Valentine's Meat-Juice In many well known Hospitals, as well as in private practice, Valentine's Meat-Juice is extensively employed when an Easily Assimilated, Powerful, Rapid Blood-Making Nutrient Restorative is demanded to counteract the Exhaustion and Debility of Phthisis and Influenza. Edward Woakes, M. D., London, Consulting Physician Luton Cottage Hospital and Senior Aural Surgeon, London Hospital: "I have prescribed Valentine's Meat-Juice in hospital and private practice ever since its introduction. Recently several operation cases were attacked with Influenza, and I attribute the successful issue of all of them, largely, to the facility with which nutrition could be administered and vitality maintained through the medium of Valentine's MeatJuice. Without it I should often be at a loss." R. B. Watson, M. D., Surgeon Pennsylvania Co. and Lockhaven Hospital, Lockhaven, Pa.: "The results obtained from the use of Valentine's Meat-Juice establish all that is claimed for it. In a case of Phthisis, it alone kept the patient alive for weeks, as it was the only nourishment she was able to take." Valentine's Meat-Juice Company RICHMOND, VIRGINIA, U. S. A. , 1906 THE MEDICAL WORLD The knowledge that a man can use is the only real knowledge; the only knowledge that has The Medical World C. F. TAYLOR, M.D., Editor and Publisher Entered at the Philadelphia Post-Office as Second-Class Matter. SUBSCRIPTION RATES: To any part of the United States, Canada, and Mexico, ONE DOLLAR per year, or FOUR YEARS for THREE DOLLARS; to England and the British Colonies, FIVE SHILLINGS SIX PENCE per year; to other foreign countries in the Postal Union, the equivalent of 5s. 6d. Postage free. Single copies, TEN CENTS. These rates are due in advance. HOW TO REMIT: For their own protection we advise that our patrons remit in a safe way, such as by postal money order, express order, check, draft, or registered mail. Currency sent by ordinary mail usually reaches its destination safely, but money so sent must be at the risk of the sender. We cannot always supply back numbers. Should a number fail to reach a subscriber, we will supply another, if notified before the end of the month. Notify us promptly of any change of address, mentioning both old and new addresses. If you want your subscription stopt at expiration of the time paid for, kindly notify us, as in the absence of such notice we will understand that it is the subscriber's pleasure that the subscription be continued, and we will act accordingly. Pay no money to agents unless publisher's receipt is given. ADDRESS ALL COMMUNICATIONS TO "THE MEDICAL WORLD" 1520 Chestnut Street VOL. XXV. Philadelphia, Pa. Language is a growth rather than a creation. The growth of our vocabulary is seen in the vast increase in the size of our dictionaries during the past century. This growth is not only in amount, but among other elements of growth the written forms of words are becoming simpler and more uniform. For example, compare English spelling of a century or two centuries ago with that of to-day! It is our duty to encourage and advance the movement toward simple, uniform and rational spelling. See the recommendations of the Philological Society of London, and of the American Philological Association, and list of amended spellings publisht in the Century Dictionary (following the letter z) and also in the Standard Dictionary, Webster's Dictionary, and other authoritativ works on language. The tendency is to drop silent letters in some of the most flagrant instances, as ugh from though, etc., change ed to t in most places where so pronounced (where it does not affect the preceding sound), etc. The National Educational Association, consisting of ten thousand teachers, recommends the following: "At a meeting of the Board of Directors of the National Educational Association held in Washington, D. C., July 7, 1898, the action of the Department of Superintendence was approved, and the list of words with simplified spelling adopted for use in all publications of the National Educational Association as follows: "You are invited to extend notice of this action and to join in securing the general adoption of the suggested amendments.IRVING SHEPARD, Secretary." We feel it a duty to recognize the above tendency, and to adopt it in a reasonable degree. We are also disposed to add enuf (enough) to the above list, and to conservativly adopt the following rule recommended by the American Philological Association: Drop final "e" in such words as definite," "infinite," "favorite," etc., when the preceding vowel is short. Thus, spell "opposit," "preterit," "hypocrit," "requisit," etc. When the preceding vowel is long, as in "polite," "finite," "unite," etc., retain present forms unchanged. We simply wish to do our duty in aiding to simplify and rationalize our universal instrument-language. JANUARY, 1907. Treatment of Croupous or Lobar Pneumonia. The bulk of the periodical literature upon the treatment of pneumonia is rendered unavailable for use as a basis of practical improvement in clinical methods because of the widely divergent views as to what actually constitutes a pneumonia. One writer labels his cases "pneumonia" as soon as they develop pronounced fever, rapid and labored breathing, and pain referred to the chest. This too careless class is offset by the too deliberate men who delay their verbal diagnosis till the stage of engorgement is markedly in evidence, and who are, presumably, also slow in adopting energetic therapeutic measures. The former class are those who make up the reports of "aborted cases of pneu No. 1 monia"; the latter class meet such reports with the retort that a true pneumonia did not exist in those cases. 