Page images
PDF
EPUB

to our better judgment and satisfied approval. That the National, State and city public officials have often in the past largely ignored the public gratuitous work of the medical profession as well as treated with ridicule their voice in matters pertaining to hygiene, sanitation, education and general forms of legislation is very clear.

Moreover they have treated with scorn and utmost contempt the purely medical ethical rights of the profession and severely criticized our most sincere efforts to elevate the practical standards of public health and social betterment, branding them as sordid motives and selfish interests.

By the mutual correction of all such mistakes and a more intelligent, sympathetic public co-operation and study of our social, moral and medical needs may we arrive at a better understanding of ourselves and our neighbors, and may we not only as physicians but as the more favored citizens of a great and growing city as well as republic, work more harmoniously for the greater good of humanity and thus make ourselves more worthy disciples of the sacred vocation to which we are called. Such a divine purpose as this constitutes the very essence of the Newer Mission of the Doctor and Hospital, and as medical men it is our privilege as well as duty to help in its speedy consummnation.

900 Rialto Building.

MELUBRIN AS AN ANTIRHEUMATIC AND

ANTIPYRETIC.

DR. ERICH KEUPER, Berlin Assistant in the First Division for Internal Medicine of the City Hospital at Urban, Berlin.

In the past few years, a number of new substances differing very decidedly from one another, have been introduced as antirheumatics; some of these, which are given in relatively small doses-pyramidon for example-possess a purely antipyretic action. To this group belongs melubrin, recently placed on the market by the Farbwerke-Hoechst Co., and which has been shown by Leoning and Schrenk to possess equal powers with pyramidon. We have tested from this viewpoint 164 cases comprising not only rheumatic affections of all kinds but also other highly febrile affections in order to determine whether the benefit is to be attributed to the antipyresis. We had in mind especially acute rheumatic polyarthritis. If we were to rest content

The present work done under Prof. Starck at the Medical Division of the City Hospital, Karlsruhe.

with the surprising results obtained in some of the cases, we could not state that melubrin was superior alike to all other antirheumatics and antipyretics. We too have had failures in which the salicylic preparations and aspirin either alone or in combination with melubrin have obtained results better than those from the latter alone. But we have shown that when melubrin is given in proper dosage it is equivalent to all previously tested remedies, especially in acute articular rheumatism.

We perceived one disadvantage, the necessity of giving melubrin in large doses. An advantage, however, appears in our experience of the innocuousness of the latter even in large doses, as neither the gastroenteric tract nor kidneys showed any effects of irritation. When we give salicylic preparations in large quantities it is the gastri. tis which may develop that antagonizes the treatment. Melubrin was once given with success despite the presence of hemorrhagic nephritis. If albumin did appear in the urine under melubrin it lasted but a few days. Hence nephritis in rheumatism does not form a contraindication to this drug, which may be given intensively in the severest cases of acute polyarthritis.

During a half year we have given 150,000 grains of melubrin to 164 patients of every age and both sexes. It seemed to us important to investigate daily the urine and its centrifugate. We did not see a collapse after a large dose; neither was there any complaint of tinnitus, vertigo, profuse sweats, etc. In two cases only diarrhea set in and was successfully treated for two days with opium without stopping the melubrin. We used the daily dose of 120 to 150 grains, because this had been found safe in every way by Loening and Schrenk. On this basis we almost always secured defervescence in from three to six days, while the pain subsided and the swelling yielded quite notably. In all such cases we gave about 90 grains daily for the next four to six days. After that we gave 45 grains daily and usu ally completed the cure in a couple of days

more.

The cessation of fever and pain was strikingly prompt, and 36 cases of acute articular rheumatism thus ¡yielded to melubrin.

