Explanatory note:-"R. S." Right Side. "L. S." Left Side. "E." We are told by a number of writers that we now have outlined. I think we should regard these cases as pulmonary septicemia, due to the absorption of pus organisms caused by faulty or imperfect drainage. With this conception I have been stimulated to devise some plan by which drainage could be favored, thereby ameliorating the conditions above referred to, and contributing in no small measure to the comfort and well-being of these patients. Some two years ago at the Watauga Sanitarium we instituted a systematic form of postural treatment to meet this indication, and up to the present time our results have been most gratifying. The accompanying chart, which is schematic only, and does not in any sense represent the usual locations of cavities, will serve to illustrate that which is to follow. In instructing our nurses whose duty it is to carry out this postural treatment, we have explained that these pus cavities are but veritable cups containing pus and a multiplicity of toxic materials, which, if allowed to remain, would greatly prejudice the patient's welfare and materially add to the discomfort and suffering, and that by postural treatment it is our purpose to put the patient in such varying positions as will enable us to turn all of the cups upsidedown during a given period. The plan outlined is about as follows: In the early morning, after the patient has finished his first morning cough or respiratory toilet, and before he has had his breakfast, he is requested to lie upon the right side for twenty minutes. An hour and a half after breakfast he is requested to lie upon his left side for the same length of time. Toward the middle of the day, before having his mid-day meal, he is required to lie on his stomach for twenty minutes. In the afternoon he is either placed in a sitting position or allowed to be on his feet for the same length of time; and at some time before retiring for the night he is put in an inverted position, by having him lie upon his stomach, moving him cross-wise of the bed, and allowing his body to hang over the side of the bed, resting his head, sup ported by his hands, upon the floor. This routine is repeated daily, and of course presupposes that the patient sleeps upon his back, thus giving him a complete postural treatment that will favor the emptying of all pus cavities in his lungs having a satisfactory outlet. This routine is of course modified to meet individual requirements made necessary by the physical condition of the patient, and it is necessary to use judgment here as in all other therapeutic measures. We have not failed to have a prompt and almost complete disappearance of the group of septic symptoms in every case on which this method has been tried, and we believe that if it is intelligently and Judiciously carried out in properly selected cases, much good can be accomplished. Many patients suffering with moderately advanced and advanced tuberculosis will complain that they cannot lie upon the right side, or perhaps the left side, for the reason that it produces an intolerable fit of coughing. Postural treatment will, within a very short time, enable the patient to sleep in almost any position without this annoyance, as I have demonstrated in many instances. I shall not take up your time further in discussing the many interesting features in connection with this subject, as it is only my desire at this time to bring before you the above observations, which, so far as I know, have never heretofore been brought to the attention of the profession, and if the above method of postural treatment or any modification thereof shall prove of value in your hands, I will be gratified. TUBERCULAR LARYNGITIS* BY M. M. CULLOM, M.D., OF NASHVILLE, TENN. Gentlemen:-Mrs. T. W. S., age 36 years, dates her present illness, Feb. 23rd, 1916, from mumps ten years ago. Took cold and settled in ovaries. Dr. W. D. Haggard re *Reported at regular meeting of the Nashville Academy of Medicine, Tuesday, May 29th, 1917. moved ovaries three years ago. Father living, in good health, aged seventy years, three brothers and one sister living, in good health, two sisters died in childhood; mother died at forty-seven with malarial fever. Previous to mumps had no illness except whooping cough. A year ago became hoarse, with gradual loss of weight; nine months ago lost voice, now speaks in almost inaudible whisper. Appearance, emaciated; color, pale; weight, eighty-two; temperature, 100 F. Dr. Haggard reports no physical signs in chest. In the larynx there is a mass the size of a chestnut occupying the space between the arytenoids. Vocal cords almost obscured but very red. The diagnosis lies between malignancy, syphilis and tubercle. Doctor Haggard was advised that appearance indicated tuberculous laryngitis. eral tuberculin tests were negative but after several times a positive reaction was obtained. A formalin and carbolic acid spray was given patient, while a twenty-five per cent solution of argyrol was used in larynx. Sev It was decided to try the efficacy of sunlight treatment. A glass sun parlor was built out of the second story window of her residence and the patient was instructed to expose feet to sunlight four times a day for five minutes. The second day the feet were to be exposed ten minutes, and the legs below the knees five minutes. The third day the feet fifteen minutes. The lower leg ten minutes, the upper leg five minutes. The surface of the body was gradually exposed in this way until the whole body was exposed in about two weeks. A wet towel was kept over the heart when the whole body was exposed. The exposures were from twenty minutes to a half hour at a time and an effort was made to secure from five to eight hours exposure during the day, depending upon the heat of the day. The patient's family physician was instructed to give the Mulford series of tuberculin injections once a week. The patient has gone through the first four series of injections and is ready to start on the fifth. She took in addition to generous feeding two raw eggs after each meal, and a pint of cream at bedtime. She also kept up her formalin and carbolic spray. The tubercular mass has disappeared from her larynx, her voice has returned, she has gained twenty-one pounds in weight, which is as much as she has ever weighed, and has the appearance of health. Editorial. WANTED, TWENTY THOUSAND DOCTORS Our country by act of Congress approved by the President being in a "state of war" with Germany is preparing to put into the field one million of her citizens. Among the paramount necessities is a competent, efficient and able medical corps of adequate numerical strength. At the present time there are less than 500 physicians in the regular Medical Army Corps. About 2500 in the Medical Reserve Corps and about 800 in the Militia, or a total of about 3800 physicians when we need twenty thousand and must have them promptly and ready for service as soon as the soldiers are assembled. In time of war the American Doctor has never been a "slacker." In our personal experience in the great war between the States-186165, when our armies in the South were organized, not only did we have an ample number come forward to supply the Medical Department with a competent medical staff, but fully as many entered the service as line or field officers and private soldiers. Again, in the Spanish-American war there was no lack of numbers to offer services but a similar condition prevailed, and even General Leonard Wood now occopying so prominent a position in the Army of the United States, although a regular physician entered the army as Colonel of a regiment. That there is a deficiency now can only be due to the fact that the medical profession as a whole, are not sufficiently aware of their country's need. Especially is this the case as to those living in the central or interior States. The idea prevails that we will have but little trouble from an enemy so far away across the salt sea who have their hands full with our English, French and Italian allies. "Oh no" is the expression made by some, "it is not worth while for me to abandon my practice and waste two or three months or more in a training camp, to which my be added only a few weeks or months of service." My good friends, you must wake up; take cognizance of the oc |