66 It is not our purpose here to combat the personal ideas of any one as regards what he shall decide constitutes a pneumonia," otherwise than to call attention to the fact that when cases of "aborted pneumonia" are reported, each case should be accompanied by a complete and accurate record of the results of detailed physical examination, so that the reader may be able to intelligently apply the recommended therapeutic measures, if they appeal to him. Manifestly, if a writer commends a treatment against "pneumonia" which has not yet reacht the stage of engorgement, and fails to define exactly the physical condition of his patient at the time the medication produced results, a reader attempting to follow him and who has a patient in the stage of red hepatization, must of necessity be disappointed in obtaining results. No report of favorable results can be considered of practical value unless accompanied by an accurate clinical picture of the disease at the time of exhibition of the medicament. The generally accepted pathological beginning of a pneumonia is considered to be a hyperemia of the lung tissue. From this hyperemia develops a stage of inflammation, and the inflammation progresses, if the course continues, thru engorgement, red hepatization, and gray hepatization. Now, if this process can be stopt at any stage, or if any phase of the disease or its preliminary conditions can be modified by medication, it is not the part of wise therapeutics to quibble over hair-splitting arguments as to the exact time at which one is justified in asserting that premonitory conditions have given way to the actual condition classically known as pneumonia; except, of course, in so far as the exactness in reporting the case as above referred to is concerned. However much we may differ in our opinion as to whether or not the pneumococcus of Fraenkel is responsible for all cases of pneumonia, all will agree that the symptoms of a pneumonia are generally typical, however much they may vary in individual cases. A distinct chill, followed by a rapidly rising temperature reaching its maximum within the first twenty-four hours and falling by crisis within nine days; supprest secretions; flusht face; quickened pulse and respiration; restlessness or delirium; pain in the affected area; cough, becoming more aggravated as the temperature rises; rusty-colored sputum ; together with the signs elicited by methods of physical diagnosis which denote consolidation, go to make up a complete clinical picture. The mortality of such a group of symptoms is high. These symptoms are familiar enuf to us all. We have met them by antiphlogistic, heroic, expectant, stimulant, and a variety of other tactics. There is little doubt but that therapeutic errors have been made. Certain practicians claim to be "able to abort pneumonia with ease"; "to have run a series of dozens of severe cases without a death," etc. To deny such claims without having observed a case so conducted, or to ignore them as the vaporings of incompetent enthusiasts, cannot be lookt upon as rational, in the face of the ever present and increasing mortality under old forms of treatment. Less rabid assaults upon the methods of those who are practising at variance with our own customs, and a judicious study and trial of their methods, might result in much good being accomplisht. In our opinion, the practise of the dominant school is, in many instances, too drastic. We are convinced that, under pretense of "sustaining the heart," many a heart has been driven to physical exhaustion by illyadvised doses of such drugs as strychnin. The disease in itself is rapidly devitalizing in nature, and demands a high degree of skill in nourishing and sustaining the patient, but it is not proven by results so far in evidence that routine stimulation to the limit of the potency of drugs has been of benefit. Nor has the custom of giving a severe cathartic at the outset of the disease any rational ground for its continuance. If the patient is constipated, a gentle laxativ is indicated, but "sweeping out the bowels" is unnecessarily weakening to the patient and is not indicated. To begin "prodding" the heart with stimulants at the outset of the disease "to guard against weakness later on" cannot be defended. It is quite soon enuf to employ heart stimulants when the heart gives evidence of weakening under its load. We have never had the courage to apply cold to the chest of the pneumonic patient. While the local application of cold primarily induces contraction of the capillaries, its later effect is to slow the blood stream and induce congestion. The final effect is identical with that of acute inflammation. Heat, locally applied, on the contrary, is continuously stimulating to the capillaries, and induces the arterial capillaries to hurry the blood along to the veins. It should be persisted in so long as it is evidently aiding in abatement of the symptoms. Thoro Every precaution should be taken to conserve the vitality and strength of the patient. He should not be allowed to converse with his attendants more than is absolutely necessary. The use of the bed pan should be insisted upon as rigidly as in typhoid fever. Nothing should be done which can in any manner aggravate nervous irritation, decrease vital force, cause pain, or induce weakness. The temperature of the room should be maintained at 70°F. ventilation is imperativ, but direct draughts are to be avoided. All "fussiness" about the patient should be avoided, and one attendant is ample. We like to keep the air in the room moist, and the vapor may be medicated with carbolic acid, turpentine, or eucalyptus. An improvised vaporizer may be made by placing a couple of nails across the top of a lamp chimney in such manner as to give steady foundation for an ordinary pint tin cup; the lamp is lighted, the