With chronic articular rheumatism and muscular rheumatism we must expect reverses under any treatment. In 60 cases of chronic articular rheumatism we were unable to convince ourselves that melubrin was a specific, but it was at least as useful as any other measure now before the public. It is certainly an asset that melubrin

can be given over long periods without causing disagreeable collateral effects. This cannot be said truthfully of all antirheumatics. In any case, however, the medical treatment must be backed up thoroughly with hydro-and electro-therapy; so that high doses of drugs need not be increased. The author, in fact, was able by using physical methods to keep the dose of melubrin down to 90 grains daily, and in more obstinate cases to 75 grains. With the condition still obstinate the dose could gradually be brought down to 45 grains, and even to 15 grains with successful outcome.

Affections other than arthropathies also yielded to melubrin. Not only rheumatic pleurisies but those actually tuberculous were healed in the same manner. Four

cases of sciatica and one of chorea minor on a rheumatic background were fully healed as was also a case of morbus maculosus Werlhofii in quick time.

Aside from the 112 cases in which melubrin was employed for rheumatic affections, it was also used in 2 cases for its antipyretic and analgesic effects. These were a great variety of conditions (typhoid, septicemia, inuflenza, erysipelas, etc.). It may be stated that the drug exerted no influence whatever on measles, although it was able to lower the temperature decisively in the other affections. The antipyretic power was shown in the positive cases by suspending it from time to time where upon fever retained.

We present a few case histories in which patients with acute rheumatic polyarthritis, chorea minor, sciatica, purpura hemorrhagica and exudative pleurisy were treated with melubrin. These are given in ab

stract only.

In acute rheumatic polyarthritis the patient was a farmer, aged 38. On June 17, 1912, he was attacked with chill. Violent pains in knee and ankle joints. High fever and mental confusion. He was given salicylate of soda at home and at first improved. Pyrexia, however, did not abate, and this with dyspena brought him to the clinic (July 1). In addition to the original inflamed joints he was found to have bronchitis and left-sided exudative pleurisy. He was placed upon melubrin for three days by which time the condition was under control. There was no steady fall in temperature, for the latter showed the daily rise as usual; but by July 6, five days after admission, patient was comparatively free from all serious symptoms. He was left under treatment until July 20 and was then discharged "essentially improved.'

[ocr errors]

It is difficult to judge of the efficacy of

any remedy given for chronic articular rheumatism. Certain cases refactory to the action of a remedy improve under a change of medicines, especially if hydro- and electro-therapeutics are added. In the case of melubrin, however, we are dealing with a specific antirheumatic, which should also be of use in chronic rheumatism when employed with system and patience. Some such course is necessary to prevent permanent incapacity and invalidism. We have treated ten such patients within the last six months with melubrin. All were between 30 and 60 years of age, save a 15-year old boy. Most of them had had at least ten attacks of acute articular rheumatism, and all had organic heart disease. There was no temperature when first examined, save in one case, and the joints of all were swollen but not very painful. In addition to drugs all had the advantage of treatment with salt baths, hot air douches, electric light baths, local use of salicylic acid, eosin, sunlight, etc., while both old and new tuberculin cures had been tested as well as purely mechanical treatment. Five of the ten were discharged as able to work, there remained invalids because of stiff joints and senescence, and in the other two the severity of the cardiac lesion gave hopeless prognosis.

In one case in a man aged 34 the benefit from melubrin was very distinct. This as the one in which fever existed; 120 grains daily of melubrin causes complete defervescence. After eight days without fever 90 grains salicylic acid per day were given whereupon fever returned and persisted seven days. Then melubrin, 90 grains, daily, was substituted and once more everescence occurred and remained under the continuance of the remedy. On the other hand salicylic acid showed better control over the pain. The cure was completed with hydro-therapeutic measures and a tuberculin cure.

We gave melubrin in 15 cases of acute and 31 cases of chronic muscular rheumatism. Of the first series 12 were cases of lumbago.

