only is the said pressure removed but the weight of the blood aids the heart. Thus the heart's work is lessened and hence the said fall from 160 to 80.
Hearty food also physically lessens heart work. Blood that is thicker than normal from absence of water, from presence of fibrin filaments, thickened, massive, in skeins, thrombi; from crystals or granules of oxalate of lime, carbonate of lime, triple phosphate, cystin stellin, stellurin, uric acid, et cetera, is with more difficulty propelled than normal blood. The autonomic governing nerve centers of the heart take cognizance of the need of more power to be exerted to sustain life and make it work harder and hence it becomes enlarged. The blood impact in the ventricles and the direct reversal of the blood stream in cavities strung with heart strings offer favorable conditions for the formation of fibrinous concretions previously in the blood, and which also increase the heart work, and so the heart continues to grow. Now, I have been taught, and testify as second witness, that hearty food (assuming that the mineral foods, air and water, are always present in proper sufficiency) does bring enlarged fibrin filaments down to normality and thus removes the thrombi, skeins and fibrinous concretions. The water removes the crystalline bodies. This hearty food makes the blood easier to propel, and the work being lessened nature will restore normality, as nature is all the time trying to cure, other things being equal.
Again, hearty food confers the most force or dynamics to the heart. It does not ferment, as carbohydrate food ferments, into CO2 gas which when found in the stomach in large excess and long continued is absorbed through the pericardium and partially paralyzes the heart, causing many deaths at night in bed. (I testify as second witness).
Again, when the heart is overwhelmed and enlarged, it, in my opinion, needs strengthening, not toning down. To give sedatives when the heart is working as hard as it can to save life, though conventional, seems out of place. If your horse has a hard day's work before him (he cannot work if his heart is weak) you feed him liberally. If the locomotive has a heavy train to haul more fuel is required. Hearty food does this for the heart in like circumstances. This law applies in asthenic-disease treatment. If, as the evidence seems to show, our bodies, save hair, teeth, and nails, metabolize, transform, or change once in seven months (not years), then plenty of good air, water and hearty food ought to make an enlarged heart normal by lessening its work, strengthening its tissues, replacing abnormal with normal tissues and giving nature a chance to cure. This has been done.
Again, inasmuch as the heart is a terminal organ, its blood vessels are largely looped, bent backwards on themselves. Its coronary arteries run in the opposite direction to the aorta, their source. Thus the heart tissue circulations are easier to be impeded or retarded and hence the heart is more liable to fatty degenerations and to crystalline deposits. Now, the daily studies recently published in this journal, as to food producing or not producing albuminuria, renal casts, and fatty epithelia, evidence that hearty food is inimical to the signs of kidney degeneration. Hence it may be expected that hearty food would help to restore fatty degenerated hearts. Clinically it has proved so. Hearts weak, sounding as if, at a distance, painful and associated with the said signs in the urine, and blood too, for that matter, have been restored to strength, normal distance sounds with normal urine and blood. It would be difficult to prove this by autopsies. Patients are not killed as cattle are, for diagnosis of the cardiac fatty muscular fibers at the outset. Nor after the clinical cure can you kill and autopsy to prove absence of said fat fibers. Even this demonstration would not prove that they had been previously fattily degenerated. For practical purposes, however, such cases have been cured so that the disease could not be detected clinically, and this, we think, is doing pretty well. It goes without saying that the word hearty has direct sthenic relations to the heart or else our vernacular is all wrong.
Some hearty foods.—Beef, good and sound, freed from white fibrous tissue and extra fat, stands at the head. Whites of eggs next, then lean mutton, soft clams (mya arenaria), and whole wheat freshly prepared. The Bible "bread that strengthens the heart" was not made of modern flour.* Raw potatoes, sliced and fried with fat, only enough to keep them from adhering to the pan, and dates and rice are hearty
*The word translated bread (Psalm 104: 15) is translated meat (Revised Version) in Samuel 20: 24. The Hebrew Dictionary, in “Strong's Concordance," makes said bread include meat. In Genesis 18: 5 (Revised Version) Abraham said to the three men, “and I will fetch a morsel of bread and strengthen ye your heart," while according to the 6th, 7th and 8th verses he set before them cakes, butter, milk and the calf he had dressed
and they did eat. So also in Genesis 1: 29 and 30 the word translated food (vegetable) is in Ezekiel 29: 5 applied to Pharoah and "all the fish of the river being meat for beasts and birds” (Authorized Version). So the inclusion of animal food here is Biblical.