cup half filled with water, and the medication added; this should be kept simmering, and the contents be thrown out and renewed every third hour. If seen early, within a few hours of the initial chill, it is our custom to give a hot sitz bath of twenty minutes duration; or, if this be inconvenient, a hot mustard impregnated foot bath, in a deep vessel. A flannel cloth is then well greased with lard, upon which is sprinkled eclectic emetic powder,* and this is applied to the chest. This dressing may be supplemented by a hot-water bottle so placed that its weight will not fall directly upon the patient's chest. Such treatment does not prove weakening to the patient; on the contrary, patients express themselves as refresht and relieved. If twenty-four hours have elapst since the initial chill, however, such a bath does not induce the beneficial effects which it does when given earlier, and some patients seem exhausted by it; we do not order it when so much time has passed after the chill. With a full, strong, bounding pulse, small doses of veratrum every one, two, or three hours is of pronounced benefit. The eclectics use 30 minims of the specific veratrum to four ounces of water, and give a teaspoonful dose at above intervals. If the pulse is rapid, but hard and wiry, aconite is the drug of choice; but this drug is strongly contraindicated if there is the slightest evidence of weakness in the pulse. Jaborandi acts happily on the hot skin, nervous excitement, and high temperature of the earlier stages. A fractional dose of morphin will assist in combating the nausea sometimes noted in those taking repeated doses of veratrum. the eclectic plan of adding the 30 drops to the 4 ounces of water be followed, a grain or half grain of morphin may be included in the prescription. If the cough be excessiv, fractional doses of ipecac may be employed. Divided doses of Dover's powders act well. Codein, in doses oftograin, is also efficient. If the catarrhal condition in the bronchial tubes causes distress outside of the coughing, ammonium carbonate or lobelia may be given to facilitate expectoration. If the pain be severe, wet or dry cups may be tried, but in many instances only the use of morphin will gain rest for the patient. In severe dyspnea, the use of oxygen lessens cyanosis, makes the breathing easier, and is conduciv to sleep. Dyspnea is not always a call for cardiac stimulation. If there is evidence of heart weakness, alcohol in judiciously divided doses and strychnin in grain doses are the agents of choice. Digitalis is often disappointing here, and should not be used where a certain effect is so essential. Do not give heart stimulants till convinced that they are actually deThe eclectic emetic powder referred to in the above article is composed of: ...........6 drams .3 drams .3 drams 4 drams ......1 dram Powdered lobelia...... Powdered skunk cabbage root Powdered capsicum They are now using extensivly a mixture similar to the above compounded with glycerin and clay, much as many of the regulars employ kaolin poultices. See, by aid of the Yearly Index in December issue of each year, references to eclectic emetic powder, and eclectic treatment of pneumonia. manded; but when deciding on their use, give them so that the effect will not be in question. The secret of successful treatment of pneumonia lies in gentleness. Many cases will not demand more. If alarming symptoms develop, stronger methods must be employed; but, to our mind, the profession has erred in instituting heroic treatment too early. Opsonic Therapy. While it has been the policy of THE WORLD to omit mention of "new things in medicin" until after they had been proven of practical clinical worth, the general and widespread interest in the theories which Wright has built up around the opsonins impels us to give at this time an outline of the theory and the work. An opsonin, as defined by Dorland, is: "That constituent of the blood serum of a normal animal which renders bacilli prone to be absorbed by phagocytes." Sir A. E. Wright, assisted by Doctors Stewart R. Douglas and J. Freeman, have been for some time past experimenting and working along the line of developing a serum therapy in accordance with the facts regarding opsonin that are now known. They do not perform their experiments upon the lower animals, but work with men and women; their "laboratory" is not an isolated back room, but is the pathological laboratory of St. Mary's Hospital. They have been averaging about 30 patients, each reporting three times a week. According to Wright's theory, this normal constituent of the blood, opsonin, acts upon such germs as gain entrance to the blood in such manner that they more readily succumb to the phagocytes. In the blood of man a variety of opsonins circulate, each of which is capable of acting against a certain pathological organism, should such organism reach the blood stream. In health, this amount of opsonin remains at a certain quantity, known as "the opsonic index." Wright has devised a method by which the "opsonic index" for any given pathological germ may be ascertained. Fresh leucocytes from human blood, the serum to be tested, and the bacteria in question, are blended; after allowing time for incubation, this mixture is stained and examined under the microscope. The germs are found within the phagocytic leucocytes, and by counting the number of germs in a number of leucocytes, making an average, and comparing it with serum which has not been so blended, the "opsonic index" for that germ is establisht. If infection with a germ occur, the opsonic index for this germ is lowered; or, as stated by Wright, "then the serum is in a negativ phase of opsonic power." Hence, in tuberculosis infection, the tuberculosis index is lowered. In |