In order to obtain a pure picture of the action of melubrin we did not as usual resort likewise to electric baths, hot air baths or vapor douches. In 10 of the 15 acute cases we obtained by the end of the third day, with an initial dose of 120 grains of melubrin, a disappearance of the pain, while all the cases showed improvement. We then reduced the doses gradually. The average duration of treatment, until patients were able to resume work, was nine days. Two cases terminated in

two days while in the two most unfavorable 20 days were required.

In chronic muscular rheumatism it is naturally difficult to estimate the action of the remedy. There were no total failures, and we were able to note a prompt, favorable influence over the pains. No unpleas ant collateral effects were noted. In 18 cases melubrin was alternated with other salicylic acid preparations, but no essential differences were noted. In all 31 cases patients were able to return to work.

There was one case of purpura hemorrhagica, male 37, with exacerabations of articular rheumatism. The first severe outbreak was accompanied by much swelling of numerous joints and gingivitis. The latter was so severe as to interfere with nutrition. Prupuric spots developed over knees and ankles. Melubrin brought down the fever and pain and some of the swelling. The stomatitis improved slowly, with one sight relapse. Discharged cured after about five weeks' treatment with melubrin.

There was one case of chorea minor, in a 12-year old boy. History clean until a recent attack of influenza. Chorea followed close upon, of severe type, boy unable to feed himself. Treated with hydrotherapy, aspirin, arsenic and chloral. Then placed on melubrin, which for the first few days produced no change. Improvemement now became rapid. Motor, disorder limited to intention movements, and patient could walk a little. Mental state, which has been one of apathy, then improved. After nine weeks of melubrin he was pronounced cured. Initial doses 90 to 120 grains, gradually reduced after improvement set in.

Thirteen cases of pleurisy with exudation were seen. Two also had polyarthritis rheumatica, and, with the addition of three others, form a series which are classed as rheumatic. The other eight were evidently tuberculous pleurisy. All cases pursued a favorable course under melubrin, the exudate having been quickly absorbed. The author, however, is far from imputing the results solely to melubrin as other measures usually employed were not omitted. The eight tuberculous cases with one exception

received no tuberculin. Melubrin was nat

urally given to antagonize fever and pain as well as a possible rheumatic tendency.

Do Your Christmas Shopping Early.-On another page, in this issue, you will find a plan for making it easy for the doctor." It is a suggestion made by Emery, Bird, Thayer Co., whose name is a household slogan in Kansas City.

Heraldings

Are you an active member of the medical knockers? Ye must be born again!

Is cleanliness next to godliness" a quotation from the Bible?

The indications then for the removal of adenoids and hypertrophied tonsils would be the presence of demonstrable enlargement plus symptoms, and these symptoms would be the result of mechanical obstruction or of infection or of both.

Shop early! The holiday season rapidly approaches.

¶ Some one says that good taste is a large part of religion, while some one else says that the kind of help given the farmer for his stock should be given for his family.

The family dinner when all can meet, should be a daily happy event, with jollity and every one in the best of spirits. Then we could get along perhaps without so The poor many "Gastric Aphorisms." bachelors take notice!

The point has been raised that there are Otherwise, too many medical societies. how could the married man have a frequent excuse for his absence from home?

Our tubercular friend Knopf suggests that discarded battleships be used for the tuberculous.

The future of preventive medicine may be right and all embracing, but it will prove debilitating to the medical profession. Salus populi suprema lex will prove to be our undoing.

In London a man, responding to a toast, lifting his glass said, "A doctor is the man who prolongs life and makes death easy."

"He that conquers himself is greater than he that taketh a city." Let hunters after happiness consider.

¶ We are against "raw food faddism" and consider it the diet of cranks. Dietetics a neglected study.

¶ Dejerine says that psychotherapy depends wholly and exclusively upon the beneficial influence of one person on another. Electricity and vibration experts please notice. The ancient adage, "It is faith that saves or cures."

Also, neurasthenia is due wholly to psy. chological factors, and that these psychological factors are essentially, if not exclusively, determined by emotion.

When you educate the public in cancer do P.I.L. you tell them the cause?

Incorporating

The Kansas City Medical Index-Lancet

An Independent Monthly Magazine

Under the editorial direction of

CHARLES WOOD FASSETT and S. GROVER BURNETT

ASSOCIATE EDITORS

P. I. LEONARD, St. Joseph
JNO. E. SUMMERS, Omaha

CONTRIBUTING EDITORS
JOE BECTON, Greenville, Texas
HERMAN J. BOLDT, New York
A. L. BLESH, Oklahoma City
JACOB BLOCK, Kansas City
G. HENRI BOGART, Paris, Ill.

ST. CLOUD COOPER, Fort Smith, Ark.
T. D. CROTHERS, Hartford, Conn.
O. B. CAMPBELL, St. Joseph
W. T. ELAM, St. Joseph
JACOB GEIGER, St. Joseph

S. S. GLASSCOCK, Kansas City, Kan.
J. D. GRIFFITH, Kansas City
JAS. W. HEDDENS, St. Joseph
GEO. H. HOXIE, Kansas City
DONALD MACRAE, Council Bluffs
L. HARRISON METTLER, Chicago.
DANIEL MORTON, St. Joseph
D. A. MYERS, Lawton, Okla.

JOHN PUNTON, Kansas City PAUL V. WOOLEY, Kansas City

W. T. WOOTTON, Hot Springs, Ark. HUGH H. YOUNG, Baltimore

DEPARTMENT EDITORS

KANSAS CITY

P. T. BOHAN, Therapeutics
C. C. CONOVER, Diagnosis

DON CARLOS GUFFEY, Obstetrics
H. C. CROWELL, Gynecology
FRANK J. HALL, Pathology

J. E. HUNT, Pediatrics

JOS. LICHTENBERG, Ophthalmology
HERMAN E. PEARSE, Surgery

R. T. SLOAN, Internal Medicine
HALSEY M. LYLE, Dermatology

EDW. H. THRAILKILL, Rectal Diseases

ST. JOSEPH

J. M. BELL, Stomach

C. A. GOOD, Medicine

A. L. GRAY, Obstetrics

J. W. MCGILL, Rectal Diseases

L. A. TODD, Surgery

OMAHA

H. M. McCLANAHAN, Pediatrics H. S. MUNRO, Psychotherapy

DES MOINES

WALTER L. BIERRING, Medicine

Address all communications to Chas. Wood Fassett, Managing Editor, St. Joseph, Missouri.

Vol. XXXII

DECEMBER, 1913

No. 12

Editorial

A RETROSPECTIVE GLIMPSE INTO

MEDICAL MATTERS.

With this issue another year shall have passed, and it may be profitable to cast a retrospective glimpse into medical matters which have apparently been of paramount importance, perhaps mostly ephemeral. Medical interests are much wider at the present time, than was the case even a few Education, publicity, prevenyears ago. tive medicine, the various forms of therapeutics, serum, vaccine and anti-treatment, tuberculosis, cancer, syphilis, these and many others have occupied the attention of physicians. We have had many important medical and scientific meetings, including the International Medical Congress in London during August. Many interesting original and profitable suggestions were made, for instance, Dr. Kerr, of Glasgow, strongly advocated establishing compulsory

During

notification of pregnancy, for official surveillance by health authorities. the past year the salvarsan therapy seems to have developed into the treatment of syphilis by the "Combined Salvarsan-Mercury Treatment.

The immense expectation by our hopeful confreres of one particular form of treatment and the minor fads are rainbow hued bubbles, they come and go, as Byron sang of his time:

"Cowpox, tractors, galvanism and gas,

The bubble bursts, and all is air at last." Fads practically, so much is "fads." Of course experimental physiology, pathology, bacteriology, immunity, susceptibility-are gradually beginning to show us glimpses into the regions in which we suspected the light to be hidden-the human body. In the time before medicine had any science,

when the law of the survival of the fittest reigned, we must admit that the human body was capable of weathering the environment and survived. Survival of the physically unfit may not be even desirable. The unfit must be made fit. We must not regard the present and near past as all important. The treatment of lues by mercury has been used in Europe four hundred years; we are told it has been used much longer in China, while Egyptian mummies, whose bones show undoubted evidences of syphilis, have been found impregnated with metallic mercury. Salvarsan during the past year has not proven all sufficient, and chemotherapy has joined hands with mercury. Says Longfellow:

"From the barred vision of antiquity Reflected shines the eternal light of truth As from a mirror.”

"Magna therapia sterilans" is modified. Prevention still plays the most important role in tuberculosis, while tuberculin has only a limited application in certain chosen

cases.

Sir James K. Fowler at the International Medical Congress said, that in the first place, the use in any form of tuberculin in the treatment of pulmonary tuberculosis is not free from danger, and is absolutely inadmissible in any case where there is fever. Fever he regards as the guide to the activity of the disease, and general reactions should be avoided.

In cancer we believe in early diagnosis and operation, judging from clinical statements in the medical journals. Its etiology is defiant. Preventive medicine means more than vaccination against disease, disinfection and sanitation, it means as well the study of heredity and eugenics; it aims at the prevention of disease and improvement of the race.

We notice in the Journal of Experimental Medicine that Noguchi has detailed his discovery of the treponema in 25 per cent of the 200 cases of paresis that he has investigated. The old discussion between Fournier and Charcot is soon to be settled in favor of the former. Old conditions are to be reversed; there will be no waiting for secondary symptoms, but prompt therapeutic attention to primary syphilis is to destroy the infecting organisms before they disperse and become disseminated throughout the system. Time will tell whether there is hope that paretics will gradually disappear, and that a finding of an antisyphilitic serum will become a reality.

The striking success of the treatment of thyroid insufficiency is one of the most bril

[ocr errors]

liant chapters in the history of medicine. Now attention is directed to the pancreas, the supra-renal bodies, the spleen and the pituitary gland. While no therapeutic triumph compared with that in connection with myxedema has attended recent researches, it is reasonable to hope that progress in treatment will soon follow. Until about ten or fifteen years ago medicine, like the other sciences, in the absence of definite medical knowledge was negative.

With hygiene, sanitation and bacteriology medicine has become positive as a result of the accumulation of facts.

In spite of our knowledge of the prevention of yellow fever, malaria, plague, typhoid fever, rabies, lues, etc., Rosenau says that we have but scratched the surface and its environment, and he continues that the dawn of a positive program foreshadows the day of useful achievements.

During the present year we see the formation of a College of Surgeons that will place American surgery upon the high place it deserves, that will be beneficial in an ethical sense. Undoubtedly the F.C.S. will prove an advertising mark, and the surgeon, upon his honor, will have to sign his name that he will never, oh no, never divide a fee, under any guise whatever. Still it is a step in advance which will not be unfriendly to the democracy of medicine. The question of the hour with the regular medical profession is the suppression of quackery. The quack is a blot upon modern civilization; the extravagant promises, the smooth and honeyed words succeed in extracting the hard-earned money from the pockets of their victims, thanks to the partnership of the doctor and the daily newspaper. It is a question of tainted money.

The regular profession is not entirely free from those who think disease, imaginary or real, is created for their benefit, and the patient is to be exploited. Of course a medical college or society can not give us a conscience. But we are optimistic even to the point, that the so-called "practical" man, who is not seriously devoted to ethics when they interfere with his "successful" onward march, even he improves.

There is indeed a great future ahead for our profession if we accept Rosenau's paraphrasing of Victor C. Vaughan's admirable address:

"Preventive medicine dreams of a time when there shall be enough for all, and every man shall bear his share of labor in accordance with his ability, and every man shall possess sufficient for the needs of his body and the demands of health. These things he shall have as a matter of justice

« PreviousContinue »